CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R000700030002-1
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: June 17, 1998
• Sequence Number: 2
• Publication Date: March 4, 1982
• Content Type: FORM

Ao b~ b_!~~Y - 6-00788R0 0( 0
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For use of this f rr ,see AR 380-5; the proponent agency is the Office, Assistant Chief of Staft for Intolleuenre.
SECTION A - GENERAL
TO: FROM:
ITAC
DATE RECEIVED
ACTION OFFICEISI
SUSPENSE DATE(S)
REGISTER OR CONTROL NO.
CONTROL. LOG
OR FILE NO.
CLASSIFI-
CATION
NUMBER OF
COPIES
DESCRIPTION (Type. F'ikc Ref. Unclassified Subject
or Short Title and Number of Iuciorsenrcnts/tack)
DATE OF
DOCUMENT
ORIGINATOR
GF-010-82
s......0.
S/NOF
.......
RN 1
.. 0...
Cy 2 of 2 cys Session 855 on
TGT 8123 .......................
.....NOTHING FOLLOWS.... .......
.......
.........
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SECTION e - ROUTING
TO COPY NO, DATE PRINTED NAME SIGNATURE
2.
3.
4
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SECTION C . DESTRUCTION CERTIFICATE (Cheek appropriate block)
MATERIAL DESCRIBED HEREON HAS BEEN: El ? DESTROYED EJ TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 38O., )
OFFICE SYMBOL
DATE
PRINTED NAME OF CUSTODIAN OR REP
SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFYING/DESTR. OFF.
SIGNATURE
PAGE OR COPY NUMBER
DATE
PRINTED NAME OF WITNESSING OFFICIAL
SIGNATURE
SECTION D ? REPRODUCTION AUTHORITY
NUMBER OF COPIES TO BE REPRODUCED j
AuTHOrnDITv DA(E
SECTION E - RECEIPT/TRACER ACTION (('heck appropriate b(ock)
[~-RECEIPT OF DOCUMENT(S) ACKNOWLEDGED El DOCUMEN 1(51 HAVE NOT BEEN RECEIVED
OTRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT (SEEN RECEIVED.
DATE PRINTED NAME. GRADE OR TITLE SICGNATURE
COMMENTS
Approved For Re`teaseb ETCIA-RDP96-00788R000700030002-1
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