[104-10225-10006.pdf — page 212]
ADMINISTRATIVEInternal Use Only# REPORT OF SERVICE ABROADTO: Office of Personnel, Contol Division, Statistical Reporting Branch|            |                |          || ---------- | -------------- | -------- || SERIAL NO. | NAME           |          ||            | LAST           | FIRST    ||            |                | MIDDLE   || 236150     | (Print) *Lhor* | *Daniel* |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 USINGTHE NUMBER FOR THE MONTH AND LAST TWO DIGITS ONLY FOR YEAR. REFER TO OFI NO. 58. REVISED.## PCS DATES OF SERVICE|       | ARRIVAL O/S |       |       | DEPARTURE O/S |       |     | TYPE OF DATA |     | O/P USE ONLY | COUNTRY |       || ----- | ----------- | ----- | ----- | ------------- | ----- | --- | ------------ | --- | ------------ | ------- | ----- || MONTH | DAY         | YEAR  | MONTH | DAY           | YEAR  |     |              |     |              |         |       || 25-26 | 27-28       | 29-30 | 31-32 | 33-34         | 35-36 |     |              |     |              |         |       ||       |             |       |       |               |       | 1   | PCS (Basic)  | 37  | 38 39        |         | 40-42 ||       |             |       |       |               |       | 3   | CORRECTION   |     |              |         |       ||       |             |       |       |               |       | 5   | CANCELLATION |     |              |         |       |## TDY DATES OF SERVICE|       | ARRIVAL O/S |       |       | DEPARTURE O/S |       |     | TYPE OF DATA |     | O/P USE ONLY | AREA(S) |       || ----- | ----------- | ----- | ----- | ------------- | ----- | --- | ------------ | --- | ------------ | ------- | ----- || MONTH | DAY         | YEAR  | MONTH | DAY           | YEAR  |     |              |     |              |         |       || 25-26 | 27-28       | 29-30 | 31-32 | 33-34         | 35-36 |     |              |     |              |         |       || *1*   | *1*         | *77*  | *1*   | *2*           | *77*  | 2   | TDY (Basic)  | 37  | 38 39        | *WH*    | 40-42 ||       |             |       |       |               |       | 4   | CORRECTION   |     |              |         |       ||       |             |       |       |               |       | 6   | CANCELLATION |     |              |         |       |OFFICE OF PERSONNEL USE ONLY - PUNCH AREASOURCE DOCUMENT AND CERTIFICATION[X] TRAVEL VOUCHERCABLEDISPATCHDUTY STATUS OR TIME AND ATTENDANCE REPORTOTHER (Specify)DOCUMENT IDENTIFICATION NO.*L-II-10 77*DOCUMENT DATE/PERIOD*I Mar Thru 30 Sept 77*REMARKS|                  |                                     |                                                                || ---------------- | ----------------------------------- | -------------------------------------------------------------- ||                  | PREPARED BY                         | ABOVE DATA CERTIFIED CORRECT, BASED UPON SOURCE DOCUMENT CITED || *BCM*            | *C & L Division, CTRO*              |                                                                || *C & T Division* | REPORT ANNOTATED ON CONTROL DOCUMEN | SIGNATURE                                                      || DATE             | */ /77*                             | */-L_ C.*                                                      |THIS REPORT WILL BE FILED IN THE OFFICE OF PERSONNELIN THE INDIVIDUAL'S OFFICIAL PERSONNEL FOLDERADMINISTRATIVE-Internal Use Only(4-10)