(When Friday In)
DESCRIPTION OF EXPENDITURE - ATTACH RECEIPTS AND OTHER SUPPORTING DOCUMENTS
Payment to BOLITA Subproject 52 per paragraph IV-D or the INULTA Fiscal Annex. I certify that to the best of my knowledge and belief the amount shown has been disbursement agency authorized activities, and services or materials have been received. The documents upon which this statement is based are maintained in the files of TSD for security reasons, and will be made available to the certifying officer at his re-quest.
PIS forward check to C/TSD/RD thru TSD/PR no later than 11 March 1964 AMOUNT
APPROVED DATE
7/26/64 SIGNATURE OF PAYEE
(A)
DATE SIGNATURE OF APPROVING OFFICER
DATE
10 MAR 1964 CERTIFIED FOR PAYMENT OR CREDIT DATE SIGNATURE OF RECIPIENT
DATE SIGNATURE OF CERTIFYING OFFICER
SPACE BELOW FOR EXCLUSIVE USE OF FINANCE DIVISION
PREPARED BY
REVIEWED BY
VOUCHER NO. 7-12
SCRIPTION-ALL OTHER ACCOUNTS 13-33 34-39 STATION CODE 40-42 EXPEND CODE 43 FUNDS 45-46 PAY PER LID CODE 47-52 OBLIG REF. NO. 53 CAVR 54-57 GENERAL LEDGER ACCOUNT NO. 58-67 ALLOT. OR COST ACCT. NO. 68-70 DUE DATE 71-80 AMOUNT
DESCRIPTION-ADVANCE ACCOUNTS 13-27 26-33 TA. NO.
PUR. ORDER NO.
32-30 DAY IPY 62.67 OK. NO.
X REF. NO. OBJECT CLASSES DEBIT CREDIT
FORM 264 USE PREVIOUS 6-59 EDITIONS.