ACKNOWLEDGMENT OF INDEBTEDNESS TO THE U.S. GOVERNMENT

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP61-00274A000200150008-2
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 11, 2016
• Document Release Date: August 27, 1998
• Sequence Number: 8
• Content Type: FORM

Approved F&WReleas - -0274A000200150008-2
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MEMORaNr UM
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SUBJECT ? Acknowledgment of Indebtedness to the U. S. Government
1. This is to advise you that the Finance Division is not authorizer] to grant
you a financial clearance from the Agency since the records of this office show that
you are indebted to the U. S. Government in the amount of $ ?
indebted-
ness is represented by the following types to you
represent of overpayments or advances mace to you
present the balances of funds unaccounted for by you as of
_?
This amount does not include. which you may have received from
overseas installations, other than your unreported
last RCS advances a Station.
on.
a. Salary and/or Allowances... - -.,____-_____,-____ ~
`1D, Travel an.`or Transportation-__-- -----------
d. Other ___.,._>..---- .-_----- -
Total
2. It is requested that you acknowledge this indebtedness by affixing your
signature in the space provided below. You are further advised that, before effecting
final payment of all amounts due you by this Agency, the Finance Division will offset
any of the following credits you may have with this Agency against the above mentioned
indebtedness, in the order shown below, until the indebtedness is fully liquidated:
a. Approved claims currently in process,
b. Final salary, allowances and terminal leave,
c. Retirement deposits.
Signature of Certifying Officer
I certify that I have read and understood the above and hereby acknowledge an
indebtedness to the U. S. Government in the amount of $
Date
Signature
Note: Use reverse side for additional information or remarks?
Approved For Release : CIA-RDP61-00274A000200150008-2
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