Francesco/who-killed-jfk huggingface dataset:
[104-10291-10000.pdf — page 200]
RNPJerome FOXREADING ANALY313 PROGRAM## OBJECTIVES OF PROGRAM1.  To determine employees' proficiency level in scanning, extensive and intensive reading tasks.2.  To determine employees' degree of reading versatility. Versatility is defined as the ability to apply the general reading skills appropriately to various reading situations.3.  To ascertain the probable gain which would accrue from further training in reading skills.4.  To inform each employee concerning his relative reading proficiency in scanning, extensive and intensive reading and his versatility.READING COMPREHENSION TESTS: Measures speed and accuracy of basic comprehension skills. Complete and objective understanding, analysis, and interpretation are required in this test.EXTENSIVE READING TEST: Measures the degree of proficiency in informational, or general reading.INTENSIVE READING TEST: Measure reading proficiency in acquiring basic knowledge of new subjects.SCANNING TESTS: Measure proficiency in the organization and location of specific information, main ideas, and questions.## ANALYSIS OF READING PERFORMANCE|                               | Poor | Fair | Avg. | Exc. | Sup. || ----------------------------- | ---- | ---- | ---- | ---- | ---- || 1. Basic Comprehension Skills |      | X    |      |      |      || 2. Extensive Techniques       |      |      | X    |      |      || 3. Intensive Techniques       |      | X    |      |      |      || 4. Scanning Techniques:       |      |      |      |      |      || Recall for Main Idea          |      |      | X    | X    |      || Quantitative                  |      |      | X    |      |      || Organization                  |      |      |      | X    |      || 5. Versatility                |      |      | X    |      |      |## COMMENTS AND RECOMMENDATIONS:Mr. Fox scans for specifics quickly and accurately; he scans for main ideas satisfactorily, but could improve his use of that technique with practice. Poorer comprehension in intensive reading could be caused by lack of concentration or failure to organize information while re-reading. Extensive reading could be improved by adjusting rate to read selectively for pertinent information. The Reading Improvement Course would be of benefit in developing use of more diversified skills.MJHFOR THE DIRECTOR OF TRAININGFrances CookChief Instructor
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# SECRET# TRAINING EVALUATION -- BASIC ORIENTATIONSECTION INAME OF STUDENT: FOX, JeromeIDENTIFYING INFORMATION:DATE OF BIRTH: 9 October 1928END DATE: Juno 155DATES OF COURSE: 6 - 23 September 1955OFFICE:PROJECTED ASSIGNMENT OR PRESENT POSITION: Identification SpecialistSECTION IICHARACTERISTICS OF THE COURSEMaterial in this course is presented primarily by lecture, and exhibit; several seminars and discussions are also held. The rating on Introduction to Intelligence is determined by the results of one multiple choice test, based on lecture material; the rating on Communism and the USSR is de- termined by one multiple choice test covering the lecture and readings.SECTION IIIOBJECTIVESA. The Basic Orientation Course is designed to provide the student with information in the following areas:1.  