PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040107-4
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 4
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 107
• Publication Date: March 26, 1959
• Content Type: FORM

~ A ' wY ptro Prescribed by~ (li T~ ~A
Comptroller c3enetAL,Ved For Rene ?G/}~JY4
C~p o if
Be. No. 7
(a.. Rea. No. 51 1, Supp. No. 11) tJ RP I- U
U. 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) (Estate)
No. and Date of
Order
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description
and item supply
other Information deemed necessary)
Discount Terms _
PAYMENT:
Complete
Partial
Final
QU600040107-4 2424
Shipped from to Weight Government B/L No. I Total
(Payee must NOT use this space)
1certify that the ;above bill is correct and. just,and thatpayment has not been received.
Differences ---------------------------------
$2,114.166
2,2,,11 e
---------------
---------------
---------------
----- --------- -----------------------------
vyee on atteohed bla or bill.) -
ivired wboa alike oertifiente Ir made by
Amount verified; correct for ___________
_ Title ------------------------------ ---------- (Signature or initials) -------------
Date - Req. No, Date Invoice Rec'd.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
SIGN
ORIGINAL
ONLY
---------------------- ---------
(Authorized Certifying Officer)
Title --------------------------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
by I Check No. dated ______________________________. on Treasurer of the United States in favor of
+ 19 + for $ {payee named above.
Paid
Cash, $ + on. ----- ---- -- + 14- Payee ----------------------------- ---------- - -
(eisn orlainal only)
? When a voucher Is $igned or receipted in the name of a company or corporation, the name of the person Per_________________________________________________________________
writingthecompanyoj G? Flll l t l` ~' m PRDN 50`0'3 OR000600040107-4
"John Doe Company, pbr o m) , 8ecrotary a e m o.
ar od in ono yyerso o signature only is nec- Title _______________________________________________________
t If the ability to certify and authority to app i / q
essary; otherwise the approving officer will sig ii ow }Appr~,Ved 4 _____-____________", and 16-22900-8
over his official title.
 Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040107-4
Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040107-4
 ApprovedlFor Releasi 2001/08M5: CIA -RDQ64-QO36ROOP60004UI
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INC. INC. - OAKLAND - PRINTED IN U.N.A.
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