SURVEILLANCE CONSENT AUTHORIZATION (Sanitized)

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00789R002100150047-2
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 47
• Publication Date: September 3, 1986
• Content Type: CONT

~*s
A roved For Release 20~9fOT': - ~96-00789R002100150047-2
pp
SURVEILLA;vCE CO;~SENT AL'THOYI7_A'I'ION
SG1J
WARNING NOTICE: INTELLIGENCE SOURCES AND METHODS INVOLVED
SG1J
SGFOIA3
training anal operational missions. I understand that as a BEACON, I will serve as
the focus f:or Remote Viewers. In consenting to this statement I acknowledge that
this authar.ization:
da vo un arl y consen iZn duties as a BEACON (U Y for Project
I 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b. Can be entirely or selectively withdrawn without question or penalty.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
e.xplanat.i.on.
c. Will. suppose the possibility of inadvertent surveillance of my most intimate
a.nd 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
collected -information will. be held in strictest confidence.
d. Will at no time be construed as authorization, implied or stated, to conduct
any type of physical, technical or yet to be defined form of surveillance without my
prior knowledge and consent.
This statement of authorization ~s executed in the presence of he witness whose
signature. appears on this ~ r day of , 19 ~, without
x-eservatian, amendment or restriction and witho t coercion or implied and/ar stated
inducements.//END//
Approved For Release 2001~~C1
vdP12NINGNOTICE: SENSITIVE
;NrELUGENCE SOURCES AND
-00789 R002100"1~~`"1otvEo