Introduction to Intelligencea. Organization for national security, with emphasis on the intelligence community and the organization and mission of CIA as it fits into the whole national security effort.b. The principles and methods of intelligence, emphasizing the substantive components of CIA, considering the types of information, and the collecting, processing, and disseminating functions.c. An introduction to clandestine activity, with emphasis on the functions of the clandestine services.2. Communism and the USSRThis deals with Marxist theory, the history of Socialism and Communism, Communist activities outside the USSR, history and geography of Russia, political structure of the USSR, Soviet foreign policy, and potentialities and vulnerabilities of the USSR.B. Throughout the three weeks of the course discussions and conferences deal with the American Thesis.SECTION IVSTUDENT ACHIEVEMENT RATINGSThe numbers placed in the columns below show how many students received each rating. An asterisk (*) shows the rating this student received.| SUBJECT                      | HOURS | FAIL | POOR | SATISFACTORY | EXCELLENT | SUPERIOR || ---------------------------- | ----- | ---- | ---- | ------------ | --------- | -------- || INTRODUCTION TO INTELLIGENCE | 64    | 4    | 9    | 30           | 45 *      | 32       || COMMUNISM AND THE USSR       | 56    | 2    | 14   | 40 *         | 37        | 29       |SECTION VCOMMENTSINDICATE ANY STRONG AND WEAK POINTS OF THE STUDENT. OR ANYTHING THAT MAY HAVE INFLUENCED HIS PERFORMANCE IN THE COURSEFOR THE DIRECTOR OF TRAINING:SIGNATURE OF CHIEF INSTRUCTOR: Edward J. O'SaraFORM NO. 450 OBSOLETE PREVIOUS EDITIONS.SECRET(45)
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# SECRETCOVER CONTROL OF RETIREMENT PROCESSING-TO: Retirement Operations BranchOffice of PersonnelRETIREE: *XXXXX Fox*CATEGORY OF EMPLOYMENTFILEDATEOn the basis of a review of the records of the Cover & Commercial Staff, the following action is to be taken on processing retirement documentation for the person named above.| TYPE RETIREMENT | CIVIL SERVICE | X                               | CIARDS               | DATE                |          |     || --------------- | ------------- | ------------------------------- | -------------------- | ------------------- | -------- | --- || COVER           | OVERT ROUTINE | COVERT (OFFICIAL COVER) LOCK-UP | COVERT (NOC) SPECIAL | RETENTION OF AWARDS | YES      | NO  || CORRESPONDENCE  | X             | OVERT                           |                      | COVERT              | THRU CCS |     || ANNUITY PAYMENTS SHOULD BE | FINANCES | U.S. GOVT. CHECK | OTHER | (Payment inc. structions follow) || TAX DOCUMENTATION SHOULD BE | CIA | CSC | OTHER | (MEMO FOLLOWS) || REQUEST TRANSFER OF FUNDS FROM CIVIL SERVICE COMMISSION | YES | NO | INTERNAL TRANSFER || FEGLI | X | OVERT | INSURANCE |  |  || TYPE OF HOSPITALIZATION CARD: | GEHA | COVERT | MAINTAIN RECORDS INTERNALLY ONLY || AUTHORIZATION TO CONVERT INSURANCE | X | YES | CONVERSION MUST BE APPROVED BY CCS || RESERVE                    |     |     |       |        || -------------------------- | --- | --- | ----- | ------ || MEMBER OF CIVILIAN RESERVE | YES | NO  | OVERT | COVERT |REMARKSOTHER INSTRUCTIONS AS FOLLOWS:THIS SECTION TO BE COMPLETED BY OFFICE OF SECURITYCHIEF, COVER SUPPORT BRANCH COVER & COMMERCIAL STAFFNO SECURITY OBJECTIONS TO ABOVE.CHIEF, EMPLOYEE ACTIVITY BRANCH, OFFICE OF SECURITYFORM 3429SECRETE-2. IMPDET CL. BY: 0076227 - OFF. PERS. FILE ROOM
