U.s. State Department Form Ds-2008 - Notice Of Termination

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OMB APPROVAL NO. 1405-0061

EXPIRATION DATE: 06-30-2006

ESTIMATED BURDEN: 10 MINUTES *

1. DATE (mm-dd-yyyy)

U.S. Department of State

NOTICE OF TERMINATION OF DIPLOMATIC, CONSULAR,

OR FOREIGN GOVERNMENT EMPLOYMENT

TO:

2. FROM (Name of Embassy/Mission)

3. TYPE OF PERSONNEL

Secretary of State,

OFFICER

STAFF

Attention - Office of Protocol

Embassy

Consulate

Domestic

Miscellaneous

Int'l Organ Mission

CONTACT NAME AND TELEPHONE NO.

4. NAME (Last, First, Middle)

5. PERSONAL IDENTIFICATION NUMBER (If available)

6. DATE OF BIRTH (mm-dd-yyyy)

7. PLACE OF BIRTH (City, Country)

8. POSITION/EMPLOYING OFFICE

9. DATE OF APPOINTMENT (mm-dd-yyyy)

10. DATE OF TERMINATION (mm-dd-yyyy)

11. DESTINATION OR NEW ADDRESS

12. ENCLOSURES (Identification cards, etc.)

TYPED NAME AND SIGNATURE OF CHIEF OF MISSION OR AUTHORIZED DEPUTY

(Official Seal)

FOR OFFICIAL USE ONLY

PRIVACY ACTS and PAPERWORK REDUCTION ACT STATEMENTS

The Privacy Act of 1974, as amended, 5 U.S.C. 552a, contains provisions regarding the maintenance, collection, use, and dissemination of

information about United States citizens and aliens lawfully admitted for permanent residence in the United States. The following information

is provided in accordance with subsection (e)(3) of the Privacy Act.

AUTHORITIES: Vienna Convention on Diplomatic Relations of 1961; Vienna Convention on Consular Relations of 1963; Diplomatic Relations

Act (22 U.S.C. 254a-e); International Organizations Immunities Act (22 U.S.C. 288e(a)).

PURPOSE: The principal purpose for the collection of this information is to implement various provisions of the above-cited authorities which

are predicated upon acceptance by the U.S. Department of State.

ROUTINE USES: The principal users of this information are offices within the U.S. Department of State, including but not limited to, the Office

of Protocol, the Office of Foreign Missions, and the Office of Visa Services. In response to inquiries from law enforcement agencies, the

Office of Protocol may confirm status as recognized by the U.S. Department of State. Information may also be provided to other government

agencies having statutory or other lawful authority to maintain such information.

Submission of these forms is mandatory. Failure to provide any of the requested information may prevent acceptance and the extension

of benefits to principals or family members as provided in the above-cited authorities.

*Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time required for searching existing data sources, gathering the

necessary data, providing the information required, and reviewing the final collection. In accordance with 5 CFR 1320.5(b), persons are not required to respond to the collection of this

information unless this form displays a currently valid OMB control number. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to:

U.S. Department of State (A/RPS/DIR) Washington, DC 20520.

DS-2008

(Formerly DSP-115)

Page 1 of 2

06-2003

Clear