CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001900110002-9
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 2
• Publication Date: May 3, 1983
• Content Type: FORM

QC:Release ~00~f0&/08 CIA-#DP96--OQ78$100'~OQ:1'100Q=
C ASSiFIED DOCUMENT ACCOUNTABILITY RECORD
proponent agency is the Office, Assistant Chief of Staff fe. Intelligence.
TO: - ~.
FROM:
ACSI
DATE RECEIVED -- -
ACTION QFFICI (S) SUSPENSE DATE(S) R
EGISTER OR CONTROL NO
CONTROL. LOG CLASSIFI-
NUMBER OF DESCRIPTION (Type. File Ref. U,iclassrfied Subject
DATE OF
OR FILE NO. CATION
COPIES orS',art Title and Number of Indorsements/Jncls)
DOCUMENT ORIGINATOR
CL-022--83
/NOFORN
1
Cy 1 of 1 cy RoporL CL-1003/E3305/01 ...
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SECTION B - ROUTING
KNOWLEDGE RECEIPT OF THE MATERIAL DESCRIBED HEREON
TO
COPY NO.
DATE
PRINTED NAME
-'--SIGNATURE
1.
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SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL DESCRIBED HEREON HAS BEEN I
PAGE OR COPY NO
DESTROYED TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 380-5/
OFFICE SYMBOL
DATE
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PRINTED NAME OF CUSTODIAN OR REP
SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFYING/DESTR. OFF.
SIGNATURE _-~
PAGE OR COPY NUMBER
DATE
PRINTED NAME OF WITNESSING OFFICIAL
SIGNATURE
SECTION 0 - REPRODUCTION AUTHORITY
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NUMBER (,F COPIES
TOR REPRODUCED AUTHORIZED BY
DATE
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- RECFI'T/TRACER ACTION (Check appropriat.? blocii)
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"E:]Y-;CEI?T OF DOCUMENT(S) ACKNOWLEDGED ? DOCUMENT(S) HAVE NOT BLEN RECE.-,'ED
L]YRAC. , ACTION: SIGNED RECEIPT FOR MATERIAL DE ]CRIUED ABOVE HAS NOT BEEN RECEIVED.
DATE
PRINTED NAME. GRADE OR TITLE
SIGNATURE
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-20=0810$ ' C 1A4-RI ESS-00788
001900110042-.9-~_~_