PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

Document Type: 
Collection: 
Document Number (FOIA) /ESDN (CREST): 
CIA-RDP64-00360R000600040146-1
Release Decision: 
RIPPUB
Original Classification: 
K
Document Page Count: 
3
Document Creation Date: 
December 9, 2016
Document Release Date: 
June 2, 2001
Sequence Number: 
146
Case Number: 
Publication Date: 
March 13, 1959
Content Type: 
FORM
File: 
AttachmentSize
PDF icon CIA-RDP64-00360R000600040146-1.pdf130.56 KB
Body: 
Standard Form No. 10 3F,tlf eed For Release 2001/08/15: CIA-RDP64-00360R00060BQ40 t4&ra ............................... Form proscribed by ~ Comptroller General, U. S. F LIC VOUCHER FOR PURCHASES ANI'" ? 103 September 7 1950 (Gen. RCg. No. 61, dupp.No. 11} ERVICES OTHER THAN PERSONAL Bu. Vou. No_ ________ 2-F________ (Amended February 2u, 1952) U. S. ___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) (State) No. and Date of Order PAYMENT: Complete ^ Partial ^ Final ^ Date of Delivery or Service f' ~Y/r- ~[yrr6 COPY Shipped from to Weight Government B/L No. I Total I certify that the above bill is correct and just and that payment has not been received. I (Payee must NOT use this space) Date ------ 3 -1 Per Title ---------------- _______------------------- (Signature or initials) ---- Contract No. 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 t ------------------------------------------------------------------------------ (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 Check No- ________________________ dated ------------------------------ 19 ------ for $-------------------------------------- Treasurer of the United States in favor of jl , lpaYea named above. Paid by Cash, $---------------------- on ------------------ ----------------- ., 19-----. Payee ------------------------------------------------------------------------- (6ian o,Iso,1 ouly) ARTICLES OR SERVICES (Enter description item number of contract or Federal supply schedule, and other information deemed necessary) Discount Terms 58 5-8.110 - ------------- --------------- - ------- --------- ------------ aaulred wLen n Itke is is msde by osgee on nttaa4ad biLL or 6)Ile) S D Amount verified; correct for-_______-_- " When a voucher Is signed or receipted in the name of a company or corporation, the name of the person Per _____________________________________________ writing the company or corporate name, as well as the capacity in which he signs, must appear. For example: "John Doe Company, per John Smith, Secretary", or "Treasurer", as the case may be. t If the ability to certify a d anthorit t a rev a ombined,p~o o si r ~,t~ c- ,~ essarv; otherwise the apps IDiae9lf`@ s a-n e~ evCkn~n t~I i_:_ . '- .k'i~ 360RWO600040146!1 ----------- --- - ..... 16 --2200" s Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040146-1 Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040146-1 Approved For Release' 2001/08/15 : CIA-RDP64-0036OR000600040146-1 Approved For keleas 2001/08/15 : I ~ ~ II i IA-RDP64-00 0 oo 60R0006000 0446-1 x z a o m 0 en A 0 Tax Class Cost Element TR. CODE