~ iinkds hohe x VOvite : sD a CE bw DO NOT CoM COMPLETE FOR 1} a — ~ oumt LS) tei AUTMENTECAT 10% oF Sionats VTER RYO vemiricattoy or Vyaeag ff \; ina ee ee gene eee ns san bemene sme neta gn ee | G | maze oF EMPLOVEE (tewe) pattcfeos ftes §-f)] mask oF SUPERVISOR (Erue) lcate (feow item §.2)|2 a \ | ¥] Newton. Scott—Miler _lie Jan_G4____ ee ee _ _ 19 Bj mame AND SEGNWATURE OF CFFICTAL AT READQUARTERS | DATE 4 Zi autmorize£o TO AUTHENTICATE SEGNSTYRES an r [ VIGIFY DATA Ih PTEMS NOS. 1 TeROUGH 7, GELOmr | a ee ——-— oe aaeemamemediies io] Pod — TO BE COMPLETED BY EMPLOYEE } 3. CURRENT POSITION TIPLE AnD Gaane | Ta, DATE GF PCS ARRIVAL Ih FIELG OM THE Tour j Chief of Station 9_Sept_1961_ 5. CURRENT STATION OF FIELD HAZE \ 28. CRPECTED DATE OF OEP AAR. . ru FB OM e Le “sy Phay "idee OATE OF BIRTH Mar 1926 @. SERVICE OESIGNATION (af known) 2. GRADE 6. GIHER OUTY. STATIONS OR FIELD O8505 OURING CURRTNF TOUR FO. EMPECTED OATE OF AABEVAL - AT NEADQUARTLAS PCS Chief of Station : Lo ; 9. PREFERENCE FOR MERE ASSIGNMENT? BRITE A DALEF DESCRIPTION OF TME TYPE OF WORK YOU BOULD FREFER FOR YOUR KEXT ASSIGNMENT IF tT OUFFEAS FROM ~ THAT INGICATED IM ITEM 4O. 8, ABOVE. IF YOU HAVE MORE THAN ONE PALFIQENCT, ENDICATE YOUR CHOICES. a. im OROTR TO iMCHT ASE YOUR VALUE 0 rug ORGAMELATION feoter Bi. FNOECATE SHAY TRAIRENG YOU BELIEVE YOu SHOULD Have to catalog of courees, if avaisablea): aah ooee go cesouest eetvieve SECRET 3°48 20 deertons,
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