CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001600270002-5
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: May 4, 2000
• Sequence Number: 2
• Publication Date: April 28, 1983
• Content Type: FORM

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Foruse is fo rm, too AR'FWS; the proponent agency in the Office. Assistant Chief of Staff for
28 Apr i 1 1983
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SECTION A - GENERAL
FROM:
CIA
DATE RECEIVED ACTION OFFICE(SI SUSPENSE DATE(S) REGI5TER OR CONTROL NO.
CONTROL, LOG CLAS5IFI? NUMBER OF DESCRIPTION (Type. File Ref.. Unclassified Subject DATE OF ORIGINATOR
rt Title and Number of Lrdursements/Incls) DOCUMENT
Sh
o
OR FILE NO. CATION COPIES or
CL-029-83
/NOFOR
1
Cy 1. of 1 cy Report 1010/8302/08 ......
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.?.........
.NOTHING FOLLOWS............
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...........
SECTIONS. ROUTING
._
T OFT TN MA7Eft1 l DE.SCT;iF3El7 HE
V
?-,??~-s -
ACKNOWLEDGE RECEIP
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
x.
SECTION C DESTRUCTION CERTIFICATE (Check appropriate block)
PAGE OR COPY NO
MATERIAL DESCRIBED HEREON HAS BEEN
DESTROYED LJ TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 3854_
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 COP E5 TO BE REPRODUCED AUTHORIZED BY -.----'"
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
:]REECEIiT OF DOCUMENT(S) ACKNOWLEDGED DOCUMENT(S) HAVE NOT BEEN RECEIVED
iI
L._._ITRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED. -~~
DATE PRINTED NAME GRADE OR TITLE SIGNATURE
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