DEPARTMENT OF DEFENSE CONTRACT PRICING PROPOSAL (RESEARCH AND DEVELOPMENT)

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00792R000100140026-4
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 6
• Document Creation Date: November 4, 2016
• Document Release Date: October 28, 1998
• Sequence Number: 26
• Publication Date: September 28, 1978
• Content Type: CONT

Appro
)FA FrD AR( ALCIA-RDP96-0079280001 014QQZ proved
(RESEARCH AND DEVELOPMENT) Budget Bureau No. 22-RO100
This form is for use when (i) submission of cost or piri-sing dots (see ASPR 3-807.3) is PAGE NO.
required and (ii) substitution for the DD Form 633 is authorized by the contracting officer. 1
. OF PAGES
NO 2
NAME OF OFFIROR
SRI International
SUPPLIES AND/OR SERVICES TO BE FURNISHED
Research
HOME OFFICE ADDRESS (Include ZIP Code)
333 Ravenswood Avenue
Menlo Park, California 94025
DIVISION(S) AND LOCATION(S) WHERE WORK IS TO BE PERFORMED
As above
TOTAL AMOUNT OF PROPOSAL
$ 74,986
GOVT SOLICITATION NO,
DETAIL DESCRIPTIO
N OF COST ELEMENTS
1. DIRECT MATERIAL (Itemize on Exhibit A)
EST COST($)
TOTAL
EST COST(
REFER- 2.
ENCE
a. PURCHASED PARTS
....................
~~?~?~-??~?~????~~
.
~
b. SUBCONTRACTED ITEMS
C. OTHER (1) RAW MATERIAL
(2) YOUR STANDARD COMMERCIAL ITEMS
....................
(3) INTER DIVISIONAL TRANSFERS (At other than coat)
TOTAL DIRECT MATERIAL
....................
2. MATERIAL OVERHEAD 3 (Rate 7-X $ base=)
3. DIRECT LABOR (Specify)
ESTIMATED
HOURS
RATE/
HOUR
EST
COST ($)
TOTAL DIRECT LABOR
.............
.......................
.......................
4. LABOR OVERHEAD (Specify department or cost cehter)3
O.H. RATE
X BASE =
EST COST ($)
I
.............
TOTAL LABOR OVERHEAD
....................
:...............
......................
5. SPECIAL TESTING (Including field work at Government Installations)
EST COST (l)
...................
TOTAL SPECIAL TESTING
.......................
6. SPECIAL EQUIPMENT (If direct charge) (Itemize on Exhibit A)
7. TRAVEL (If direct charge) (Give details on attached Schedule)
EST COST ($)
e. TRANSPORTATION
b. PER DIEM OR SUBSISTENCE
....................
TOTAL TRAVEL
...........
8. CONSULTANTS (Identity - purpose - rate)
EST COST (f)
;:
TOTAL CONSULTANTS
.....................
.......................
.......................
9. OTHER DIRECT COSTS (Itemize on Exhibit A)
10. TOTAL DIRECT COST AND OVERHEAD
11. GENERAL AND ADMINISTRATIVE EXPENSE (Rate 7 of cost element Noe. ) 3
12. ROYALTIES 4
13. TOTAL ESTIMATED COST See Part Two-
-Contrac
tual
14. FEE OR PROFIT Provisions c
SU
15. - TOTAL ESTIMATED COST AND FEE OR PROFIT
This proposal is submitted for use in connection with and in response to (Describe RFP, etc.i
and reflects our best estimates as of this date, in accordance with the instructions to offerors and the footnotes which follow.
TYPED NAME AND TITLE Philip J. O'Donnell!
Manager
SIGNATU _
L2'--?; , , (`Z)-n-
NAME OF FIRM
SRI International
DATE OF SUBMISSION
1978 SEP
DDIAPRaa 633- 4
09110 r ID RDPg6-00792R000100140026-4
-:,?Y~ ~ t-.,t*.4?. ~ `Y 141` ~ i `e~. SI?., ..., i ,. ,. 1': .
 E rto6ecf (IIdfrs"@9gF( fli&, i 01MMIRM-0011-99REM IMO e ts)
EST COST (S)
ITEM DESCRIPTION (See footnote 5)
HAVE THE DEPARTMENT OF DEFENSE, NATIONAL AERONAUTICS AND SPACE ADMINISTRATION, OR THE ATOMIC ENERGY COM-
MISSION PERFORMED ANY REVIEW OF YOUR ACCOUNTS OR RECORDS IN CONNECTION WITH ANY OTHER GOVERNMENT PRIME
CONTRACT OR SUBCONTRACT WITHIN THE PAST TWELVE MONTHS?
LA YES O NO it yes, identity below.
Defense Contract Audit Agency
u YES q] NO it yes, identity on a separate page.
III DO YOU REQUIRE GOVERNMENT CONTRACT FINANCING TO PERFORM THIS PROPOSED CONTRACT?
M YES LX] NO if yes, identify: t_7 ADVANCE PAYMENTS C] PROGRESS PAYMENTS OR C~ GUARANTEED LOANS
IV. DO YOU NOW HOLD ANY CONTRACT (or, do you have any
- 1 en era Pv rule PPnPner=n t nNTRAr'T7
[XI NO If yes, identify
THIS COST SUMMARY CONFORM WITH THE COST PRINCIPLES SET FORTH IN ASPR, SECTION XV (See 3-807.2 (c) (2))?
I-K YES 0 NO It no, explain on a separate page.
