[104-10224-10012.pdf — page 218]
# SECRET(When Filled In)VERIFIED RECORD OF OVERSEAS SERVICETO: Office of Personnel, Statistical Reporting Branch, ROOM 5 E 2506 Headquarters| ENPLOYEE SERIAL NO. | NAME OF EMPLOYEE |          | OFFICE/COMPONENT |       || ------------------- | ---------------- | -------- | ---------------- | ----- || 3-6                 | LAST             | FIRST    | MIDDLE           | 25-26 || 006192              | (Print) Wigren   | 7-24 Lee | H.               | RR    |INSTRUCTIONSUSE APPROPRIATE SPACE BELOW TO REPORT DATA FOR EITHER PCS OR TDY. INSERT APPROPRIATE CODE NUMBER IN "CODE" COLUMNTO DESIGNATION OF BASIC DATA, CORRECTION, OR CANCELLATION (One only). REPORT DATES BY USING the NUMBER FOR THE MONTH, AND LAST TWO DIGITS ONLY FOR YEAR.| TYPES OF DATA   | PCS DATES OF SERVICE |         |           |         |       |       |       |     |       |     |     |     || --------------- | -------------------- | ------- | --------- | ------- | ----- | ----- | ----- | --- | ----- | --- | --- | --- ||                 | CODE                 | ARRIVAL | DEPARTURE | COUNTRY | OMIT  |       |       |     |       |     |     |     ||                 |                      | MONTH   | DAY       | YEAR    | MONTH | DAY   | YEAR  |     | 40-47 |     |     |     || 1. PCS (Basic)  | 77                   | 78-29   | 30-31     | 32-33   | 34-35 | 39-31 | 29-38 |     |       |     |     |     || 3. CORRECTION   |                      |         |           |         |       |       |       |     |       |     |     |     || 5. CANCELLATION |                      |         |           |         |       |       |       |     |       |     |     |     || TYPES OF DATA   | TDY DATES OF SERVICE |           |          |          |          |          |          |     |       |     |     |     || --------------- | -------------------- | --------- | -------- | -------- | -------- | -------- | -------- | --- | ----- | --- | --- | --- ||                 | CODE                 | DEPARTURE | RETURN   | AREA(S)  | OMIT     |          |          |     |       |     |     |     ||                 |                      | MONTH     | DAY      | YEAR     | MONTH    | DAY      | YEAR     |     | 40-47 |     |     |     || 2. TDY (Basic)  | 2                    | 27 10     | 28-29 13 | 30-31 66 | 32-33 11 | 34-35 13 | 36-37 66 | AF  | 803   |     |     |     || 4. CORRECTION   |                      |           |          |          |          |          |          |     |       |     |     |     || 6. CANCELLATION |                      |           |          |          |          |          |          |     |       |     |     |     |SOURCE OF RECORD DOCUMENT[X] TRAVEL VOUCHERCABLEOTHER (Specify)DISPATCHDUTY STATUS ON TIME AND ATTENDANCE REPORTDOCUMENT IDENTIFICATION NO.AF-69-67DOCUMENT DATE/PERIOD13 October - 13 November 1966REMARKS|     | PREPARED BY    | REPORT ANNOTATED ON SOURCE DOCUMENT | ABOVE DATA VERIFIED CORRECT. BASED UPON SOURCE DOCUMENT CITED || --- | -------------- | ----------------------------------- | ------------------------------------------------------------- || X   | OSA            | DATE                                | SIGNATURE V. F. Palmer                                        ||     | C & L DIVISION |                                     |                                                               ||     | C & T DIVISION |                                     |                                                               |FORM4-65 1451aSECRET(4-10)