(SANITIZED)

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-03424A000800010058-1
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 1
• Document Creation Date: December 22, 2016
• Document Release Date: February 8, 2012
• Sequence Number: 58
• Content Type: FORM

Declassified in Part - Sanitized Copy Approved for Release 2012/02/08: CIA-RDP78-03424A000800010058-1
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Declassified in Part - Sanitized Copy Approved for Release 2012/02/08: CIA-RDP78-03424A000800010058-1