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REFERENCE REQUEST-FEDERAL RECORDS CENTERS NOTE: Use a separate form for each request. <br /> SECTION 1—TO BE COMPLETED BY REQUESTING AGENCY <br /> ACCESSION NO. AGENCY BOX NUMBER RECORDS CENTER LOCATION NUMBER <br /> - OF Ut^ <br /> DESCRIPTION OF RECORD(S)OR INFORMATION REQUESTED <br /> ❑ BOX <br /> T <br /> FOLDER(include file number and title) <br /> REMARKS <br /> NATURE OF SERVICE <br /> ❑ FURNISH COPY OF PERMANENT TEMPORARY <br /> RECORD(S)ONLY ❑ WITHDRAWAL ❑ LOAN OF RECORD(S) REVIEW IJ (SpecHy) <br /> SECTION 11—FOR USE BY RECORDS CENTER <br /> REMARKS <br /> ❑ RECORDS NOT IN CENTER CUSTODY ❑ RECORDS DESTROYED <br /> ❑ WRONG ACCESSION NUMBER—PLFJSE RECHECK <br /> ❑ WRONG BOX NUMBER—PLEASE RECHECK <br /> ❑ WRONG CENTER LOCATION—PLEASE RECHECK <br /> ADDITIONAL INFORMATION REQUIRED TO IDENTIFY RECORDS <br /> ❑ REQUESTED <br /> ❑ MISSING(Neither reeord(s),information nor charge card found in <br /> conwlner(s)speaftd) <br /> ❑ RECORDS rRNIOUSLY CHARGED OUT TO(Name,agency and date). <br /> D TIME SEARCHER'S <br /> ATE SERVICE <br /> REQUIRED INIT LS <br /> 1^ <br /> SECTION III—TO BE COMPLETED 13Y REQUESTING AGENCY <br /> NAME 7 REQUESTER TELEPHONE NO. ❑FTS D.%TE <br /> 7,.21_ RECEIPT OF RECORDS <br /> NAME AND <br /> ADDRESS <br /> OF AGENCY Requester please sign,date and return this form,joy <br /> (lndude ,I / file hem(s)listed above,ONLY if the block to righ!has ❑ <br /> sneer �/ beer,checked by the Records Center. <br /> eddre=s <br /> budding, <br /> room no. SIGNATURE DATE <br /> and Z(P <br /> Code) <br /> NSN 7510-W-682-6423 OPTIONAL FORM 11 (Rev.7-87) <br /> 501;-106 PREVIOUS EJ:-.ON USABLE NATIONAL ARCHIVES AND <br /> RECORDS ADMINISTRATION <br /> 36 CFR 1228.162 <br />