[104-10222-10002.pdf — page 52]
ABM: 23 NOV 62SECRET(When Filled in)# OCF## NOTIFICATION OF PERSONNEL ACTION1. SERIAL NUMBER   0590902. NAME (LAST-FIRST-MIDDLE)   SRB SPECIAL3. NATURE OF PERSONNEL ACTION   PROMOTION4. EFFECTIVE DATE   11 25 625. CATEGORY OF EMPLOYMENT   SRB SPECIAL6. FUNDS   CF TO V X CF TO CF7. COST CENTER NO. CHARGEABLE   3176 1062 10008. CSC OR OTHER LEGAL AUTHORITY   50 USC 403 J9. ORGANIZATIONAL DESIGNATIONS   IAS   FOREIGN FIELD   SPECIAL DETAIL FOREIGN10. LOCATION OF OFFICIAL STATION    OS UNDETERMINED11. POSITION TITLE    GENERAL POSITION12. POSITION NUMBER    080313. CAREER SERVICE DESIGNATION    UD14. CLASSIFICATION SCHEDULE (GS, LB, etc)    GS15. OCCUPATIONAL SERIES    1301.0716. GRADE AND STEP    16 317. SALARY OR RATE    1700018. REMARKSSPACE BELOW FOR EXCLUSIVE USE OF THE OFFICE OF PERSONNEL| 19. ACTION CODE | 20. Employ Code            | 21. OFFICE CODING Numeric |                          | 22. STATION CODE                      | 23. INTEGREE CODE | 24. Hagirs Code      | 25. DATE OF BIRTH | 26. DATE OF GRADE | 27. DATE OF LEI || --------------- | -------------------------- | ------------------------- | ------------------------ | ------------------------------------- | ----------------- | -------------------- | ----------------- | ----------------- | --------------- ||                 |                            |                           | Alphabetic               |                                       |                   |                      | MO DA YR          | MO DA YR          | MO DA YR        || 22              | 52                         | 29994                     | IAS 99999                | 3                                     | 01 12 01 18       | 11 25 62             | 11 25 62          |                   |                 || 28. NTE EXPIRES | 29. SPECIAL REFERENCE Code | 30. RETIREMENT DATA       | 31. SEPARATION DATA CODE | 32. CORRECTION/CANCELLATION DATA TYPE |                   | 33. SECURITY REQ NO. | 34. SEX           |                   |                 ||                 |                            |                           |                          |                                       | EOD DATA          |                      |                   |                   |                 || MO DA YR        | CSC Code                   | FICA 540 Code             |                          | MO DA YR                              |                   |                      |                   |                   |                 |35. VET. PREFERENCE36 SERV COMP. DATE37. LONG COMP. DATE38 CAREER CATEGORY39. FEGLI/HEALTH INSURANCE40. SOCIAL SECURITY NO.CODEMO DA YRMO DA YRCODEWAIVER HEALTH INS. CODE1.0 PT2.10 PTRESVTEMP41. PREVIOUS GOVERNMENT SERVICE DATA42 LEAVE CAT CODE43. FEDERAL TAX DATA44. STATE TAX DATACODEFORM EXECUTED CODENO TAX EXEMPTIONSFORM EXECUTEDCODENO TAX STATE CODE0. NO PREVIOUS SERVICE1. NO BREAK IN SERVICE2. BREAK IN SERVICE (LESS THAN 1 YRS)3. BREAK IN SERVICE (MORE THAN 1 YRS)1. YES2. NO1. YES2. NOSIGNATURE OR OTHER AUTHENTICATIONFORM 11504-62Use Previous Edition 11/12/62 AtomSECRETE.O. P-1Excluded from automatic downgrading and declassification(When Filled In)(4-61)