United States Coast Guard Auxiliary Flotilla Check Request printable pdf download

United States Coast Guard Auxiliary Flotilla Check Request

Instructions:

1. Complete Part A of Form

2. Attach all original receipts and/or invoices that substantiate request.

3. Obtain proper approvals in Part B as required by your office.

Note:

FSO Requests must be approved by the FC (or VFC if FC is unavailable).

Member requests must be approved by the appropriate FSO as well as the FC

(or VFC if FC is unavailable).

Part A: Payment Request

Payee: ______________________________________ Total Amount Requested: $__________.__

Address: ____________________________________

Flotilla: 053-____-____

____________________________________________

Explanation of expenses: _______________________________________________________________

____________________________________________________________________________________

Date of Request (e.g., 1 JAN 2001): ____/____/20___

_______________________________/_____________________________________/_______________

Name of Requester

Signature of Requester

Office (if held)

Part B: Approval Endorsements (OFFICIAL USE ONLY)

From and approved for payment by:

FSO-__: _________________________________ Date: _____________

FC: _____________________________________ Date: _____________

VFC (alternate): ___________________________ Date: _____________

If approved, please forward check request to the FSO-FN: FSO-FN 053-02-76

4425 LINDEN AVE

PHILA., PA 19114-3967

Part C: Accounting (OFFICIAL USE ONLY)

Request Received Date: ________ Check #: ________ Dated: __________ Memo: _________________

Posted from Account #:_____________________ Amount: $_____________.__

United States Coast Guard Auxiliary Flotilla Check Request