APPROVED FOR
RELEASE^DATE:
03-Sep-2008
~EUicEtic
F
SECURITY REGULATIONS CERTIFICATION
Date -- y
I CERTIFY THAT I HAVE READ THE SECURITY REGULA-
TIONS MANUAL OF THE CENTRAL INTELLIGENCE AGENCY.
I UNDERSTAND THESE REGULATIONS AND WILL ABIDE BY
THEIR PROVISIONS.
0-14 UV _
NAME (typed or printed)
APPROVED FOR
RELEASE DATE:
03-Sep-2008
OUTSIDE ACTIVITY APPROVAL ROUEST
AND FORWARD ORIGINAL AND 3 COPIES T
CTOR OF SECURITY;
division or office head and securityofficer where assigned)
Staff,
NAM AOE OF EMPLOYEE (Print or
type)
(b)(2).:
(b)(3)
(b)(6)
CIA INTEE USE ONLY
(Class When Filled In)
FROM:
TERMINATION SECRECY OATH ---
J
I,
CN on ~' lG1S, becoming dissociated
with the ograms in the
ealize that by virtue of my duties with t 'nose programs have
been the recipient of information and intelligence which concerns the
present, and future security of the United States of America. I am
aware that the unauthorized disclosure of such information is
punishable under the Espionage Laws.
TERMINATION SECRECY AGREEMENT
1. I acknowledge that by virtue of my duties I have been exposed to or the recipient
of classified information, which, in itself, or by the implications drawn from it, is highly sen-
sitive and its unauthorized disclosure or negligent handling could adversely affect the interests
of the United States. I am aware that the unauthorized disclosure of classified information
is prohibited by the Espionage Laws (18 U.S.C., Sections 793, 794 and 798) and that a vi-
FITNESS REPORT (Part I) PERFORMANCE
INSTRUCTIONS
FOR ME ADMINISTRATIVE OFFICER: Consult current instructions for completing this report.
FOR WE SUPERVISOR: This report is designed to help you express your evaluation of your subordinate and to transmit
this evaluation to your supervisor and senior officials. Organization policy requires that you inform the subordi-
nate where he stands with you. Completion of the report can help you prepare for a discussion with him of his
APPROVED FOR
RELEASE^DATE:
03-Sep-2008
CONFI TIAL
(Whe illed In)
TERMINATION SECRECY AGREEMENT
(b)(1)
(b)(2)
(b)(3)
(b)(6)
1. I, John W. Debe 1 iuS , am about to terminate my association with
the Central Intelligence Agency.. I realize that, by virtue of my duties with that agency, I have
been the recipient of information and intelligence that concern the present and future se-
curity of the United States of America.
TERMINATION SECRECY AGREEMENT
1. I acknowledge that by virtue of my duties I have been exposed to or the recipient
of classified information, which, in itself, or by the implications drawn from it, is highly sen-
sitive and its unauthorized disclosure or negligent handling could adversely affect the interests
of the United States. I am aware that the unauthorized disclosure of classified information
is prohibited by the Espionage Laws (18 U.S.C., Sections 793, 794 and 798) and that a vi-
NAME OF SUBJECT
DEBELIUS, John W.
REASON FOR INTERVIEW
Retirement 1 June 1973
PERMANENT ADDRESS
APPROVED FOR
RELEASE DATE:
03-Sep-2008
(b) (2)
(b)(3)
(b)(6)
1. ALL PHASES OF SECURITY WITH RESPECT TO SUBJECT'S RESPONSIBILITY TO THE ORGANIZATION WERE FULLY AND COM-
PLETELY DISCUSSED.
2. SUBJECT WAS ADVISED THAT ALL INFORMATION RECEIVED AND COMPILED BY THE AGENCY IS OFFICIAL DATA. AND IS THE
APPROVED FOR
RELEASE DATE:
03-Sep-2008
(b
Interne Use Only
[b
CLAS (CATION
FITNESS REPORT
SECTION A GENERAL INFORMATION
1. EMPLOYEE NUMBER
2. NAME (Last, first, middle) 3. [)ATE OF BIRTH
4. SEX
S. GRAD
E 6. SD
Debelius, John W. 1 04/03/26
M
GS-14
SS
7. OFFICIAL POSITION TITLE-
S. OFF/DIV/BR OF ASSIGNMENT
9. CURRENT STATION
to. H
Q Co
FOIA
