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3. NATURE OF PERSONNcc-AC?vT ((LARGER EXGGP7E APi'7 19. ACTION ZODE: 20. EmploP. Code 2l--NTE--EXPTRE~ M0.' DA. YR. 3ECURtTY OFFICER 39:-SPECIAL REFERENCE t - csc E -FICA E -NONE 0 ? NO PREVIOUS SERVICE 1 - NO BREAK IN SERVICE 2 BREAK IN SERVICE (LESS THAN 3 VRS.1 ~ -BREAK IN SERVICE (MORE THAN 3 YRS.) APPROVED FOR RELEASE DATE: NOV 2007 22. STATION 123.1 12. LEAVE CAT. CODE 31. SEPARATION DATA (ODE FORM E%ECUTEO 1 -YES 2-NO o~ ~ 3I 66 FORM EXECUTED 1 -YES 2?NO MO. DA. YR. YO. DA. YR. YO. DA. YR. .!~ 11 3 ~ I ~~ __ A5) 181.38 141 1 ! (64 33. SECURITY RED. N0. STATE TAX DATA CODE NO. TAX EXEMP. NOTIFICATION OF PERSONNEL ACTION (b) (1) (b) (3) (b) (6)