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Standard Form No. 1084a^-Rev, ' Form approved Comptroller General, TJ. S. May 28,1938 (Amended August 16,1941) PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL D . O. Vou. N o .. Bu. Vou. No. GENERAL ACCOUNTING OFFICE PREAUDIT Certified for payment in the sum erf $ _ _ __ - - U.S. (Department, bureau, or establishment) Voucher prepared at__ PAID BY (Give place and date) THE UNITED STATES, Dr., Comptroller General off the United States Tn um visas mu® & mtm emmms (Payee) Addr^c 2nd St., hm Vegas, tfavada By----------------------------------------- Payee’s Account No........................ (For use of Paying Office) No. and Date off Order Date off Delivery or Service OatoMr Hoveith?: bsr, | Articles or Services (Enter description, item number off contract or general supply schedule, and other information deemed necessary) Terms________________% Discount Cash_______________days # Brought forward from continuation sheet(s) For v»t«r service &% 123 Sot&b H&lu St*, I Quantity UNIT PRICE Cost «© m Shipped from________________________to. . Weight. , Government B/L No.___________________________!— Total. Per tmm las® a wtm m ____________general Ifanager (Payee must NOT use this space) Differences ________________,___________ Account verified; correct for. (Signature or initials)________ AMOUNT Dollars f 5© Cts. ISQ Contract No. Date __________________ Req. No. Date __..........Invoice Rec’d MEMORANDUM ACCOUNTING CLASSIFICATION (for completion by Administrative Office) Appropriation, limitation, or project symbol Appropriation title Limit'n or Proj't Amount Appropriation Amount Allotment symbol Amount Obligations liquidated COST ACCOUNT OBJECTIVE CLASSIFICATION Symbol Amount Symbol Amount f Check No._____SI ; _______dated ______________________ 19____, for $_____ Paid by < (Cash, $_____________________ on____________________________, 19____. Payee. * When a voucher it tuned or receipted in the name of a company or corporation, the name of the person writing the company or corporate name, as well as the capacity in which be signs, mutt appear. For example: “John Doe Company, per John Smith. Secretary*', or “Treasurer", at the cate may be. t If the ability to certify and authority to approve are combined in one person, one signature only ie necessary; otherwise the approving officer will sign in the blank space below "Approved for S___-________”, and over his official title. U. S. GOVERNMENT PRINTING OFFICE 16—22900a-l {on Treasurer of the United States in favor of payee named above. (Sign original only) Per Tide