PHASE_II__Amendment_MOTCO_FM_190-2_Camera_Pass.pdf
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- W91238-15-R-0014
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PHASE II MOTCO CAMERA PASS
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MOTCO FORM 190-2 (PM)
OCT 2011
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.
DEPARTMENT OF THE ARMY
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