PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040105-6
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 105
• Publication Date: March 26, 1959
• Content Type: FORM

.Norm pJ'e Crlben by
Guiliptzolter~e era] U S. ~
8eptember~~1'OVed For Rele
(Caen. Reg. N o, 51, p No. 11)
I~oucher ~re~rared at --------------------------------------------------------------------------------------------------------
((3ive place and date)
THE UNITED STATES, Dr., Par~cc's Account No_ ________________
(Department, bureau, or eatablishmen?)
FF~~ D. O. Vou. No. ------------?--------?--?-----
~Q~f~U,U.0040105-6 2-16
VVVV1111vvvvAALL Bu. Vou. No. -----------?--?-----`---------_
U. S. _____---COST RE IMBURSI~BI,E
(Amended February 20, 1962)
To ------------------------------------------------------------------------------------------------
-----------------------------------
(Payce)
~D-zyaz -sf
C?PY 1 QF ?~,
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (9tato)
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
~
UANTITY
Q
UNIT PRICE
AMOUNT
Order
or Service
schedule, anc
other information deemed necessary)
Discount Terms
Cost
Per
Dollars
Cta.
Costs
$3oq .
I1+
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
~
~~
'
---------------
-----
(Sign original only)
2
Date _---~? -2
heo a like aortiaante le mnde by pnyae on ettnnhed bia or bill.)
---------------?-----------'------------------
Amount verified; corrector ___________
---------------
~ ~ y
-----
(Signature or initials) ~___!
- ~ --- -
By ----------------------------- -----^-------------------?
SIGN
ORIGINAL
oNLv
fi -------------------------------------------------------
-----------------------
(Authorized Certifying Officer)
Title ------------------------?---------- Date -------?--?--------~_..-?------?-------------...-----?--------------
THE REYERSE OF THiS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERYlCES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be showni other classification optional)
? When a vouchor is signed or recelpted in the name of a company or cor oration, tho name of the arson
writing the company or fpyp6CptdDHS~b1 t~plk r~~p ~y ~p ~/ mu r
"John Doo Company, I15g1MJMtn~$3h2tH" Hec2~6tat~"; 6cRSistST~~ A9 c ~1da~~~~~
t If the ability to ccrt fy and authority to appppppr~~_~ove gg~~o co in d in o po ~~,, ppne signature only is noo-
essary; otherwise the approving officer will ai~~n ~i>~~el~' Ap~ov~~$___________________", and
ovor his official titlo. n
Check No. ________________________dated _____________________________, 19_____,fOI ~________________________-------_-____, on Treasurer of the United Statcain favor of
{payee named above.
Paid by
Cash, $ . on --------------------?--=-----------+ 19-----. Payee -------------?---?-----------------------------------------------------
d~UUU~6UUU-4U'1~'5-~-----------------------------------
Title -------?----------------------------------------------
 Approved For Release 2001/08/15 :CIA-RDP64-003608000600040105-6
Approved For Release 2001/08/15 :CIA-RDP64-003608000600040105-6