(SANITIZED)

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-03424A000500060003-9
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 1
• Document Creation Date: December 22, 2016
• Document Release Date: February 22, 2012
• Sequence Number: 3
• Publication Date: March 31, 1959
• Content Type: FORM

Declassified in Part - Sanitized Copy Approved for Release 2012/02/22 : CIA-RDP78-03424A000500060003-9
WHEN FILLED IN
CONFIDENTIA
Contract No. -/Q
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Date 3
TO: 0C - E-
FROM: DL ?,PLC A
Approval:
Stractor:
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on Ext:
If additional information is required, please contact the undersigned on
WHEN FILED IN
CONFIDENTIAL
Declassified in Part - Sanitized Copy Approved for Release 2012/02/22 : CIA-RDP78-03424A000500060003-9