PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040160-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 160
• Publication Date: March 19, 1959
• Content Type: FORM

eitttndtkrd Forms No. 103 --1tovised
Form prescribed by `UBLIC V UCI-IJ
Comptroller (l~o,,7n,e.,r~a1l U. 6, 8 15
Sg.No1 F tlh lf or ReI a -VIG I 0
(Qon. Reg. No,
(Amonded February 20, 1052) I A
D. O
66-64 . .you. t ro. __----_- -?----
-------------....
040160-
5
*T
ONA Su. Vou. No. --------- 2.418--------------
U. S- ------
----------------------------
-=--------------------------
(Department, -UiSI_
(Department, bureau, or establishment) ------------------- ---- - ` ` """ '
Voucher prepared at ---- --------------------------------------- =
---------------------------------------
(Give place and date) "`"" "
THE UNITED STATES, Dr., Payee's Account No. ----------------
To ----------------------- -- - ----- - - - -
----------------------------
(Payee) -----?--
----- - ---------- ----------
-----
(Addrtss)
(CItP)
(State)
No. and Data of
Order
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description item numbar of contract or Federal supply
schedule, and other Information deemed necessary)
Discount Terms
PAYMENT:
Complete ^
Partial ^
Final []
Use continuation sheet(s) if necessary
Shipped from to, Weight Government B/L No. --~
Total
I certify that the above, bilk is correct and just and that payment has not been received. I (Payee must NOT use this space)
Differences
-------------------------------------------
-----------------------------------------------
-------------------------------------------------- - -------------------------
i,Ired wb,e ? Ilk. .ertlao+te I. mad* kr a+re+ on +te+ohed bia or bllbY '- ------ `"-"`--" ----""
1,819
1_1 ~1
Cts.
68
68
Title ------------------ (Signature or initials) Contract No. D
ate R N
eq.o. Date
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
t Approved for $ _______-__--___--?_-______..__-_---
By -------------- ---- - - - - - - -- -----
Title --?
SIGN
ORIGINAL
ONLY
f ----------------------------------------- ------------
(Authorised Oertlfying Officer) - -- -
Title -? - -- - ------ --.
Date
--------
--
-
------
----------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANT FORM -
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be chows; other classification optional)
Check No.
dated
Paid by __-------------------------- 19 for $ fon Treasurer of the United States in favor of
lpayee named above,
Cash, $ -- - - on - - --------------------------- 19------ Payee ---------------------------------
When a voucher is signed or receipted in the name of a com any or coy t: tsaa uric+??i ............................ writing the companyorgned ,~s
"John hi Doe oo.p.,Y,c nter}dhft ~fpf ie' i5CAr}r' , t Q Qg d on,. LUYA35Ftrr v?RO~~~~~~ 1~~= 5 ------------------ - y
1 a, u or ' , as t e case may ay be be.
I If the ability to certify and authority to approve are combined in one person, one signature only is nee.
Oil e, official otherwise t It
title. e approving?ofllcor will sign on the, lino below "Approved for $_____________ _", and Title _______ __
over ---------------------------------------
10 -2290f"
 Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040160-5
Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040160-5