## Page 1

SECRET to

completed)

POTENTIAL SOURCE DROP OR EXTENSION OF INTEREST NOTICE

2188SC-SD file Number)

(Date or Subilission)

SUBJECT:

(Specify: Drop

Drop Notice or Extension of Interest

TO:

WFASC-SD

1o (x) Reporting Unit: USAFAC

2. ( ) Source Identifying Data:

a.

bo

(Vate and place of Birth)

30

( ) Justification for Action:

ao Drop interest with prejudice.

Reason:

bo Drop interest without prejudice.

Reason: NO FURTHER EX"LOITABLE LACEMENI.

Other reason(S) for dropping interest.

do

Extension of Interest.

Reason:

Postponement

Section 6(3)

GLSSIFIED BY DIA

EXLIPT FROM GENERAL DECLASSIFICATION

SCHEDULE OF EXECUTIVE ORDER 11652

EXITPTION CATEGORY 2

DECLASSIFY ON August 2003

24:0

THEO. D. CARR

LTC, MI

Cormanding

& SECRET 30A T

completed

USAFAC Form Id

NW 55538 DocId: 32108732 Page 1

USATAC1 4 70 9/12

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