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DSS- 69c7(F+ev.iaso) TIME CARD A.TACeUMINT 2 <br />Empioyrnent Programs Section <br />NAME: <br />MONTKIYEAk <br />ADDRESS: � <br />SOCIAL SECURITY NO.: TELEPHONE NO.: <br />SPONSOR OR ACTIVITY: <br />TOTAL HOURS SCHEDULED: TOTAL HOURS COMPLETED: <br />71ME TIME I w OF I MILE• TIME TIME I N OF I MILE- 'TIME TIME IHOWLS', <br /># OF I I-ULZ- TIME TIME I OF MILE - <br />DATE IN OUT HOURS AC.LE DATE IN OLrr IHOUKS! AGL DATE lN OUr AGE DATE IN OUT HOURS ACE <br />FT_ <br />__�H7 <br />Signature Date Telephone Numt)er <br />"Enter Comments on back of Card" <br />