PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP81B00879R000100180010-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 3
• Document Creation Date: November 11, 2016
• Document Release Date: January 7, 1999
• Sequence Number: 10
• Content Type: STATEMENT

Stanrlarcl Form No. 1054-Revised
'Fq~ m rescribed by
~,i 9
iomyrdc ft-ReleasSERV
e c er
(Gen. Reg. No. 51, Sapp. I4'o. 11)
(Amended February 20, 1062)
Payee's Account No_ ________________
U. S. _ c4sT__mum .UIB_ ------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at _________________________________________(Give place and date)
THE UNITED STATES, Dr.,
---------------------------------------------------------
-? - (Payee)
-----------------
-----------------?-----------i------------'---------?---'(State) --
No. and Date of
Order
Date of Delivery
or Service
ARTICLES OR SERVICES
(Enter description Item number of contract or Federal supply
schedule, and other information deemed necessary)
Discount Terms
PAYMENT:
Complete ^
Partial ^
-533___________________
98000Bu. V100ou. o. 1 *001-0---
------
- Total
Shipped from to Weight Government B/L No.
(Payee must NOT use this space)
..certify that the above: bill is correct and just and that payment, has pat been received. I ,
Differences ---------------------------------
(Sign original only)
25X1A9a
2-k-7-59--- "P.
2--
t for
if
d
----------
; correc
e
Amount ver
(Signature or initials).,- --------------------
Date Date Invoice Recd.
R eq N
Contract No. (4.-
Pursuant to author: ?vested in me, I certify that this account is correct and proper for payment.
f Approved for $ -----------------------------------
SIGN
ORIGINAL
ONLY
----------------------
--------------------------------------------------
(Au--thorized Certifying Officer)
Title --------------------------------------------------------------------------
Date -------------------------------------------------------------------------
Title ----------------------------------------------------------
THE REVERSE OF THIS FORM MUST BE EXECUTED WHEN PURCHASES ARE MADE OR SERVICES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be showng other classification optional)
I ASS. te:.,.: . _ .
Jam- ire
DATEI
Final ^
on Treasurer of the United States in aver of
Check No. dated 19 for $ {Payee named above.
Paid by
--------------------------------------
----- 19----- Payee - -- leas oo.~ o.,1y)
Cash. $------------------------- on -----------------------------
? Whep-gyq~yr,~ ~gg do receI d ' the name p y o/r cor gorreation theenme of the person
writing t"Ar h 7r; t~"' ~`73~ ~D'c ' OW D Pv V
"John Doe Company, per Jon mit coreta or s aso
t If' the ability to certify and authority to approve are combined in one person, one signature only is'neetcd-
t ---------11
essary; otherwise the approving officer will s gn on the line below "Approved for $______-_
over his official title.
$2,323
70
Z
Per -----------------------------------------------------------------
879R000100180010-5
Title -------------------------------------------------------
 Approved For Release 1999/09/08 : CIA-RDP81 B00879R000100180010-5
1. Advertising in newspapers Yes ^ No ^.
2. (a) Advertising by circular letters sent to -------------------- dealers.
(b) And by notices posted in public places Yes ^ No ^.
(If notices were not posted in addition to advertising by circular letters sent to dealers, explanation of each omission must be
made below.)
------------------ ,----------------------- r-------`---------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(Here state in detail the nature of the exigency or circumstances under which the securing of competition was impracticable under 3 and 4)
NOTE.-The above form "Method of or Absence of Advertising" is to be used when purchases are made or services secured under
proper authority without written agreement in any form. In case of a written agreement (formal contract, proposal, and acceptance, or
legs formal agreement) Standard Form No. 1036-Revised should be used for abstracting the method of or absence of advertising and
award of contract. (See General Regulations No. 51, as amended.)
Approved For Release 1999/09108 : CIA-RDP81 B00879R0000100180010-5
 Form prescribed b f " thTIAO- E?Pgfb@@9 '9 0100180010-5
+C~~'~or R~lea
(Gen. Reg. No. blr Supp. fo. 11) ervices Other .Than Personal
CONTINUATION SHEET
U. S---------------------------------------------------------------------------------------------------- Sheet No- -----1----- of Bureau Voucher No- ----- 33--.
(Department, bureau, or establishment)
d D
t
N
Date of
ARTICLES OR SERVICES
UAN-
UNIT PRICE
AMOUNT
a
e
o. an
of Order
Deliver
y
(Enter description, item number of contract or Federal supply schedule,
Q
ITY
or service
and other information deemed necessary)
Cost
Per
Dollars
Cts.
t ((CDP -4)
t
C
rac
on
Direct Costs Properly Chargeable to
Contract for the period
11-1-58 thru 12-31-5b
Re
search
&
MJO 4048
De
velopm
ent
Total
Labor fo
r the period 11-1-58 thru 11-30-58
180
40
Labor fo
r the period 12-1-58 thru 12-31-58
1,628-
34
1,808
74
Other Di
ect Costs - Material Requisitions
JV 128143
514
96
Total Bi
lling
2,323
,70
.r.
Approved For Release I 999/0&IQ8 weC,IA-ROP8 0879R000100180010-5