PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040161-4
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 161
• Publication Date: March 19, 1959
• Content Type: FORM

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D. O. You. rvo. -------------------------------
040161-4
fstt. Vou. No. --------- 241-
S. -COST REIMBURSABLE ----------- -- ------------------------------------- -__________________________--
U.
----- --------------------------- ---
(Department, bureau, or establishment)
Voucher prepared at ---- ------------------------------------(C-- -live-------place -----and -date- ---) ----------------------------- -----------
THE UNITED STATES, Dr., Payee's Account No_ ----------------
TO -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
------------ ---------??---^- ---------------- -- --------------------------
(Address) (City) (State)
ARTICLES OR SERVICES
tion item number of cnntract or Federal supply
r descri
t
(E
UNIT PRICE
AMOUNT
No. and Date of
Order
Date of Delivery
or Service
p
n
e
schedule, and other information deemed necessary)
T
QUANTITY
Cost
Per
Dollars
Cts.
erms _
Discount
Costs
$3,051
58
PAYMENT;
Complete ^
Partial ^
Final ^
-
Use continuation sheet(s) if necessary
Weight Government B/L No.
t
Total
$3,051
5-9
o_
Shipped frorn
I certify that the above- bilhis correct and just and that payment has not been received.
(Payee must NOT use this space)
Differences ------------------__------------_-
(Sign original only)
------------------------------------
---------------
-----
Date ------------------------- --------"----
""- ______ " _a ..b....11k. oath..,. I. m.d. b. payee on .ttwhed bla or bill,)
-----------
Amount - verified; correct Jqr -----
Per _ Title ---------------------------------------------I Signature or initials) --or initials) _yt -------------
cd
R
I
i
.
ce
nvo
e
Contract No. - ate Req. No. Date
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
t Approved for $ ------------------------------------
SIGN
ORIGINAL
ONLY
-- -- - -- -------------------
f -------?-
(Authorized Certifying 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 shown( other classification optional)
---------
Check No. Treasurer of the United States in favor
------------- dated ------------------------------ 19-----'for $---------------------------?---------- on payee named above.
Paid by
Cash, $-------------------------on 19 Payee ?? (also oH.1?>1 ---- ..1y) ------------------------
"When avoucy~r, q{~ I`d 11?9~NlWWWt>8sigr dklrst4L~Eabop C IE t
"Jwriting the an tl'd n at" d
"John Doe Cop Company, per ohn Srnith, Secretary", or "Treasurer", as the case may be.
t If the ability to certpify 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 hla official title.
OD60002v0161- ---------------------------------------
Title ------- --------------------------------------------
1a-22aeo=a
 Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040161-4
Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040161-4