[104-10194-10026.pdf — page 52]
# SECRET(When Filled In)## REQUEST FOR PERSONNEL ACTIONDATE PREPARED| Mo  | Da  | Yr  || --- | --- | --- || 3   | 6   | 58  |1. Serial No.2. Name (Last-First-Middle)3. Date of Birth| Mo  | Da  | Yr  || --- | --- | --- || 10  | 31  | 22  |4. Vet. Pref.5. SOS6. CS + LOD| Mo  | Da  | Yr  || --- | --- | --- |7. SCD| Mo  | Da  | Yr  || --- | --- | --- |Yes-1No-2Code8. CSC Permit. 9. CSC Or Other Legal Authority 10. Apnt. Affidev. 11. FEGLI 12. M LCD 13. Mil. Stmy. CAL.LCD| Mo  | Da  | Yr  || --- | --- | --- |Yes-1No-2Code## PREVIOUS ASSIGNMENT14. Organizational Designations    DDP/NEA    PROJECT ANNEX    EGYPT & ARAB STATES BRANCH    PROJECT PECTATE| Code | 15. Location Of Official Station | Station Code || ---- | -------------------------------- | ------------ |16. | Dept.-Field | 17. Position Title |    | ----------- | ------------------ |    Dept.    Valld.    Frgn.    Code    5 | OFS. OFFICER (FI))BEIRUT, LEBANON18. | Position No. | 19. Serv. | 20. Occup. Series |    | ------------ | --------- | ----------------- |    | PEP 8127     | GS        | 0136.31           |21. | Grade & Step | 22. Salary Or Rate | 23. SD | 24. Date Of Grade | 25. PSI Due | 26. Appropriation Number |    | ------------ | ------------------ | ------ | ----------------- | ----------- | ------------------------ || Mo  | Da  | Yr          | Mo  | Da  | Yr  |               || --- | --- | ----------- | --- | --- | --- | ------------- || 14  | 3   | $ 11,835.00 | DP  |     |     | 9-3331-91-212 |## ACTION27. | Nature Of Action | Code | 28. Eff. Date | 29. Type Of Employee | Code 30. Separation Data |    | ---------------- | ---- | ------------- | -------------------- | ------------------------ |    | RESIGNATION*     |      | 8 / 13 / 58   | REGULAR (SA)         |                          |## PRESENT ASSIGNMENT31. | Organizational Designations | Code | 32. Location Of Official Station | Station Code |    | --------------------------- | ---- | -------------------------------- | ------------ |33. | Dept.-Field | 34. Position Title |    | ----------- | ------------------ |    Dept.    Valld.    Frgn.    Code35. | Position No. | 36. Surv. | 37. Occup. Series |    | ------------ | --------- | ----------------- |38. | Grade & Step | 39. Salary Or Rate | 40. SD | 41. Date Of Grade | 42. PSI Due | 43. Appropriation Number |    | ------------ | ------------------ | ------ | ----------------- | ----------- | ------------------------ || Mo  | Da  | Yr  | Mo  | Da  | Yr  | Mo  | Da  | Yr  || --- | --- | --- | --- | --- | --- | --- | --- | --- || A. Requested By (Name And Title) | SOURCE OF REQUEST | C. Request Approved By (Signature And Title) || -------------------------------- | ----------------- | -------------------------------------------- |FRANK J. DEWALL, Jr., NEA/SS/PERSONNELB. For Additional Information Call (Name & Telephone Ext.)Shirley M. Ryen ext. 5612| Clearance         | Signature    | Date | Clearance      | Signature                 | Date || ----------------- | ------------ | ---- | -------------- | ------------------------- | ---- || A Corear Board    | Randall Gage | 8/13 | D. Placement   |                           |      || B Pos Control     |              |      | E.             | Completed _ Rogers 8/14/2 |      || C. Classification |              |      | F. Approved By | followed a.i. therefore   |      |Remarks |  |  |  | county — Sun —  C. 21 are*See reverse side. |  |  |  | regesters - - bugly - a thing by be.![logo of cia]FORM 1152a (USE PREVIOUS EDITI18-69SECRET(4)