PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040181-2
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 181
• Publication Date: January 22, 1959
• Content Type: FORM

Ie Septembe0cved For Re No. 51 (C(Amended February 0 962)1)
D. O. Vou. No- ----------------------------_--
GU l T MMEPCF AL71"~VCIf 609600040181-2
~' SERVICES OTHER THAN PERSONAL Bu. Vou. No. ----------- 2 72______________
U. S. _ C T _ r rMBURSAB ------- - ----------*--------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No_ ----------------
TO -------------------------------------------------------------------------------------- -
-------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
No. and Dote of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
UANTITY
UNIT PRICE
AMOUNT
Order
or Service
schedule, and other information deemed necessary)
Q
Discount Terms
Cost
Per
Dollars
Cts.
Costs
$1,059
.89
PAYMENT:
Complete F-1
Partial ^
Final F1
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
$1059
(Payee must NOT use this space)
(P
I certify that the above bill is correct and just and that payment has not been received.
Differences ---------------------------------
---------------
-----
(Sign original only)
l 22
-----------------------------------------------
---------------
-----
Date ____
--------------------------------------------------
who, alike .ortlsastnl. m.d. by csy.,enntt.ohod bill or bill.)
----------------------------------------------
Amount verified; correct for ___________
-------------
` 015-7
----
-
-7
(Signature or initials) _ _ _ ______________________________
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
Check No. ________________________ dated ------------------------------ 19 ------ for $-------------------------------------- Jon Treasurer of the United States in favor of
Paid by j tpayee named above.
` Cash, $------------------------, on - - - - - -- - - 19 Payee ------------------------------
(Si?n origloni only)
" When a voucher is s q~ omr}p pp ~ti amp pie
'f - - --
writing the company or W06 tkb i4piSilU>tf Ms7ma IiflCl 6i@ flflfl6flflfl441B
"John Doe Company, per John Smith, Secretary", or `Treasurer", as the case may be.
tIf the ability to certify and authority to approve are combined in one person, one signature only is nec- Title _______________________________________________________
essary; otherwise the approving officer will sign on the line below "Approved for $---------------------- and
10-22900-e
over his official title.
 Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040181-2
Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040181-2