(When Filled In)
Voucher No. (Finance use only)
ACCOUNTING BY INDIVIDUAL FOR ADVANCE
NOTE: Follow Instructions on Reverse
SUBMITTED BY
PERIOD OF ACCOUNTING
FROM 27 December 1962 TO 7 January 1963
DISBURSEMENTS
1. CASH ON HAND BEGINNING OF PERIOD
2. RECEIPT NUMBER
DATE
DESCRIPTION
3. VOUCHER NUMBER
DATE
DESCRIPTION
AMOUNT
Invoice
$ 400.00
4. REFUNDED HEREWITH
5. CASH ON HAND END OF PERIOD
TOTAL ACCOUNTED FOR $ 400.00
TOTAL TO ACCOUNT FOR $ 400.00
I CERTIFY FUNDS ARE AVAILABLE
OBLIGATION REFERENCE NO. CHARGE ALLOTMENT NO.
2125-1390-3902
DATE 8 - JAN '63
SIGNATURE OF APPROVING OFFICER
I certify that the expenditures listed hereon and on any attachments were incurred for official purposes of a confidential nature, that payment or credit therefor has not been received, and that this accounting is true and correct.
SIGNATURE OF PAYEE
(A)
CERTIFIED FOR PAYMENT OR CREDIT
SIGNATURE OF CERTIFYING OFFICER
DATE
APPROVED
SIGNATURE OF AUTHORIZING OFFICER
SPACE BELOW FOR EXCLUSIVE USE OF FINANCE DIVISION
Voucher No. 7-12
40-42
43-46
47-52
53
54-57
59-67
68-70
71-80
EXPEND PER.
PAY LID.
OBLIG. REF. NO.
FI ADVANCE ACCT. NO.
GENERAL LEDGER ACCT. NO.
ALLOT. LEDGER ACCT. NO.
DUE DATE
AMOUNT
CODE
CODE
EMP. NO.
CR. NO.
CR. NO.
CR. NO.
OBJECT CLASS
8821
841
601.0
25-1390-3902 752
400.00
142.9
DESCRIPTION - ALL OTHER ACCOUNTS
23-39
DESCRIPTION - A/P ITEMS 13-33
DESCRIPTION - ADVANCE ACCOUNTS 13-24
MKULTRA SUB 52 INV 20
25090019
400.00
52-19
(1)
FORM 282 USE PREVIOUS EDITIONS.
6-57