PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP81B00878R001300010011-0
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 16, 2016
• Document Release Date: September 7, 1999
• Sequence Number: 11
• Publication Date: February 9, 1960
• Content Type: STATEMENT

5 4
Stta,auisa[ai Form No. 1034- Itcvised
'
,
Com rm proscribed b
g"~ for Releas~
(Gen Itnded February 2p 11)
20 ,1962)
D. O. V--?. No- -------------------------------
001
00fl011-0
6
----------------------
AL
Page 1 of 1
------------------- --------
U. U.S. ---------------------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at ---------------------------------------- --------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No- ----------------
To ----------------------
(Payee)
Boston, Massachusetts
-------------------------------------- - ---s
(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
Discount Terms Thy. NOB .
Cost
Per
Dollars
Cta.
10
$1,034.
4
11
(79.
0)
12
1,146.
9
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Weight Government B/L No.
Shipped from to
Total
~i 101.
_
(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)
-----------------------------------------------
---------------
-----
Date
-------------------- ' Payee --
---
-----------------------------------------------
__
-- ----------
------- ------
-----
(Thie oertia,uto not rnuhed when n like certificate ie made by payee on attnohed bill or bill,)
Amount verified; correct for
Per ------ ----------------------------- Title ---------------------------------------------
(Signature or initials) ----
Contract No. BB 0 Date Req. No. Date
Pursu o aut ority vested in me, I certify that this account is correct and proper for pay
f Approved for $ ----------------------------------- t
SIGN
ORIGINAL Ti
By
_--
ONLY
r,
I)4itf 'M w ,
,: ~`s f y-Z
I #FI TT
25X1A
I Check No- ------------------------ dated -----------------------------, 19-----,for $-------------------------------------- on Treasurer of the United States in
Paid by { favor of payee named above.
Cash, $------------------------- on ------------------------------------? 19------ Payee ----------------- ----------------------------------------
(Sign orioinul only)
* When a voucher is signed ~olr. recpeipted in the name of a company or corporation, the name of the person p r _ _
j7ohn D" Dsn aNn rA~rth, 1Q~ m 2R B'aY 3 6878R00180001001'f -0---------