CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001600260003-5
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: June 19, 1998
• Sequence Number: 3
• Publication Date: April 28, 1983
• Content Type: FORM

proVed:F r-:l 6l. st.20O0%08/08 i-N'RDP96-00788ROO160026-000T-S
CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD
DATE
28 April 1983
For use of this form, see AN 3 WS; As, proponent agency is the Office, Assistant Chief of Staff for Intel9i9.nC..
SECTION A - GENERAL _-_------------
TO: FROM:
DATE RECEIVED ---- ACTION QFFICEIS SUSPENSE DATE(S) REGISTER OR CONTROL NO.
CONTROL. LOG CLASSIFI- NUMBER OF DESCRIPTION (Type. File Ref.. unclassified Subject DATE OF ORIGINATOR
OR FILE No. CATION COPIES or Short Ti11e and Number of Lrdorsenlents/lncls) DOCUMENT
CL-027/83
S/NOFOR
1 C
yl of 1 cy Report CL-1009/8302/01....
......?
......??
..,...NOTHING FOLLOWS,...........
~Y-~~
.......
......?...
SECTION B ROUTING
-~
IX-L I ACKNOWLEDGE REC EIPT OF THE MATER DES BED HEEit T
TO COPY NO. DATE PRINTED NAME SIGNATURE
Q.
SECTION C - DESTRUCTION CERTIFICATE (Cheek appropriate block)
----- _"
~
MATERIAL DE>C}tIBED HEREON HAS BEEN -~ ? -
PAGE OR COPY NO
DESTROYED 0 TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 3NC15
- ~_
OFFICE SYMBOL
DATE
PRINTED NAME OF CUSTODIAN OR REP
SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFYING/DESTR. Or F.
SIGNATURE
PAGE OR COPY NUMBER
DATE
PRINTED NAME OF WITNESSING OFFICIAL
SIGNATURE
? .._~.
.... R SECTION D - REPRODUCTION AUTHORITY
NUMBER OF COPIES TO BE REPRODUCED AUTHORIZED BY DATE
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
[-]RECEIPT OF DOCUMENTIS) ACKNOWLEDGED L~ DOCUMENTISI HAVE NOT BEEN RECEIVED
TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE PRINTED NAME. GRADE OR TITLE SIGNATURE
COMM roved For Release 2000/08/08 : CIA-RDP96-00788RO01600260003-5