PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040173-1
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 23
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 173
• Publication Date: January 22, 1959
• Content Type: FORM

. - ieorm presenDea D *~r
Com troller Cie RN
~epte~ i-$ved for Rel
(Gen. ftcg.:, , Sapp. No. Its r
------------------------------------ ------- --------------- -----
Amount verified; correct for __________- o?S Lin?
(Signature or initials) _A5-' ________ ______________________
D. O. Vou. No. --------__._?-----------
600040173-1
6 Bu. Vou. No. ------------ ---------------
U. S. ----COST--REIMBURSABLE
(Department, bureau, or establishment)
Voucher prepared at ----------------------------------------------------------------
----------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ----------------
7,0 -------------------------------------------------------------------------------------- .--------------------------------------------
(Payee)
--=-------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
ARTICLES OR SERVICES
UNIT PRICE
AMOUNT
No. and Date of
Date of Delivery
(Enter description item number of contract or Federal supply
UANTITY
Order
or Service
schedule, and other information deemed necessary)
Q
Cost
Per
Dollars
Cts.
Discount Terms
Costs
$25,776
.88
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
$25 776
.$
(Payee must NOT use this space)
1 certify that the above bill is correct and just and that payment has not been received.
Differences ----------------------?----------
---------------
-----
(Sign original only)
Date -----1'J2 ------------ ------------------------------
------------------------?----------------------
---------------
-----
ike oo,iifloete 1. .de by p.yee on.tt.,hod bill., bill.)
SIGN
ORIGINAL
ONLY
t ------------------------------------------------------------------------------
(Authorized Certifying Officer)
Title --------- Date --------------------------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
I Check No. ------------------------ dated ------------------------------ 19----- , for $-------------------------------------- on Treasurer of the United States in favor of
Paid by jl lPayee named above.
Cash, $------------------------,on - -- --- -- - - . 19 Payee ----------------------------- ------------------------------
(eign original only)
* When a voucher is signed or receipt d the s of s eom coq on, ,Qf or o
writing the companyor#{ tiq~ p LJOr b6R000600040'X73='1------------------------------------
"John Doe Company, per n mi ,Secretary' , or reasurer , as t o case may .
f If the ability to certify and authority to a grove are combined in one person, one signature only is nee- Title ____________________________
---------------------------
o r ; otherwise the approving officer will s gn on the line below "Approved for $___________________", and
over is official title. 16-22000 -6
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