+-----+------------------+---+----+--------------------------+---+---+
| **R |                  | C |    |                          | > | > |
| ECO |                  | o |    |                          |   |   |
| RDS |                  | m |    |                          | P | O |
| TR  |                  | p |    |                          | A | F |
| ANS |                  | l |    |                          | G |   |
| MIT |                  | e |    |                          | E | 1 |
| TAL |                  | t |    |                          |   | P |
| AND |                  | e |    |                          | 1 | A |
| REC |                  | a |    |                          |   | G |
| EIP |                  | n |    |                          |   | E |
| T** |                  | d |    |                          |   | ( |
|     |                  | s |    |                          |   | S |
|     |                  | e |    |                          |   | ) |
|     |                  | n |    |                          |   |   |
|     |                  | d |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | i |    |                          |   |   |
|     |                  | g |    |                          |   |   |
|     |                  | i |    |                          |   |   |
|     |                  | n |    |                          |   |   |
|     |                  | a |    |                          |   |   |
|     |                  | l |    |                          |   |   |
|     |                  | a |    |                          |   |   |
|     |                  | n |    |                          |   |   |
|     |                  | d |    |                          |   |   |
|     |                  | t |    |                          |   |   |
|     |                  | w |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | c |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | p |    |                          |   |   |
|     |                  | i |    |                          |   |   |
|     |                  | e |    |                          |   |   |
|     |                  | s |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | f |    |                          |   |   |
|     |                  | t |    |                          |   |   |
|     |                  | h |    |                          |   |   |
|     |                  | i |    |                          |   |   |
|     |                  | s |    |                          |   |   |
|     |                  | f |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | m |    |                          |   |   |
|     |                  | t |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | t |    |                          |   |   |
|     |                  | h |    |                          |   |   |
|     |                  | e |    |                          |   |   |
|     |                  | a |    |                          |   |   |
|     |                  | p |    |                          |   |   |
|     |                  | p |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | p |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | i |    |                          |   |   |
|     |                  | a |    |                          |   |   |
|     |                  | t |    |                          |   |   |
|     |                  | e |    |                          |   |   |
|     |                  | F |    |                          |   |   |
|     |                  | e |    |                          |   |   |
|     |                  | d |    |                          |   |   |
|     |                  | e |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | a |    |                          |   |   |
|     |                  | l |    |                          |   |   |
|     |                  | R |    |                          |   |   |
|     |                  | e |    |                          |   |   |
|     |                  | c |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | d |    |                          |   |   |
|     |                  | s |    |                          |   |   |
|     |                  | C |    |                          |   |   |
|     |                  | e |    |                          |   |   |
|     |                  | n |    |                          |   |   |
|     |                  | t |    |                          |   |   |
|     |                  | e |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | f |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | a |    |                          |   |   |
|     |                  | p |    |                          |   |   |
|     |                  | p |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | v |    |                          |   |   |
|     |                  | a |    |                          |   |   |
|     |                  | l |    |                          |   |   |
|     |                  | p |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | i |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | t |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | s |    |                          |   |   |
|     |                  | h |    |                          |   |   |
|     |                  | i |    |                          |   |   |
|     |                  | p |    |                          |   |   |
|     |                  | m |    |                          |   |   |
|     |                  | e |    |                          |   |   |
|     |                  | n |    |                          |   |   |
|     |                  | t |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | f |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | e |    |                          |   |   |
|     |                  | c |    |                          |   |   |
|     |                  | o |    |                          |   |   |
|     |                  | r |    |                          |   |   |
|     |                  | d |    |                          |   |   |
|     |                  | s |    |                          |   |   |
|     |                  | . |    |                          |   |   |
+-----+------------------+---+----+--------------------------+---+---+
| >   |                  |   |    | > 5\. FROM *(Enter the   |   |   |
| 1\. |                  |   |    | > name and complete      |   |   |
| >   |                  |   |    | > mailing address of the |   |   |
|  TO |                  |   |    | > office retiring the    |   |   |
| > * |                  |   |    | > records. The signed    |   |   |
| (Co |                  |   |    | > receipt of this form   |   |   |
| mpl |                  |   |    | > will be sent to this   |   |   |
| ete |                  |   |    | > address.)*             |   |   |
| >   |                  |   |    | >                        |   |   |
| the |                  |   |    | > **Federal Aviation     |   |   |
| > a |                  |   |    | > Administration**       |   |   |
| ddr |                  |   |    | >                        |   |   |
| ess |                  |   |    | > **ABC-100, Room 612**  |   |   |
| >   |                  |   |    | >                        |   |   |
| for |                  |   |    | > **800 Independence     |   |   |
| >   |                  |   |    | > Avenue SW**            |   |   |
| the |                  |   |    | >                        |   |   |
| > r |                  |   |    | > **Washington, DC       |   |   |
| eco |                  |   |    | > 20591**                |   |   |
| rds |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
