EFTA00129473

# Draft Request

2. Date: 11/11/09

3. Request for: ( ) Advance ( ) Expense

4. Social Security No:

5. Payee Name:

6. File No: 72.MM1.1.3.3.7.

7. Description OTD-

8. Amount

01 95500 uc Hotel Rooms 177.30

02

03

04

05

06

07

9. Total $ 177.30

10. Justification: Room used for uc meeting

Asset/Informant File No.: Symbol No.
Payment/Code Name: Period Covered to
One Time Non-symbol Source Payment:
True Name: DOB: / / SSAN:
Date of Waiver: / / /

11. Payment for reimbursable expense - forfeiture or drug related? Yes No

12. Requested by: 13. Telephone No:

14. Approval Date

Supervisor Initial(s):
SAC / ASAC / AO / SAP Approval:
Supply Technician Approval:
Draft Approval Officer:
Procurement Authorization:

15. Vendor No: GNM M M BD RA Group No: A 17. Obligation No: 1081999

18. Cost Center: 34.60 Squad/RA 20. Follow-up Date: 11/12/07

19. Document No: 1400 mm 10/320/405/22 CONF COMM

21. Draft No: 1052.64 Date: 11/03/25 Cashier:

26. Settlement of Advance: Prior month Advance Balance: $177.30
This Advance: $177.30
Less: Receipts: $177.30
Funds Returned and/or Cash on Hand: $
Amount to Be Reimbursed:

27. Document No: ACPM M M BD RA 34/

28. Draft No: 29. Date: 11/20/00

Shaded areas for draft office use only

Classification:
Classified By: