[104-10194-10026.pdf — page 198]
# SECRET(When Filled In)REPORT OF SERVICE ABROADTO: Office of Personnel, Transactions and Records Branch, Status File onSERIAL NO.024545LAST (Print)PhillipsNAMEFIRSTDavidINSTRUCTIONSUSE APPROPRIATE SPACE BELOW TO REPORT DATA FOR EITHER PCS OR TDY. INSERT APPROPRIATE CODE NUMBER IN "CODE" COLUMNTO DESIGNATE WHETHER SUBMISSION IS OF BASIC DATA, CORRECTION, OR CANCELLATION (One only): REPORT DATES BY USINGTHE NUMBER FOR THE MONTH. AND LAST TWO DIGITS ONLY FOR YEAR. REFER TO OFI NO. 50. REVISED.PCS DATES OF SERVICE| ARRIVAL O/S | DEPARTURE O/S | TYPE OF DATA | O/P USE ONLY | COUNTRY | CODE  |                 |      |       |       || ----------- | ------------- | ------------ | ------------ | ------- | ----- | --------------- | ---- | ----- | ----- || MONTH       | DAY           | YEAR         | MONTH        | DAY     | YEAR  |                 |      |       |       || 25-26       | 27-28         | 29-30        | 31-32        | 33-34   | 35-36 |                 | CODE | 38 39 |       ||             |               |              |              |         |       | 1. PCS (Basic)  | 37   |       |       ||             |               |              |              |         |       | 3. CORRECTION   |      |       |       ||             |               |              |              |         |       | 5. CANCELLATION |      |       | 40-42 |TDY DATES OF SERVICE| ARRIVAL O/S | DEPARTURE O/S | TYPE OF DATA | O/P USE ONLY | AREA(S) | CODE  |                 |      |            |      || ----------- | ------------- | ------------ | ------------ | ------- | ----- | --------------- | ---- | ---------- | ---- || MONTH       | DAY           | YEAR         | MONTH        | DAY     | YEAR  |                 |      |            |      || 25-26       | 27-28         | 29-30        | 31-32        | 33-34   | 35-36 |                 | CODE | 38 39      |      || 11          | 29            | 73           | 12           | 04      | 73    | 2. TDY (Basic)  | 37   | WESTERN    |      ||             |               |              |              |         |       | 4. CORRECTION   |      | Hemisphere | 8 11 ||             |               |              |              |         |       | 6. CANCELLATION | 2    |            |      |OFFICE OF PERSONNEL USE ONLY - PUNCH AREA[Figure: signature]SOURCE DOCUMENT AND CERTIFICATION* TRAVEL VOUCHERCABLEOTHER (Specify)DOCUMENT IDENTIFICATION NO.WH BTO “1/74REMARKSDISPATCHDUTY STATUS OR TIME AND ATTENDANCE REPORTDOCUMENT DATE/PERIOD.11/10-12/4/73| PREPARED BY           | REPORT ANNOTATED ON CONTROL DOCUMENT | ABOVE DATA CERTIFIED CORRECT, BASED UPON SOURCE DOCUMENT CITED || --------------------- | ------------------------------------ | -------------------------------------------------------------- || DCO                   | DATE                                 | SIGNATURE                                                      || C & L DIVISION, CTRB. | 1/23/74                              | [Figure: signature]                                            || C & T DIVISION        |                                      |                                                                |THIS REPORT WILL BE FILED IN THE OFFICE OF PERSONNELIN THE INDIVIDUAL'S OFFICIAL PERSONNEL FOLDERFORM 1451a OBSOLETE PREVIOUS3-67 EDITIONSSECRET[Figure: OBOCT logo](4-10)