For use of this form, see At 380-3; the proponant a
C.
I ACTION QFFICTE(S)
  is the Offka, Assislani Chief of Staff for InOolliganct.
SECTION A - GENERAL
FROM:
SUSPENSE DATEiSv
REGISTER OR CONTROL NO,
CONTROL. LOG CLASSIFF NUMBER OF DESCRIPTION (Type. File Ref. Unclassified Subjecl DATE OF ORIGINATOR
OR FILE NO. CATION COPIES ot Short Tille and Number of IndorsemewslInds) DOCUMENT
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NOTH NG FOLLOWS ............. ...........
     SECTION 8 - ROUTING
-TO------T COP~NO -PRI =TE -I~A`ME
DATE
SECT ION C - DESTRUCTION CERTIFICATE (Cheek appopriale block)
MATERIAL DESCRIBED HEREON HAS BEEN~ GE OR C&P-Tw0i
D DESTROYED El TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR
                   DATE WINTED NAME OF CUSTODIAN OR REP SIGNATURE
P ii -14fE 1) -NA M i-07 TIFY-ING/DESTR. OFF. SIGNATURE
O'F'- -W1TN-ESSIN-GOF"C-tAL
SECTION D - REPRODUCTION AUTHORITY
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A
UMB~-W'67-CO-~I~E-Ii5 _BCR-EP-RODUCE-0- XG~iTO-4-IZED -DY
SECTION E - RECEIPT/TRACER ACTION tCheck appropriate block)
ORIECEiPT OF DOCUMENTiS) ACKNOWLEDGED DOCUMENT(S) HAVE NOT BEEN RECEIVED
0TRACER ACTION~ SIGNED RECEIP'r FOR MArERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE MINTED NAME. GRADE OR TITLE SIGNATURE
DAFORM39 1Ju179
                        fAIRMIWO788RO01 9,G03&0QQ&Zx,9
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