EFTA00186994¶
U.S. Department of Justice Washington, D.C. 20530¶
Request for Financial Information (Authorization, Purchase Order, Receiving Report)¶
| 1 Purchase Order Number: | 2 Date Order Prepared:8/15/2007 | 3 Case Number:(Optional) | |
| Section A - Authorization and Purchase Order | |||
| 4 Name and Address of Financial Institution:Bear Sterns Company | |||
| 5 Deliver To:FBI Special Agent Nesbitt Kuyrkendall at | 6 Return Date:9/4/2007 | ||
| 7 Remarks:FOR REIMBURSEMENT PLEASE RETURN THIS FORM, THE RECORD OF SERVICES, AND A COPY OF THE SUBPOENA. | |||
| 8 Name of Requestor:(Type or Print)AUSA | 9 Telephone Number: | 10 Date of request:8/15/2007 | |
Section B - Financial Institution Invoice¶
| If Service/Financial Records Provided: | Quantity | Unit Price | Amount | |||
|---|---|---|---|---|---|---|
| Cost | Per | |||||
| FOR PROMPT PAYMENT INCLUDE TAX LD. NUMBER. Please note that reimbursement cannot be made for the records pertaining to corporations or large partnerships of six or more. IMPORTANT: The DCIA Mandates the use of EFT/DD. In order to receive payment complete the attached EFT enrollment form. | 0.25 | Copy | ||||
| 11.00 | Hour Clerical Tech | |||||
| 17.00 | Hour Manger or Supervisor | |||||
| Do not proceed with compliance: If cost will exceed $500 without prior approval of Budget Officer Lazaro Feliciano, Fax any request to (305) 530-7679 | ||||||
| 12 Signature of Financial Institution Official: | 13 Date Signed: | Total Amount Claimed By Financial Institution | 0.00 | |||
| Section C - Receiving Report | 16 Disallowance (See Attached) | |||||
| 14 I certify that the articles and services listed were received: | 15 Date Received: | 17 Net to Financial Institution | ||||
| 18 Right to Financial Privacy Act - Public Law 95-630 (12 U.S.C. 3401-3422) Request Pursuant To: (Check One Only) | 19 Signature of Approving Official: | |||||
| SECTION OBJECT CLASS | 20 Accounting Classification Code | |||||
| ☐ 3404 Customer Authorization 2540 | FY FC 1 2 3 4 5 PROJ | |||||
| ☐ 3405 Administrative Subpoena or Summons 2541 | ||||||
| ☐ 3406 Search Warrant 2542 | ||||||
| ☐ 3407 Judicial Subpoena 2543 | ||||||
| ☐ 3408 Formal Written Request 2544 | ||||||
| ☐ 3413 1 Grand Jury Subpoena 2545 | 21 Schedule and Voucher Number: DC# | |||||
| ☐ 3414 Special Procedures 2546 | ||||||
Date:¶
Budget Officer:¶
This form was electronically produced by Elite Federal Forms, Inc.¶
FORM OBD-211 APR. 84¶