The DS-2076 form, officially titled "Purchase Order, Receiving Report and Voucher," serves as a multifaceted document used by the U.S. Department of State. It outlines the process and protocols for placing orders with vendors, receiving those ordered goods or services, and the subsequent payment procedures. By including pertinent details such as the purchase order number, date, and a thorough description of items with their quantities and agreed prices, it facilitates a transparent transaction between the government and vendors. Furthermore, the form underscores the U.S. government's commitment to accountability by requiring signatures from ordering and receiving officers, ensuring that all parties confirm the accuracy and receipt of goods or services before payment is processed. The necessity for presenting invoices in quadruplicate, along with specific instructions for both the seller and the purchaser regarding invoice certification and discounts, emphasizes the document's role in maintaining a clear and auditable trail for financial transactions. Essential for smooth operational exchanges, the form represents a critical checkpoint in the procurement process, ensuring that all acquisitions are properly recorded, received, and compensated in alignment with federal regulations.
| Question | Answer |
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| Form Name | Ds 2076 Form |
| Form Length | 5 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 15 sec |
| Other names | ds2076, ds 2076 form print, form ds 2076, jf 144 form |
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U.S. Department of State |
Purchase Order Number |
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PURCHASE ORDER, RECEIVING REPORT AND VOUCHER |
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Purchaser: The United States Government, DR. - This Document Prepared At |
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D.O. VOU. Number |
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Vendor: |
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BU. VOU. Number |
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Paid By |
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Order is Hereby Placed with the |
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Furnished to |
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Signature of Ordering Officer |
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Total |
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Amount |
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I Certify That the Ordered Items Listed were Received |
Availability of Funds |
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PAYMENT |
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Amount Billed, as Per Attached Bill(s)... |
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Complete |
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Title |
Signature of Receiving Officer |
Final |
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Amount Verified Correct For... |
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Approved For |
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Pursuant to Authority Vested in Me, I certify That This Voucher is Correct and Proper for |
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Payment. |
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Exchange Rate |
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To $1.00 |
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Authorized Certifying Officer |
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Accounting Classification
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On Treasurer Of U.S. |
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Payee (Signature and Title)
[Formerly |
ORIGINAL - D.O. VOUCHER |
Page 1 of 5 |
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U.S. Department of State |
Purchase Order Number |
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PURCHASE ORDER, RECEIVING REPORT AND VOUCHER |
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Purchaser: The United States Government, DR. - This Document Prepared At |
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D.O. VOU. Number |
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Vendor: |
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Contract Number |
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BU. VOU. Number |
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Paid By |
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Order is Hereby Placed with the |
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Furnished to |
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ITEM |
ARTICLES OR SERVICES |
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AMOUNT |
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PER |
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Signature of Ordering Officer
Title
Total
Amount
I Certify That the Ordered Items Listed were Received |
Availability of Funds |
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(1) |
Articles Nos / Numero / Laufende Nummer / Articulos Nos. |
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On |
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(2) |
Articles ou Services / Descrizione / Ware oder Dienstleistung / Articulos o servicios |
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PAYMENT |
Amount Billed, as Per Attached Bill(s)... |
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(3) |
Quantite / Quantita / Menge / Cantidad |
Complete |
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Differences |
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(4) |
Prix par unite / Prezzo Unitario / Einzelpreis / Precio pro Unidad |
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Montant total / Totale / Gesamtpreis / Importe |
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Signature of
Amount Verified Correct For...
BITTE WENDEN FUER EINEN WICHTIGEN HINWEIS FUER DEN LIEFERANTEN
Pursuant to Authority Vested in Me, I certify That This Voucher is Correct and Proper for
VEDI RETRO PER UNA AVVERTENZA IMPORTANTE PER IL FORNITORE
Payment.
VER AL DORSO POR AVISO IMPORTANTE AL VENDEDOR
Exchange Rate |
To $1.00 |
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Authorized Certifying Officer |
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THE INVOICES MUST BE SUBMITTED IN QUADRUPLICATE.
LES FACTURES DOIVENT ETRE SOUMISES EN QUATRE EXEMPLAIRES. RECHNUNGEN SIND IN VIERFACHER AUSFERTIGUNG EINZUREICHEN.
