upr000059 66

8“S2jr' PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL May 26, 1938 (Amended August 15,1941) D. O. Vou. N o .. Bu. Vou. N o .__ GENERAL ACCOUNTING OFFICE PREAUDIT U.S._____ PAID BY (Department, bureau, or establishment) Certified for payment in the sum of $_____ Voucher prepared at ....____ _ (Give place and date) THE UNITED STATES, Dr„ Comptroller General of the United States To_______ (Payee) By----------------------------------------- Address___ Payee’s Account No............. (For use of Paying Office) No. and Date of Order Date of Delivery or Service Articles or Services (Enter description, item number of contract or general supply schedule, and other information deemed necessary) Terms--------------------% Discount Cash________________days Brought forward from continuation sheet(s) Quantity UNIT PRICE Cost Shipped from------------------------------to-------------------------------Weight___________________Government B/L No.. Per Total*; I certify that the above bill is correct and just; that payment therefor has not been received; that all statutory requirements as to American production and labor standards, and all conditions of purchase applicable to the transactions have been complied with; and that State or local sales taxes are not included in the amounts billed. ?Payee _ <Thi« certificate not required when a like oertifioate is made by payee on attached bill or biUs) Per......................—-----------------------------------Title________________ (Sign original only) (Payee must NOT use this space) Differences ____________________________ Account verified; correct for. (Signature or initials)_______ AMOUNT Dollars Cts. Contract No.________________________________________ Date Req. No. Date________________ Invoice Rec’d . Pursuant to authority vested in me, I certify that the above articles were received in good condition, after due inspection, acceptance, and delivery prior to payment as required by law, or the services were performed as stated; that they were procured under the contract numbered above or the unnumbered contract attached hereto, or that tjWCre- Pro?,ur®° without written contract, in open market, and with or without advertising, under the circumstances stated in No___________________of “Method of or Absence of Advertising shown on reverse hereof, and were necessary for the public service; and that the prices charged are just and reasonable and in accordance with the agreement. fApproved for $_ (Sign original only) Title 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 Check No. Paid by ( (Cash, $___ . dated on___ 19____, for $______ 19___., Payee. f on Treasurer of the United States in favor of \ payee named above. (Sign original only) When a voucher u signed or receipted in tbe name of » company or corporation, the name of the person writing the company or corporate name! as well as tho oapacity m whioh he signs, must appear. For example: “John Doe Company, per John Smith, Secretary", or "Treasurer**, aa the ease may be. t If the ability to certify and authority to approve are combined in one person, one signature only is necessary; otherwise the approving offioer will sign in the blank space below '‘Approved for I......____and over his official title. V. S. GOVERNMENT PRINTING OFFICE 16—22900 Per_________ Title