This page's OCR needs a second look (cut short, looping or weak): read the scan itself.
(When Filled In)
REIMBURSEMENT VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL
NAME OF CLAIMANT: [redacted]
CHARGE TO ALLOTMENT OR PROJECT: MULTIA Sub 52
Voucher No. (Finance use only)
REIMBURSEMENT OR PAYMENT IS CLAIMED FOR MATERIALS, SERVICES, OR OTHER EXPENDITURES ITEMIZED BELOW WHICH ARE PROPERLY CHARGEABLE TO THE ALLOTMENT OR PROJECT DESIGNATED.
DESCRIPTION OF EXPENDITURE - ATTACH RECEIPTS AND OTHER SUPPORTING DOCUMENTS
Payment to [redacted] for MULTIA Sub-Project #52, Invoice #23, per paragraph IV D of the MULTIA Fiscal Annex.
I certify that to the best of my knowledge and belief the amount shown as having been disbursed for Agency authorized activities and services or material have been received. The documents upon which this statement is based are maintained in the files of TSD or Security reasons and will be made available to the Certifying Officer upon his request.
Please forward check to C/TSD/DB thru TSD/EF no later than 15 October 1963
I CERTIFY THAT THIS VOUCHER AND ANY ATTACHMENTS ARE CORRECT, THE EXPENDITURES WERE INCURRED ON OFFICIAL BUSINESS OF A CONFIDENTIAL, EXTRAORDINARY, OR EMERGENCY NATURE; PAYMENT OR CREDIT HAS NOT BEEN RECEIVED, AND I SHALL NOT BE REIMBURSED FROM ANY OTHER SOURCE.
I CERTIFY FUNDS ARE AVAILABLE
OBLIGATION REFERENCE NO. 098 841
CHARGE ALLOTMENT NO. 1123-1330-3902 2123-1330-3902
DATE 10/9/63
SIGNATURE OF AUTHORIZING OFFICER [redacted]
APPROVED
SIGNATURE OF APPROVING OFFICER SIDNEY COTTLER, DC/TSD
CERTIFIED FOR PAYMENT OR CREDIT
DATE
SIGNATURE OF CERTIFYING OFFICER
DATE
SIGNATURE OF PAYEE
SIGNATURE OF RECIPIENT
PAYMENT RECEIVED IN THE AMOUNT OF $ 500.00
SPACE BELOW FOR EXCLUSIVE USE OF FINANCE DIVISION
PREPARED BY
REVIEWED BY
Voucher No. 7-12
DESCRIPTION-ALL OTHER ACCOUNTS 13-33
34-39 STATION CODE
40-42 EXPEND CODE
43 FUNDS
45-46 PAY PER. LIO. CODE
47-52 OBLIG. REF. NO. -