REQUEST FOR PAYMENT AND POSTING VOUCHER

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP90B00224R000300300004-5
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 3
• Document Creation Date: December 22, 2016
• Document Release Date: July 6, 2011
• Sequence Number: 4
• Publication Date: October 5, 1967
• Content Type: FORM

VOUCHER NO.-DATE 2-12
REQUEST FOR PAYMENT
AND POSTING VOUCHER
TO Accounts Division (Room
Bldg.
Bld
)
DIVISION VOUCHER NO.
(
&
.7
THROUGH: Monetary Division (Room
g.
C'
'
t be made and/or transaction
t
R
be recorded as indicated below.
Pertinent documentation in support of this transaction
paymen
eques
ffi
h
ce.
is o
is on file in t
SUBJECT
INVOICE NO(S). O 25X1
CONTRACT NO. d~7_ ?Q
PAYMENT
CHECK TO BE DATED
RUNT OD
CASH PAYMENT
U.S. TREASURY CHECK
AGENT CASHIER CHECK
BANK CASHIER'S CHECK
THE ATTACHED CHECKS AND/OR CASH IN THE AMOUNT OF SHOULD BE TAKEN INTO ACCOUNT AS INDICATED BELOW.
I HEREBY AUTHORIZE MY AGENT, WHOSE SIGNATURE APPEARS BELOW TO RECEIVE $
OF OFFICIAL FUNDS IN CURRENCY ON MY BEHALF.
DATE SIGNATURE OF PAYEE DATE SIGNATURE OF AGENT
DATE SIGNATURE OF RECIPIENT
DESCRIPTTQN-ALL OTHERACCOUNTS 13-83
84-99
49
41
42-47
BLIG
48-49
CAA
51.54
55-36
ALLOT. COST-FAN
67-70
OBJECT
71-80
AMOUNT
?-..
8-38
A po
STATION
CODE
E
C
.
O
REF' NO.
PAY
OR
C
ACCOUNT SYMBOL
CLASS
DESCRIPTION- -'-
CCOUNTS 13-27~
ADVANCE
.
/
_DOC' NO.
SHIP
REC.RPT.NO.
X
E D
0
ADVANCE'
ACCT. NO.
PER.
LIQ.
S
T
GENERAL
LEDGER
Iu
F N
CK. 16, 60.
68-70
DUE
DEBIT
CREDIT
.
;
_
s2-sa
DIV.
PROJECT NO.
D E
MP. NO.
EMP.
CODE
YR
ACCT. NO.
y s
X REF. NO.
DATE
497340
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25X1
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TOTALS
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DATE
REVIEWEP BY
CERTIFIED FOR PAYMENT OR CREDIT
DATE SIGNATURE
(Signed)
( 10-49)
FORM 1822 a
SECRET
G1DY.
2-66
EEC LYDED II.OM AY TOw.ATC
OOWMGIIADIMG AMD OECIAffiEt ATOw
Sanitized Copy Approved for Release 2011/07/06: CIA-RDP90BOO224ROO0300300004-5
SECRET
hen Filled In)
Sanitized Copy Approved for Release 2011/07/06: CIA-RDP90BOO224ROO0300300004-5
 Sanitized Copy Approved for Release 2011/07/06: CIA-RDP90B00224R000300300004-5 10 3 6 9
11\ V vlt.L ,o.
?s*xkxZx1Tx*!*2
September 30, 1967
STAT
Post Office Box 8298
Southwest Station
Wasldngton, D. C. 20024
iCT 4 t 09 FM '67
SHIP
TO
L RE-7300
F33657-87-C-1599
OUR JOB No. 3112 (Ref. SO# 1708 & FPRD 5828)
20
DATE SHIPPED 9/"/67 NO. BOXES: 1
QUANTITY
ORDERED
QUANTITY
SHIPPED
BACK
ORDER
RIXON
PART NO.
DESCRIPTION
UNIT
PRICE
AMOUNT
1
1
0
907-0038B
Spare Parts Kit Option "B"
$275.0
consisting of:
$275.00
1 ea
905-4115 Extender Cable
1 ea
905-4114 Extender Card
Shipping Indicator RE-7300
This shipment completes
Item 5 of Purchase Order.
TAT
Pat
e);
O CT
196
(Pat
?
blt
9-30-
7
S
Sanitized Copy Approved for Release 2011/07/06: CIA-RDP90B00224R000300300004-5
 Sanitized Copy Approved for Release 2011/07/06: CIA-RDP90B00224R000300300004-5
M
1. PROC. INSTRU. ID NTRACTI (ORDER) N0
6. )ICE 7
. PAGE1 OF 1
ATERIAL INSPECTION
NO
AND
RE7300 F33657-67-C-1599
8
. ACCEPTANCE POINT
RECEIVING REPORT
DATE
S
2. SHIPMENT N0.
3. DATE SHIPPED
4. B/L
5. DISCOUNT TERMS
RX
00002
20SEPT67
TCN
9. PRIME CONTRACTOR CODE
10. ADMINISTERED BY CODE
25X1
FOB
12. PAYMENT WILL BE MADE BY CODE
ED FOR CODE
R
13. SHIPPED TO cuut:
14. MA
K
Customer Pick Up
15. ITEM
16 STOCK/PART NO. DESCRIPTION
(Indicate number of shopping containers type of
17
SHIP/REC'QUANTITYD.
18
UNIT
19
UNIT PRICE
20
AMOUNT
NO.
container - container number.)
5
Spare Parts Kit, Option "B"
1 ea.
275.00
$275.00
Rixon P/N 907-0038B
21 PROCUREMENT QUALITY ASSURANCE
22 RECEIVER'S USE
A ORIGIN B. DESTINATION
Quantities shown in column 17 were received in
apparent good condition except as noted
^ PQA (]ACCEPTANCE of listed items has been mode ^ P9A (]ACCEPTANCE of listed ;tsms has been made by me
by me or under my supervision and they conform to contract, or under my supervision and they conform to contract, except as
except as noted herein or on supporting documents. noted herein or on supporting documents.
DATE SIGNATURE OF AUTH GOVT REP
STAT
TYPED NAME
AND OFFICE
20 Sept6
DATE
DATE SIGNATURE OF AUTH GOVT REP
o1 quantity received by the Government is the some as
quantity shipped, indicate by ( b/ ) mark, if d f
TYPED NAME
TYPED NAME
quantity received below quont,ty
feerent
r actal
e
AND OFFICE
AND TITLE
lf
,
nnd
I OCT 4250
PREVIOUS EDITIONS ARE OBSOLETE.
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