Mkultra Subproject 52 (108 Documents with Pubdates from 560614 to 64062 4)

Read from the scan by GLM-OCR; expect the odd misread word.

# REQUEST FOR COVERT PAYMENT OTHER THAN CASH

FD/O&L Log No. ___

TO : Finance Division, Room

FROM: T6D/EB Division

It is requested that payment authorized on documents reflecting obligation reference number (or other divisional ref. no.) 2125-1390-3902 be made in the following manner:

1. Payment to: (C) Name of Payee (True) Status (e.g., CA; SA; CE; Integree) $ 500.00

By:

a. ___ U. S. Treasury Check (for official cover only)

b. ___ Covert Check (individual type - circle city below)

c. Covert Check (commercial type = circle city below)

d. Bank Cashier Check (circle city below)

e. ___ Deposit to Payee's Bank Account (complete par. 3, below)

CITY DESIRED

## 2. Payment by other means:

A. If payment is to be originated by foreign bank - specify requirements: ___

B. Payment by other means and/or special instructions (foreign and domestic bank drafts, cover story, travelers check, letter of credit, etc.) specify: ___

C. Payment by either 2 A or B above, should be discussed with the Monetary Branch Banking Officer, Ex

3. Banking instructions (for use by Requesting Officer if instructions are not on file in Finance Division):

Account Name: ___

Bank and Bank Address: ___

4. For further information regarding this request please contact: TSD/FASS

Ext.

(A)

Requesting Officer, Ext. 2841

* Notify for delivery of check

FOR USE BY FINANCE DIVISION ONLY

Payroll Number:___ Roll Number:___

Method of Payment:___ City:___