[104-10163-10176.pdf — page 54]
# REQUEST FOR PAYMENTOFCONFIDENTIAL FUNDSTO WE/C *Amcircle/AMBIDDY*Finance Division 12 Nov 65CONFIDENTIAL FUNDS ARE REQUESTED FOR OFFICIAL BUSINESS & CONFIDENTIAL. EXTRAORDINARY OR EMERGENCY NATURE AND ARE INTENDED FOR USE AS FOLLOWS:November payment to AMBIDDY-1 of $5,000 for supporting the dependents of member of his EvolutionaryRecovery Loremont who are currently imprisoned in Cuba.I certify that to the best of my knowledge and bolief, funds passed to AFBIDD7-1 are being used or have been used for the purpose intended and further advances ero warranted.DATE-VOUCHER NO. 2-18PAYEE AMBIDDY-1 AMOUNT $5,000PAYMENT INSTRUCTIONSSee attachmentTHE AMOUNT REQUESTED IS OF THE PAYEE FOR SATISFACTORY PERFORMANCE OF DUTIES IN ACCORDANCE WITH THE TERMS OF HIS CONTRACT OR OTHER WRITTEN OR ORAL AGREEMENTS. (To be signed when applicable)DATE TITLE SIGNATUREWE/C/CA Andrew D. RohlfingDATE SIGNATURE OF APPROVING OFFICERJohn L. Hart *[Signature] John Le Hart*CERTIFICATE FOR PAYMENT OR CREDITSIGNATURE OF CERTIFYING OFFICERCERTIFY FUNDS ARE AVAILABLEOBLIGATION REFERENCE NO.CHARGE FAN ACCOUNT NO.7386135-1176DATERECEIPT FOR FUNDSI ACKNOWLEDGE RECEIPT OF FUNDS TO BE USED FOR THE PURPOSE STATED ABOVEDATE11/15/65 SIGNATURE OF AUTHORIZING OFFICER[Signature]AMOUNT $5,000SIGNATURE OF AGENT PAYEESPACE BELOW FOR EXCLUSIVE USE OF OFFICE OF FINANCEDESCRIPTION-ALL OTHER ACCOUNTS 13-33DESCRIPTION ADVANCE ACCOUNTS 13-27|                  | 28-33        | 34-39        | 40. | 42-47             | 48-50 | 51-54          | 55-66          | 67-70        | 71-00    || ---------------- | ------------ | ------------ | :-: | ----------------- | ----- | -------------- | -------------- | ------------ | -------- ||                  | SHIP.DOC.NO. | STATION CONF | 41  | OSLIS.            | COS   | GENERAL LEDGER | COST-FAN       | OBJECT CLASS | AMOUNT   ||                  |              |              |     | REF. NO.          |       | ACCT. NO.      | ALCOUNT SYMBOL |              |          || Adv Pay. Amandy/ |              |              |     | ADVANCE ACCT. NO. | PER.  | CODE           |                | DUE DATE     |          || *Ambidy*-1       |              |              |     | REC.APT. PROJECT  | CODE  | YR             |                |              |          ||                  |              |              |     |                   |       |                |                |              |          ||                  |              |              |     |                   |       |                |                |              |          ||                  |              |              |     |                   |       |                |                |              |          ||                  |              |              |     |                   |       |                |                |              |          ||                  |              |              |     |                   |       |                |                |              |          ||                  |              | 039962       |     |                   |       | 1441           | 2384/016       |              | 5,000.00 ||                  |              |              |     |                   |       |                |                |              |          ||                  |              |              |     |                   |       |                |                |              |          ||                  |              |              |     |                   |       |                |                |              | 5,000.00 ||                  |              |              |     |                   |       |                |                |              |          ||                  |              |              |     |                   |       |                |                |              |          |DATE 11/22 PREPARED BY*Joseph C. Carey*DATE REVIEWED BY TOTALSSECRETGROUP 1Excluded from automatic downgrading and declassification