DISBURSEMENT BY TREASURY CHECK

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP67B00074R000500170050-0
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 2
• Document Creation Date: December 21, 2016
• Document Release Date: December 30, 2008
• Sequence Number: 50
• Publication Date: February 10, 1960
• Content Type: MEMO

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Boston, Massachusettts
----------------------------------------------------------------------------------------------------------------------------------------
(Address) (City) (State)
ARTICLES OR SERVICES
UNIT PRICE
AMOUNT
No. and Date of
Date of Delivery
(Enter deacriptIon item number of contract or Federal supply
UANTITY
Order
or Service
schedule, an~ other information deemed neceuar )
Q
Discount Terms Inv? l~os ?
Cost
Per
Dollus
Ct..
3
~3,g~3.
89
4
3,025.
95
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Shipped from to Weight Government B/L No.
Total
~~
(Payee must NOT use this apace)
I certify that the above bill is correct and just and that payment has not been received.
Differences --
- ----------- --- - ----------~ -------
--
--
(Sisn original only)
-
-----
-
--
Date -------------------- *Payee --------------------------------------------------------------------------
---------------------------------------------- - ----
- ----
-
(ThL eertlfiaare not re?uired when a like eertificete it msde by wYee on nttNked bill ar bills)
~
o
Amount verified; correct STAT
Per - - -- ------r- -------------- Title ----------------- ----------------------------
(Signature or initials) ___
Pursuant to authority vested in me, I certify that this account is correct and propu for
t APProved for $----------------------------------
SIGN
ORIGINAL
ONLY
Title ________
STAT
Check No. ________________________dsted _____________________________, 19_____, for $------------__________________________ on Treasurer of the United States in
Paid by j {favor of payee named above. -
` Cash. $------------------------- on ------------------------------------~ 19-----. Payee ----------- -
---__-~-----------ISiAn orieinal 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 be signs, must appear. For example:
"John Doe Company, per John Smith, Secretary", or "Treasurer", 9& 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
over his official title.
Per - -------------------------------------------------------
STAT
Approved For Release 2008/12/30 :CIA-RDP67B00074R000500170050-0