PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• 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
• Publication Date: March 13, 1959
• Content Type: FORM

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"
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 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 :
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IA-RDP64-00
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