Standard Form No. 1034a
7 GAO 5030
1034-206-16

PUBLIC VOUCHER FOR PURCHASES AND
SERVICES OTHER THAN PERSONAL

Use continuation sheet(s) if necessary

D. O. VOU. NO.

BU. VOU. NO. 40

U. S. Army - Surgeon General

(Department, bureau, or establishment)

Voucher prepared at St. Louis, Missouri

(Give place and date)

Payee's Account No. 23 2464 64117 3235 Discount Terms

TO WASHINGTON UNIVERSITY

(Payee)

Lindell & Skinker Blvds., St. Louis 30, Missouri

(Address)

PAID BY

Contract No. DA-49-007-MD-1024 Date 1/1/59

Req. No.

Date

Invoice Rec'd.

Shipped from

to

Weight

Govt. B/L No.

No. and Date of Order	Date of Delivery or Service	ARTICLES OR SERVICES (Enter description, item number of contract or Federal supply schedule, and other information deemed necessary)	Quantity	UNIT PRICE		AMOUNT
				Cost	Per
	February 1, - February 28, 1963	Direct Salaries				$500.00
		Direct Materials				113.48
		Other Direct Costs				39.40
		Overhead				219.00
TOTAL						$871.88

PAYMENT:

COMPLETE

PARTIAL

FINAL

PROGRESS

ADVANCE

(PAYEE MUST NOT USE THIS SPACE)

DIFFERENCES

Amount verified; correct for

(Signature or initials)

MEMORANDUM

ACCOUNTING CLASSIFICATION (Appropriation Symbol must be shown; other classification optional)

Paid by

Check No. __________ on Treasurer of the United States
Check No. __________ on __________ (Name of Bank)
Cash, $ __________, on __________, 19 __________

☆ U. S. GOVERNMENT PRINTING OFFICE: 1960-556940

Source: https://www.industrydocuments.ucsf.edu/docs/hklg0227