CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001900080003-2
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: April 11, 2000
• Sequence Number: 3
• Publication Date: May 31, 1983
• Content Type: FORM

-APPMORWO
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For se of this farm, sae AN 3M S; the proponent agency is the Ofice, Assistant Chief oI Staff for Intelliy nco
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SECTION A - GENERAL
ry
TO: FROM:
NSA
DATE RECEIVED ACTION OFFICE(S) SUSPENSE DATE(S)
REGISTER OR CONTROL NQ.
CONTROL LOG CtASSIFI- NUMBER OF DESCRIPTION (Type. File Ref. Unclassified Subject
DATE OF
OR FILE NO. CATION COPIES or Short Title and Number of Indorsements/Arcls)
ORIGINATOR
DOCUMENT
CL_-035--83 S/NOFOR 1 Cyl of 1 cy Report CL-1015/8304/08 .....
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SECTION B - ROUTING _~.~_
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.--I ACKNOWLEDGE RECEIPT -OF-1 H
F tlMATf EFil L ESC R 1 ED H#
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
2.
3.
4.
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL D
EESCRIBED HEREON HAS SEEN
PAGE OR COPY NO
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DESTROYED L,.J TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 38O-5)
OFFICE SYMBOL DATE PRINTED NAME OF CUSTODIAN OR REP SIGNATURE
DESTRUCTION RECORD NO. DATE PRINTED NAME OF CERTIFYING/DESTR. OFF. SIGNATURE
PAGE I?R COPY NUMBER ( DATE PRINTED NAME OF WITNESSING OFFICIAL SIGNATURE
SECTION 0 - REPRODUCTION AUTHORITY
NUMBER C3F COPIES TO BE REPRODUCED AUTHORIZED BY DATE
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
RECEIPT OF DOCUMENT(SI ACKNOWLEDGED ? DOCUMENTIS) HAVE NOT BEEN RECEIVED
oTRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE
Pi4INTED NAME. GRADE OR TITLE
SIGNATURE