[104-10225-10009.pdf — page 33]
# REQUEST FOR ADVANCE OF FUNDSSECRET (When Filled in)NAME OF ADVANCEERobert L. FambriniDATE19 April 1968AMOUNT$200.00PAYABLE TOPURPOSEOperational Advance to ANSTALK-1 to replace funds spent in preparation for his travel to Buenos Aires.ROOM3B 09BUILDINGHqsTELEPHONE EXT6609Charge Project BIFFINSTATUS OF OUTSTANDING ADVANCES| DATE | AMOUNT              | UNACCOUNTED BALANCE                       | DUE DATE |     || ---- | ------------------- | ----------------------------------------- | -------- | --- ||      |                     | ON ARRIVAL AT DESTINATION OR ON ABOUT     |          |     ||      |                     | MONTHLY-ON THE LAST WORKDAY OF EACH MONTH |          |     ||      |                     |                                           |          |     || DATE | PLACE OF ACCOUNTING | DATE                                      |          |     |I agree that I will fully account for this advance by submission of vouchers and refund of any unexpended balance to the place of accounting stated and by the due date checked below. In the event of my failure to account and refund such funds and me responsibility therefor, when paid to me agent.I authorize my agent.Robert L. FambriniSIGNATURE OF ADVANCEEREQUESTING OFFICERSIGNATUREAPPROVEDSIGNATURE OF APPROVING OFFICERRaymond A. WarrenChief, WH/4SIGNATURE OF AGENTMary L. RiveraRECEIPT FOR FUNDS ADVANCEI certify funds are available.DATEOBLIGATION REF NOCHARGE FOR ACCOUNT NO813-0635I acknowledge receipt of funds in the amount stated hereinder to be used for the purpose stated and accounted for as shown above.DATEAMOUNT$200.000DATEAUTHORIZED CERTIFYING OFFICERSIGNATURE OF ADVANCEE AGENTMary L. RiveraDESCRIPTION-ALL OTHER ACCOUNTS 35-53SPACE BELOW FOR EXCLUSIVE USE OF OFFICE OF FINANCE| DESCRIPTION: ADVANCE ACCOUNTS 13-27 | 34-39 STATION CODE | 40-41 EXC | 42-47 OBLIG. REF NO | 48-49 ORL ADVANCE ACCT. NO | 90 SUB. ACCT. NO | 51-54 GENERAL LEDGER ACCT. NO | 55-66 COST-FAM ACCOUNT SYMBOL | 61-66 CR. NO | 67-70 ORIG CLASS | 68-70 DUE DATE | 71-80 AMOUNT |        || ----------------------------------- | ------------------ | --------- | ------------------- | -------------------------- | ---------------- | ----------------------------- | ----------------------------- | ------------ | ---------------- | -------------- | ------------ | ------ ||                                     |                    |           |                     |                            |                  |                               |                               |              |                  |                | DEBIT        | CREDIT ||                                     |                    |           |                     |                            |                  |                               |                               | X REF. NO.   |                  |                |              |        ||                                     |                    |           |                     |                            |                  |                               |                               |              |                  |                |              |        ||                                     |                    |           |                     |                            |                  |                               |                               |              |                  |                |              |        ||                                     |                    |           |                     |                            |                  |                               |                               |              |                  |                |              |        ||                                     |                    |           |                     |                            |                  |                               |                               |              |                  |                |              |        ||                                     |                    |           |                     |                            |                  |                               |                               |              |                  |                |              |        |DATEREVIEWED BYTOTALSFORM 281 OBSOLETE PREVIOUS EDITIONSSECRET