SURVEILLANCE CONSENT AUTHORIZATION (Sanitized)

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00789R002100150045-4
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 45
• Publication Date: September 17, 1986
• Content Type: CONT

Approved For Release 2001/03/07 :CIA-RDP96-007898002100150045-4
SG1J
WP.R.NING NOTICE: INTELLIGENCE SOURCES A1`U METHODS INVOLVED
SGFOIA3
I born on
duties as a
d
o v
training and operational iss~ons. I understand that as a BEACON, I will serve as
the focus for Remote Viewers. In consenting to this siaten~ent I acknowledge that
this authorization:
a. Will only pertain to training and actual SUh STREAK (U) missions and only
with my prior consent and knowledge.
b. Can be entirely or selectively withdrawn without question or penalty. To
do so, I need only to orally inform my immediate supen~isor, the unit operation=
officer or the project manager that I wish to withdraw my consent without further
explanation.
c. Will suppose the possibi.Iity of inadvertent surveillance of my most intimate
and personal thoughts and that such inadvertent surveillance will not be reported
nor become a matter of any official. records and that the nature of this inadvertently
col]ected information will be held in strictest confidence.
d. Will at no time be construed as authorization, implied or stated, to conduct
any type of physical, technical or yet to be defined form of surveillance without my
prior knowledge and consent.
'This statement of authorization is executed in the re 'nlg of~ t~e'witness whose
signature appears on this ____~Z_day of ,~ without
reservation, amendment or restriction and without coercion or implied and/or stated
inducements.//END//
SG1J
Approved For Release 2001/03/07 I
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