PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040032-7
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 8
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 32
• Publication Date: May 21, 1959
• Content Type: FORM

Standard Form No. 1034-Revised
Firm prescribed by ,,ttt7y i ~yT,o
Comptroller Cener?1r~L.T ved For Rer E1 U I J
September 7,
(Con. I",
""o. 51, Sup 9621) EItVIC
Amended ebruary. )
(0040032-7 2444
Bu. Vou. No.
U. S. COST REIMBURSABLE
----------------------- --------------
(Department, bureau, or establishment)
Voucher prepared at ---------- -----------------------------------
----------------------------- ---------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No_ ----------------
TO -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
No. and Date of
Order
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms
PAYMENT:
Complete ^
Partial ^
Final ^
COPY / OF
Use continuation sheet(s) if necessary I I
to Weight Government B/L No. Total
I (Payee must NOT use this space)
dsertify that the above bill is coX~tand just and_that payment has not been received.
$11,646
11,
---------------
---------------
---------------
Amount verified; correct fill __________-_zwl
(Signature or initials) _G~ -----------
t No. ate Req. No. Date Invoice Recd.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
SIGN
ORIGINAL
ONLY
t ------------------------------------------------------------------------------
(Authorized Certifying Officer)
Title ----------- --- Date -----------------------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
Check No- ------------------------ dated __________ 19 , for $-------------------------------------- on Treasurer of the United States in favor of
---' ----- payee named above.
Paid by
Cash, ----------------------- on ---------------------------------- 19-----? Payee _---------------------------- i----- -- -- -----------------------------
95
When a voucher is tied or reeei In t a e of a co a y r cor oration the name of the person
writing the company o rim
"John Doe Company, per ohn Smith, Secretary , or roasurer ', as t o case may. e.
rrtt ----------------------
t If the ability to certify and authority to approve are combined in one person, o o signature only is nee- Title
ossary; otherwise the approving officer will sign on the line below "Approved for $__________________ ", and 6S T}~ 1T ~~ ~~yi ra-2zsoos
over his official title. II1I
 Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040032-7
Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040032-7
 ---------y4ppr8ed F Release 2001f08115-: CIA-RDP64-00360R000600040032-7
KLY PURCH
CK Il1 tI p - ACT 'C
RATED PU CHASE
Z -11),Z VALL Y LEC 1 i .5
.249521
2405
2160 WE c
41*:.0
29 A010 PRODUCTS SAL
24487
290 RADIO PRODUCTS SAL
24987
MIIXT5 SAL
764 ZERO MAA F'ACTUi ING
2526
NC INTYRE RUTH
13764
374_
59675 107
Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040032-7
4110,4
2835
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4 10 9
3450
8 0
410 9
X880
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410 9
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2125
520
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