DOJ-OGR-00028953.tif

aaa FD-794 (Rev, 2-7-00) (AD) Crirninal OCDETF Case {AF} FCI Case (BC) InformantiCW (CPF) Asset “ (DC) Group 1] ucO (DD) OCDETF Group II (BD) informanvCW Providing Drug info. {E} Group! {F} FCLUCO Draft Request | . 2. Date 3. Request for: ( } Advance eat Expense 4. Social Security No: 5. Payee Name: eo" 6 __ fAC) Criminal Case! {GA} SOG (GB} OPS {GC} Air Operation Hy SSG iJ} FCt Lookout i f/je,. i. / 6. i - 10. Justification: Asset/Informant File No. Payment/Code Name One Time Non-symbol Source Payment: True Name: : fi Date of Waiver: Supervisor Initials: SAC‘/ ASAC / AO / SAS Approval: Supply Technician Approval: Draft Approval Officer: Procurement Authorization: 26, Settlement of Advance: Prior month nAdvanes Balance: $ This Advance: Less: Receipts: §. Funds Returned and/ or Gash on Hand: $ Amoi z erish 97, “Document No "28, Draft No: Shaded areas for draft office u use <2 only Classification: Classified By: Declassify on: 3lé- Blue Copy - Administrative/Case File Symbol No. Period Covered SSAN: 22. CONF ~ CON 38. Cashier: 03956-349 MM-(O¥ 06 2- - GF DOJ-OGR-00028953