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Use to reply to a request for maintenance support. Reference: FM 9-43-1.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — REFERENCE _________________________________(DTG and Other Identifying Information of Communications Which Requested Maintenance Support)

LINE 4 — DISPOSITION_________________________________(Status of Request: APPROVED, DISAPPROVED, MODIFIED)

LINE 5 — SUPPORTING UNIT____________________________(Identifier or Designator of Supporting Unit)

LINE 6 — LOCATION___________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 7 — PRIORITY____________________________________(Priority of Maintenance Support Mission)

LINE 8 — START_______________________________________(DTG the Requested Support Will Start)

LINE 9 — COMPLETE___________________________________(Estimated DTG Support Mission Will be Completed)

LINE 10 — INSTRUCTIONS______________________________(Special Instructions Relevant to Support Required by the SupportingUnit)

LINE 11 — COORDINATION_____________________________(Coordination Instructions Required Between Supporting Units)

**Lines 5 through 11 are applicable only if line 4 is approved or modified.

LINE 12 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 13 — AUTHENTICATION___________________________(Report Authentication)

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