SURVEILLANCE CONSENT AUTHORIZATION (Sanitized)

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00789R002100150044-5
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 44
• Publication Date: July 7, 1988
• Content Type: CONT

Approved For Release 2002/05/17: CIA-RDP96-0078980021 d
SURVEILLANCE CONSENT AUTHORIZATION
do voluntarily consent to per orm duties as a BEACON (U) for Project SUN STR AK (U)
training and operational missions. I understand that as a BEACON, I will serve as
the focus for Remote Viewers. In consenting to this statement I acknowledge that
this authorization:
I __L ~, born on
a. Will only pertain to training and actual SUN STREAK (U) missions and only
with my prior consent and knowledge.
b. Can be entirely or selectively withdrawn without question or penalty. To
do so, I need only to orally inform my immediate supervisor, the unit operations
officer or the project manager that I wish to withdraw my consent without further
explanation.
c. Will suppose the possibility of. inadvertent surveillance of my most intimate
anti personal thoughts and that such inadvertent surveillance will not be reported
nor become a matter of any official records and that the nature of this inadvertently
co:Llected information-will be held in strictest confidence.
d. Will at no time be construed as authorization, implied ar stated, to conduct
any type of physical, technical or yet to be defined form of surveillance without my
prior knowledge and consent.
Thais statement of authorization is executed in the presence of the witness whose
signature appears on this day of 19 without
reservation, amendment or r striction and without c,ercion or implied and/or stated
inducements.//END//
(S:CGNATURE) (DATE)
W:CTNESS D T
Approved For Release 2002/05/17: CIA-RDP96-007898002100150044-5