NOTICE OF CHANGE IN HEALTH BENEFITS ENROLLMENT - CARANCI, JOHN C.

Document Type: 
Collection: 
Document Number (FOIA) /ESDN (CREST): 
0001411857
Release Decision: 
RIPPUB
Original Classification: 
U
Document Page Count: 
6
Document Creation Date: 
June 22, 2015
Document Release Date: 
December 31, 2008
Sequence Number: 
Case Number: 
F-2007-00327
Publication Date: 
April 1, 1970
File: 
AttachmentSize
PDF icon DOC_0001411857.pdf507.39 KB
Body: 

Standard Form No. 2810
U.S. Civil Service Commission
FPM Supplement 890.1
November 1965
Part A.-IDENTIFYING DATA
(bl61
(b131
ONLY THE ITEM WHICH IS CHECKED BELOW AFFECTS YOUR ENROLLMENT. READ THAT ITEM CAREFULLY AND FOLLOW ANY PERTINENT
INSTRUCTIONS. KEEP THIS FORM UNLESS YOUR ENROLLMENT IS TERMINATED AND YOU APPLY FOR CONVERSION.
Part B.-TERMINATION
^ YOUR ENROLLMENT TERMINATES ON THE DATE IN PART A, ITEM 7, ABOVE.
APPROVED FOR RELEASE DATE:
10-Nov-2008