CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001900070003-3
• 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 31, 1983
• Content Type: FORM

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For use of this form, see AR 300-Sg the proponent mpanay is the Office, Assistant Chief of Staff for int?IIeRencs.
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SECTION A - GENERAL
TO: FROM:
[PATE F ECEIVED
ACTION OFFI
CEISi SUSPENSE DATEISI
REGISTER OR
CONTROL NCS.
CONTROL. LOG
CLASSIFI-
NUMBER OF
DESCRIPTION (Type. File Ref.. Unclassified Subject
I DATE OF
OR FILE NO.
CATION
COPIES
or Short Title and Number of Lndoisements/fncls)
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DOCUMENT
ORIGINATOR
CL.--033-83
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SECTION B - ROUTING
I ACKNOWLEDGE RECEIPT 6"F' TH
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E MATER 11Tl D E S C f1 1 E S] 41 5 ~Ji~T
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
1.
3.
4.
SECTIO
N C - DESTRUCTION CERTIFICATE (Check appropriate bl
ock)
MATERIAL DESC RIESED HEREON H
AS BEEN
PAG E O R COPY NO
~_~--^-
DESTROYED
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TORN IN HALFAND PLACED IN A CLASSIFIED V ASTE C
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.ONTAINER (AR ,7&4
OFFICE SYMBOL.
DATE
PRINTED NAME OF CUSTODIAN OR REP
SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFYING/DESTR OF f"
SIGNATURE
PAGE OR COPY NUMBER
DATE
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SIGNATURE
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NUMBER OF COPIES TO BE REPRODUCED AUTHORIZED BY DATE
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
DRECEIP-T OF DOCUMENTISt ACKNOWLEDGED Q DOCIIMENT4S; HAVE NOT BEEN RECEIVED
^TRACFR ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE PRINTED NAME, GRADE OR TITLE SIGNATURE
COMMENTS
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. Approved For Release 2000./08108.; CIAi~F QP:9-fi.-04 8 .R.0A 9,0.0.0.../ ,11 '