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Standard Form No. 1034a
PUBLIC VOUCHER FOR PURCHASES AND
VOUCHER NO.
7 GAO 5000
034-210-04
SERVICES OTHER THAN PERSONAL
71
U.S. DEPARTMENT, BUREAU, OR ESTABLISHMENT AND LOCATION
DATE VOUCHER PREPARED
SCHEDULE NO
February 16, 1966
U. S. Army Medical Research
CONTRACT NUMBER AND DATE
PAID BY
Office of the Surgeon General
DA-49-007-1024
Washington, D.C.
REQUISITION NUMBER AND DATE
PAYEE'S
NAME
Washington University
DATE INVOICE RECEIVED
AND
Lindell & Skinker Boulevards
ADDRESS
St. Louis, Missouri 63130
DISCOUNT TERMS
PAYEE'S ACCOUNT NUMBER
SHIPPED FROM
TO
WEIGHT
GOVERNMENT B/L NUMBER
NUMBER
AND DATE
DATE OF
DELIVERY
ARTICLES OR SERVICES
(Enter description, item number of contract or Federal
QUAN
UNIT PRICE
AMOUNT
OF ORDER
OR SERVICE
supply schedule, and other information deemed necessary)
TITY
COST
PER
Jan.
1966
For detail, see SF 1035, Continuation
Sheet, total amounts claimed trans-
ferred from page 1 SF 1035.
1, 133.03
COST REIMBURSABLE
PROVISIONAL PAYMENT
(Use continuation sheet(s) if necessary)
(Payee must NOT use the space below)
TOTAL
PAYMENT:
COMPLETE
DIFFERENCES
PARTIAL
FINAL
PROGRESS
Amount verified; correct for
ADVANCE
(Signature or initials )
MEMORANDUM
ACCOUNTING CLASSIFICATION
CHECK NUMBER
ON TREASURER OF THE UNITED STATES
CHECK NUMBER
ON (Name of bank )
PAID BY
CASH
DATE
*U. S. GOVERNMENT PRINTING OFFICE: 1965-764-457
Source: https://www.industrydocuments.ucsf.edu/docs/jrig0227

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