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Use to establish and change mail routing for assigned or co-located units. Reference: FM 12-6.

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)

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