PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040039-0
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 8
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 39
• Publication Date: May 21, 1959
• Content Type: FORM

Form preSCrlbCC1 b q
Comptroller a~dl~ed For Ret Sq~J~1~"
(
~,
Soptomb YY tt V
Qen. Reg. No. 51, Su' No. Il)F
(Amended February 20, 1952)
0040039-0
Bu. Vou. Na.._
U. S. _____COST _ REIMBURSABLE
------------------------------------r--~~---------?---------------------------------------------------------
(Department, bureau, or establishment)
Voucher fre~ared af ---------------------------------------- --------------------------------------------------------------
(C}ivo place and dato)
Tf~E UNITED STATES, Cr., Payee's Account No_ ________________
To ----------------------------------------------------------------------- ----------------------------------------------------------
(Payee)
No. and Date of
Oeder
I'l+YMENT:
t
Complete ^
Partial ^
Final ^
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description item number of contract ar Federal supply
schedule, and' other information deemed necessary)
Discount Terms
------ 2~I-~+9 ---------
COPY ~ Of~
Shipped from to Weight Government B/L No. ~ Total
- _ - - ~ (Payee must NOT use this apace)
$9,707?
X9,707?{
5o
~o
Date --- 5 - ----------------------------------------------- -------_-------------'----------------------- ------------- ~-
hen a libe oertif oats L mad" by payee on attaabed bia or Mlle) ~ ~ ., /, .7 ~ f ''p
Amount vertfied? correct or ______-___ 1,-/ ~ ~--IV
Pcr _ le ---------------------------------------------- (Signature or initials) --- ---------------------^-^r,.-?-,..._
Contract No. - ~ / ~ / ate Req. No. Date Invoice Rec d.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
t APProved for $-----------------------------------
By -----------------------------------------------------?-----
Title -??---------------------?------------------------------
SIGN
ORIGINAL
ONLY
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 $__-----------_---_-_____-.-__----.___-- Jon Treasurer of the United States in iuvri of
Paid by i payee named above.
Cash, $------------------------? on ------------------------------------? 19-----. Payee --------?_--------___------------------------------------~-----------
(sign orlrb,al only)
(Authorised Certify[ng Officer)
Date ----------------------------------------------------------------------.. _
"Plhen a voucher 33g ~Q ame of a ,Q~,cp g~rat h t o pr
writing tho compan~Il~~FaAl~c~t'11D~b~~ns, ~U7~~ {~Q~4~~~------------------------------?_..._. ~-
"John Doe Company, per John Smith, Secretary", or "Treasurer", as the caso may bo. T ~y
t If the ability to certify and authority to approvo are combined in one person, one signature only is nee- 65 e t ~__~~-____~ _dY~._______
ossary; otherwise the approving officer will sign on the line below "Approved for $___________________" and i -
' 18-2'l4(M~FS
over his oflicia] title.
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