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.
