CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001900060003-4
• 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 12, 1983
• Content Type: FORM

LA5SIFIED DOCUMENT ACCOUNTABILITY RECORD
DATE
12 May 83
For use of his form, was AR 380.5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence.
SECTION A - GENERAL
To.
T
FROM:
NSA
BATE RECEIVED
ACTION OFFICE(S!
SUSPENSE DATEIS)
REGISTER OR CONTROL NO.
CONTROL, LOG
CIASSIFI-
NUMBER OF
DESCRIPTION (Type. File Ref.. (Inelussi[ed Subject
DATE OF
OR FILE NO.
CATION
COPIES
or Short Title and Number of lnd nsen castsfine(s)
DOCUMENT
ORIGINATOR
CL--038-83
S/NOFOR
1
Cy 1 of 1 cy -Report C1-1012/8304/08 ...
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........NOTHING FOLEJWS ...............
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SECTION B - ROUTING
-'~-----~ ~~ ~- '-~J I ACKNOWLEDGE RECEIPT pF TH ATE.~I L l7E5 .RIBE~1-1Efi
TO COPY NO. DATE PRINTED NAME __ _- _ SIC NATURE
2.
3.
A.
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL DESCRIBED HEREON HAS BEEN_ PAGE OR COPY HO
0 DESTROYED TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 380-5)
_ - ---_. -'
OFFICE SYMBOL.
DATE
_______.
PRINTED NAME OF CUSTODIAN OR REP
SIGNATURE
DESTRUCTION RECORD NO.
_
DATE
w
PRINTED NAME OF CERTIFYING/DESTD. OFF
SIGNATURE
k AGE OR COPY NUMBER
DATE
PRINTED NAME OF WITNESSING OFFICIAL.
SIGNATURE
SECTION D - REPRODUCTION AUTHORITY
NUMBER OF COPIES Tv~ Bt: REPRODUCED
AUTHORIZED BY
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
f JRECEIPT OF DOCUMENTISI ACKNOWLEDGED ? DOCUMENTISI HAVE NOT BEEN RECEIVED
TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE PRINTED AME, GRADE OR TITLE SIGNATURE
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COMMENTS
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