CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001900050003-5
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: June 25, 1998
• Sequence Number: 3
• Publication Date: May 18, 1983
• Content Type: FORM

Appr0i*ggf B ANA -
ATE
For use of this form, sea AR 384.5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence.
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SECTION A - GENERAL
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TO:
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FROM:
NSA
DATE RECEIVE[) ACTION QFFICEIS!
SUSPENSE DATEISI REGISTER OR CONTROL NO.
CONTROL. LOG
CLASSIFI?
NUMBER OF
DESCRIPTION (Type. File Ref. Uiiclossified Subject
DATE OF
OR FILE NO.
CATION
COPIES
or Short Title and Number of LIdoisenienls/lads)
DOCUMENT
ORIGINATOR
,L.-O39-?83
1/NOFORN
1.
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SECTION ?- ROUTING
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I AC`KNOWLEGG_E Fl CEIPT OF YH MATERI -tJE3 Ti1F.iEd 4i T1 (~
TO COPY NO. DATE PRINTED NAME SIGNATURE
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SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL DESCRIBED HEREON HAS BE N
OR COPY NO
FA TORN
C_.J DESTROYED L__)TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 3Hf1.i)
OFFICE. SYMBOL DATE PRINTED NAME OF CUSTODIAN OR REP SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFYING/DESTR. OF
SIGNATURE
PAGE OR COPY NUMBER
DATE
PRINTED NAME OF WITNESSING OFFICIAL
SIGNATURE
SECTION D - REPRODUCTION AUTHORITY ._ .mr.. .q~_.
NUMBER OF COPIES TO BF REPRODUCED AUTHORIZED BY IIC)A7E -'?"?`-`?""
SECTION E - RECEIPT/TRACER ACTION (('heck appcopriat,' hloih)
RECEIPT Of DOCUMENTISI ACKNOWLEDGED DOCUMENTISI HAVE NOT BEEN RECEIVED
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C JTRACFR ACTION. SIGNED RECEIPY- FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE PRINTED NAME, GRADE OR TITLE SIGNATURE
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