PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040147-0
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 8
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 147
• Publication Date: March 13, 1959
• Content Type: FORM

Standard Form. No. 1031-Revised
Form prescribed by
Comptroller Cie ral U. S.
September?7i roved For Rele ~~i(j~~-
(Gen. Reg. No. P1, Su No. 11)
D. O. You. No. -----------------------------
6 040147-0 1'
Bu. You. No.
U. S. __ COST - RENIBURSABLE----------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No_ ----------------
To -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
only)
(Sign original
STATI I'ITL
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
UANTITY
UNIT PRICE
AMOUNT
Order
or Service
schedule, and other information deemed necessary)
Q
Cost
Per
Dollars
Cts.
Discount Terms
Costs
$2,953.
24
PAYMENT:
Complete ^
Partial El
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
$2,953
_
2+
(Payee space)
must NOT use this
I certify that the above bill is correct and just and that payment has not been received.
Differences ---------------------------------
---------------
------------------------------------------ ----
---------------
-----
Date _Z
-----------------------------------------------
-
-
-
-
-
---- --------- --------- ------ --- ------
---------------
=- - - --
-----
-----
when n like ooetifoat, i. male by psyee on atteohod bla or bill.)
Amount
verified;
correct
for
___________
t Approved for $- ---------------------------------
By - --------- ------------------------------------------
Title ------------------ ----------------------??---------
(Signature or initials) --------------------------------
SIGN
ORIGINAL
t ------------------------------------------------------------------------------
(Authorised Certifying Officer)
Title --------------------------------------------------------------------------
ONLY
Date -------------------------------------------------------------------------
When a voucher is si ned or receipted in the name of a com an or corporation, the name of the Orson
writing the company or @; nnlougl t w1} 00 5mu(f~ e [ i~ (
"John Doo Company, ~e 6hhnmj3~&&" ~eor'etary or reasurer , as a ease may` De.
t If the ability to certify and authority to approve are combined in one person, one signature only is nec-
essary; otherwise the approving officer will sign on the line below "Approved for $___________________ ,and
over his official title.
Check No- ________________________ dated ------------------------------ 19_____, for $-------------------------------------- on Treasurer of the United States in favor of
Paid by ) lpayee named above.
Cash. $----------------------- on ------------------------------------, 19-----. Payee ------------------------------------- -- -
(Sign oriolnnl only)
d 2ooD8UUU-4.0147-a------------------------------------
Title -------------------------------------------------------
16-22000-6
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