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# DESIGNATION OF BENEFICIARY FEDERAL EMPLOYEES GROUP LIFE INSURANCE PROGRAMStandard Form No. 54January, 1969U.S. Civil Service CommissionFPM Supplement 290-154-105IMPORTANTRead instructions on back of duplicate before filling in this formINFORMATION CONCERNING THE INSURED:NAME (Last) (First) (Middle) DATE OF BIRTH (Month, day, year)Jerome (M) October 9, 1938PLACE AN "X" IN THE APPROPRIATE BOX BELOW TO SHOW WHETHER YOU ARE:[ ] AN EMPLOYEE [ ] RETIRED OR AN APPLICANT FOR RETIREMENT [ ] RECEIVING FEDERAL EMPLOYEES COMPENSATION BENEFITS OR AN APPLICANT FOR SUCH BENEFITSIF YOU ARE RETIRED OR RECEIVING FEDERAL EMPLOYEES COMPENSATION GIVE YOUR "CSA", "CSI", "A", or "X" NUMBERDEPARTMENT OR AGENCY IN WHICH PRESENTLY EMPLOYED (If retired, former department or agency):(Department or agency) (Bureau) (Division) (Location City, State, and ZIP Code)I, the individual identified above, canceling any and all previous Designations of Beneficiary under the Federal Employees Group Life Insurance Program heretofore made by me, do now designate the beneficiary or beneficiaries named below to receive any amount of LIFE INSURANCE and ACCIDENTAL DEATH INSURANCE due and payable at my death. I understand that this Designation of Beneficiary will remain in full force and effect, with respect to any amount payable, unless or until canceled by me in writing, or until such time as it is automatically canceled (see regulation "f" on reverse side of duplicate copy).INFORMATION CONCERNING THE BENEFICIARY OR BENEFICIARIES (SEE EXAMPLES OF DESIGNATIONS):Type or print first name, middle initial, and last name of each beneficiaryType or print address (Including ZIP Code) of each beneficiaryRelationshipShare to be paid to each beneficiaryKaren Smith Fox 5019 Coney Ct.Daughter 50%Annandale, Va. 22003Peter James Fox 5019 Coney Ct.Son 50%Annandale, Va. 22003For each type of insurance (regular and optional): (1) I hereby direct, unless otherwise indicated above, that if more than one beneficiary is named, the share of any beneficiary who may predecease me shall be distributed equally among the surviving beneficiaries, or entirely to the survivor, (2) I understand that this Designation of Beneficiary shall be void if none of the designated beneficiaries is living at the time of my death.I hereby specifically reserve the right to cancel or change this Designation of Beneficiary at any time without knowledge or consent of the beneficiary.(Date of signature-Month, day, year)(Signature of Insured)WITNESSES TO SIGNATURE (A witness is ineligible to receive payment as a beneficiary):(Signature of witness)(Signature of witness)(Number and street)(Number and street)(City, State, and ZIP Code)(City, State, and ZIP Code)PRINT OR TYPE NAME AND ADDRESS (Including ZIP Code) OF INSUREDTHIS SPACE RESERVED FOR RECEIVING AGENCYJUL 9 1974(Indicate date and by whom received).SEE REVERSE SIDE OF DUPLICATE COPY FOR INSTRUCTIONS ON WHERE TO FILE THESE FORMS. DO NOT FILE WITH THE OFFICE OF FEDERAL EMPLOYEES GROUP LIFE INSURANCE
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# SECRETELECTION, DECLINATION, OR WAIVEROF LIFE INSURANCE COVERAGEFEDERAL EMPLOYEES GROUP LIFE INSURANCE PROGRAMIMPORTANTAGENCY INSTRUCTIONSON BACK OF ORIGINALTO COMPLETE THIS FORM-1. FOLLOW THESE GENERAL INSTRUCTIONS:*   Read the back of the "Duplicate carefully before you fill in the form.*   Fill in BOTH COPIES of the form. Type or use ink:*   Do not detach any part.2. FILL IN THE IDENTIFYING INFORMATION BELOW (please print or type):NAME (Last, First, Middle)FOX, JeromeDATE OF BIRTH (month, day, year) SOCIAL SECURITY NUMBEROctober 9, 1928102 22 9136EMPLOYING DEPARTMENT OR AGENCY017974LOCATION (City, State, ZIP Code)3. MARK AN "X" IN ONE OF THE BOXES BELOW (do NOT mark more than one):Mark here if you WANT BOTH optional and regular InsuranceELECTION OF OPTIONAL (IN ADDITION TO REGULAR) INSURANCEI elect the $10.000 additional optional insurance and authorize the required deductions from my salary, compensation, or annuity to pay the full cost of the optional insurance. This optional insurance is in addition to my regular insurance.