BRIEFING ACKNOWLEDGEMENT (Sanitized)
Document Type:
Collection:
Document Number (FOIA) /ESDN (CREST):
CIA-RDP96-00789R002100150018-4
Release Decision:
RIPPUB
Original Classification:
K
Document Page Count:
2
Document Creation Date:
November 4, 2016
Document Release Date:
June 17, 2003
Sequence Number:
18
Case Number:
Publication Date:
April 8, 1988
Content Type:
FORM
File:
Attachment | Size |
---|---|
CIA-RDP96-00789R002100150018-4.pdf | 138.64 KB |
Body:
NAME t r~Rprq,~ed iQr aser20P3/0?/f9 :.CI -RDP9 00 8980021001500 $]'e1cphone Numhcr
014/1 AN A R L, L L I A ru' JO D/,23
JOB TITLE ,~7G/b/ j"0/
I CEP`fIFy THAT THE ABOVE--NAMED INDIVIDUAL MEETS TI?E REQUIREMENTS FOR ACCESS
TO CLASSIFIED DEFENSE INFORMATION INDICATED BELOW.
ACCESS AUTHORIZATION TO CLASSIFIED INFORMATION
PROJECT AUTHORIZED: SUN STREAK
BRIEFING ACKNOWLEDGEMENT
1. I acknowledge I have been briefed concerning the project indicated
above. Having received h;ghl
.-.l
- . r -
y
f
t
h
+--- ~"L.lfey
o t
e
United States Government, I am aware the unauthorized dis
l
c
osure could
seriously damage the national security and the transmission or revelation
of i'tr-h infnrrnni- Irn to ,,,,-,.,4- 1,...--'-__n _---_ - _ _
.tiun under the Espionage Laws (Title 18, USC, Sections 793, 794 and 798) or
oth
li
bl
er app
ca
e laws including the Uniform Code of Military Justice.
2. 1 (3o solemnly swear or affirm that I will never divul
e
ubli
h
g
, p
s
, or
reveal by word, conduct, or any other means such information or knowl
d
e
ge
except when necessary to do so in the performance of my official d
ti
i
u
es
n
connection with the project indicated above and in accordance. with the laws
of the United States, unless specifically authorized in writiriq in each anr<
---
i ted St
it tt
a Leis
Government. I take this obligation freely, without any mental re ervation
or Durpose of evasion and in ahsenc, of duress.
3. I -cknowledge that information I receive is provided only to'persons
.q nPr-i Al 1XY n r~7'1r i,ca.-~nl .r t.. L. .. ~,. -._ _
id t=
further divulged without specific prior written approval from the Project
Head
uart
All
q
ers.
access is restricted to ":nusta-know" based upon one's
res
t
iti
p
e:ri
pos
on of functional use.
4. I understand that in the event I am reassigned from my present I
position, I will.notify the office granting access to the project indicated
for briefing on actions deemed necessary at the time.
SIGNATURE OF INDIVIDUAL BRIgFED
ved For Release 2003/09/09 : CIA-RDP96-00789R002100150018-4
Approved For Release 2003/09/09 : CIA-RDP96-00789R002100150018-4
DR RIE'FING AGREEIIE:NT
1. I hereby reaffirm my acknowledgement of being briefed on the DIA SUN
STREAK Project, the text of which appears on the reverse of this form.
2. I certify I have surrendered and no longer have in my possession or
custody any classified information or material acquired as a result of this
association.
3. I further acknowledge and agree I have a continuing individual respon-
sibility to the United States Government. for the protection of such infor-
mation and termination of access to information concerning this project
aloes not relieve me of my obligations under this oath or any other
previously executed agreements or those imposed by law.
4. I take this obligation freely, without any mental reservation or
purpose of evasion and in absence of duress.
SG1J
1,2
DA?I r__
PRIVACY ACT STATEMENT
:L1?IHOFITY: 10 U.S.C. 8012; 44 U.S.C. 3101 and EO 9397.
PRINC:[PAL PURPOSE: FOR GRANTING ACCESS TO A CLASSIFIED PROJECT AND TO
1MJThOI, {:ZI-D{ ACCESS TO PROJECT DOCUMENTATION.
k OLTTII'.TE USE: TO RECORD PROJECT ACCESS. USE OF SSN IS NECESSARY TO
POSITIVE IDENTIFICATION OF THE INDIVIDUAL AND RECORDS.
DISCLOSURE IS VOLUNTARY: FAILURE TO PROVIDE THE INFORMATION AND SSN WILL
Approved For Release 2003/09/09 : CIA-RDP96-00789R002100150018-4