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Date <br />D TRANSMITTAL P Q <br />TO: (Name, ice symbol, room number, Initials" Date <br />bui dim , Agency/Post <br />V IV <br />8.' LL <br />3. �y( <br />,C -� <br />14. <br />Action File Note and Return <br />Approval For Clearance Per Conversation <br />As Requested For Correction Prepare Reply <br />Circulate For Your Information See Me <br />Comment Investigate Signature <br />Coordination Justify <br />REMARKS r ' rk 4 <br />VA <br />/� � �� ������ ♦ ✓_" P {i6+'� 4rJJJJJJ::::::CCCCCC555555 <br />s <br />aF.7y4 <br />:. S^4�xF fi"v"' �. �'✓1 aY ',' ,. 'lA �. +. ..iR L a` �k^ � `�f a1. <br />DO NOT use this form as a RECORD of approvals, concurrences, disposals, <br />clearances, and similar actions <br />FROM: (Name, org. symbol, Agency/Post) Room No. Bldg. <br />Phoe No. � �' <br />5041-102 6 hTIONAL F RM 41 (Rev. 7-76) _, <br />Prescribed by GSA <br />t} U.S. G.P.O.1980LL-311-156/1': FPMR (41 CFR) 101-11.206 <br />a <br />