(A)Mark here if you DO NOT WANT OPTIONAL but do want regular insurance.DECLINATION OF OPTIONAL (BUT NOT REGULAR) INSURANCEI decline the $10,000 additional optional insurance. I understand that I cannot elect optional insurance until at least 1 year after the effective date of thus declination and unless at the time I apply for it I am under age 60 and present satisfactory medical evidence of insurability. I understand also that my regular insurance is not affected by this declination of additional optional insurance.(B)Mark here if you WANT NEITHER regular nor optional insuranceWAIVER OF LIFE INSURANCE COVERAGEI desire not to be insured and I waive coverage under the Federal Employees Group Life Insurance Program. I understand that I cannot cancel this waiver and obtain regular insurance until at least 1 year after the effective date of this waiver and unless at the time I apply for insurance I am under age 50 and present satisfactory medical evidence of insurability. I understand also that I cannot now or later have the $10,000 additional optional ional insurance unless I have the regular insurance.(C)4. SIGN AND DATE. IF YOU MARKED BOX "A" OR "C", COMPLETE THE "STATISTICAL STUB." THEN RETURN THE ENTIRE FORM TO YOUR EMPLOYING OFFICE.SIGNATURE (do not print)![signature]DATEFebruary 19, 1968FOR EMPLOYING OFFICE USE ONLY(official, receiving date stamp)OFFICE OF PERSONNELFEB 28 01 12 68See Table of Effective Dates on back of OriginalORIGINAL COPY-Retain in, Official Personnel FolderSECRETSTARDARD FORM No. 176-1JANUARY 1964(for use only until April 14, 1968)176-10)
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SECRET13 December 1973Letter of CommendationTO: Jerome Fox1. I heroby commend you for your performance in a sensitive Station operation which was completed on 3 and 4 December 1973. Your role ensuring the security of the operation was of the utmost Importanco. To your credit you remained alert and carried out your duties professionally, dospito the initial frustrations and the long hours involved. In doing so you have contributed to the successful accomplishment of a priority objective of our organization.2. A copy of this letter will be placed in your official personnel file.![signature of James W. Nottacker]James W. NOTTACKERChief of StationSECRET
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# CONFIDENTIAL# RESIDENCE AND DEPENDENCY REPORTAN ORIGINAL OF THIS FORM WILL BE EXECUTED AT EACH EMPLOYEE AT THE TIME OF HIS APPOINTMENT AND WHEN A CHANGE OCCURS IN THE INFORMATION SHOWN BELOW. ITEMS OF CHANGE MAY BE REPORTED IN THE APPROPRIATE BLOCKS WITHOUT COMPLETING THE REMAINDER OF THE FORM EXCEPT THE EMPLOYEE'S SIGNATURE AND DATE. WHEN EXECUTING ITEM 4 ALSO COMPLY WITH MR 30-7 PERSONNEL EMERGENCY AND LOCATOR RECORDS. THIS FORM WILL BE COMPLETED ONLY BY HEADQUARTERS PERSONNEL AND NOT SENT TO THE FIELD. FORM WILL BE FILED IN THE EMPLOYEE'S OFFICIAL PERSONNEL FOLDER.