CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001600300003-0
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: May 16, 2000
• Sequence Number: 3
• Publication Date: March 29, 1983
• Content Type: FORM

DA FORM 3%4, 1 Jul 79 EDITION OF 1 NOV 72 IS OBSOLETE. *-U.S.GPO:1980-O-
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For ase of this forn-, to* AR 380.5; the proponent agency is the Office, Assistant Chief of Staff for Inlalliyrnce.
T E
A n
2-y M A2 (53
SECTION A - GENERAL
TO:
NSA
D
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FROM:
ATE RECEIVED
ACTION OFFICE(S)
SUSPENSE DATESI
REGISTER OR CONTROL NO.
CONTROL. LOG
OR FILE NO.
CLASSIFI?
CATION
NUMBER OF
COPIES
DESCRIPTION (Type. File Ref.. Unclassified Subject
orShurt Title and Nurnbcr of lndorsenreuls/Ibrcls)
DATE OF
DOCUMENT
ORIGINATOR
CL-019083
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S/NOFOR
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1
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Cy 1 of 1 cy, Report CL-1000/8303/08..
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SECTION 8 - ROUTING
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I ACKNOWLEDGE RECEIPT OF TE-MATER IILL pES R BEER
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
2.
3.
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block,)'--*y-_~
MATERIAL DESCRIBED HEREON HAS BEEN: ~~---yy
CJ DESTROYED J TORN IN HALF AND PLACED IN ACLASSIFIED WASTE CONTAINER (AR 380-5)
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PAGE OR COPY NO
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
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SECTION 0 - REPRODUCTION AUTHORITY
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NUMBER O F
C O P I E S TO BE REPRODUCEQ AUTHORIZ EQ BY
pAT
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
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RECEIPT OF DOCUMENT(SI ACKNOWLEDGED
DOCUMENT(S) HAVE NOT BEEN RECEIVED
DTRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
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DATE
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PRINTED NAME, GRADE OR TITLE
SIGNATURE i~
COMMEFIS