PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040163-2
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 163
• Publication Date: March 17, 1959
• Content Type: FORM

Standard Form No. 084-Revised
Form Genera iroved For Rele ggl 0~ pRq ~ F~00060064619T`--`f o- -------------------------------
Comptroller ler
111'''r ~~~.
September 7, 1950 r N-W
(Ge na Waco Fe51ruy , Su 20 19.11) SERVICES 0THEkt THAN PERSONAL
U. U.S. ---------------------------- --------------- -------------------------------------------
(Department, bureau, or establishment
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr.,
Payee's Account No__________________
To ---------------------------------- Thomson Rama Woolcti.dge, Inc --------------------------------------
(Payee)
------------------------------------------------------------ os-_An.eles -?i,__ California -----------------------
(Address) (city) (State)
No. and Date of
Order
PAYMENT:
Complete ^
Partial ^
Final ^
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms Invoice No.
2396
2397
2398
2399
200
Page 1 of 1
Cts.
60-
77
85
58
00
16
6o4
13,494
397
15,623
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 -------------------- Payee --------------------------------------------------------------------
(Thi. oertigoate cot raqulred when a like oorta,0ta ie made by payee ov attached bill or bitte)
Pursuant to authority vested in me, I certify that this account is correct and proper for paym
t Approved for $ -----------------------------------
By ------------------------------------------------------------
Title ----------------------------------------------------------
SIGN
ORIGINAL
ONLY
.71116
---------------
---------------
---------------
80
Check No- ________________________ dated ------------------------------ 19 ------ for $-------------------------------------- on Treasurer of the United States in
Paid by favor of payee named above.
Cash. $ . on 19 Payee -------------------
cstea griataai enly)
. * When a voucher is signed or receipted In the name of a company or corporation, the name of the person
writing the company or corporate names jabs well as the capacity in which he signs, must appear. For example:
"John Doe Company, ifs I 1~}tt~i`~ raSF fagi~~e4S~4~aY hig4fE/tTkA~difCy~tQ
fi If the e Company, p amt o o ne 1
essary; otherwise the approving officer will sign on the line below "Approved for $__________________", and
.~, his nffinial title.
-----------------------------------------------
Amount verified; correct-for -----------
(Signature or initials) e
Per -----------------------------------------------------------------
360R0O0600040163-2