CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001900160002-4
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: June 23, 1998
• Sequence Number: 2
• Publication Date: May 24, 1983
• Content Type: FORM

I OORV j
For arse of this form, see AN SMS; the proponent o?e_..nar~a 1 s the O ff . Assistonl Chi of of Staff for In-olli9once.
"24 IOLJV I UVUVL-9
May 83
SECTION A - GENERAL
- -~
TO: -.____~_~
ACSI
FROM:
DATE RECEIVED
ACTION OFFICE(S)(
SUSPENSE DATE(S)
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 Indor:sementslIncls)
DATE OF
DOCUMENT
ORIGINATOR
1-041_083
.........
S/NOFOO
.....
1
.......
Cy 1 of 1 cy Report CL-1016/8305/01 ....
...........NOTHING FOLLOWS...........
....... .
........
...........
...........
SECTION fl - ROUTING
I ALRNOW ED Gr ER EC. CI PT OF THEMAT ERI DE I 6 H
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
x.
3
4.
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
_ ----~~
MATERIAL DESCRIBED HEREON HAS BEEN: .~~~~~
L..._1 DESTROYED TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 380.5)
_
AGE OR COPY NO
__ _
OFF IC ESYMBOL
DATE
PRINTED NAME OF CUSTODIAN OR REP
SIGNATURE
-~~ _
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFYING/DESTR. OFF.
SIGNATURE
PAGE OR COPY-NUMBER DATE - PRINTED NAME OF WITNESSING OFFICIAL SIGNATURE
SECTION 0 - REPRODUCTION AUTHORITY
NUMBER OF COPIES TO BE REPRODUCED AUTHORIZED BY
DATE
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
[]RECEIPT O!' DOCUMENT(S) ACKNOWLEDGED 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
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,
COMMENTS
b? P For Release 20U1b' 7b1 f4- 6 b788R001900160002-4