Visit_Authorization_Memo.pdf

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Attached to
SMC Furniture Federal contract opportunity
Solicitation number
FA254319RA007
Issued by
Department of the Air Force

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Please fill out and return no later than 06 March 2019 at 1300 MST/MDT.

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Text version

“FOR OFFICIAL USE ONLY”

DEPARTMENT OF THE AIR FORCE

460TH SPACE WING (AFSPC)

“The information herein is For Official Use Only (FOUO) which must be protected under the Freedom of Information Act of 1966 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this

PERSONAL INFORMATION may result in criminal and/or civil penalties”

AMERICA’S MISSILE WARNING WING

Date: _________________

MEMORANDUM FOR 460 SFS/S5IV

FROM: 460 CONF

SUBJECT: Visit Authorization for Short-notice or Emergency Visits to the Restricted Area

1. The below individual requires short-notice/emergency access to the restricted area.

DATE OF REQUEST VISIT DATES

NAME: (Last, First, MI) SSN

DATE & PLACE OF BIRTH CITIZENSHIP

CLEARANCE TYPE/DATE GRADE ORGANIZATION

PURPOSE OF VISIT POC/SPONSOR (Grade, Name, Off Sym, Phone)

2. Preannounced visitors are required to have two valid forms of identification. Valid forms of identification must be Federal or State issued. Visitor authorizations will only be accepted from the sponsoring agency and must be approved by an authorized signing official. Requests that do not contain all required information will not be processed and returned to the sponsoring agency.

Approval Authority Signature:__________________________________ Commander/Designated Representative

Printed Name/Title:__________________________________

Security Forces Authentication Signature:_________________________________ Printed Name/Title:

Date:
DATE OF REQUEST:
VISIT DATES:
NAME Last First MI:
SSN:
DATE PLACE OF BIRTH:
CITIZENSHIP: US
CLEARANCE TYPEDATE:
ORGANIZATION:
PURPOSE OF VISIT:
POCSPONSOR Grade Name Off Sym Phone:
GRADE MIL/CIV: [.]
Printed NameTitle:
Printed NameTitle2: SSgt McCullough, Stephon/NCOIC Pass & ID
Printed NameTitle3: : SSgt Wilson, Andre/Pass & ID Clerk

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