Form SF-1034 Public Voucher for Purchase and Services Other than Pers

Standard Form 1034
Revised October 1987
Department of the Treasury
1 TFM 4-2000

VOUCHER NUMBER

PUBLIC VOUCHER FOR PURCHASES AND
SERVICES OTHER THAN PERSONAL

U.S. DEPARTMENT, BUREAU, OR ESTABLISHMENT AND LOCATION

DATE VOUCHER PREPARED

SCHEDULE NUMBER

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

NUMBER AND DATE
OF ORDER

TO
DATE OF
DELIVERY
OR SERVICE

ARTICLES OR SERVICES
(Enter description, item number of contract or Federal supply schedule,
and other information deemed necessary)

(Use continuation sheet(s) if necessary)
PAYMENT:
PROVISIONAL
COMPLETE
PARTIAL

WEIGHT

QUANTITY

ADVANCE

UNIT PRICE

TOTAL

EXCHANGE RATE
=$

PER

COST

(Payee must NOT use the space below)

APPROVED FOR

=$1.00

DIFFERENCES

BY 2

FINAL
PROGRESS

GOVERNMENT B/L NUMBER

Amount verified; correct for payment

(Signature or initials)

TITLE

Pursuant to authority vested in me, I certify that this voucher is correct and proper for payment.
(Authorized Certifying Officer) 2

(Date)

(Title)

ACCOUNTING CLASSIFICATION

P
A
I
D
B
Y

CHECK NUMBER

ON ACCOUNT OF U.S. TREASURY

CHECK NUMBER

CASH
$

DATE

PAYEE

ON (Name of bank)

3

1. When stated in foreign currency, insert name of currency.
2. 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.
3. When a voucher is receipted in the name of a company or corporation, the name of the person writing the company or 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.

PER
TITLE

Previous edition usable
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.

AMOUNT
(1)