CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001200230025-8
• Release Decision: RIFPUB
• Original Classification: U
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: December 7, 1998
• Sequence Number: 25
• Publication Date: January 21, 1980
• Content Type: FORM

B AM i e 0EO6rISitaIN-R M129R4DO788R00120023 0278
For UNiaf thin farm see AR..3flf1-5; the proponent agency Is the Office. Assistant Chief of Staff for Inteil)genae. 21 Jan 1980
SECTION A - GENERAL
TOt
F ROMs
DATE RECEIVED
ACTION OFFICE(S)
SUSPENSE DATE(S)
REGISTER OR CONTROL NO.
CONTROL, LOG
OR FILE NO,
CLASSIFI-
CATION
NUMBER OF
COPIES
DESCRIPTION (Type, File Ref., Unclassified Subject
or Short Title and Number of Indorsements/Incls)
DATE OF
DOCUMENT
ORIGINATOR
DAMA-ZD
1-80
S
1
l ! 1
?
Dec79
DAMA-ZD
SECTION 8 - ROUTIN`10
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
AS A(RDA)
Dr. Yore
o
f
/
L11~~''~'
C..`~.
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
ERIAL DESCRIBED HEREON HAS BEEN:
[-l DESTROYED ? TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 380-5)
OFFICE SYMBOL
DATE
PRINTED NAME OF CUSTODIAN OR REP. -?_-m
SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFYING/DEBT-I. OFF.
SIGNATURE
PAGE OR COPY NUMBER
DATE
PRINTED NAME OF WITNESSING OFFICIAL
SIGNATURE
SECTION D - REPRODUCTION AUTHORITY
UMBER OF COPIES TO BE REPRODUCED
AUTHORIZED BY
DATE
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
RECF_IPT OF DOCUMENT(S) ACKNOWLEDGED fl DOCUMENT(S) HAVE NOT BEEN RECEIVED
[TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
ATE
PRINTED NAME, GRADE OR TITLE
SIGNATURE
OMMENTS
DA FORM 3964, 1 Nov 72
REPLACES DA FORMS 1203, 1 SEP 58: 1204, 1 JAN
546, 1 OCT 63, WHICH ARE OBSOLETE.
Approved For Release 2003/09/10 : CIA-RDP96-00788R001200230025-8