PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040137-1
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 4
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 137
• Publication Date: January 16, 1959
• Content Type: FORM

Standard Form No. 103t-Revised ~~2~ ;1F D. O. Vou. No- -------------------------------
?Fporm pr' ri O bp~~~
ved For ~ ~O~ E~ i~ [~PB~= $0 00040137-1
Com mber 7 r990
ptel
66 THAN PERSONA ?~ *' 2361
TH ER
nu.
(Con. Reg.dNo. b1, Supp. No. 11) SERVICES O
(Amende February 20, 1952)
U. S. COST REIMBURSABLE -- -------- -----------------------------------------------------------
- ---------------
(Department, bureau, or establishment)
Voucher prepared at ------------------------------------------------- ---------d----------------------------------------------
dt
)
l
i
THE UNITED STATES, Dr.,
ace an a e
(Q
vo p
Payee's Account No. ----------------
To -------------------------------------------------------------------------------------- ---------------------------------------------
(Payee)
-----------------------------------------------------------------------------------------
-----------------------------------------------
(Address) (City) (State)
No. and Data of
Order
PAYMENT:
Complete ^
Partial ^
Final ^
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms
686
Use continuation sheet(s) if necessary I I
Shipped from to Weight Government B/L No. Total
(Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
(Signature or initials) -
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
f Approved for $- ---------------------------------
SIGN
ORIGINAL
ONLY
686 13_
---------------
---------------
---------------
- ------------
/3
- -- -------------------
(Authorized 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
IC ,
I Check No. ------------------------------- {on Treasurer of the United States in favor of
- dated ---- 19 ------ for $ )payee named above.
Paid by
- -
Cash, $ ?---------------------- (81?n , on ------------------------------------+ 19-----. Payee ----------------------------------- ori,inni only)
nly)
-----------------------------------------------
When voucher i~t P fg a9p~p~gr~~ratapy e t to
writing thecompanyedlo ~317vtlRbNb91g}ts rkut e~ UUUODUU4Q1-'C ?- ---?
"John Doe Company, per ohn Smith, Secretary", or "Treasurer", as the case may be.
tIf the ability to certify and authority to approve are combined in one person, one signature only is nec- Title -------------------------------------------------------
essary; otherwise the approving officer will sign on the line below "Approved for $-------------------", and 10-ssseo-e
over his official title.
 Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040137-1
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