## GENERALNAME OF EMPLOYEE: FoxFIRST: JeromeSOCIAL SECURITY NUMBER: 102-22-9186MARITAL STATUS (check one):SINGLE: :x:MARRIED:SEPARATED:DIVORCED:WIDOWED:ANNULLEDIF MARRIED, PLACE OF MARRIAGE: New York, N.YDATE OF MARRIAGE: 2 Sept 1956IF DIVORCED, PLACE OF DIVORCE DECREE: DATE OF DECREE:## MEMBERS OF FAMILYNAME OF SPOUSE: Mary Ann FoxADDRESS: 5019 Cockney Ct. Annandale, Va 22003TELEPHONE NO: 978-6527NAME OF CHILDREN:Laura Louise FoxADDRESS: SameDATE OF BIRTH: F 22 Nov 59Peter Jerome FoxADDRESS: SameDATE OF BIRTH: M 17 Feb 61NAME OF FATHER (or male guardian):ADDRESS:TELEPHONE NO.DeceasedNAME OF MOTHER, INCLUDING MAIDEN NAME (or female guardian):ADDRESS:TELEPHONE NO.DeceasedWHAT MEMBERS OF YOUR FAMILY IF ANY, HAS BEEN TOLD OF YOUR AFFILIATION WITH THE ORGANIZATION IF CONTACT IS RE- QUIRED IN AN EMERGENCY?: Brother (staff Employee)3. OTHER RELATIVES WHO ARE DEPENDENT UPON ME FOR AT LEAST 51% OF THEIR SUPPORT AND MEET OTHER REQUIRE- MENTS IN TRAVEL REGULATIONS (HR 22-12). SPECIFY NAMES AND RELATIONSHIPS.NAME:DATE OF BIRTH:RELATIONSHIP:4. PERSON RESIDING IN U.S. TO BE NOTIFIED IN CASE OF EMERGENCYNAME: Traicor, AnnRELATIONSHIP: FriendHOME ADDRESS: 8815 Trifolger Ct. Springfield, VaBUSINESS ADDRESS: HousewifeHOME TELEPHONE NUMBER: 461-7237IS THE INDIVIDUAL NAMED ABOVE OBLIGATING OF YOUR AGENCY AFFILIATION (IF "NO" STATE NAME AND ADDRESS OF ORGANIZATION TO WHOM YOU OWE): USAFIS THE INDIVIDUAL AUTHORIZED TO MAKE DECISIONS ON YOUR BEHALF IN THE EVENT YOU ARE INCAPACITATED (IF "NO" STATE NAME AND ADDRESS OF PERSON, IF ANY, WHO CAN MAKE SUCH DECISIONS IN CASE OF EMERGENCY.) : YesDOES THIS INDIVIDUAL KNOW THAT HE HAS BEEN DESIGNATED AS YOUR EMERGENCY ADDRESSEE? (IF answer is "NO" explain why in item 6.) : YesThe persons named in item 2 or 3 above may also be notified in case of emergency. IF SUCH NOTIFICATION IS NOT DE- SIRABLE BECAUSE OF HEALTH OR OTHER REASONS, PLEASE SO STATE IN ITEM 6 ON THE REVERSE SIDE OF THIS FORM.
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CONFIDENTIAL(When Filled In)VOLUNTARY ENTRIES5. Experience in the handling of employee emergencies has shown that the absence of certain personal data often delays and complicates the settlement of estate and financial matters. The information requested in this section may prove very useful to your family or attorney in the event of your disability or death and will be disclosed only when circumstances warrant.INDICATE NAME AND ADDRESS OF ANY BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS, AND THE NAMES IN WHICH THE ACCOUNTS ARE CARRIED:Northern Virginia Bank Acct # 49298ARE YOU A MEMBER OF THE NORTHWEST FEDERAL CREDIT UNION? [X] YES [ ] NOIF YES, DO YOU HAVE A JOINT ACCOUNT? [ ] YES [X] NO (If "Yes" where is document located?)HAVE YOU COMPLETED A LAST WILL AND TESTAMENT? [X] YES [ ] NONorthern Virginia Bank, Rosemworth BranchHAVE YOU PREPLANNED AN ARRANGED GUARDIANSHIP OF YOUR CHILDREN IN CASE OF COMMON DISASTER TO BOTH PARENTS? [X] YES [ ] NO (If "Yes" give name(s) and address)HAVE YOU EXECUTED A POWER OF ATTORNEY? [ ] YES [X] NO (If "Yes" who possess the power of attorney?)6. ADDITIONAL DATA AND/OR CONTINUATION OF PRECEDING ITEMS7. RESIDENCE DATA - TO BE COMPLETED ONLY BY EMPLOYEES ENTERING ON DUTY. (No Approval Required)RESIDENCE WHEN EMPLOYED (Full Address)PERMANENT PLACE OF RESIDENCE AS DEFINED IN HR 22-3 (Full Address)8. CHANGE IN PERMANENT PLACE OF RESIDENCE (See HR 22-3) (To Be Completed by Employee Desiring Such Change While Assigned to Headquarters)FULL ADDRESSDEPUTY DIRECTOR OR DESIGNEE DATEDIRECTOR OF PERSONNEL (when applicable per HR 22-3) DATESIGNED ATDATESIGNATUREWash DC 4 Oct 73CONFIDENTIAL
