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Use to cancel a message, add, delete, or replace information in the referenced message by a message originator. Reference: FM 11-32.

LINE 1 -- DATE AND TIME______________________________(DTG)

LINE 2 -- UNIT________________________________________(Unit Making Report)

LINE 3 -- REPORT_____________________________________(Report Type Referenced)

LINE 4 -- ORIGINATOR_________________________________(Originator of Referenced Report or Order)

LINE 5 -- SERIAL______________________________________(Serial Number of Referenced Report or Order)

LINE 6 -- ACTION _____________________________________(Action Directed: CANCEL, ADD, DELETE, or REPLACE)

LINE 7 -- NARRATIVE__________________________________(Free Text for Additional Information Required for Clarification of Report

LINE 8 -- AUTHENTICATION____________________________(Report Authentication)