SECRET (When Filled In)
VERIFIED RECORD OF OVERSEAS SERVICE
To: Office of Personnel, Statistical Reporting Branch, ROOM 5 E 2506 Headquarters
EMPLOYEE SERIAL NO. LAST NAME OF EMPLOYEE FIRST MIDDLE OFFICE/COMPONENT
B-8 (Print) T-18 B-18
Doe 32 Woods James 5 45
INSTRUCTIONS
USE APPROPRIATE SPACE BELOW TO REPORT DATA FOR OTHER PCS OR TDY. INSERT APPROPRIATE CODE NUMBER IN "CODE" COLUMN OPPOSITE THE INFORMATION TO BE REPORTED (I.E. BASIC DATA, CORRECTION, OR CANCELLATION (One only)). REPORT DATES BY USING THE NUMBER FOR THE MONTH, AND LAST TWO DIGITS ONLY FOR THE YEAR.
PCS DATES OF SERVICE
TYPE OF DATA CODE DEPARTURE ARRIVAL DEPARTURE COUNTRY UNIT
PCS (Basic) 1 20 31 31 1 9 29 44 64 Japan 375
Correction
Cancellation
TDY DATES OF SERVICE
TYPE OF DATA CODE DEPARTURE RETURN AREA(S) UNIT
TDY (Basic) 1 20 31 31 1 9 29 31 31 1 9 29 40-41
Correction
Cancellation
SOURCE OF RECORD DOCUMENT
X MY STATUS IN TIME AND ATTENDANCE REPORT
Other (Specify):
DOCUMENT IDENTIFICATION NO. DOCUMENT DATE/PERIOD
8/23 9/23/64
PREPARED BY REPORT VERIFIED ABOVE DATA VERIFIED CORRECT, BASED UPON SOURCE DOCUMENT CITED
X SOURCE DOCUMENT
C. J. Smith 10/16/64 R. A. Wilson
SECRET