[104-10224-10007.pdf — page 318]
SECRET(When Filled In)VERIFIED RECORD OF OVERSEAS SERVICETO: Office of Personnel, Statistical Reporting Branch, ROOM 192 Curie Hall| EMPLOYEE SERIAL NO. | NAME OF EMPLOYEE | OFFICE/COMPONENT |              |     || :-----------------: | :--------------: | :--------------: | ------------ | --- ||         1-6         |   LAST (Print)   |    FIRST 7-24    | MIDDLE 25-26 |     ||        12773        |      MILLER      |      KELEN       | SCOTT        | 52  |INSTRUCTIONSUSE 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 USING THENUMBER FOR THE MONTH. AND LAST TWO DIGITS ONLY FOR YEAR.PCS DATES OF SERVICE| TYPE OF DATA     | CODE 27 |   ARRIVAL   | DEPARTURE |  COUNTRY   | OMIT 40-42  |           |            |     |     || ---------------- | :-----: | :---------: | :-------: | :--------: | :---------: | --------- | ---------- | --- | --- ||                  |         | MONTH 28-29 | DAY 30-31 | YEAR 32-33 | MONTH 34-35 | DAY 36-37 | YEAR 38-39 |     |     || 1 - PCS (Basic)  |         |             |           |            |             |           |            |     |     || 3 - CORRECTION   |    /    |     09      |    09     |    *61*    |             |           | ETHIOPIA   | 220 |     || 5 - CANCELLATION |         |             |           |            |             |           |            |     |     |TDY DATES OF SERVICE| TYPE OF DATA     | CODE 27 |  DEPARTURE  |  RETURN   |  AREA(S)   | OMIT 40-42  |           |            |     |     || ---------------- | :-----: | :---------: | :-------: | :--------: | :---------: | --------- | ---------- | --- | --- ||                  |         | MONTH 28-29 | DAY 30-31 | YEAR 32-33 | MONTH 34-35 | DAY 36-37 | YEAR 38-39 |     |     || 2 - TOY (Basic)  |         |             |           |            |             |           |            |     |     || 4 - CORRECTION   |         |             |           |            |             |           |            |     |     || 6 - CANCELLATION |         |             |           |            |             |           |            |     |     || TRAVEL VOUCHER  | SOURCE OF RECORD DOCUMENT                 || --------------- | ----------------------------------------- || ✓ CABLE         | DISPATCH                                  || OTHER (Specify) | DUTY STATUS OR TIME AND ATTENDANCE REPORT || DOCUMENT IDENTIFICATION NO. | DOCUMENT DATE/PERIOD || --------------------------- | -------------------- || 15-37419                    | 12 September 61      || REMARKS                     |                      || PREPARED BY                            | REPORT ANNOTATED ON SOURCE DOCUMENT | ABOVE DATA VERIFIED CORRECT. BASED UPON SOURCE DOCUMENT CITED || -------------------------------------- | ----------------------------------- | ------------------------------------------------------------- || FISCAL DIVISION FINANCE DIVISION *M*   | DATE 4/12/61                        | SIGNATURE *?? ???*                                            || **FORM 9-28 1451a PREVIOUS EDITIONS.** | SECRET (10-101)                     |                                                               |