REQUEST TO PROCUREMENT DIVISION FOR SERVICES

• Document Type: CREST
• Collection: NGA Records (Formerly NIMA)
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78B05171A000100010088-2
• Release Decision: RIPPUB
• Original Classification: C
• Document Page Count: 1
• Document Creation Date: December 28, 2016
• Document Release Date: September 8, 2003
• Sequence Number: 88
• Publication Date: December 12, 1968
• Content Type: FORM

UNCLASSIFIED .App
d A M 1003/12/OLPCR 78805 _ (specify)
6Q~U 00 100882
REQUEST TO PROCUREMENT DIVISION FOR SERVICES
(other than property or building maintenance and repairs)
OFFICE/DIV/DR
REQUEST NO.
DATE OF REQUEST
I CERTIFY ~HAT FUNDS -N ESTIMATED
TSSG/LSD/LB
55-8609-67 (A-2)
12 Dec. 1968
AMOUNT OF ,r- ARE
V
I
A
A
LABLE. CHARGE TO FAN
PROJECT TITLE PROJECT OR CONTACTOFFICER EXTENSION SIGNATURE OF BUDGET OFFICER rr DATE
'gereo Comparator
+y69
1Design R
CONTRACTOR (if known) PROPOSAL NO. AN A CONTRACT & TASK ORDER NO. (if )
mown
P
E
APPLICABLE ONLY TO REPAIRS AND MODIFICATIONS
TY
E OF SERVICE REQUEST
D
.
TECHNICAL INSPECTION 19 REOUIRED BY
X
RESEARCH/DEV
TRANSFER OF FUNDS TO
1 RECEIVING DEPOT T & I = TECHNICAL MONITOR
GRANT
OTHER GOVT. AGENCY
(specify if applicable)
ITEMS TO BE PICKED UP OR SERVICES PERFORMED AT:
REP*IR'
MAINTENANCE
ITEMS TO BE REDELIVERED TO:
MODIFICATION
STERILITY
CONTRACT CLASSIFICATION
WORK CLASSIFICATION
HARDWARE CLASSIFICATION
REPORTS CLASSIFICATION
0
X I
CONFIDENTIAL
9C 2
SHORT SUBSTANTIVE TITLE AND/OR DESCRIPTION OF SERVICE. TO BE PERFORMED
N xi Increase Funding by to cover Final Award Fee.
Fiscal Year .1967 R E D funds are not available in NPIC allotments.
A Fan citation entry and a certification signature are both required.
It is requested that appropriate action be taken to authorize expen-
? X1 diture of from unobligated Agency funds in order to pay
?-)X1 the overrun?on thel contract.
%.rlr
(See reverse for specific information
required on R&D requests.)
APPROVAL
DESIGNATION
SIGNATURE
DATE
DTSSGNPI
PROCUREMENT DIVISION USE
DATE RECEIVED- IN PD
RECORDED BY
SECTION ASSIGNED TO
NEGOTIATOR
Declass Review by
25X1
I
FORM r~r~REPLACES FORMS
3.67 24`2O 2420 AND 24, s UNCLASSIFIED ? CONFIDENTIAL SECRET (specify)
Y DE
ICH MAY
2
5X1
215X1
WH
USED. '5.12.85)
2
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