CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001600100004-1
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: June 19, 1998
• Sequence Number: 4
• Content Type: FORM

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For use of this form, st? AR 380-5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence.
SECTION A - GENERAL
TO:
FROM:
DATE RECEIVED
ACTION QFFICE)S)
SUSPENSE DATE(S)
REGISTER OR CONTROL NO.
CONTROL. LOG
OR FILE NO.
CLASSIFI-
CATION
NUMBER OF
COPIES
DESCRIPTION (Type. File Ref.. Unclassified Subject
or Short Title and Number of Indorsements/Incls)
DATE OF
DOCUMENT
ORIGINATOR
CL-003-82
..........
S/NOFOR
.......
1
......
Cy 1 of 2, report CL-972/8210/01 W/1
Exhibit ............... ..............
.........NOTHING FOLLOWS .............
.......
.......
...........
..........
SECTION B - ROUTING
I -ACKNOWLEDGE RECEIPT OF THE MAERI L DESCRIBED ED HE
TO COPY NO. DATE PRINTED NAME SIGNATURE
2.
3.
4.
5.
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL DESCRIBED HEREON HAS BEEN: PAGE OR COPY NO
D DESTROYED DTORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 3845)
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
AUTHORIZED BY
DATE
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
RECEIPT OF DOCUMENT(S) ACKNOWLEDGED Q DOCUMENT(S) HAVE NOT BEEN RECEIVED
^TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE
PRINTED NAME, GRADE OR TITLE
SIGNATURE
COMMENTS
Approved For Release 2000/08/08 : CIA-RDP96-00788R001600100004-1