DA FORM 3964

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R000500030001-4
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: June 10, 1998
• Sequence Number: 1
• Publication Date: April 9, 1982
• Content Type: FORM

pllc 0com F L1& I l1 OSIC P96-00788
For use of this form, see AR 380-5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence.
D0050003000-4
SECTION A - GENERAL
TO-
4 7-TA!; 2."q C)/ S
FROM:
DATE RECEIVED
ACTION OFFICE(S)
SUSPENSE DATE(S)
REGISTER OR CONTROL NQ.
CONTROL. LOG
OR FILE NO.
CLASSIFI-
CATION
NUMBER OF
COPIES
DESCRIPTION (Type, File Ref.. Unclassified Subject
or Short Title and Number of Indorsements/Inc(s)
DATE OF
DOCUMENT
ORIGINATOR
SECTION B - ROUTING
I ACKNOWLEDGE RECEIPT OF THEMATERIAL DESCRIBED HEREON
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
2.
3.
a.
s.
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL DESCRIBED HEREON HAS BEEN:
D DESTROYED OTORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 380-5)
PAGE OR COPY NO
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DATE
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SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFYING/DESTR. OFF.
SIGNATURE
PAGE OR COPY NUMBER
DATE
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SECTION D - REPRODUCTION AUTHORITY
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SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
RECEIPT OF DOCUMENT(S) ACKNOWLEDGED O DOCUMENT(S) HAVE NOT BEEN RECEIVED
[:]TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE
J
PRINTED NAME. GRADE OR TITLE
eJlN t
SIGNATURE
COMMENTS Approved For Release 2000/08/07 : CIA-RDP96-00788R000500030001-4
DA FORM 3964, 1 Jul 79 EDITION OF 1 NOV 72 IS OBSOLETE. 4 U.S. G.P.O. 1979-297-093