[104-10438-10237.pdf — page 176]
# ROUTING AND RECORD SHEETSUBJECT: (Optional)FROM:AC/SE5B4803TO: (Officer designation, room number, and building)|                     | DATE                     | OFFICER'S INITIALS | COMMENTS (Number each comment to show from whom to whom. Draw a line across column after each comment.) || ------------------- | ------------------------ | ------------------ | ------------------------------------------------------------------------------------------------------- || 1. O/SA/DO/O 2D0109 | RECEIVED FORWARDED 24 th |                    |                                                                                                         || 2.                  |                          |                    |                                                                                                         || 3. Shep             |                          |                    |                                                                                                         || 4.                  |                          |                    |                                                                                                         || 5.                  |                          |                    |                                                                                                         || 6.                  |                          |                    |                                                                                                         || 7.                  |                          |                    |                                                                                                         || 8.                  |                          |                    |                                                                                                         || 9.                  |                          |                    |                                                                                                         || 10.                 |                          |                    |                                                                                                         || 11.                 |                          |                    |                                                                                                         || 12.                 |                          |                    |                                                                                                         || 13.                 |                          |                    |                                                                                                         || 14.                 |                          |                    |                                                                                                         || 15.                 |                          |                    |                                                                                                         |EXTENSION JUN 24 NO. 10 26 AM '779045 DATE 23 June 1977![photo of form 610]