| cen |                  |   |    |                          |   |   |
| ter |                  |   |    |                          |   |   |
| > s |                  |   |    |                          |   |   |
| erv |                  |   |    |                          |   |   |
| ing |                  |   |    |                          |   |   |
| > y |                  |   |    |                          |   |   |
| our |                  |   |    |                          |   |   |
| > a |                  |   |    |                          |   |   |
| rea |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
|  as |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
|  sh |                  |   |    |                          |   |   |
| own |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
|  in |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
|  36 |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
| CFR |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
|  12 |                  |   |    |                          |   |   |
| 28. |                  |   |    |                          |   |   |
| 150 |                  |   |    |                          |   |   |
| .)* |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
| **F |                  |   |    |                          |   |   |
| ede |                  |   |    |                          |   |   |
| ral |                  |   |    |                          |   |   |
| > R |                  |   |    |                          |   |   |
| eco |                  |   |    |                          |   |   |
| rds |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
|  Ce |                  |   |    |                          |   |   |
| nte |                  |   |    |                          |   |   |
| r** |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
| **W |                  |   |    |                          |   |   |
| ash |                  |   |    |                          |   |   |
| ing |                  |   |    |                          |   |   |
| ton |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
|  Na |                  |   |    |                          |   |   |
| tio |                  |   |    |                          |   |   |
| nal |                  |   |    |                          |   |   |
| > R |                  |   |    |                          |   |   |
| eco |                  |   |    |                          |   |   |
| rds |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
|  Ce |                  |   |    |                          |   |   |
| nte |                  |   |    |                          |   |   |
| r** |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
| > * |                  |   |    |                          |   |   |
| *Wa |                  |   |    |                          |   |   |
| shi |                  |   |    |                          |   |   |
| ngt |                  |   |    |                          |   |   |
| on, |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
|  DC |                  |   |    |                          |   |   |
| > 2 |                  |   |    |                          |   |   |
| 040 |                  |   |    |                          |   |   |
| 9** |                  |   |    |                          |   |   |
+-----+------------------+---+----+--------------------------+---+---+
| >   | > TRANSFERRING   |   | >  |                          |   |   |
| 2\. | > AGENCY         |   | Da |                          |   |   |
| >   | > OFFICIAL       |   | te |                          |   |   |
| AGE | > *(Signature    |   | >  |                          |   |   |
| NCY | > and title)*    |   | >  |                          |   |   |
| >   | >                |   | ** |                          |   |   |
|  TR | > **Lisa         |   | -- |                          |   |   |
| ANS | > McGlasson,     |   | -- |                          |   |   |
| FER | > Agency Records |   | -- |                          |   |   |
| >   | > Officer**      |   | -- |                          |   |   |
| AUT |                  |   | -- |                          |   |   |
| HOR |                  |   | ** |                          |   |   |
| I-\ |                  |   |    |                          |   |   |
| >   |                  |   |    |                          |   |   |
| ZAT |                  |   |    |                          |   |   |
| ION |                  |   |    |                          |   |   |
+-----+------------------+---+----+--------------------------+---+---+
| >   | > TRANSFERRING   |   |    |                          |   |   |
| 3\. | > AGENCY LIAISON |   |    |                          |   |   |
| >   | > OFFICIAL       |   |    |                          |   |   |
| AGE | > *(Name, office |   |    |                          |   |   |
| NCY | > and telephone  |   |    |                          |   |   |
| > C | > No.)*          |   |    |                          |   |   |
| ONT | >                |   |    |                          |   |   |
| ACT | > **----------** |   |    |                          |   |   |
+-----+------------------+---+----+--------------------------+---+---+
| >   | > RECORDS        |   |    |                          |   |   |
| 4\. | > RECEIVED BY    |   |    |                          |   |   |
| > R | > *(Signature    |   |    |                          |   |   |
| ECO | > and title)*    |   |    |                          |   |   |
| RDS | >                |   |    |                          |   |   |
| >   | > **----------** |   |    |                          |   |   |
| CEN |                  |   |    |                          |   |   |
| TER |                  |   |    |                          |   |   |
| > R |                  |   |    |                          |   |   |
| ECE |                  |   |    |                          |   |   |
| IPT |                  |   |    |                          |   |   |
+-----+------------------+---+----+--------------------------+---+---+

**6. RECORDS DATA**

<table>
<colgroup>
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 6%" />
<col style="width: 31%" />
<col style="width: 2%" />
<col style="width: 12%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 13%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
</colgroup>
<thead>
<tr class="header">
<th colspan="3"><blockquote>
<p>ACCESSION NUMBER</p>
</blockquote></th>
<th></th>
<th></th>
<th></th>
<th></th>
<th></th>
<th colspan="2"></th>
<th colspan="4">COMPLETED BY RECORDS CENTER</th>
</tr>
<tr class="odd">
<th><p>RG</p>
<p><em>(a)</em></p></th>
<th><p>FY</p>
<p><em>(b)</em></p></th>
<th><p>NUMBER</p>
<p><em>(c)</em></p></th>
<th><p>VOLUME</p>
<p><em>(cu. ft.)</em></p>
<p><em>(d)</em></p></th>
<th><p>AGENCY</p>
<p>BOX</p>
<p>NUMBERS</p>
<p><em>(e)</em></p></th>
<th><p>SERIES DESCRIPTION</p>
<p><em>(With inclusive dates of records)</em></p>
<p><em>(f)</em></p></th>
<th><p>Res-</p>
<p>tric-</p>
<p>tion</p>
<p><em>(g)</em></p></th>
<th colspan="2"><p>DISPOSAL AUTHORITY<br />
(Schedule and item number)</p>
<p><em>(h)</em></p></th>
<th><p>DISPOSAL DATE</p>
<p><em>(i)</em></p></th>
<th><p>LOCATION</p>
<p><em>(j)</em></p></th>
<th><p>Shelf</p>
<p>Plan</p>
<p><em>(k)</em></p></th>
<th><p>Cont.</p>
<p>Type</p>
<p><em>(l)</em></p></th>
<th><p>Auto.</p>
<p>Disp.</p>
<p><em>(m)</em></p></th>
</tr>
</thead>
<tbody>
<tr class="odd">
<td>237</td>
<td>97</td>
<td>601</td>
<td>––</td>
<td>–––––</td>
<td><blockquote>
<p>–––––</p>
</blockquote></td>
<td>R</td>
<td colspan="2"><blockquote>
<p>–––––</p>
</blockquote></td>
<td>–––––</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>