LINE 1 -- DATE AND TIME______________________________(DTG)
LINE 2 -- UNIT________________________________________(Unit Making Report)
LINE 3 -- GAINING NUMBER____________________________(Number of the Facility Gaining Responsibility)
LINE 4 -- GAINING LOCATION__________________________(Place Name for the Facility Gaining Responsibility)
LINE 5 -- EFFECTIVE DATE _____________________________(DTG the Change in Mail Distribution Will be Effective)
LINE 6 -- LOSING NUMBER_____________________________(Number of the Facility Losing Responsibility)
LINE 7 -- LOSING LOCATION___________________________(Place Name for the Facility Losing Responsibility)
LINE 8 -- EFFECTIVE DATE_____________________________(DTG the Change in Losing Facility Will be Effective)
LINE 9 -- FOOTNOTE CODES___________________________(Letter(s) or Letter-Number(s) of Applicable Postal Footnote(s))
LINE 10 -- GAINING FACILITY__________________________(Location Name of the Affected Military Post Office)
LINE 11 -- MAIL CLASS________________________________(Mail Classification Code(s) Permitted at the Location Named in Line 9 (if not ALL, Also Provide Required Disposition of Mail Classifications not Permitted))
LINE 12 -- NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)
LINE 13 -- AUTHENTICATION___________________________(Report Authentication)