ADMINISTRATIVE REMARKS
E-32
NAVPERS 1070/613
S/N 0106-LF-010-6991
SHIP OR STATION
NROTC UNIVERSITY OF COLORADO, BOULDER, CO. 80309
Counselor:
Occasion:
----------------------------------------------------------------------------Date: _________I hereby acknowledge the above NAVPERS 1070/613 entry and
desire to make/not make (circle one) a statement.
(For more space, use reverse)
Member’s Signature: ________________________
Witness’ Signature: ________________________
Note: If the member refuses to sign, a notation shall be indicated and signed by an officer.
NAME(LAST, FIRST, MIDDLE)
SSN
BRANCH/CLASS
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