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# SECRET## TURMENT QUESTIONNAIRENAME: Jerome FoxDATE RECEIVED AT HEADQUARTERS:14 March 197314 Mar 73DISPATCH NUMBER:FPMT-15218DATE: 14 Mar 73George Kalaris1. DATE OF BIRTH: 10/9/282. SERVICE DESIGN: D3. YOUR CURRENT POSITION, TITLE AND GRADE: Ops Ofcr, G8-134. STATION OR BASE: Manila5. CRYPT FOR CURRENT COVER: MIHALLUX6. DATE OF PCS ARRIVAL IN FIELD (2nd tour): 29 June 71   6a. REQUESTED DATE OF DEPARTURE: 1 July 1973   6b. EXPECTED DATE OF CHECK-IN AT HQ: 1 August 1973   6c. DESIRED DATE TO REPORT TO DUTY AFTER LEAVE: 1 September 19737. NUMBER AND AGES OF DEPENDENTS WHO WILL TRAVEL WITH YOU:   Wife; Dau - 13; Son - 128. PERSONAL CIRCUMSTANCES THAT SHOULD BE CONSIDERED IN DETERMINING NEXT ASSIGNMENT:   Wife cannot travel by air for medical reasons. Separate travel has been utilized in past assignments with principal and dependents going by air and wife following by ship.9. LIST YOUR MAJOR DUTIES DURING CONRENT TOUR (See special note on transmittal form). (Also attach personal cover questionnaire in accordance with CS1-9-280-8):Referent on MHABYSS matters 1 July 1972 to present.Referent on MPWATCH matters prior to 1 July 1972.Recruit and handle unilateral agents.Backup liaison officer with official services.Station PERAMPART officer.10. TRAINING DESIRED:INDICATE WHAT TRAINING YOU BELIEVE YOU SHOULD HAVE DURING THE NEXT SEVERAL YEARS:None
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SECRET11. PREFERENCE FOR NEXT ASSIGNMENT.11a. DESCRIBE BRIEFLY THE TYPE OF DUTY YOU WOULD PREFERRED FOR NEXT ASSIGNMENT. IF DIFFERENT FROM THAT INDICATED IN ITEM NO. 9 ABOVE, IF YOU HAVE MORE THAN ONE PREFERENCE, INDICATE YOUR CHOICE.Supervise field unilateral and liaison MIHABYSS program.11b. INDICATE IF YOU DESIRE TO EXTEND YOUR CURRENT TOUR BY CHECKING IN APPROPRIATE BOX. ALSO INDICATE PREFERENCE FOR NEXT REGULAR ASSIGNMENT BY INSERTING 1, 2, 3 (for 1st, 2nd, and 3rd choice) IN REMAINING BOXES. COMPLETE ALL ALTERNATE CHOICES AND OPTIONS IN ALL CASES EVEN THOUGH YOU ARE REQUESTING AN EXTENSION OF YOUR TOUR.* EXTEND TOUR. 12 MONTHS AT CURRENT STATION TO 1 July 1974a. BE ASSIGNED TDY/TDTS FOR A TOUR OF DUTY. INDICATE YOUR CHOICE OF DIVISION OR OFFICE1ST CHOICE FE 2ND CHOICE WH 3RD CHOICE EUR.b. BE ASSIGNED TO ANOTHER FIELD STATION. INDICATE CHOICE OF GEOGRAPHIC AREA OR SPECIALIZATION1ST CHOICE Bangkok 2ND CHOICE Seoul 3RD CHOICE Singaporec. RETURN TO MY CURRENT STATIONTO BE COMPLETED BY FIELD STATION12. IN CONSIDERATION OF THE EXPERIENCE AND PERFORMANCE OF THE EMPLOYEE AND HIS PREFERENCE FOR NEXT ASSIGNMENT. INDICATE YOUR RECOMMENDATION FOR HIS NEXT ASSIGNMENT, AND, TRAINING.I believe that Subject could make a contribution as a case officer at a station with an active MHABYSS program. He knows the subject well and can get along with LNAGON personnel. His other strength lies in Communist Party operations either as a handler of recruited assets or as an analyst of doctrine. In light of the foregoing, Bangkok Station might well be an appropriate assignment. Should that not be practical, recommend that Subject be reassigned to HQs. In a component where his strengths can be utilized. If assigned at HQs, he should be given the-(CONT'D)13. IN CONSIDERATION OF THE EXPERIENCE AND PERFORMANCE OF THE EMPLOYEE, HIS PREFERENCE FOR NEAT ASSIGNMENT, AND THE STAFFING REQUIREMENTS OF YOUR COMPONENT, INDICATE YOUR COMPONENT'S RECOMMENDATION FOR HIS NEXT ASSIGNMENT AND TRAINING,Mr. Fox will be assigned to EA/PMI upon completion of his tour and homo leave. He has been so advised.DATE 21 Jul 73 TITLE C/EA/PERSONNELFOR USE BY CAREER SERVICE: Ernest L. Hardt![signature]14. APPROVED ASSIGNMENT:15. EMPLOYEE NOTIFIED BY DISPATCH NO.:CABLE NO.:DATE:CAREER SERVICE REPRESENTATIVE:![signature]DATE:SECRET
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FRO - Jerome Fox - 14 March 1973Operations Review course and training in writing.
