23857122-1355-505297-0010

LOAN RECEIPT FOR THE NATIONAL ARCHIVES INSTRUCTIONS: Requesting agency completes items 12 and 15 and retums the white copy to the address shown in item 6 below. 1. DATE DUE 2. DATE LOANED 3. LOAN NUMBER 4. RECORD GROUP NUMBER 5. DELIVER RECORDS TO: (Name of borrowing agency) 6. RETURN RECORDS TO: 7. AGENCY CONTACT 8. FELEPHONE NUMBER 9. TO RETURN RECORDS TELEPHONE 10. LOAN HANDLED BY 11, RECORD IDENTIFICATION The receipt on loan from the National Archives of the records listed above is hereby acknowledged. It is expressly agreed that they will be carefully protected against any injury or loss, kept in their present order or sequence, and returned promptly on or before the above-stated "Date due” unless special permission for an extension of the loan for a specified period of time has been obtained from the above-named Division or Branch of the National Archives. 12. RECORDS TO BE USED BY (Name) 13% NO. OF ITEMS 14, LOCATION OF RECORDS 15. RECEIPT ACKNOWLEDGED BY 16. RETURN ACKNOWLEDGED BY GENERAL SERVICES ADMINISTRATION Declassification Authority: NND 57565 GSA form 6770 (rev. 10-74)