PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400090010-8
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: December 12, 2016
• Document Release Date: March 8, 2002
• Sequence Number: 10
• Publication Date: June 14, 1956
• Content Type: FORM

.-darcl Form No. 1084-Fevised
Form prescribed by I V0U
Comptroller General, U. S.
d' 0 ~
Approve
September 195(Gen. Reg. No. 51, !)upp. No. 11) i s
(Amended 3ebruary 20, 1952)
t -----
U. 9 _-__-__.__ COST-REIMBURSABLE
(Department, bureau, or establishment)
Voucher prepared at ----------------------------------------------------------- --------------------------------------------
(Give place and date)
THE UNITED STATES, Dr., Payee's Account No. __1052
To -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
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)
Q
Discount Terms
Cost
Per
Dollars
Cts.
Costs
13:5Ii-7
92
PAYMENT:
Complete ^
Partial ^
Final ^
Use continuation sheet(s) if necessary
Government B/L No.
Shipped from to Weight
T
otal
(Payee must NOT use this space)
.
I certify that the above bill is correct and just and that payment has not been received
STATINTL
Differences ---------------------------------
---------------
-----
(Sign original only)
Dat
----------
m or bill.)
-----------------------------------------------
-----------------------------------------------
---------------
--4 -r
'
-----
Amount verified; correct _
-----------
(Signature or initials __!_ ___ _________
________________
_____
t Appr ved-- or $ STATI NTL
By
ORIGINAL
ONLY
APPROVING OFFICER A
I (IW TEP X956
60R000400090010216
Bu. Vou. No- ---------------------------------
Title -------- S.ThTI1- TL?---------------------------------------------
Title ---------------------------------------------------------- Date --------------------------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANT FORM
STATINTL
Check No. ________________________ dated ------------------------------ 19 ------ for $___-______-_____-_____-___-______-____J on Treasurer of the United States in
Paid by favor of payee named above.
Cash, $----------------------- on ------------------------------------- 19-----. Payee ----------------------------- -- ----------------------------------------
* 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 nar~ @~gc I ,Tn- ~:(~(~60RBB0000~0CT(T=8
"John Doe Company, per John 9mitl3e fS"'~br1ahei~TrgY70! F
If the ability to certify and authority to approve are combined in one person,'one signature only Is neo- Title __________
assary otherwise the approving officer will sign on the line below "Approved for $___________________ , and ?'""'"""? ' ' """"""
ever his official title. le-22900-5
 25X1A
Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090010-8
Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090010-8
 Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090010-8
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Approved For Release 2002/06/10 : CIA-RDP64-0036OR000400090010-8