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REIMBURSEMENT VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL
(when Filled In)
NAME OF CLAIMANT
CHARGE TO ALLOTMENT OR PROJECT
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
AMOUNT
Payment to [redacted] for MULTRA Sub-project #22, Invoice #22, for paragraph IV D of the MULTRA 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 for security reasons and will be made available to the Certifying Officer upon his request.
$300.00
Pls forward check to C/TSD/BB thru TSD/BF no later than 1 July 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.
CHARGE ALLOTMENT NO.
DATE
SIGNATURE OF AUTHORIZING OFFICER
APPROVED
SIGNATURE OF AUTHORIZING OFFICER
DATE
SIGNATURE OF PAYEE
20 JUN 1963
2125-1300-3002
[redacted]
27 June '63
[redacted]
CERTIFIED FOR PAYMENT OR CREDIT
DATE
SIGNATURE OF CERTIFYING OFFICER
PAYMENT RECEIVED IN THE AMOUNT OF $
DATE
SIGNATURE OF RECIPIENT
SPACE BELOW FOR EXCLUSIVE USE OF FINANCE DIVISION
REVIEWED BY
Voucher No. 7-12
DESCRIPTION - ALL OTHER ACCOUNTS
40-42
45-46
47-52
53
54-57
59-67
68-70
71-80
EXPEND
PAY
OBLIG
GENERAL
ALLOT. LEDGER
DUE
AMOUNT
CODE
REF. NO.
LEDGER
ACCT. NO.
DATE
ADVANCE
ACCT. NO.
YR ACCT. NO.
62-67
OBJECT
CODE
EMP. NO.
CLASS
CLASS
DESCRIPTION - A/P ITEMS 13-33
34-39
PAYABLE
VOL. NO.
DESCRIPTION - ADVANCE ACCOUNTS 13-24