CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001600360003-4
• 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
• Content Type: FORM

Approved For Release 2000/08/08 : CIA-RDP96-00788R001600360003-4
CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD
For use of this forme, see AR 380-5; the proponent agency i? the Office, Assistant Chief of Staff for Intefifgence
DATE
SEC71ON A - GENERAL
TO:
NSA
FROM:
()ATE RECEIVED
ACTION OFFICEIS)
SUSPENSE DATEAS)
REGISTER OR CONTROL NO.
CONTROL. LOG
OR FILE NO.
CLASSIFI-
CATION
NUMBER OF
COPIES
DESCRIPTION (Type. File Ref. Uncl(rssi/red Subjecl
or Short 'rifle and Number of Indnrsemerrls/In cis)
DATE OF
DOCUMENT
ORIGINATOR
CL-0449-83
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COPY NO.
DATE
_
.
PRINTED NAME
SIGNATURES
A.
SECTION C . DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL DESCRIBED HEREON HAS BEEN: 11
0 DESTROYED CC 6_..J TORN IN HALF _AND_PLACED IN A CLASSIFIED WASTE
CONTAINER (A.It 380 j.5,
PAGE OR COPY NO
OFFICE SYMBOL
DATE
_
.
PRINTED NAME OF CUS1ODIAN OR REP
SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFYING/OESTR OFF.
SIGNATURE
PAGE OR COPY NUM6FR
DATE
PRINTED NAME OF WITNESSING OFFICIAL
SIGNATURE
__ _ SECTION 0 - REPRODUCTION AUTHORITY
NUMBER OF COPIES TO HE REPRODUCED
AUl HORIZED BY OATS
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
(RECEIPT OF DOCUMENT(S) ACKNOWLEDGED DOCUMENT(S1 HAVE NOT BEEN RECEIVED
EITRACER ACTION SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE
PRINTEO NAE, RAi7E OR TITLE
SIGNATURE
COMMENTS
1) A FORM , 1 Jul 79 EDITION OF I NOV 72 IS OBSOLETE. * U.8.Gf'A:198(8U-319- 3
Approvetl-For-Release, 2{ 00/08/08 : C1A-RDP96.O0788RO016eG3 3-- -