Standard Form No. 1035-A
September 1973
4 Treasury FRM 2000
1035-209-01

PUBLIC VOUCHER FOR PURCHASES AND
SERVICES OTHER THAN PERSONAL
MEMORANDUM

CONTINUATION SHEET

U.S. DEPARTMENT, BUREAU, OR ESTABLISHMENT

NUMBER 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