CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001600320003-8
• 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: March 30, 1983
• Content Type: FORM

Apps
For use of this form, soa At 9810-5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence.
M MAP- 83
SECTION A - GENERAL
TO:
FROM:
NSA
DATE RECEIVED
ACTION QFFICE(S)
SUSPENSE DATEISI - ~-
REGISTER OR CONTROL NO
CONTROL. LOG
CLASSIFI-
NUMBER OF
DESCRIPTION (Type. F'de Ref. (hlrlassr/red Subject
DATE OF
OR FILE NO.
CATION
COPIES
or Short Title and Number of Indorsements/htds)
DOCUMENT
ORIGINATOR
CL_-021-03
S/NOFOR
1
Cy 1 of 1 cy, Report CL-1002/f3303/08 ..
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SECTION B- ROUTING
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'~ 1 ACKNOWLEDGE R ECEIPT OF THE MAT-rRI L DES R1B .b
TO COPY NO. DATE PRINTED NAME SIGNATURE
2.
_
3.
?~ .... ~~m~.
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_ SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
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MATERIAL D
ES
CRIBED HEREON HAS BEEN:
PAGE OR COPY NO
p
g
~--t
DESTROYED TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER .~ .M,
DATE PRINTED NAME OF CUSTODIAN OR REP SIGNATURE
DESTRUCTION RECORD NO.
DATE
.-rv
PRINTED NAME OF CERTIFYING/DESTR. OFF
SIGNATURE
PAGE OR COPY NUMB-F,R
DATE
PRINTED NAME OF WITNESSING OFFICIAL
SIGNATURE
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NUMBER
OF COPIES
i
3 ?E REPRODUCED
AUTHORIZED BY
DATE
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
RECEIPT OF DOCUMENT(S) ACKNOWLEDGED ~j DOC UMENf151 HAVE NOT BEEN RECEIVED ~_ -
DTRACER ACTION: SIGNED RECEIPT FOR MATEF41AL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE PRINTED NAME, GRADE OR TITLE SIGNATURE
COMMENTS
t7 d Ff1RdA BRA 1 8
.roved-.For Release2D.D01Q.$(igQ -~_I~4-RQP96 00788