DISBURSEMENT BY TREASURY CHECK

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP65-00523R000100070012-2
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 3
• Document Creation Date: December 21, 2016
• Document Release Date: November 13, 2008
• Sequence Number: 12
• Publication Date: September 16, 1959
• Content Type: MEMO

Approved For Release 2008/11/17: CIA-RDP65-00523R000100070012-2
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16 Septenber.1959
10931 SEP 2159
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Approved For Release 2008/11/17: CIA-RDP65-00523R000100070012-2
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HEB:jt 16 September 1959
Approved For Release 2008/11/17: CIA-RDP65-00523R000100070012-2
Distribution:
 Approved For Release 2008/11/17: CIA-RDP65-00523R000100070012-2
gtall(iard Form No. 1033-Revised D. O. Vou. No. -------------------------------
Form prescribed , U. S. i'UBLIC VOUCHER FOR PURCHASES OD
Catnptroller Ceneral
September 7, 1950
(Gen. R ded No. 51, Sup. No. 11) SERVICES OTHER THAN PERSONAL 20,
U. U.S. --------------------------------------------------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at ------------------------------------------------------------------
-------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. ----------------
TO ----------------------------------------------------
Date of Delivery
or Service
---------------------------------------------------------------------bankr- ~al3.fnrnia----------------------------
(Address) (City) (State)
No. and Date of
Order
ARTICLES OR SERVICES
(Enter description item number of contract or Federal supply
schedule, and other information d med necessary)
Discount Terms MLV . Nb s
5-13 Supplemental
Release of Patent
& Royalties
PAYMENT:
Complete ^
Partial ^
Final ^
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 --------------------------------------------------------------------------
(Thin eertificnte not required when o like certificote is made by Payee on attached bill or bills)
Per -------------------------------------------- Title ----------------------------------------------
$5? 'QQ
---------------
---------------
---------------
-------- --------- ------- --- --------
Amount verified; correct for _________ 25X1
(Signature or initials) ------------------------------------------
t Approved for $ -----------------------------------
By ------------------------------------------------------------
Title ---------------------------------------------------------
SIGN
ORIGINAL
ONLY
page 1of1
25X1-------------
Date -----------------------------------------------------
r Check No- ________________________ dated ------------------------------ 19_____, for $______________________________________ on Treasurer of the United States in
Paid by j I. favor of payee named above.
l Cash, $ ? on 19 Payee -------- ------ -- ---- --- --
(Siga original only)
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 name, as well as the capacity in which he signs, must appear. For example: Per
"John Doe Company, per John Smith, Secretary", or "Treasurer", as the case may be.
t If 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 Title
over his official title. Approved For Release 2008/11/17: CIA-RDP65-00523R000100070012-2 7e-22900-5