[104-10225-10006.pdf — page 204]
# SECRET(When Filled In)# REPORT OF SERVICE ABROADTO: Office of Personnel, Control Division, Statistical Reporting Branch|            |         |             |        || ---------- | ------- | ----------- | ------ || SERIAL NO. | LAST    | NAME        | MIDDLE ||            | (Print) | FIRST       |        || 226130     | FLORIB  | 7-24 DANIEL |        |INSTRUCTIONSUSE APPROPRIATE SPACE BELOW TO REPORT DATA FOR EITHER PCS OR TOY. INSERT APPROPRIATE CODE NUMBER IN "CODE" COLUMN TO DESIGNATE WHETHER SUBMISSION IS OF BASIC DATA, CORRECTION, OR CANCELLATION (One only) REPORT DATES BY USING THE NUMBER FOR THE MONTH, AND LAST TWO DIGITS ONLY FOR YEAR. REFER TO OFI NO. 58 REVISEO.PCS DATES OF SERVICE| MONTH | DAY   | YEAR  | MONTH | DAY   | YEAR  | TYPE OF DATA    | CODE | O/P USE ONLY |         |       || ----- | ----- | ----- | ----- | ----- | ----- | --------------- | ---- | ------------ | ------- | ----- || 25-26 | 27-28 | 29-30 | 31-32 | 33-34 | 35-36 |                 |      |              |         |       ||       |       |       |       |       |       | 1. PCS (Basic)  | 37   | 38 39        |         |       ||       |       |       |       |       |       | 3. CORRECTION   |      |              |         |       ||       |       |       |       |       |       | 5. CANCELLATION |      |              |         |       ||       |       |       |       |       |       |                 |      |              | COUNTRY | CODE  ||       |       |       |       |       |       |                 |      |              |         | 40-42 |TDY DATES OF SERVICE| MONTH | DAY   | YEAR  | MONTH | DAY   | YEAR  | TYPE OF DATA    | CODE | O/P USE ONLY | ARLA(S) | CODE  || ----- | ----- | ----- | ----- | ----- | ----- | --------------- | ---- | ------------ | ------- | ----- || 25-26 | 27-28 | 29-30 | 31-32 | 33-34 | 35-36 |                 |      |              |         | 40-42 || 12    | 14    | 77    | 12    | 15    | 77    | 2. TOY (Basic)  | 37   | 38 39        | CANADA  | 120   ||       |       |       |       |       |       | 4. CORRECTION   |      |              |         |       ||       |       |       |       |       |       | 6. CANCELLATION | 2    |              |         |       |OFFICE OF PERSONNEL USE ONLY - PUNCH AREASOURCE DOCUMENT AND CERTIFICATIONTRAVEL VOUCHERDISPATCHCABLEDUTY STATUS OR TIME AND ATTENDANCE REPORTOTHER (Specify)DOCUMENT IDENTIFICATION NO.DOCUMENT DATE/PERIOOREMARKS|                                 |                                                                || ------------------------------- | -------------------------------------------------------------- || PREPARED BY                     | REPORT ANNOTATED ON CONTROL DOCUMENT                           || nra                             | DATE                                                           || ![checkbox] B L Division. CTBO. | 2/1/73                                                         || ![checkbox] B T Division        | ABOVE DATA CERTIFIED CORRECT, BASED UPON SOURCE DOCUMENT CITED ||                                 | SIGNATURE                                                      ||                                 | Akinit I turn                                                  |THIS REPORT WILL BE FILED IN THE OFFICE OF PERSONNEL IN THE INDIVIDUAL'S OFFICIAL PERSONNEL FOLDERSECRET