CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00789R002100270007-3
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: December 4, 1998
• Sequence Number: 7
• Publication Date: March 8, 1990
• Content Type: FORM

CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD
DATE
For use of this form, see AR 3180-5., %e prop .anent agency it the Office, Assistant Chief of Staff for Intelligence.
SECTION A - GENERAL
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SUSPENSE DATE(
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CONTROL. LOG
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CLASSIFI-
CATION
NUMBER OF
COPIES
DESCRIPTION I Type. File Ref. Unclassified Subject
or Short Title and Number of Indorsements/fncls)
DATE OF
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SECTION 8 B. ROUTING
1 ACKNOWLEDGE RECEIPT OF TH MATERIAL OESCRISED HEREON
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
I.
2.
3.
4.
S.
SECTION C C. DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL DESCRIBED HEREON HAS BEEN:
1
PAGE OR COPY NO
0 DESTROYED 0 TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 380-5)
OFFICE SYMBOL
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 D - REPRODUCTION AUTHORITY
NUMBER OF COPIES TO BE REPRODUCED;
AUTHORIZED BY
DATE SG 1 J
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
RECEIPT OF DOCUMENT(S) ACKNOWLEDGED Q DOCUMENT(S) HAVE NOT BEEN RECEIVED
[!)TRACER ACTION: SIGNED RE
COMMENTS
Approved For Release 2000/08/08 : CIA-RDP96-00789R002100270007-3
DA FORM r?Y or a ease ,zI 0?400270007-3 U.S. G.P.O. 1986-162-374