PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040143-4
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 6
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 143
• Publication Date: March 13, 1959
• Content Type: FORM

Standard Form No. 1034-Revised
Form prescribed by t1 906?"016 D. O. Vou. No_ -------------------------------
Comptroller ?7~ial oved For ReI Q "G'IPC- '0040143-4 11
(Gen. Reg. No. 51, Su p. No. 11)
(Amended February 20, 1952) ~ l~t R HER THAN PERSONAL Bu. Vou. No- -------- 402
-----------------
U. S. --COST--REIMBURSABLE
------------ -------------~~--: -----------r----------------------------------------------------- PAID BY
(Department, bureau, or establishment)
Voucher prepared at -------------------------------------------------------------------------------------------------------- f
(Give place and date) -&-cl THE UNITED STATES, Dr., f1 -/,,k
Payee's Account No_ ________________
Amount verified; correct or ___________
__ Title ______________________________________________I (Signature or initials) ----------------------------------
Date Req. No. Date
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
To
-------------------------------------------------------------------------------------- --------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City)
No. and Date of
Order
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule
and other i
f
r
ti
d
QUANTITY
UNIT PRICE
AMOUNT
,
n
o
ma
on.
eemed necessary)
Discount Terms
Cost
Per
Dollars
Cts.
Costs
$4,213.
82
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government
B/L No. Total
213
2
I certify that the above bill is correct and just and that payment has not been received.
(Payee must NOT use this space)
Differences ---------------------------------
-----------
STATI NTL (Sign original only)
-----------------------------------------------
----
---------------
-----
-----
Date ------
-----
-----------------------------------------------
-
---------------
----
-
------------------------------------------------- -
eeulrad wbon alike certifloeta i. mode by payee on ettsohud b i LL --ll.)
-----
-----------------------------------------
'------
~ -
,-2-/3
-----
SIGN
ORIGINAL
t ---------------------- ------------ ----------
(Authorized Certifying Officer)
Title
ONLY
Title ---------------------------------------------------------- Date -------------------------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)
Check No- ________________________ dated ------------------------------ 19------ for ;____________-____--____--_ Jon Treasurer of the United States in favor of
Paid by payee named above.
Cash, $ ------------------------- on ---------- ------------- ------------ 19-----. Payee
-------------------------------------------------------------------------
(eign original only)
? When a voucher is signed or receipted in the name of a company or cor or tb , th o 0
cor ~yg$@ 6M } ys a gs p y~
writing the company or
"John Dec Company, or t , t d SL? nr00 TIQ @~~I~C bYP1d1 3~~}R0006 4 3r'~ - - ?--
reasuror , as t e case may be.
fIf the ability to certfy and authority to approve are combined in one person, one signature only ie nec- Title _______________________________________________________
essary; otherwise the approving officer will sign on the line below "Approved for $___________________", and
over big official title. 16-22000-6
 STATOTHR Approved For Release 2001/08/15 : CIA-RDP64-00360R000600040143-4
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