DATE
NOTICE OF DELEGATION OF AUTHORITY - RECEIPT FOR SUPPLIES
25 Oct 2013
For use of this form, see DA PAM 710-2-1. The proponent agency is DCS, G-4.
AUTHORIZED REPRESENTATIVE(S)
ORGANIZATION RECEIVING SUPPLIES
LOCATION
Intelligence & Sustainment Company, HHBN, 25th ID
3004 Lyman Road Rm#178, Schofield Barracks, Hawaii 96857
AUTHORITY
LAST NAME-FIRST NAME-MIDDLE INITIAL
REQ
SIGNATURE AND INITIALS
REC
1LT Doe, John L.
YES
YES Signature & Initials
SGT Doe, Jane M.
YES
YES Signature & Initials
*********** Nothing Follows ************
AUTHORIZATION BY RESPONSIBLE SUPPLY OFFICER OR ACCOUNTABLE OFFICER
THE UNDERSIGNED HEREBY
THE AUTHORITY TO:
DELEGATES TO
WITHDRAWS FROM
THE PERSON(S) LISTED ABOVE,
Establish, Request and Withdraw Local or Deployment MWR Unit Funds
REMARKS
This card supercedes all previous cards
I ASSUME FULL RESPONSIBILITY
UNIT IDENTIFICATION CODE
DODAAC/ACCOUNT NUMBER
{SAMPLE WALXB0}
LAST NAME-FIRST NAME-MIDDLE INITIAL
CPT Doe, Elliot.
DA FORM 1687, MAY 2009
GRADE
03
{SAMPLE UF135}
TELEPHONE
NUMBER
808.655.1234
EXPIRATION DATE SIGNATURE
24 Oct 2014 (signature)
PREVIOUS EDITIONS ARE OBSOLETE
APD PE v1.00ES