GRILL FLAME SECURITY AGREEMENT (ANN E. DJUPMAN)

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00789R002100150022-9
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 22
• Content Type: CONT

Approved For Release 2001/03/07 :CIA-RDP96-007898002100150022-9
DATE : ~ ~ ~"' ~~
GRILL FLAME SECURITY AGREEMENT ~ ~ /1,
I, (,,L.y~z/ ~;. /,,~1~~?yy(~~~~ , understand that the highly sensitive
and classified in ormation I have, or a~ about to receive as part of the
GRILL FLAME Program belongs to the United States Government. I understand
that disclosure of this information is punishable under Title 18, Section
798, U.S.C. "Disclosure of Classified Information," June 1948 as amended.
I do solemnly swear that I will never divulge, publish, or reveal by ward,
conduct, or by any other means such classified information or knowledge,
except in the performance of my official duties, and as specifically
authorized. in writing in each case by the appropriate agency of the United
States Government.
I understand that no change in my assignment or employment will relieve me of
my obligation under this agreement and that the provisions of this agreement
will remain binding upon me even after the termination of my services with
the United. States Government.
I take .this obligation of my own free will, without any mental reservation
or purpose of evasion.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
C5 U.S.C. 552x)
1. Authority: National Records Act, 44 U.S.C. 3102; E.O. 9397, Numbering
System for Federal Accounts Relating to Individual Persons, November 22, 1943?
2. Principal Purpose: To maintain a record of those individuals who have
or have had access to GRILL FLAME information through the use of their. name
and/or Social Security Number.
3. Routine Uses: The Social Security Number is to be used to identify the
individual, and the information is to be retained strictly within the Program.
4. Mandatory or Voluntary Disclosure: Information is disclosed on a
voluntary basis, but withholding information will render it impossible to
grant an individual access to or participation in the Program.
Approved For Release 2001/03/07 :CIA-RDP96-007898002100150022-9
 Approved For Release 2001/03/07 :CIA-RDP96-0078980.02100150022-9
(TRILL FLAME SECURITY AGREEMENT CONTINUATION PAGE
DATE C `- ~ ~.--_
~iITNESS :.,,,sue ~'
~'~ ~ G~~'~~~c SIGNED
NAME, RANK/GRADE
NAME , RANK RARE -
UNIT/ORGANIZATION
UNIT/ GANIZAT ON
~~ `~~~
POSITION ~`
Approved For Release 2001/03/07 :CIA-RDP96-007898002100150022-9