REQUEST FOR PAYMENT AND POSTING VOUCHER
Document Type:
Collection:
Document Number (FOIA) /ESDN (CREST):
CIA-RDP90B00224R000300250007-8
Release Decision:
RIPPUB
Original Classification:
S
Document Page Count:
3
Document Creation Date:
December 22, 2016
Document Release Date:
August 22, 2011
Sequence Number:
7
Case Number:
Publication Date:
April 13, 1966
Content Type:
FORM
File:
Attachment | Size |
---|---|
![]() | 142.35 KB |
Body:
REQUEST FOR PAYMENT AND POSTING
VOUCHER
VOUCHER NO. -
TO : Accounts Division (Room Bldg. )
DIVISION VOUCHER NO.
THROUGH: Monetary Division (Room Bldg. )
?J
Request payment be made and/or transaction be recorded as indicated
below. Pertinent documentation in support of
this trans-
action is on file in this office.
SUBJECT
INVOICE NO(S).
/
PAYMENT TO
CONTRACT NO. u
,..
L~
U
11171,
JUNT
CHECK TO BE DATED
CASH PAYMENT I
U.S. TREASURY CHECK I
I
AGENT CASHIER CHECK
I
I 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 S
OF OFFICIAL FUNDS IN CURRENCY ON MY BEHALF.
D/TE
SIGNATURE OF PAYEE I
DATE I
SIGNATURE OF AGENT
I
DATE
I SIGNATURE OF RECIPIENT
DESCRIPTION - ALL OTHER ACCOUNTS 13 - 33
54 - 89
STATION
40 -
41
42 - 47
OBLIG
48 - 49
50
CA
51 - 54
55 - 66
ALLOT. - COST - FAN
67 - 70
OBJECT
71 - 80
28 -88
T/A NO.
CODE
E
C
.
REF. NO.
PAY
OR
C
GENERAL
ACCOUNT SYMBOL
CLASS
AMOUNT
DESCRIPTION -
ADVANCE ACCOUNTS 18 - 27
-------
SNIP. DOC. NO.
REC. RPT. NO.
---------
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ED
__
ADVANCE
ACCT. NO.
PER ER.
LI Q.
S
LEDGER
ACCT
NO
F II
IMF
61.- NO66
----------
1 68 - 70
DUE
DEBIT
CREDIT
-----------
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MP
NO
CODE
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DATE DATE REVIEWED BY
CERTIFIED FOR PAYMENT OR CREDIT
25X1
DATE SIGNATURE OF CERTIFYING OFFICER
FORM 1822 OBSOLETE
$_ga
SECRE
GROUP 1
EXCLUDED FROM AUTOMATIC
(10-49)
DOWUSNADINS AND DECLASRIFICATION
Sanitized Copy Approved for Release 2011/08/22 : CIA-RDP90B00224R000300250007-8
SECRET
(When Filled In)
Sanitized Copy Approved for Release 2011/08/22 : CIA-RDP90B00224R000300250007-8
Sanitized Copy Approved for Release 2011/08/22 : CIA-RDP90B00224R000300250007-8
Standard Form No. 1084 PUBLIC 'OCHER FOR PURCHASES AND
7 GAO 5000
1094-110-04 SERVICES OTHER THAN PERSONAL
U.S. DEPARTMENT, BUREAU, OR ESTABLISHMENT AND LOCATION
DATE VOUCHER PREPARED
VOUCHER NUMBER
31 March 1966
7
CONTRACT NUMBER AND DATE
PAID BY
REQUISITION NUMBER AND DATE
r 1
I
25X1
PAYEE'S
NAME
DATE INVOICE RECEIVED
AND
___
ADDRESS VVV
DISCOUNT TERMS
L J
PAYEE'S ACCOUNT NUMBER
SHIPPED FROM TO WEIGHT
GOVERNMENT B/L NUMBER
NUMBER
DATE OF
ARTICLES OR SERVICES
QUAN-
UNIT PRICE
AMOUNT
AND DATE
OF ORDER
DELIVERY
OR SERVICE
(Pbsar description, item number of contract or Pederal
.apply schedule. and other informaian deemed n.ceasmy)
TITY
COST
p
('I
19 Feb
Reimbursable Costs
8247.54
25 Mar
Fixed Fee
784.17
25X1
Dat
!APR
lJ I9FF
Irate}
ssar
) if
h
(
)
TOTAL
9031.71
(Use continuation s
y
nece
s
es
PAYMENT:
APPROVED F
OR
D
IFFERENCES
R COMPLETE
_ $
=$1.00
PARTIAL BY
FINAL
^ PROGRESS TITLE
Amount verified; correct for
13 ADVANCE
(9lp atera or uuials)
Pursuant to authority vested in me, I certify that this voucher is correct and proper for payment.
(Date) (Authorized Certifying Officer)' (le)
ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)
Appropriation Symbol
and Subhead
Object
Class
Expenditure
Account
Chargeable
Activity
Bureau Cont. or
Subauth'n Activity
Bureau
Control No.
Sub-
auth'n No.
Identifi-
cation No.
Amount
I.R. No's.
CHECK NUMBER ON TREASURER OF THE UNITED STATES
CHECK NUMBER ON (Name of bank)
Q
CASH DATE
PAYEE '
IL
$
1 When stated in foreign currency, insert name of currency.
Y If the ability to certify and authority to approve are combined in one person, one signature only is necessary;
ial title
ffi
hi
PER
.
s o
c
otherwise the approving officer will sign in the space provided, over
When a voucher is receipted in the name of a company or corporation, the name of the person writing the
"
TITLE
John Doe
company or corporate name, as well as the capacity in which he signs, must appear. For example:
-upany, per John Smith, Secretary" or "Treasurer", as the case may be.
Sanitized Copy Approved for Release 2011/08/22 : CIA-RDP90B00224R000300250007-8
Sanitized Copy Approved for Release 2011/08/22 : CIA-RDP90B00224R000300250007-8
6624.00
TOTAL 76289.00
ANALYSIS OF CLAIM,IE:'D CURRENT AND
CUMULATIVE COSTS AND FE_ EARNED
MAR 25,1966
CLASSIFICATION OF COSTS
SALARIES AND WAGES
TECHNICAL OVEREAD ( .846000)
MATERIALS AND SERVICES
TRAVEL
SUBCONTRACTS
TOTAL DIRECT COSTS
GENERAL/ADMIN. CCSTS ( .186300)
TOTAL COSTS
FIXED FE_ EARNED (PCT COv=.)
TOTAL AMOUNTS CLAIMED
Materials and Services:
Computer usage
Services of D. Stone, 9-28 Feb.,
96 hours
PC 'ic Voucher for Purchases anc'
oervices Other Than' Personal
CONTINUATION SHEET
Sheet No. 1 of Bureau Voucher No. 7
CURREN! T "10
2936.94
2484.66
1532.43
0.00
0.00
6954.36
1293.46
8247.54
784.17
9031.71
$3.48
1529.00
1532.48
FISCAL YR/DT
7233.34
6119.41
2429.81
0.00
0.00
15732.55
2935.:6
16718.12
2155.66
20873.78
PER IcD/DATE
17359.90
14694.94
2337.06
43.95
0.00
34945, G
64y9.~q
41=+4;.7d
^P40.66
45385,4+
Sanitized Copy Approved for Release 2011/08/22 : CIA-RDP90B00224R000300250007-8