FormFD-221a informant payment authorization with handwritten receipt, Sub 5827 February 1973page 1 of 2
fbi_formLegibility: high

Part 115, page 222

DB Cooper-52704Serials SE 164-81

Document date 7 February 1973

Open in FBI Vault (Part 115, page 222 of the PDF)

FBI 164-81, Vault Part 115 p. 222 (DB Cooper-52704), Form, dated 7 Feb 1973 — cooper.theunsolved.net/parts/Cooper-Part-115/pages/222

Transcript

The scan is the source; the transcript is machine-generated from it.

FD-221a (Rev. 7-15-70)

CITY Seattle, Washington DATE February 7, 1973

Request of Special Agent in Charge, FBI, Seattle

[REDACTED] dollars, and [REDACTED] cents,

($ [REDACTED] ), which money is to be paid by me on [REDACTED]

to SPECIAL AGENT [REDACTED] Seattle

expenses for information concerning the case entitled NORJAK (164-81)

For purchase of [REDACTED]

___________________________________________

Services: [REDACTED] Federal Income Tax Withheld [REDACTED] Expenses [REDACTED]

Signed: [REDACTED] Special Agent

Have payments been made by other Offices? XXNo ☐ Yes (List Offices below.)

Authority (date) _____ SAC _____ Period Covered by Payment [REDACTED] Authorization Checked ______________ ✓ Check Number _______________ [REDACTED] Receipts Received __________________ ✓ Voucher Prepared [REDACTED] [REDACTED] Item 1 Date of Actual Payment _______________ By whom SA [REDACTED] Informant's File No. 164-81 Approved [REDACTED] SAC

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Sub 582 ONLy

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16 4-81- Sub-562

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REC. [illegible] INDEXED 60... FILED [illegible] FEB 26 1973 FBI - SEATTLE

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DB COOPER-52704