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104-10120-10274,

Se

ial

2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992

REQUE

FOR PERSONNEL ACTION

2. Name (Last-First-Middle)

13. Date Of Birth

Mo.

Da.

43133

6. 65-EOD

Yr.

Moi Da

FIL

Yr.

BLAN

8, CSC Reimt:

11:

Code

Nor 2001

9

: CSC Or Other Legal Authority

Vet: Pre

None 0:

5 Pt-1

10 Pt-2:

11. FEGLI

Yes-1 Code

No-2

14. Organizational Designations

MR ONESE

16. Dept?-Field

Dept

Code

UStld

Frgn

21. Grade & Step

17. Position Mitle

22. Salary Or Rate

972

27. Nature Of Action

31. Organizational Designations

10. Apmt. Affidav.

Mo.

Da.

Yr.

12

Mo

JOCA 407

No Codo

PREVIOUS ASSIGNMENT

Code :

15. Location Of Official Station

F RECORDED

CONTROL SEES

180Pc

23.1

SD

24. Date Of Grade

PSI Due

26. Appropriation Number

Code

28.

Mo.

3110 153

ACTION

Eff. Date

Da.

Yra

10191247

29. Type Of Employee

Code 30. Separation bata

PRESENT ASSIGNMENT

Code

32. Location Of Official Station

Station code

33: Dept

Field a 34, Position Title

Dept

Sode

usfld

Frgn

38. Grade & Step

39. Salary Or Rate

1534

Docup, Series

40.

SD

41. Date Of Grade 1 42: PSI Duer

MenAppropriationau

Mon Daan

Mos

Da

A. Requested By (Name And Tille

B.

For Additional Information Call (Name & Telephone Ext.)

SOURCE OF REQUEST

Reques eaRloved By Signature are lite

g& SUP 1980

Clearance da

A. Career Board

B. Pos. Control

C. Classification

Gmarks

Signature

CLEARANCES

•Date

Doledrance.

ALONG

•ed B

Engle Signatur

chinal Security

FOR: NO.

MAR

57

1152

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