Check Number LE FATTUREDated |
ESSEREFor |
Payee (Signature and Title) |
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PRESENTATEOnINTreasurerORIGINALEOf U.S. E TRE COPIE. |
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Check Number |
LAS FACTURAS HAY QUE PRESENTARLAS POR QUADRUPLICADO. |
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NO. 1 - VENDOR |
Page 2 of 5 |
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U.S. Department of State |
Purchase Order Number |
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Date |
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PURCHASE ORDER, RECEIVING REPORT AND VOUCHER |
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Purchaser: The United States Government, DR. - This Document Prepared At |
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D.O. VOU. Number |
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Vendor: |
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Contract Number |
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BU. VOU. Number |
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Date |
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Paid By |
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Order is Hereby Placed with the |
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Furnished to |
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ITEM |
ARTICLES OR SERVICES |
QTY |
UNIT PRICE |
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AMOUNT |
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PER |
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Signature of Ordering Officer |
Title |
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Total |
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Amount |
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I Certify That the Ordered Items Listed were Received |
Availability of Funds |
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PAYMENT |
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Amount Billed, as Per Attached Bill(s)... |
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Complete |
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Title |
Signature of Receiving Officer |
Final |
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Amount Verified Correct For... |
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Approved For |
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Pursuant to Authority Vested in Me, I certify That This Voucher is Correct and Proper for |
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Payment. |
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Exchange Rate |
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Accounting Classification
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On Treasurer Of U.S. |
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Check Number |
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Payee (Signature and Title)
NO. 2 - VOUCHER AUDIT |
Page 3 of 5 |
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U.S. Department of State |
Purchase Order Number |
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PURCHASE ORDER, RECEIVING REPORT AND VOUCHER |
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Purchaser: The United States Government, DR. - This Document Prepared At |
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D.O. VOU. Number |
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Vendor: |
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Contract Number |
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BU. VOU. Number |
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Paid By |
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Order is Hereby Placed with the |
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Furnished to |
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ITEM |
ARTICLES OR SERVICES |
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Signature of Ordering Officer |
Title |
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Total |
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Amount |
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I Certify That the Ordered Items Listed were Received |
Availability of Funds |
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PAYMENT |
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Amount Billed, as Per Attached Bill(s)... |
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Complete |
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Signature of Receiving Officer |
Final |
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Amount Verified Correct For... |
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Approved For |
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Pursuant to Authority Vested in Me, I certify That This Voucher is Correct and Proper for |
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Payment. |
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Exchange Rate |
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To $1.00 |
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Authorized Certifying Officer |
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Title |
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Accounting Classification
Check Number |
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On Treasurer Of U.S. |
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Check Number |
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Dated |
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Cash |
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Payee (Signature and Title)
NO. 3 - ACCOUNTING/OBLIGATION |
Page 4 of 5 |
U.S. Department of State |
Purchase Order Number |
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IMPORTANT NOTICE TO SELLER |
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PURCHASE ORDER, RECEIVING REPORT AND VOUCHER |
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Purchaser: The United States Government, DR. - This Document Prepared At |
D.O. VOU. Number |
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1. The invoice must be submitted in quadruplicate. |
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2.The Purchase Order No. must be quoted on your invoices and in all communications concerning this order.
3.The following certificate must be duly signed on the invoice original: "I certify that the above bill is correct,
Vendor: |
Contract Number |
BU. VOU. Number |
just and that payment therefore has not been received". |
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4. Discount terms, if any, must be shown on all invoices. |
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Paid By |
AVIS IMPORTANT AU FOURNISSEUR |
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Order is Hereby Placed with the |
Account |
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Furnished to |
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1.Les factures doivent etre soumises en quatre exemplaires.
2.Priere de mentionner, dans les factures et toutes communications au sujet de la presente commande, le
numero de commande (Purchase Order No.).
3. |
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UNIT PRICE |
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Chaque facture devra porter le certificat suivant, dont l'original seulement devra etre signe: :"Je certifie |
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ITEM |
ARTICLES OR SERVICES |
QTY |
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AMOUNT |
NUMBER |
COST |
PER |
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que la presente facture est correcte et juste, et que paiement n'en pas ete recu". |
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Priere d'indiquer, le cas echeant, les conditions de'escompte dans toutes les factures presentees. |
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WICHTIGER HINWEIS FUR DEN LIEFERANTEN
1.Rechnungen sind in vierfacher Ausfertigung einzureichen.
2.Die Purchase Order No. ist auf Ihren Rechnungen, sowie in allen ubrigen Zuschriften, anzugeben.
3.Das Original Ihrer Rechnung ist mit folgendem rechtsgultig unterschriebenen Passus zu versehen: "Ich bestatige, daB obige Rechnung richtig und korrekt ist und daB Zahlung hierfur nicht erhalten wurde".
4.Zahlungsbedingungen (Skonti) sind in allen Rechnungen anzugeben.
AVVERTENZA IMPORTANTE PER IL FORNITORE
1.Le fatture devono essere presentate in originale e tre copie.
2.Le vostre fatture e tutte le comunicazioni dovranno recare il numero del presente orginativo (Purchase Order No.).
3.L'origniale deve contenere la seguente dichiarazione, debitamente firmata: "Dichiaro che la presente fattura e esatta ed equa e che non e stata ancora pagata".
4.Le eventuali condizoni di sconto dovranno essere riportatesu tutte le fatture.
Signature of Ordering Officer |
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Total |
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Amount |
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AVISO IMPORTANTE AL VENDEDOR |
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I Certify That the Ordered Items Listed were Received |
Availability of Funds |
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On |
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1. Las facturas hay que presentarias por quadruplicado. |
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PAYMENT |
Amount Billed, as Per Attached Bill(s)... |
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2. Las facturas y todas las comunicaciones referentes a este pedido deben mencionar el numero de orden |
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al reverso (Purchase Order No.) de este pedido.Complete |
Differences |
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3. Las facturas deben lievar el siguiente certificado firmado en el original solamente. |
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4. Se ruega indicar en todas las facturas presentadas los descuentos concedidos. |
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Partial |
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Signature of Receiving Officer |
Final |
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Title |
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Amount Verified Correct For... |
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Approved For |
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Pursuant to Authority Vested in Me, I certify That This Voucher is Correct and Proper for |
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Payment. |
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Exchange Rate |
To $1.00 |
Date |
Authorized Certifying Officer |
Title |
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Accounting Classification |
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Check Number |
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Payee (Signature and Title) |
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Dated |
For |
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On Treasurer Of U.S. |
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Check Number |
Dated |
For |
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On |
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Cash |
On |
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Page 5 of 5 |