MOTCO_FM_190-2_Camera_Pass.docx

DEPARTMENT OF THE ARMY

Military Surface Deployment and Distribution Command 834Th Transportation Battalion 410 Norman Avenue Concord, California 94520-1142

REQUEST FOR MOTCO CAMERA PASS

Requestor Name: _______________________________________________________ Address: ______________________________________________________________ Driver License #: _________________________ Issuing State: _________________ Telephone: ____________________________ Signature of Requestor: __________________________________________________ Purpose of Request: _____________________________________________________ Camera Brand: ___________________________________ Model: __________________________________________ Serial Number: ____________________________________

Camera Request From: _____________________________ Camera Request Through: ___________________________

Camera Pass Number: _____________________________ Authorized by: ____________________________________ PRIVACY ACT STATEMENT: Authority to request this information is derived from 5 USC 301 Departmental Regulations. The purpose is to record information pertaining to camera permits. Routine use if for the maintenance of files as a permit control system, and may include the release of such information to state or federal law enforcement agencies in connection with criminal investigation or court action. Disclosure of the required information is voluntary. Failure by the individual to provide the required information may result in denial of a camera pass.

MOTCO FORM 190-2 (PM)

OCT 2011

image1.png oleObject1.bin