REQUEST FOR SECURITY APPROVAL OF LIAISON ONE-TIME BASIS NON-CIA EMPLOYEES (Sanitized)

• Document Type: CREST
• Collection: NGA Records (Formerly NIMA)
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78B04770A002900030018-0
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 1
• Document Creation Date: December 28, 2016
• Document Release Date: August 26, 2005
• Sequence Number: 18
• Publication Date: October 4, 1965
• Content Type: FORM

Approved Release 2005/11/21 :CIA-RDP78B0`OA00290d0~0(~8~0
REC-UEST FOR APPROVAL OF LIAISON
CLASSIFY WHEN FILLED IN
~ _
2E
C
c~
DATE
'
'~
~
(Submit in duplicate - one tvilL be returned to requester)
f
T
J
~
~
(
.
TO Chief, Employee Activity Branch, PSD~OS
SUBJECT: Request for Security Approval of Liaison
on a continuing basis ~ one-time basis
CIA EMPLOYEES
NON-CIA EMPL YEES
NAME
EXT.
OFFICE
RANK
C_
NAME
EXT.
OFFICE
TITLE, / ~~ /r
NAME EXT. OFFICE
NAME EXT. OFFICE
NAME EXT. OFFICE
BRIEF OESCRIPTION/yOF LIAISON, COMMENTS, K/N OWN BIOGRAPHICAL ND C
L~E ARANCE I/N FORMATION
/~
'
~
~
r
i C
c~y-.s C "~i?~rer~rc~?l -- S~'G7~~~/~ ~G ~~/Yo ~~?~f~e/ lad ~/S 3n ~ Y
1 ~vrre:~~ Acld~Ps
~Q ~ o~ ~~~~~ . ~~ Y /9~.5'
ip~~ .~C'~ j /%~1.,/
C'/Pqr~~~>? m- T, S, ~y'~avrar
y
CLASSIFICATION OF MATTER TO BE DISCUSSED
TOP SECRET SECRET CONFIDENTIAL
OFFICE/DIVISI /STA F(F h ~
AUTHORIZED SIGNATURE
f~OM/BLDG/EXT.
~ /~
FOR OFFICE OF SECURITY USE
Security approval is granted for contact at the
security classification level indicated. This approval
does not waive any other authorization requirements
contained in Agency Regulations regarding dissemination
of intelligence and intelligence information.
Authorization for liaison contact expires one year
from date. Any change in employment status of individ-
ual named invalidates this approval.
FOR THE DIRECTOR OF SECURITY:
Declass Review by NGA.
DATE CHIEF, PERSONNEL SECURITY DIVISION
5
2
5
2
FORM
3-63
123 E D I T 1 ON S . FR E VAepprOVed For Release 2005/11 2`ri"SS "'I~[9P7&B04~A70A0029 0
r
Facluded {.om au