RECORD OF INTELLIGENCE SERVICE

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-04718A000500170005-5
• Release Decision: RIFPUB
• Original Classification: S
• Document Page Count: 1
• Document Creation Date: December 9, 2016
• Document Release Date: June 8, 2001
• Sequence Number: 5
• Content Type: FORM

Approved For Rel a 2001/08/07: CIA-RDP78-04718AO 0170005-5
SECRET
security Information
FROM TO 4GANIZATION POSITION DESCRIPTION
`X hereby cer Aity that in Mr Judgment and to mpg beet knowledge the
foregoing is a true and accurate history of my employment for the period
covered and qualifies me as having served in the field of IIn So Intelligence
for an aggregate of at least ten years prior to 1 December 19520
(Signature o yee
Approved For Release Q i ,& R E'77n-04718A000500170005-5