Public Voucher For Purchases And Services Other Than Personal (Sf-1034) printable pdf download

Public Voucher For Purchases And Services Other Than Personal (Sf-1034)

PUBLIC VOUCHER FOR PURCHASES AND

VOUCHER NO.

SERVICES OTHER THAN PERSONAL

U.S. DEPARTMENT, BUREAU, OR

DATE VOUCHER PREPARED

SCHEDULE NO.

ESTABLISHMENT AND LOCATION

CONTRACT NUMBER AND DATE PAID BY

REQUISITION NUMBER AND

DATE

PAYEE'S NAME AND ADDRESS

DATE INVOICE RECEIVED

DISCOUNT TERMS

PAYEE'S ACCOUNT NUMBER

SHIPPED FROM:

TO:

WEIGHT:

GOVERNMENT B/L NUMBER

DATE OF

NUMBER

ARTICLES OR SERVICES

QUAN-

UNIT PRICE

AMOUNT

(1)

DELIVERY

AND DATE

(Enter description, item # of contract or Federal supply

TITY

COST

PER

OF ORDER

schedule, and other information deemed necessary)

SERVICE

$0.00

(Use continuation sheet(s) if necessary)

(Payee must NOT use the space below)

TOTAL

$0.00

PAYMENT:

APPROVED FOR

EXCHANGE RATE

DIFFERENCES

PROVISIONAL

BY:

AMOUNT VERIFIED;

PARTIAL

CORRECT FOR

FINAL

PROGRESS

TITLE:

(SIGNATURE OR INITIALS)

ADVANCE

PURSUANT TO AUTHORITY VESTED IN ME, I CERTIFY THIS VOUCHER IS CORRECT AND PROPER FOR PAYMENT

(DATE) (AUTHORIZED CERTIFYING OFFICER)

(TITLE)

ACCOUNTING CLASSIFICATION

DOC NO

EARMARK

CURRCODE

CURRENCY

FUNDING

CHECK NUMBER

ON ACCOUNT OF U.S.

CHECK NUMBER

ON (Name of Bank)

TREASURY

CASH

DATE

PAYEE

When stated in foreign currency, insert name of currency.

PER

If the ability to certify and authority to approve are combined in one person, one signature only is necessary.

Otherwise the approving officer will sign in the space provided, over his official title.

When a voucher is receipted in the name of a company or corporation, the name of the person writing the company or

TITLE

corporate name, as well as the capacity in which he signs, must appear. For example: "John Doe Company, per John

Smith, Secretary", or "Treasurer", as the case may be.

Previous edition usable

NSN 7540-00-900-2234

PRIVACY ACT STATEMENT

The information requested on this form is required under the provisions of 31 U.S.C. 82b and 82c, for the purpose of disbursing Federal money. the information

requested is to identify the particular creditor and the amounts to be paid. Failure to furnish this information will hinder discharge of the payment obligation.

Standard Form 1034

1987Department of the Treasury

Revised October 1987

1 TFM 4-2000 1034-121