[1]14-0000
[3]104-10110- 10291 2 ~ [2025 RELEASE UNDER THE PRESIDENT JOHN Fe KENNEDY ASSASSINATION RECORDS SOG. 1992
[5]_ E oe NOTIFICATION ‘OF ES.AAL SHMENT OR CANCELLATION
[6]at cls OF OFFICIAL COVER BACKSTOP
[8]8S NUM
[10]BE
[11]UOS- 26-3138 RETURN TO CIA
[13]BASIC COVER PROVIDED oan Kop a
[14]EFFECTIVE DATE — FORM 3254
[16]OPERATIONAL COVER PROVIDED (HHB 20-7)
[18]FoR TDY OTHER (Speci fy) . SUBMIT FORM 642 IMMEDIATELY TO- CHANGE | TELEPHONE
[20]LIMITATION CATEGORY, TO ATEGORY _
[21](HHB 20-7) ;
[23]SUBMIT FORM 642 IMMEDIATELY TO CHANGE, TELEPHONE
[24]LIMITATION CATEGORY TO CATEGORY
[25](HHB 20-7) 0-5 —
[27]FORM 3254 _T Cease) -2 TO BE ISSUED.
[29]— “=a SUBMIT FORM 2686 FOR _
[30](HHB 20-11) .- 1 —~ 4 HOSPITALIZATION CARD.
[32]: DO NOT WRITE IN- THIS BLOCK -
[33]SUBMIT FORM 1322 FOR ANY CHANGE AFFECTING THIS
[35]COVER. (HR 240-2e)
[37]SUBMIT FORM 1323 FOR TRANSFERRING COVER
[38]RESPONSIBILITY. CHR 240-2e)
[40]| fea. CATEGORY 1! a CATEGORY 11
[42]X {SUBMIT FORM 2688 FoR AGT HOSPITALIZATION CARD
[44]REMARKS AND/OR COVER HISTORY . af
[45]SJEJECT WELL Sb DENIED PGR IIIPE PLEION OF EPLOUEMT DYCEPT FOR US COVERNVENT
[46]ATTLICATIONS.
[50]COPY 1- CO/TRB OR CPD CONTROL VS/TW
[51]COPY 2- OPERATING COMPONENT ‘
[52]COPY 3-0S/SRD . s
[53]COPY 4-0¢/DO/T
[55]COPY 5. CC5-FILE
[57]“FORM
[58]_ 77
[59]SS.