DOJ-OGR-00028957.tif

! FD-794 (Rev, 2-7-00) or ] : (AC) Criminal Ca¥ (CF} Asset : {GA) 506 {AD) Criminal OCDETF Case (DC) Group IT UCO (GB) OPS (AF) FCI Case (OD) OCDETF Group Il (GC} Air Operation H (BC) informantiCw (E} Group | (BD) tnformantCW Providing Drug info. (F) FCLuco- {J} FCI Lookout Draft Request 3. Request for: ( } Advance ( .-¥ Expense op - " 03 04 06 2. 07 __ 9. Total $ 10. Justification: ao ; Asset/Informant File No. Symbol No. Payment/(Code Name Period Covered One Time Non-symbo! Source Payment: True Name: : / SSAN: Date of Waiver: i i 11. Payment for reimbursable expense - forfeiture or drug related? Yes < No 12. Requested by: ; 4 Supervisor Initials: SAC /ASACY AO / SAS Approval: Supply Technician Approval: Draft Approval Officer: Procurement Authorization: 1S. ‘Vendor No; 7 “8. Gost Center: a “21 Document No, oo he pS 7 ee. CONF COMM __ | 23. Braft No; ii oe Es Date: 26. Settlement of Advance: Prior month Advance Balance: $ . . ] b3 -2 This Advance: : oS | be -6 Y Less: Receipts: mom), O3956-358 | ..| BIC -6 | “Funds Returied and/or Gash on Hand: $ acme _Ariount to be Reimbursed-$ —____ a2, Bocument No 28: Byatt No: Bare Shaded areas for draft office use only Classification: Classified By: Blue Copy - Administrative/Case File Deciassify on: Bl 41-10 pba -OF DOJ-OGR-00028957 pi