CERTIFICATION OF SEPARATION EMPLOYEE - MILLS, MONTRELL EUGENE

• Document Type: FOIA
• Keywords: MILLS MONTRELL E
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001309084
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 1
• Document Release Date: February 19, 2008
• Case Number: F-2005-00558
• Publication Date: December 6, 1977

 CERTIFICATION OF SEPARATI&AYEE UoOf T                               ~ lled In)               LTiID ?    D/CE ffh ER 1977 Name (INnFirst-Middle MILL; Montrell E. MEMORANDUM FOR THE RECORD  -       ATTACH TO OFFICIAL PERSONNEL FOLDER I hereby acknowledge the receipt of the following forms and/or information concerning my separation from CIA as indicated by check mark: Standard Form 8 (Notice to Federal Employee about Unemployment Compensation). Standard Form 55 (Notice of Conversion Privilege, Federal Employees' Group Life Insurance). Standard Form 56 (Agency Certification of Insurance Status, Federal Employees' Group Life Insurance Act of 195+). Standard Form 2802 (Application for Refund of-Retiremantlductions). Form 2595 (Au horization  or Disposition of Paychecks).. .    Only applicable to Retiree - Returnee (resignee-from overseas assignment). I have been advised of my right to have a medical examination before my separation from this Agency and of the importance of such a medical - check to my health and well-being. CSC Pamphlet 51 (Re-employment Rights of Federal Employees Performing Armed' Forces Duty).. Instructions for returning to duty from Extended Leave or Active Military Signature of Employee Lie, Address (Street, City, State, Zip Code) Date Sign Correspondence OVERT CORRESPONDENCE