(UNTITLED)

• Document Type: CREST
• Collection: NGA Records (Formerly NIMA)
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78B04747A002600010013-9
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: December 28, 2016
• Document Release Date: November 30, 2001
• Sequence Number: 13
• Content Type: FORM

(specify)
REQUEST TO PROCUREMENT DIVISION FOR SERVICES
(other than property or building maintenance and repairs)
INSTRUCTIONS: (11, As appropriate, refer to Contract, Task Order PrDoposal Numbers and attach any proposals, specifications or justifications.
Obtain hereon or aach evidence of R & D approval as required by DCI Memo of 23 December 1963, ER 63-8811. (2) Obtain Technical
Oucer approval or concurrence as appropriate. (3) Include in the narrative portion amplification of particular security
requirements and any
delivery or consignee instructions.
DATE OF REQUEST PROCUREMENT DIV. ASSIGNMENT
DATE RECD IN PD.
25X1
25X1
15 pity --
REQUESTING OFFICE
TYPE OF SERVICE REQUESTED +!
RESEARCH/DEV. (1) (2) (3) OTHER-SPECIFY (2) (3)
GRANT (1) (2) (3)
REPAIR (3) I CERTIFY THAT FUNDS, ESTIMATED OUNT OF
MAINTENANCE (3) ARE AVAILABLE. CHARGE TO FAN
MODIFICATION (1) (2) (3)
_
F. (r e~
( 2~', cc f
v I'if~ 1JUI
STERILITY CODE I I O 1 I 12 APPLIES
y
/ SIGNATURE ~DATE 25X1
REPAIR OR MAINTENANCE SERVICE HAS ~? I I
ILY COMPLETED 25
1 A 25X1
BEEN SATISFACTOR
X
M_ SAL LOCATED OR SERVICES TO BE PERFORMED AT
25X1
NARRATIVE DESCRIPTION OF SERVICES REQUESTED
of 4*t ,~ its t t >-
25X1
25X1
Declass Review by NIMA / DoD
Approved For Release 2002/01/02 CIA-RDP78B04747A002600010013-9
FORM 2420 UNCLASSIFIED frw.~-~1 CONFIDENTIAL SECRET (specify)
9.66 LJ -- -^ (5-12.86)
UNCLASSIFI D 1NFIDENTIAL SECRET 0