(SANITIZED)

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-03424A000800010045-5
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 1
• Document Creation Date: December 22, 2016
• Document Release Date: February 8, 2012
• Sequence Number: 45
• Content Type: FORM

Declassified in Part - Sanitized Copy Approved for Release 2012/02/08: CIA-RDP78-03424A000800010045-5
^^IkIrInM\ITINI ,vw,~ e
When Filled In
U-1
TO : 0 C ~?--, -r
FROM: OL/PD/CAB
Approval:
CONTRACTOR:
Purpose:
PERSON CONTACTED:
REMARKS:
EI-phone
I t.rC C p~ 1, C t/~% - 1
i~/ {/f.I G E~ ~(Pcf
(VV, , ('#"1fl / G / t' v~"? ? Ci T7 U lr ) C f (I - S- Uuc.L
t j l U Vr1 i L( 1 ! A,4- (114 / d C V I' f ti' 1 "F !j c~ crK ~t ~~'L3 C~i
V1 U-h 7v' J I-k G4- C CA" C csv- 41N L"r (,- tj j -pi,,
itfOnr kh > ' nn 9, 0,~ ?4
.undersigned on
nee --q-=- REV OATS ?=- 8Y
OHIO COMP OPI _- TYPE
CRIB CLASS PAUAS --J--- 40 LASS
JUST L ~-- NUT Rn 11R 18.3
V ~--
When Filled in
in
25X1
LJ/~ I
Declassified in Part - Sanitized Copy Approved for Release 2012/02/08 : CIA-RDP78-03424A000800010045-5