[104-10218-10009.pdf — page 43]
# REQUEST FOR ADVANCE OF FUNDSNAME OF ADVANCEE: WUSALIM/UCACEPAYABLE TO: See Form 1864 attachedSECRET (When filled in)DATE: 9 March 1067AMOUNT: $14,750.00DATE-VOUCHER NO. 2-12BUILD NGLLEPHONE L٨٢٠PURPOSE: Funding for KUSALINE/COACE in the amount of $14,750.00 for salary and travel expenses of Edward G. TICHBORN (P). (Copy of Authorization to Expend Funds From Other Components Allotments is in OF/PSAD)STATUS OF OUTSTANDING ADVANCESI agree that I will fully account for this advance by submission of vouchers and refund of any unexpended balance to the placeof accounting stated and by the due date checked below. In the event of my failure to so account and refund any unexpendedbalance, 1 authorize deduction from my salary to effect settlement.| DATE | AMOUNT | UNACCOUNTED BALANCE | DUE DATE                                  |                                                                                                                                                                                                                   || ---- | ------ | ------------------- | ----------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ||      |        |                     | ON ARRIVAL AT DESTINATION ON OR ABOUT     | I authorize my agent, whose signature appears below, to receive currency amounting to of official funds on my behalf and acknowledge receipt of such funds and my responsibility therefor, when paid to my agent. ||      |        |                     | MONTHLY-ON THE LAST WORKDAY OF EACH MONTH | DATE SIGNATURE OF ADVANCER                                                                                                                                                                                        |PLACE OF ACCOUNTINGDATE SIGNATURE OF AGENTREQUESTING OFFICERAPPROVEDDATE SIGNATURE: Gale W. Allen, DO/CODATE SIGNATURE OF APPROVING OFFICER: Thos. P. Schreyer,C/DOCORECEIPT FOR FUNDS ADVANCEDI acknowledge receipt of funds in the amount stated hereunder to be used for the purpose stated and accounted for as shown above.DATEAMOUNTI CERTIFY FUNDS ARE AVAILABLEDATE OBLIGATION REF. NO.: Lig, Code 1 2504 XXCHARGE FAN ACCOUNT NO: 7135-3104SIGNATURE OF ☐ ADVANCEE ☐ AGENTDATE SIGNATURE OF AUTHORIZING OFFICER: Frances Klayman, DO/BFSPACE BELOW FOR EXCLUSIVE USE OF OFFICE OF FINANCEDESCRIPTION-ALL OTHER ACCOUNTS 15-33|                                    | 26-33                         | 34-39                                | 40-41        | 42-47                          | 48-49             | 50    | 51-54                    | 55-66                   | 67-70        | 71-80        || ---------------------------------- | ----------------------------- | ------------------------------------ | ------------ | ------------------------------ | ----------------- | ----- | ------------------------ | ----------------------- | ------------ | ------------ || DESCRIPTION-ADVANCE ACCOUNTS 13-27 | T/A NO SHIP DOC. NO 4-11 DIV. | STATION CODE ALC. RPT. NO PROJECT NE | X CODE FO ND | OBLIG. REF NO ADVANCE ACCT NO. | OBL. REF SUD. NO. | C 0 E | GENERAL LEDGER ACCT. NO. | COST-FAM ACCOUNT SYMBOL | OBJECT CLASS | AMOUNT       ||                                    |                               |                                      |              |                                |                   |       |                          | FIN UNDS VYD            | X REF. NO.   | DEBIT CREDIT |DATE PREPARED BYDATE REVIEWED BYTOTALSFORM 281 OBSOLETE PREVIOUS EDITIONS7.65SECRET![group] (38-42)