PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040102-9
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 102
• Publication Date: March 26, 1959
• Content Type: FORM

Form prescribed by
OomPtroller C~enetul,nTj~Ved For Re~~~~~~~ -
September 7, C~p jj~ ~ i1~,j(
-7 li d]
lI
NF
(O
~
obruar9 0, 14)52)
(Amended
U. S. - --COST RE~MBtJR.~~-- ----------------------------------------------------------------------------------
- (Department, bureau., or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Cfivo place and dato)
THE UNITED STATES, Dr., Payees Account No. ________________
To -----------------------------------------------------------------------------------------------------------------------------------
(Payeo)
- - ---------------------------------------------------------------8t -----------------------
--------------------------------------- ---- --
(Address) (City) ( ate)
No, and Date of
Qrder
Date of Delivery
or Service
ARTICLES C)R SERVICES
(Enter description item number of contract or Federal supply
schedule, an~ other information deemed necessary)
Discount Terms __
PAYMENT:
Complete ^
Partial ^
Final ^
~~` zya ~ -S~f
COPY / C)F Z
Use continuation sheet(s) if necessary ~ ~
Shipped from to Weight Government B/L No. Total
(Payee must NOT use this space)
I certify-.that thc.abope, bill is correct and just and #hat payment has not been received.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
SIGN
ORIGINAL
ONLY
~~~~~0~000B 0 X02 9 --------- 2?l~l-5 ---------------
$9,573
91~
.go
.go
---------------
---------------
Amount verified; correct for ____ ______ r ~ 3 I j0
(Signature or initials) ~~__---------------------------?-
Date Invoice Recd.
(Authorized l)ertifying Officer)
Title ----------------------------------- Date ----------------------------------------------^?------------------------
- THE REVERSE OF TFIIS FORAi MUST BE EXECUTED WHEN PURCI{ASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
Check No. ______________________________, on Treasurer of the United Stateain favor of
_?__`__________________ dated __-______--__--__----------__. l9_____r f0! ~__-____ {payee named above.
Paid by
Cash, $------------------------? on ------------------------------------? 19-----. Payee ------------?-----------------------------------------------------------
(alra orlalonl only)
? When a voucher is y~fii~nte~d or recei t in th name oP a coy~mpa~ny~ or cor oration, the namo of t2he porsNOn R~[7S7S7S7~7Sy~ p ,r _______________________________________
writing the companyol-Fl~rr ,~_ ' . 1~~;et - f 2":~ mn~r"v~'BQv'~ Uf(V V VpVU~~}~ 1 ~~-9
.. r..,.., r.,.,, n,...,,,on,> ., n n m, ~ 3eeretarv . or reasu e t a }n e. _
__.._
__
, _
_
7 u bue nuumy u~ w. w.y W.,.. ....~......~~ -- .. r_ ___ ____-__ _-
essary; otherwise tho approving officer will i n,tp~ 1~Q+he~w "AAproy~(Br $___________________ _and is-2zfloo-s
avor his official title. 1W{ C IYa' ^9
 Approved For Release 2001/08/15 :CIA-RDP64-003608000600040102-9
Approved For Release 2001/08/15 :CIA-RDP64-003608000600040102-9