CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001600380003-2
• 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

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for use of this form, torn AR 3M5; the proponent y ogancyis the Office, As*islanl Chi,l of Staff for Intellig iro
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SECTION A - GENERAL
FROM:
NSA
DA ERECEIVED ACTION OFFICEISI SUSPENSE DATEISl 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 Tate and Number of lndorsemenis/lncl-c) DOCUMENT
CL-051.83 S/NOFOR
1
Cy of 1 cy, Report IILJ-1028/8307/0]....... ...... ...........
.......... ......
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...N.........NOTIIINC FOLLOWS......... ...... ..........
SECTION 8 - ROUTING
I A,.KNOW,-E GE RECEIPT Gf' T!-f MAT?RI !_ ( t~S~E`$ f ',,+Irw.'.-...~_...,
TO
COPY NO.
DATE PRINTED NAME SIGNATURE
2.
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SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL DESCRIBED HEREON HAS BEEN: PAGE OR COPY NO
CJ DESTROYED C~ TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 3805)
OFFICE SYMBOL DATE PRINTED NAME OF CUSTODIAN OR REP SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFYING/DESTR. F.
SIGNATURE
P AGE OR COPY NUMBER DATE
PRINTED NAME. OF WITNESSING OFFICIAL
SIGNATURE
SECTION 0 - REPRODUCTION AUTHORITY
NUMBER OF COPIES TO BE REPRODUCED
Al1fNOR12ED BY _ ~~ -
DATE
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
]RECEIPT Of DOCUMENTISI ACKNOWLEDGED c DOCUMENTISI HAVE NOT BEEN RECEIVED
[
Y
L-ITRACER ACTION SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE PRINTED NAME GRADE OR TITLE SIGNATURE
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COMbiRE#dT
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D A FORM , 1 Jul 79 EDITION OF 1 NOV 72 IS OBSOLETE.
App A-RDP96 00788R001600
A roved For Release 2000/08/08 CI 4~ __ 0