PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040074-1
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 74
• Publication Date: March 24, 1959
• Content Type: FORM

fMtandara Form No. 1084-Revised D. O. Vou. No_ ______________
-----------------------------------------------
-----------------------------------------------
----------------------------------------------
Amount verified; correut for __________
e
(Gen. Reg. No. b1, Supp. No. 11) SERVICES OTHER THAN PERSONAL Bu. Vou. No. -___-____ 224-LO_______________
(Amended Fobruary 20, 1952)
U. ,S- ------COST- RE10 3~alz ---------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------
THE UNITED STATES, Dr.,
(Give place and date)
Payee's Account No_ ________________
------------ ---------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
(Signature or initials)
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
UANTITY
UNIT PRICE
AMOUNT
Order
or Service
schedule, and other Information deemed necessary)
Q
Cost
Per
Dollars
Cts.
Discount Terms
,Cost
(4,9115,
4)
PAYMENT:
Complete El
Partial ^
Final F]
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
(Payee must NOT use this space)
(P
I certify that the above bill is correct and, just and that payment has not been received.
Differences ---------------------------------
---------------
-----
(Sign original only)
2~-- *
---------------
-----
Date
d when a ilk, oertidrate i. mode by p,yee so ettsohod bia or bill.)
$
I Ll iI #'?!
----
' ~i
SIGN
ORIGINAL
ONLY
Date
~P zyzx-~-~
COPY / OF
t ------------------------------------------------------------------------------
(Authorised 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
}ref I6 dved For Relek ~~00'1P08M"~aCWR EfM00040074-1
Con;s tembt
Cash, $----------------------- on ------------------------------------- 19-----. Payee -------------------------------------------------------------------------
(ei, odsiod ody)
e When a voucher is sy~ q m pp ignn y pro
writing the company orEA it a~~kbII a tR "i4gf~dl $$mu pp Ldtdt@ R{~{ 4O 7 a -------------------------------------
_M
t If the ability to certify and authority to appprove are combined in one ppppperso -e signature only is nec-
essary; otherwise the approving officer will slgn tbij )~ow~;Appravod _____________ , and
over his official title. ~i ~iTT p
 Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040074-1
Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040074-1