US. Department of Justice Request for EY (Authorization, Washington, D.C. 20530 Purchase Order, Receiving Report) This form shall only be 1P nor of individuals and partnerships of five or fewer individuals 2 Date Order Prepared: 1802/2006 Number: (Optional) 05-02(WPB) NOS 1-01 (OLY-01) Section A - Authorization and Purchase Order 4 Names and Address of TE: cn: IIE Research Dept. ES 1100.0", 0. 35243 5 Deliver To: Special Agent , Federal Bureau of Investigation, iS Florida 33401, Te: [6 Retum Date pl oss1 8/2006 7 Remarks FOR REIMBURSEMENT PLEASE RETURN THIS FORM, THE RECORD OF SERVICES, AND A COPY OF THE SUBPOENA 8 Name of Requestor: (Type or Print) 40s. 9 Telephone Number. 10 Date of request 0802/2006 11 Service {EE Provided: Quantity Unit Price Amount Cost Per Please note that reimbursement cannot be made for the records 0.25 Copy pertaining to corporations or large partnerships of six or more. IMPORTANT: The DCIA Mandates the use of EFT/DD. In order to receive payment complete the attached EFT enrollment Form. 11.00 Hour Clerical Tech 17.00 Hour Manager or Supervisor Do not proceed with compliance : If cost will exceed $300 without prior approval of Assistant U. PLEASE REFERENCE THE ABOVE DCN# ON YOUR INVOICE FOR PAYMENT. 12a Signature of oficial 12b Phone of (TE oniciat 13. Date Signed: Attorney/Budget Officer. Total Amount Claimed >) 16 Disallowance Section C - Receiving Report (See Attached} 14 I certify that the articles and services listed were received. 18 Right to Financial Privacy Act - Public Law 95-630 19 Sig (12 U.S.C. 401-3422) Request Pursuant To: (Check One Only) OBJECT 17 Net to 15 Date Received: TPL ture of Approval Official 20 Accounting Classification Code Fy Fc 1 2 3.64 5 PROJ SECTION CLASS TA. 3406 Cusomer Authorization 2840 Schedule and Voucher Number: T2 340s Administrative Subpoena or Summons 2541 T3 3406 Search Warrant 2540 14 3407 Judicial Subpoena 2540 TS. 3408 Formal Weiten Request - 2540 I6 sais I Grand Jury Subpoena —- 2545 TZ sai Special Procedures 2540 22 Remarks: 18 Funds Available EFTA00220999

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I9 T10 14.712 —— APR S84 Form OBD211 i This form was electronically produced by Elite Federal Forms, Inc Page 1 of 3 GENERAL This is a multi-purpose form designed to serve as an Authorization, Purchase Order, Itemized Invoice, receiving Report and Payment voucher in conjunction with “requests for | pursuant to the Right to Financial Privacy Act of 1978, P_L. 95-630, Tithe XL, 12 U.S.C. 3415. NOTE: Payments under this purchase order will be due on the 30 ‘" calendar day after the date of actual receipt of a proper invoice in the office designated to receive the invoice. The Prompt Payment Act, Public Law 97-177, 96 Stat. 85 (31 U contractors of interest or overdue payments and improperly taken discounts. Determination of interest due will be made in accordance with the provision of C. 180), is applicable to payments under this purchase order and requires the payment to the Prompt Payment Act and the Office of Management and Budge Circular A-125. PREPARATION INSTRUCTIONS ITEM | - A Purchase Order Number will be preprinted on cach form. This number will be used for reference purposes on any correspondence relating to this specific request for ITEM 2 - Self explanatory. ITEM 3 - This block may be used to identify the specific case for which the [EE is required. This block may be left blank. SECTION A - AUTHORIZATION AND PURCHASE ORDER (To be completed by the requesting official). ITEM 4 - Enter the name and mailing address of the [EEE being requested to furnish ITEM 5 - Enter the and address to which the QE is to be sent by the I). This will normally be the name and the address of the requesting official. ITEM 6 - Enter the date the I is required. ITEM 7 - Include, if appropriate, any pertinent information related to the purchase order not provided for elsewhere on the form. ITEM 8, 9 and 10 - Self-explanatory. SECTION B - EEE (Nv 01CE (70 be completed by the ED. ITEM 11 - Self-cxplanatory. Completion of this block constitutes an itemized bill or invoice for reimbursement for the costs incurred in providing the information requested. The DCLA Mandates the use of EFT/DD. In order to receive payment complete the attached EFT enrollment Form. ITEM 12 and 13 - Self-explanatory. SECTION C - RECEIVING REPORT (To be completed by the requesting official, when the requested [EE has been delivered). ITEM 14 and 15 - Self-explanatory. ITEM 16 - This block should be used to reflect any differences between the amount claimed by the (J and the correct amount to be reimbursed. Differences may result form computation errors, or failure of the [EM to deliver information requested. ITEM 17 - Enter the amount certified to be proper for payment. ITEM 18 - Check the box which identifies the appropriate procedure authorized by the Act, which necessitates the request for ITEM 19 and 20 - These blocks must be signed and dated by an official of the organization whose funds will be charged. His or her signature constitutes a statement that the records to which the invoice refers were required for official business and were provided by the [EE in accordance with the ordering instrument. ITEM 21 - The Schedule and Voucher Number will be entered by the office which actually schedules the approved amount for payment by the Treasury Department. ITEM 22 - Enter, if appropriate, any data not provided for elsewhere on the receiving report, such as, reasons for any claim amounts disallowed. FORM OBD-211 APR. 84 Page 2 of 3 VENDOR ELECTRONIC FUNDS TRANSFER (EFT) ENROLLMENT FORM Please comply to this information if you have not done so already PAYEE/COMPANY INFORMATION: Vendor Company Name: Address: Taxpayer ID Number [Contact Person Name [Telephone Number EFTA00221000

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E-mail Address (If you would like to be notified via e-mail) ee 'NFORMATION: [Bank Name Bank Address Bank Phone Number Nine Digit ABA Routing Transit Number Type of Account (Checking or Saving) Depositor Account Number Signature of Vendor's Authorizing Official Name & Title of Authorizing Official Please Return or Fax to: U.S. Attorney's Office Southern District of Florida a a Attention: ay Fax Number: The Debt Collection Improvement Act of 1996 requires that payments made by the Federal government, including vendor payments, must be made by electronic funds transfer (EFT). A benefit of receiving payments by EFT is that your funds are directly deposited to your account at a I and are available to you on the date of payment. If you have questions regarding the delivery of the remittance information, please contact the (J where your account is held. If you have any questions on the completion of this form, please contact [I =: TN. FORM OBD.211 APR. 84 Page 3 of 3 TEXT BOXES Ia to Ia l2Z it~ ia EFTA00221001

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EFTA00221002