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PUBLIC VOUCHER FOR PURCHASES .AND SERVICES OTHER THÄN PERSÞI{AI ^llurL voucher *"'
¿lot ) ya
Schedule No.
C, {r
Agent Unit a¡d Location Date Vouche¡ Prepared

17-Sep-04
Conüact Number and Date Paid By

Requisition Number and Date bss¿ ïs-lz

Date Invoice Received
I
Payee's Name LTC MAREKADAMCZYK
Discount Terms
and Address
coMMANDER 1$ ûùf illl
MND (CS)
Payee's Account Number

lrVeight Bill of Lading Number

Slipped From to

Number a¡d Date of Date of Articles or Services Quantity Unit hice Amount I
O¡der Delivery or
(Enler descrípllon, ltem number ofconlroclor olher
Servíce Cost Per
ìnfo rma!íon dee me d necus ant )
COMMANDERS EMERGENCY RESPONSE $8,ooo,ooo,oo
PROGRAM (CERP)
FTINDS FOR TI{E BENEFIT OF TI{E IRAQI
PEOPLE
IAW.MNF-I FRAGO 087
SEIZED FITNDS for MND (CS)

(Use coiltiÍuaÍíon sheel(s) if necessary) (Payee must NOT use the space below) Total $8,0oo,ooo.oo

Payment: Approved for Exchange Rate Differences

EProvisional = $1.00

Lluomplcte By' Amount verified; correct for

trPa¡tial

trFinal

!Frogress Signature Title

EAdvance

l7-Sep'04 D. DORAN, ILTEUDGET OFFIEER

Date Authorized Cerlifrine Ofücial 2 Title
Accounting Data
2142220 000000 76-2084 P136198.00 26EB 83 G3MS MNCIC842610100 83 509076 $8,000,000.00
Return a copy of the SF 1034 once signed by the payee, to MNC-I, C8, ATTN; CERP

PAUL A. DAVIS, SR.A., USAX" MNC-I, C8 RM

PAID BY Check Numbe¡ On Q,lame af Bank) | Check Number On Qttame of Bank)

Cash
q
Date
'When st¿ted in foreign cu¡Tency, insert nams of currency
lPavee'
|
f+
1- ll C
Per
früfffiC¿&tþ^,
¿
Éthe ability to certif, and authority to approve are combined in one person, one signature is neoessary;
rtherwise the approving ofticer will sign in the spacc provided, over his official title.
' whcn I vouc.ber is receiptecl ¡n t¡e name ol a company of corpomllon, tlre name ol tne person witing the
)ompany or corporate nÀme, as well as the capacity in which he signs, must appear. For example: 'Tohn Doe
Title blt L,
lomoanv". per Jcihn Doe. President. 4aç Dç
. DFI FORM 7O34,DEC2OO3

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