PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000600010028-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: July 29, 1999
• Sequence Number: 28
• Publication Date: December 30, 1957
• Content Type: FORM

x, orm preSUL-1 UUU
Comptroller Go 'u~
S,ptember 7)
.~ Pr~lyed For~
.. ... PT V
(Gen. Reg. ~~ ~51 iNoWN
(Amended F brLary W, 19~i)
D* 0* Vou, No* ----------- -------------------
P @)360R000600010028-5
Bu. Vou. No - ---------------------------------
V.S - --------------------------------------------------------------------------------------------------------------------------------
(Department, bureau, or establishment),
Vpucher prepared at --------------------------------------------------------------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No - ----------------
--------------------------------------------------------------------------
(Payee)
------- 8820 -Rallmm-Amenue ------------------------- Larz --,-A-ZgP-1aq--45 California ----------
(Address) (city) (State)
No. and Date of
Order
PAYMENT:
Complete F-1
Partial F-1
Final El
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description, item number of contract or Federal supply
schedule, and other information deemed necessary)
1095
1096
1097
1098
1099
2000
2001
2002
2003
Use continuation sheet(s) if necessary
Page I Of I
Shipped from, to Weight Government B/L No. Total
I certify that the above bill is correct and just and that payment has not been received. (Payee must NOT use this space)
Date -------------------- * Payee --- zi~ -- ------------------------------------------------------------------
,. -tift.t. ..t -qulnd ~h- Iik~ W&.t~ 1. ..d. by Py- .. tt..hd W .~ bil W
STATINTL
STATINTL SIGN
TiMp MIR ----
By ----
J~-PprOVUHKEVOEAAWAM MUS BE EXECU
ORIGINAL
ONLY
-----------------------------------------------
Amount verified; correct for -----------
6.,421
9,630
6.,423
17.,082
3.,739
4o., 688
42~708
2.,976
70
9.9741
---------------
---------------
---------------
Cts.
02
09--
98--
87-
58
66-
42
73--
55.---
-7 ---
STATINTL
TED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
by I Check No - ------------------------ dated ------------------------------ 19 ------ for $ -------------------------------------- n Treasurer of the United States in
Paid ~ favor of Payee named above.
Cash, $ ------------------------- on ------------------------------------- 19 ------ Payee ------------------------------- -----------------------------------------
t If the ability to certify and authority to approve are combined in one person, one signature only Is noc- I Title -------------------------------------------------------
essary; otherwise the approving officer will sign on the line below "Approved for $ -------------------- ", and
over his official title. 1 16-22000-5
 Staiidard Form No. 1034-Revised
Form proscribed by * --1
Comptrollor Gen al U i
(Gen. RegPV-o 61, Sup .owed For,JI~W?f ?D,N"P0)360R000600010028-5
(Amende February 20, 1952) HA ~~ Bu. Vou. No_ _________________________________
t7. ,S. ---------- -------------------------------------------------------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at ----------------------------------------------------
(Give place and date)
THE UNITED STATES, Dr.,
Payee's Account No. ----------------
No. and Date 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)
Discount Terms
~,~ llki t11Asirs~s
Q
Cost
Per
Dollars
Cts.
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheets necessary
4c
V lot
Itisko
via
Shipped from to Weight Government B/L No.
TotalA
us
ft
0
o
_
I certify that the above bill is correct and just and that payment has not been received.
(Payee must NOT use this space)
Differences ---------------------------------
---------------
-----
(Sign original only)
-----------------------------------------------
---------------
-----
Date -------------------- * Payee ----------------------- ---- ------------------- -----------------
-----------------------------------------------
---------------
-----
(This asrEificste not required when -alike certieoete le made by fern on stteehed bill or WHO
Amount verified; correct for -----------
I
Contract No. ="&k Date Req. No.
Pursuant to authority vested in me, I certify that this account is correct and proper for payment.
t Approved for $-----------------------------------
By ------------------------------------------------------------
--------------------------'--------------------------------- -----------
SIGN
ORIGINAL
(Authorized Certifying Officer)
Title -----------
- -
----
-
------------------------- -----------------
ONLY
-
-
-
-
Title ___ __
- ------- ----------------f ------------------ Date --------------------------------------------------------------- ------
E~17!lSFM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
United
Paid by l Cash, Check $ No. ___--------------- _----- ? on dated ------------------------------ 19 19 ------ for $-------------------------------------- Payee --{ on favor Treasurer
payee - of the named -
ove.-----States
--i-n--
L ---
---------- -- --------
*When a voucher is sig ed or roceipted in the namo of a company or co r i th4 a o of era
writing the company ore
el 4pp F r P64-003sot~0oas0$?1b028-5
"John Doe Company, r t ~6kolar', 0~~`73stL c 6,
tIf the ability to certify and authority to approve are combined in one person, one signature only is nee-
V Title __________________
"
"
essary; otherwise the approving officer will sign on the line below
Approved for $___________________
, and
over his official title.