AF IMT Form 122 Mwr Division Locker Issue Record

AF IMT Form 122 or the "Mwr Division Locker Issue Record" is a form issued by the U.S. Air Force IMT (Information Management Tool).

The form was last revised in September 1, 1982 and is available for digital filing. Download an up-to-date AF IMT Form 122 in PDF-format down below or look it up on the U.S. Air Force IMT (Information Management Tool) Forms website.

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NAME (Last, First, MI)
RANK/GRADE
LOCKER NUMBER
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 8012, 44 U.S.C. 3101.
PRINCIPLE PURPOSE(S): To control the issue of lockers.
ROUTINE USE: To identify individuals to whom lockers are issued, to monitor the proper payment of fees, and to control periods of issue and use.
DISCLOSURE IS VOLUNTARY: However, failure to provide the information requested may result in the locker not being used.
ORGANIZATION
DUTY PHONE
HOME PHONE
HOME ADDRESS (Street, City, State)
ZIP CODE
RECEIPT NUMBER
DATE OF ISSUE
ISSUED BY
LOCKER KEY RECEIVED BY
DATE
KEY DEPOSIT
FEE
YEAR
MONTH
$
$
$
REMARKS
CHECK BLOCK OF MONTH NEXT PAYMENT IS DUE
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
AF IMT 122, 19820901, V1
MWR DIVISION LOCKER ISSUE RECORD
NAME (Last, First, MI)
RANK/GRADE
LOCKER NUMBER
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 8012, 44 U.S.C. 3101.
PRINCIPLE PURPOSE(S): To control the issue of lockers.
ROUTINE USE: To identify individuals to whom lockers are issued, to monitor the proper payment of fees, and to control periods of issue and use.
DISCLOSURE IS VOLUNTARY: However, failure to provide the information requested may result in the locker not being used.
ORGANIZATION
DUTY PHONE
HOME PHONE
HOME ADDRESS (Street, City, State)
ZIP CODE
RECEIPT NUMBER
DATE OF ISSUE
ISSUED BY
LOCKER KEY RECEIVED BY
DATE
KEY DEPOSIT
FEE
YEAR
MONTH
$
$
$
REMARKS
CHECK BLOCK OF MONTH NEXT PAYMENT IS DUE
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
AF IMT 122, 19820901, V1
MWR DIVISION LOCKER ISSUE RECORD
NAME (Last, First, MI)
RANK/GRADE
LOCKER NUMBER
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 8012, 44 U.S.C. 3101.
PRINCIPLE PURPOSE(S): To control the issue of lockers.
ROUTINE USE: To identify individuals to whom lockers are issued, to monitor the proper payment of fees, and to control periods of issue and use.
DISCLOSURE IS VOLUNTARY: However, failure to provide the information requested may result in the locker not being used.
ORGANIZATION
DUTY PHONE
HOME PHONE
HOME ADDRESS (Street, City, State)
ZIP CODE
RECEIPT NUMBER
DATE OF ISSUE
ISSUED BY
LOCKER KEY RECEIVED BY
DATE
KEY DEPOSIT
FEE
YEAR
MONTH
$
$
$
REMARKS
CHECK BLOCK OF MONTH NEXT PAYMENT IS DUE
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
AF IMT 122, 19820901, V1
MWR DIVISION LOCKER ISSUE RECORD
NAME (Last, First, MI)
RANK/GRADE
LOCKER NUMBER
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 8012, 44 U.S.C. 3101.
PRINCIPLE PURPOSE(S): To control the issue of lockers.
ROUTINE USE: To identify individuals to whom lockers are issued, to monitor the proper payment of fees, and to control periods of issue and use.
DISCLOSURE IS VOLUNTARY: However, failure to provide the information requested may result in the locker not being used.
ORGANIZATION
DUTY PHONE
HOME PHONE
HOME ADDRESS (Street, City, State)
ZIP CODE
RECEIPT NUMBER
DATE OF ISSUE
ISSUED BY
LOCKER KEY RECEIVED BY
DATE
KEY DEPOSIT
FEE
YEAR
MONTH
$
$
$
REMARKS
CHECK BLOCK OF MONTH NEXT PAYMENT IS DUE
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
AF IMT 122, 19820901, V1
MWR DIVISION LOCKER ISSUE RECORD

Download AF IMT Form 122 Mwr Division Locker Issue Record

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