REQUEST FOR REIMBURSEMENT OR PAYMENT

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP91B00060R000100030004-8
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 2
• Document Creation Date: December 27, 2016
• Document Release Date: January 9, 2013
• Sequence Number: 4
• Publication Date: August 23, 1988
• Content Type: MISC

Declassified in Part - Sanitized Copy Approved for Release 2013/01/09: CIA-RDP91B00060R000100030004-8
-Bee'WET?
When Filled In)
H56
25X1
25X1
REQUEST FOR REIMBURSEMENT
OR PAYMENT
1. VOUCHER NO.
OP.
?
3. NAME OF CLAIMANT (LAST,FIRST,MIDDLE INITIAL)
4. EMPLOYEE NO.
5. OFFICE
0/D/OIT
PAYABLE TO
ROOM
BUILDING
EXTENSION
AMOUNT
3S35
$14,00
6 PROJECT NUMBER
7. TYPE OF ADVANCE
8. ACTIVITY NUMBER
9. DUE DATE
PURPOSE (FIRST 24 CHARACTERS OF EACH LINE WILL BE ENTERED)
10. WHAT: charges to have letter delivered via Federal Express
11. WHERE: delivered to Vice President, Computer Operations Group, Federal Express,Memphi
12 WHEN: 23 August 88
13. WHY: to expedite
16. OBLIGATION REFERENCE NO.
Ilt1111111
14. EXP
CODE
IS. AGENCY
CODE
TYPE
ORN
SUB
17.
SOC
LIQ
CD
18.
AMOUNT
I CERTIFY FUNDS ARE AVAILABLE
DATE
AUTHORIZED SIGNATURE
P
AUTHENTICATION
DATE !SIGNATURE OF APPROVING OFF
CER
1
CE
in-ICA-IL FOR PAYMENT OR CREDIT
S
1
DATE
SIGNATURE OF CERTIFYING OFFICER
PAYMENT INSTRUCTIONS
DESIGNATION OF AGENT TO PICK UP FUNDS
1 authorize my agent, whose signature appears below, to receive
S of official funds on my behalf and acknowledge
CERTIFICATION (Check when applicable)
receipt of such funds and my responsibility therefor, when paid to
my agent.
. REIMBURSEMENT
I certify that the disbursements itemized above were
by that I have not been nor will I
DATE
SIGNATURE OF AGENT
necessarily made me and
be reimbursed therefor from any other source and that this
claim and attachments are true and correct.
DATE
SIGNATURE OF CLAIMANT OR OFFICER
II PERSONAL SERVICES
The is due the for satisfactory
ACKNOWLEDGEMENT OF RECEIPT
amount requested payee
performance of duties in accordance with the terms of his
contract or other written or oral agreements.
AMOUNT 'CHECK NO.
DATE
r6 alTRAN
DATE
SIGNATURE
CODE
CODING AREA
O MONETARY
CONTRL
AMOUNT
i
.
.,_
DATE
PREPARED BY EXT
DATE
REVIEWED BY
TOTAL
FORM, ... , . USE PREvIOUS
25X1 EDITION
?SZ-C7R-ET- I - PAYMENT COPY
Declassified in Part- Sanitized Copy Approved for Release 2013/01/09: CIA-RDP91B00060R000100030004-8
(49.511
STAT
Declassified in Part- Sanitized Copy Approved for Release 2013/01/09: CIA-RDP91B00060R000100030004-8
Declassified in Part- Sanitized Copy Approved for Release 2013/01/09: CIA-RDP91B00060R000100030004-8