CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001600250002-7
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: June 19, 1998
• Sequence Number: 2
• Publication Date: March 21, 1983
• Content Type: FORM

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For use of s arm, s?? B ? Proponent oO?ncy Is 1 s ice, Assistonl C I? o Stoff or nf? p?nc?.
DA 01 `i Qi 0?9?3
SECTION A A. GENERAL
TO:
CIA
FROM:
DATE RECEIVED
ACTION OFFICES!
SUSPENSE DATE(51
REGISTER OR CONTROL NQ.
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
CL-017-83
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S/NOFOR
......
1
....
Cy 1 of 1 cy-Report CL-998/8302/01 ....
.......NOTHING FOLLOWS...............
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SECTION fb ? ROUTING
KNOWLEDGE RECEI FrT OF THE MATER( L~X DES rEW: -H- A
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
2.
3.
A.
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
_
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CRIBED HEREON
MATERIAL
HAS
BEEN:-
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0 DESTROYED _ C7 TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 3840
-
PAGE OR COPY NO
OFFICE SYMBOL
DATE
PRINTED NAME OF CUSTODIAN OR REPu- --- -
SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFY I NG/D ESTR OFF.
SIGNATURE
PAGE OR COPY NUMBER
DATE
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SIGNATURE
SECTION D - REPRODUCTION AUTHORITY
NUMBER OF COPIES TO BE REPRODUCED
A
E ? RECEIPT/TRACER ACTION (Check appropriate block)
[-]RECEIPT OF DOCUMENT(S) ACKNOWLEDGED [J DOCUMENT(S) HAVE NOT BEEN RECEIVED
[--]TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
--
DATE
PRINTED NAME, GRADE OR TITLE
-
SIGNATURE
COMMENTS
EDITION OF 1 NOV 72 IS OBSOLETE. *U.S.GPO:1980-o-319-M