PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040167-8
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 13
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 167
• Publication Date: March 2, 1959
• Content Type: FORM

No. 11)
-.-__--Form proscribed b
Comptroller Gener
,'
September 7. p oved For
rr D. O. Vou. No- ------------ -------------------
TIW! 600040167
Bu. VN 8 2
as Bu. Vou. u No. -----------'-`~---------'--------
U. S. COST REIMBURSABLE -- - ------------------ - --
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No_ ______________--
To -------------------------------------------------------------------------------------- I--------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
No. and Date of
Order
PAYMENT:
Complete ^
Partial 1:1
Final El
Date of Delivery
or Service
$13,494.
35
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, and other Informationdeemed necessary)
Discount Terms
STATINTL
Date ___ 3
Per
------------ --
---------------
---------------
-------- --------- -----------
---------- -- -----
Amount verified; carrec for -3 ~~
(Signature or initials
Invoice Rec'd.
(Authorized Certifying Officer)
SIGN
ORIGINAL
Title --------------------------------------------------------------------------
ONLY
Date --------------------------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
Use continuation sheet(s) if necessary I I
Weight Government B/L No. Total
I (Paves must NOT use this space)
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
Title ----------------------------------------------------------
? When a voucher is of ed or recei t d~.n!~ the w~@@~ of a com~l$p~ Q~' ippr~ on he name of th
writing the company or 9' 1 r i ~ e oRDPe crson
"John Doe Company,per hn Smith, Secretary", cretary", or "Treasurer, as t e case may se may e.
tIf 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 payee named above.
Cash, $ - . on ------------------------------------ 19 Payee -- ----------------- -- -
(Aiao -10-1 only)
per
------------------------------------
Title -------------------------------------------------------
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