PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600040183-0
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 9, 2016
• Document Release Date: June 2, 2001
• Sequence Number: 183
• Publication Date: January 22, 1959
• Content Type: FORM

-AtaildfiTd Form No. 1034-Revised
Form prescribed b D. O. Vou. No. -----------------------------
Comptroller Go~lglno`ed For
r00040183-0
September 19~t1
(Gen. Reg. No. 51, Sapp. No. 11) SERVICES OTHER THAN PERSONAL Bu. Vou. No- -------- 37??-----------------
19
2
0
)
(Amended February 20,
U. S. --COST-REINDURSABLE ------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No- ----------------
----------- --------------------------------------------
(Payee)
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
No. and Date of
Date of Delivery
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
QUANTITY
Q
UNIT PRICE
AMOUNT
Order
or Service
schedule, and other information doomed necessary)
Discount Terms
Cost
Per
Dollars
Cts.
Costs
$234.
71
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government
B/L No.
Total
23 .
(Payee must NOT use this space)
I certify that the above bill is correct and just and that payment has not been received.
Differences ---------------------------------
---------------
-----
(Sign original only)
1L 22 ~t
D
--------------------?-------------------------
---------------
-----
ate
------ --------------------------------------------------
d when a Ilk, eerEifleete 1. mode by payee on etteeh,d bill., bill.)
----------------------------------
- -----------
Amount verified; correct
fsrr ___________
-----
1/
{
(Signature or initials) -_(_______________________________
Date Req. No. Date Invoice Rec'd.
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 . ii
I Check No- ------------------------ dated -----------------------------, 19-----, for $-------------------------------------- Jon Treasurer of the United States in favor of
Paid by j` ) Ion named above.
Cash, $----------------------- on ------------------------------------? 19-----. Payee ------------------------------- ----------------------------------------
essary; otherwise the approving officer will sign on the line below "Approved for $----_-----------_--", and
over his official title.
(slim orlalnel only)
R008600040.1$3--G------------------------------------
Title -------------------------------------------------------
16-22900-0
 Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040183-0
Approved For Release 2001/08/15 : CIA-RDP64-0036OR000600040183-0