Record, 2007-02-06

EFTA00185336¶

U.S. Department of Justice¶

Authorization for Reimbursement of Unusual Expenses of Fact Witnesses¶

Request for Unusual Expense(s) of Fact Witness (For United States Attorney’s Office Use Only)¶

1. Case Name	2. Court Docket Number	3. Requesting AUSA
Operation Leap Year
Location of Court Proceeding West Palm Beach
5. Contact Person		6. Contact Person Number

7. Witness Name & Address, Phone #, SSN

8. Vendor Name & Address, Phone #, TIN/SSN

9. Payment to be made to:

10. Receipt/Invoice is:

11. Type of Unusual Expense:

• Medically Necessary Item (Attached Supporting Statement)
• Dependent Care
• Excess Lodging/Per Diem
• Travel & Transportation
• Pretrial Conference Waiver
• Other

12. Explanation: The witness has a small child and would not had no one who could watch the child while she testified.

13. Start Date of Service (MO/DA/YR) 2/6/07

14. End Date of Service (MO/DA/YR) 2/6/07

15. Amount

16. Justification:

17. I hereby certify that the expenses and services listed on this document are appropriate and are within the Federal laws and regulations. I fully understand that I can be held personally liable or be subject to disciplinary action for improperly using government funds or services that exceed delegated authority or that violate Federal laws or regulations.

Signature of Requesting AUSA Date¶

18. Name & Title of Approving Official 19. Date (MO/DA/YR) 20. Signature of Approving Official

GOVERNMENT EXHIBIT 4¶

UFWE Form¶