PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP64-00360R000400110089-9
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 17, 2016
• Document Release Date: November 1, 1999
• Sequence Number: 89
• Publication Date: August 9, 1956
• Content Type: FORM

t91;nnd.n.~tt Form. No. 1084-ltevlsed
D. O. Vou. No. ____------?'---------------?-
~'ormprescribc$boved Fir ~s~~
Comptroller Cene 4
~
A
0360R000400110QI~1-9
- September 7, 9 ~ ~ SERVICES OT E
~i.
t'fH
Cien. Iteg. No. bl, Supp. No. 11)
-
Bu. Vou. No- ---------------------------------
(Amended February 20, 1Db2)
U. S. _ ~3oST RE'~
------- -----
~~~
------------------------------------------
(Department, bureau, or establishment)
Voucher prepared at ----------- --
-----------------------------------------------------------------------------------------
(Clive place and date)
THE UNITED STATES, Dr.,
Payee's Account No. ____].~28____
7n -----------------------------------------------------------------------------------------------------------------------------------
(Payee)
-------------------------------------------------------
(Address) (City) (State)
ARTICLES OR 5ERVICES
UNIT PRICE
AMOUNT
item number of contractor Federal supply
l
ti
d
E
No. end Date of
Date of Delivery
eacr
p
on
nter
(
anrj other information deemed necessary)
schedule
QUANTITY
ll
D
Cta
Order
or Service
,
T
Coat
Par
ars
o
.
erms
Discount
PAY[V1ENT:
Complete ^
Partial ^
Final ^
Uae continuation sheet(s) if necessary
Weight Government B/L No.
t
Total
'~ Q
o
Shipped from
hi
n space)
(Payee must NOT use t
Differences ---------------------------------
---------------
-----
----------------------------------------------
---------------
-----
----------------------------------------------
---------------
---
-
~. 7 /D
Pursu account is correct and proper for payment.
t APP ~ ------
ORIGINAL
ONLY
Title ---------------------------------------------------------- Date -------------------------------------------------------------------------
STATOTH R THE REVERSE OF TNIS FORM MUST EE EXECUTED WHEN PURCHASES ARE MADE OR SERnCES SECURED WITHOUT WRITTEN AGREEMENT IN ANY FORM
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be showni other claaaification optional)
Check No. ___--------------------- dated _____________------_----__---. 19_____, for $______________------------------------ on Treasurer of the United States in
Paid by {favor of payee named above.
{ Cash, $------------------------~ on ------------------------------------? 19-----? Payee -------------------------------------------------------------------------
(ekn orialnnt only)
43~'
"When a voucher is s~p~$,('C c i g$pq~o com an n me p,_ o _____________
writing thocompanyoJCbF~ld~dil,~c~~RB15Fh9'4?io ~>~a~ ~ ~4=0II3FiQR0II0~OD'f'f D08~-J
"John Doe Company, pe 7 hn Smith, Secretary", or' reasuror , as t c. case may b .
}U the ability to certt[y end authority to aPProvo are combined in ono person, one signature only is nee- Title _______________________________________________________
essary, otherwise the approving officer will sign on the line below "Approved for $______-____________", and
over his official title.
 Approved For Release 2000/04/12 :CIA-RDP64-003608000400110089-9
STATOTI-fR
Approved For Release 2000/04/12 :CIA-RDP64-003608000400110089-9