OMB Standard Form 270 - united states delta force

OMB APPROVAL NO.
FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL
ELEMENT TO WHICH THIS REPORT IS SUBMITTED:
National Security Council, through the Defense Security
Service, pursuant to the National Security Act of 1947, as
3. amended, the Central Intelligence Agency Act of 1949, the
National Security Agency Act of 1959, 50 U.S.C. Section 1522,
19 U.S.C. Section 1862, Chapter 18 of Title 10 U.S.C., 18
U.S.C. Sections 1961(10), 831(d), 3331, Presidential Decision
Directive 25 (PDD 25), E.O. 12333 of 12/04/1981
7. PAYEE:
REIMBURSE-
MENT
B "X" the applicable box
CASH
PARTIAL
4. FEDERAL GRANT OR OTHER
IDENTIFYING NUMBER ASSIGNED
BY FEDERAL AGENCY
5. PARTIAL PAYMENT REQUEST
NUMBER FOR THIS REQUEST
571-305-6222
ROUTING NUMBER: 073972181
75-2489540
BANK ACCOUNT
PAGES
ACCRUAL
# 70005936515277
9.RECIPIENT ORGANIZATION
01-75-2489540
PERIOD COVERED BY THIS REQUEST
8.
Adress:
ADVANCE
FINAL
NUMBER
Name:
"X" one or both boxes
PAYMENT
REQUESTED
3
2. BASIS OF REQUEST
TYPE OF
REIMBURSEMENT
IDENTIFICATIION
a.
1.
ADVANCE OR
OF
1
0348-0004 AUTHORIZE NEW OMB
REQUEST FOR
6.EMPLOYER
PAGE
TO (month, day, year)
FROM (month, day, year)
12, 31, 2013
01, 01, 2013
10. PAYEE (Direct Deposit only)
NATIONAL SECURITY COUNCIL
DEPARTMENT OF DEFENSE
U.S. A RMY SPECIAL OPERATIONS COMMAND
U.S. ARMY DELTA FORCE
NATIONAL NUCLEAR SECURITY
5000 DEFENSE PENTAGON
WASHINGTON, DC
20301-5000
Name:
WILLIAM MAVERICK WINSLOW
RUSSELL-KNOX BUILDING
27130 TELEGRAPH ROAD
And Street:
City, State USMC BASE-QUANTICO,VA 22134
Zip Code
email: [email protected]
[email protected]
11.
PROGRAMS/FUNCTIONS/ACTIVITIES©
TITLE 50 U.S.C. SECTION 1522 ACTIVITY
INTELLIGENCE AND
COUNTERINTELLIGENCE
SERVICES ON BEHALF OF THE
UNITED STATES GOVERNMENT
ENTITIES/NATIONAL SECURITY
COUNCIL, UNITED STATES ARMED
FORCES, U.S. DEPARTMENT OF
DEFENSE, U.S. FEDERAL
GOVERNMENT ENTITIES,
RACKETEERING INVESTIGATION AND ENFORCEMENT 18 U.S.C. Section
NATIONAL SECURITY ACT OF1947,
CENTRAL INTELLIGENCE AGENCY
ACT OF 1949, INTERNAL SECURITY
ACT OF 1950, FOREIGN
INTELLIGENCE SURVEILLANCE
ACT OF1978, PRESIDENTIAL
DECISION DIRECTIVE 25, E.O.12333,
INSPECTOR GENERAL ACT OF 1978,
18 U.S.C. SECTIONS 1961(10), 3331.
THE ATOMIC ENERGY ACT OF 1954,
THE ENERGY DEFENSE ACT OF
2002, THE COMMUNICATIONS ACT
OF 1934, THE COMMUNICATIONS
SATELLITE ACT OF 1962.
TOTAL AMOUNT DUE
AUTHORIZED FOR LOCAL REPRODUCTION
1961(10).); Section 831(d)
VIOLATION OF 18 .U.S.C. SECTION 1962.
Including, but not limited to,
RACKETEERING ACTIVITY (relating to Biological Weapons, Sections 175-178);
(relating to Chemical Weapons, Section 229-229 F);(relating to nuclear material,
Section 831);
Violations of 18 U.S.C. Section 794;
Safeguarding National Security , Title 19 SECTION 1862;
Evidence collection and rendering admissible at trial;
SPECIAL GRAND JURY PROCEEDINGS 18 U.S.C. SECTION 3331
GROUP 1, 2, ORGANIZED CRIME UNDERCOVER INVESTIGATIVE OPERATIONS
AMOUNT OF REIMBURSEMENTS REQUESTED
Reimbursement for
$500.00 per month
out of pocket
for preceding
expense
12month period,
fiscal year 2013, only.
STANDARD FORM 270 (Rev.7-97) Prescribed
TOTAL OF PAYMENT
S $6,000
by OMB Circulars A-102 and A- 10
Modified on 3/3/2014. Authorized by Chief National Intelligence/ Counterintelligence Officer for the National Security Council (NSC), and U.S. Government
Administrator, pursuant to the National Security Act of 1947, the Central Intelligence Agency Act of 1949,50 U.S.C. Section 1522, 19 U.S.C. Section 1862, Chapter
18 of Title 10, 18 U.S.C. Sections 1961(10), 831(d), 3331, Presidential Decision Directive 25 (PDD 25), E.O. 12333 12/ 04/1981
12.
APROVALS/CONCURRENCE
2 OF 3 PAGES
UNITED STATES OF AMERICA
APPROVED BY:____________________________________________________DATE_____________________________
Hand Written Signature/Sample Specimen
WILLIAM MAVERICK WINSLOW, AC56, SAC, Chief National Intelligence/Counterintelligence Officer, U.S. Army Special
Operations Command, U.S. Army Delta Force/National Nuclear Security, for the National Security Council, acting U.S.
Government Administrator, acting NATO Supreme Command Officer, acting NATO Secretary General
Digital ID Signture:___________________________________________________________________________________
WILLIAM MAVERICK WINSLOW, AC56, SAC, Chief National Intelligence/Counterintelligence Officer, U.S. Army Special
Operations Command, U.S. Army Delta Force/National Nuclear Security, for the National Security Council, acting U.S.
Administrator, acting NATO Supreme Command Officer, acting NATO Secretary General
ACCEPTANCE AND CERTIFICATION
13.
DATE
I certify that to the best of my knowledge and
belief the data on this revised FORM 270 are
correct and that all outlays were made in
accordance with the grant conditions or other
Agreement(s) and that payment is due and
has not been previously requested.
REQUEST
SUBMITTED
SIGNATURE Of AUTHORIZED CERTIFYING OFFICIAL
TYPED OR PRINTED NAME AND TITLE
TELEPHONE
703-676-8185
Modified on 3/5/2014. Authorized by the Chief National Intelligence Counterintelligence Officer, U.S. Army Special
Operations Command, U.S. Army Delta Force/National Nuclear Security, for the National Security Council, acting U.S.
Government Administrator, pursuant to the National Security Act of 1947, the Central Intelligence Agency Act of 1949, 50
U.S.C. Section 1522, 19 U.S.C. Section 1862, Chapter 18 of Title 10 U.S.C. 18 U.S.C. Sections 1961(10), 831(d), 3331,
Presidential Decision Directive 25 (PDD 25), E.O. 12333 of December 04, 1981.