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SECRET(When Filled In)REPORT OF SERVICE ABROADFILEPUNCHEDTO: Office of Personnel, Transactions and Records Branch, Status SectionSERIAL NO.LAST (Prigt)017974 TexNAMEFIRST JERUMEMIDDLEINSTRUCTIONSUSE APPROPRIATE SPACE BELOW TO REPORT DATA FOR EITHER PCS OR TOY. 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 THO DIGITS ONLY, FOR YEAR, REFER TO OFI NO. 10. REVISEDPCS DATES OF SERVICE| ARRIVAL O/S | DEPARTURE O/S | TYPE OF DATA | O/P USE ONLY | COUNTRY | CODE            |                |      |       |        |       || ----------- | ------------- | ------------ | ------------ | ------- | --------------- | -------------- | ---- | ----- | ------ | ----- || MONTH       | DAY           | YEAR         | MONTH        | DAY     | YEAR            |                | CODE |       |        |       || 25-26       | 27-28         | 29-30        | 31-32        | 33-34   | 35-36           | 1. PCS (Basic) | 37   | 38 39 | MANIIA | 40-42 || 05 22 69    |               |              |              |         | 3. CORRECTION   | 1              |      |       | 575    |       ||             |               |              |              |         | 6. CANCELLATION |                |      |       |        |       |TOY DATES OF SERVICE| ARRIVAL O/S | DEPARTURE O/S | TYPE OF DATA | O/P USE ONLY | AREA(S) | CODE  |                 |      |       |     |       || ----------- | ------------- | ------------ | ------------ | ------- | ----- | --------------- | ---- | ----- | --- | ----- || MONTH       | DAY           | YEAR         | MONTH        | DAY     | YEAR  |                 | CODE |       |     |       || 25-26       | 27-28         | 29-30        | 31-32        | 33-34   | 35-36 | 2. TDY (Basic)  | 37   | 38 39 |     |       ||             |               |              |              |         |       | 4. CORRECTION   |      |       |     | 40-42 ||             |               |              |              |         |       | 6. CANCELLATION |      |       |     |       |OFFICE OF PERSONNEL USE ONLY - PUNCH AREASOURCE DOCUMENT AND CERTIFICATIONTRAVEL VOUCHERDISPATCHCABLEDUTY STATUS OR TIME AND ATTENDANCE PEPORTOTHER (Specify) PER DivisionDOCUMENT IDENTIFICATION AV.DOCUMENT DATE/PERIODREMARKSPREPARED BYREPORT ANNOTATED ON CONTROL DOCUMENTABOVE DATA CERTIFIED CORRECT, BASED UPOR SOURCE DOCUMENT CITLODATE 6/2/71SIGNATURE Jerry W. PonnyTHIS REPORT WILL BE FILED IN THE OFFICE OF PERSONNEL IN THE INDIVIDUAL'S OFFICIAL PERSONNEL FOLDERFORM 1451aSECRET