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13-00000
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CONFIDENTIAL
*(When Filled In)*
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REQUEST FOR DISSEMINATION CHANGE OR CABLE REFERENCE SERVICE
TO: CABLE SECRETARIAT BRANCH, OC CABLE REFERENCE SECTION IA-53 HQS. EXT. 6159, TUBE ES-6
FROM: NAME OF REQUESTER
DATE
DIVISION/BRANCH
16 Aug 71
EXTENSION
1604
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☐ It is requested that the dissemination of
___________________________
IN/DIR NUMBER
___________________________
STATION NUMBER
be changed as indicated.
☐ ADD: ___________________________ ___________________________ ___________________________
☐ Recall copies from: ___________________________ ___________________________ ___________________________ ___________________________ ___________________________
☐ Change action from: ___________________________ To: ___________________________
Authorized by: ___________________________
NAME (type or print)
EXT.
In coordination with: ___________________________
NAME (type or print)
EXT.
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☐ Please furnish one copy of the cable described. I have ☐ have not ☐ made inquiry of the CS Records control system.
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IN/DIR NUMBER
STATION NUMBER
DATE
SUBJECT
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