INSTRUCTIONS
I. The purpose of this form is to provide a standard format by
which the offeror submits to the Government a summary of in-
curred and estimated cost (and attached supporting information)
suitable for detailed review and analysis. Prior to the award
of a contract resulting from this proposal the offeror shall,
under the conditions stated in ASPR 3-807.3, be required to
submit a Certificate of Current Cost or Pricing Data (see ASPR
3-807.3(e) and 3-807.4).
2. As part of the specific information required by this form, the
offeror must submit with this form, and clearly identify as such,
cost or pricing data (that is, data which is verifiable and fac-
tual and otherwise as defined in ASPR 3-807.3(e)). In addition,
he must submit with this form any information reasonably requir-
ed to explain the offeror's estimating process, including:
a. the judgmental factors applied and the mathematical
or other methods used in the estimate including those
used in projecting from known data, and
h. the contingencies used by offeror in his proposed
price.
TO OFFERORS
3. When attachment of supporting cost or pricing data to this
form is impracticable, the data will be specifically identified
and described (with schedules as appropriate), and made
available to the contracting officer or his representative upon
request
4. The format for the "Cost Elements" is not intended as
rigid requirenments. These may be presented in different
format with the prior approval of the contracting officer if
required for more effective and efficient presentation. In all
other respects this form will be completed and submitted
without change.
5. By submission of this proposal offeror, if selected for
negotiation, grants to the contracting officer, or his author-
ized representative, the right to examine, for the purpose of
verifying the cost or pricing data submitted, those books,
records, documents and other supporting data which will
permit adequate evaluation of such cost or pricing data, along
with the computations and projections used therein. This
right may be exercised in connection with any negotiations
prior to contract award.
FOOTNOTES
I Enter in this column those necessary and reasonable costs 3 Indicate the rates used and provide an appropriate explana-
which in the judgment of the offeror will properly be incurred
in the efficient performance of the contract. When any of the
costs in this column have already been incurred (e.g., on a
letter contract or change order), describe theism on an attached
supporting schedule. Identify all sales and transfers between
your plants, divisions, or organizations under a common con-
trol, which are included at other than the lower of cost to the
original Iransferror or current market price.
2 When space in addition to that available in Exhibit A is
required, attach separate pages as necessary and identify in
this "Reference" column the attachment in which information
supporting the specific cost element may be found. No stand-
ard format is prescribed; however, the cost or pricing data must
be accurate, complete and current, and the judgment factors
used in projecting from the data to the estimates must be stated
in sufficient detail to enable the contracting officer to evaluate
the proposal. For example, provide the basis used for pricing
materials such as by vendor quotations, shop estimates, or
invoice prices; the reason for use of overhead rates which de-
part significantly from experienced rates (reduced volume, a
planned major re:uranggement, etc.): or justification for an in-
crease in labor rates"(anticipated wage and salary increases,
etc.). Identify and explain any contingencies which are included
in the proposed price, such as anticipated costs of rejects and
defective work, or anticipated technical difficulties.
lion. Where agreement has b--en reached with Government rep-
resentatives on the use of forward pricing rates, describe the
nature of the agreement. Provide the method of computation
and application of your overhead expense, including cost
breakdown and showing trends and budgetary data as neces-
sary to provide a basis for evaluation of the reasonableness
of proposed rates.
4 If the total royalty cost entered here is in excess of $250
provide on a separate page (or on DD Form 783, Royalty
Report) the following information on each separate item of
royalty or license fee name and address of licensor; date of
license agreement; patent numbers, patent application serial
numbers, or other basis on which the royalty is payable; brief
description, including any part or model numbers of each con-
tract item or component on which the royalty is payable; per-
centage or dollar rate of royalty per unit; unit price of contract
item; number of units; and total dollar amount of royalties.
In addition, if specifically requested by the contracting office',
a copy of the current license agreement and identification of
applicable claims of specific patents shall be provided.
5 Provide a list of principal items within each category in-
dicating known or anticipated source, quantity, unit price,
competition obtained, and basis of establishing source and
reasonableness of cost.
Approved For Release 2003/09110: CIA RDP96-90792R0001.00140 26 4
 Approved IF rIRWeaseF266i3dQfii10 : CIA-RDP96-00792R00 -
CONTRACT PRICING PROPOSAL Form Approved
(RESEARCH AND DEVELOPMENT) Budget Bureau No. 22-ROZOO
This form is for use when (i) submission of cost or priping data (see ASPR 3-807.3) is PAGE NO.
required and (ii) substitution for the DD Form 633 is authorized by the contracting officer. 1
NO. OF PAGES
2
NAME OF OFFEROR
SRI International
SUPPLIES AND/OR SERVICES TO BE FURNISHED
Research
HOME OFFICE ADDRESS (Include ZIP Code)
333 Ravenswood Avenue
Menlo Park, California 94025
DIVISION(S) AND LOCATION(S) WHERE WORK IS TO BE PERFORMED
As above
TOTAL AMOUNT OF PROPOSAL
$ 74,986
GOVT SOLICITATION NO,
- - -
DETAIL DESCRIPTIO
N OF COST ELEMENTS
1. DIRECT MATERIAL (Itemize on Exhibit A)
EST COST(S)
TOTAL
EST COST)
REFER- 2
ENCE
a. PURCHASED PARTS
.....................
....................
...................
b. SUBCONTRACTED ITEMS
....................
c. OTHER -0) RAW MATERIAL
(2) YOUR STANDARD COMMERCIAL ITEMS
(3) INTERDI VISIONAL TRANSFERS (At other than coat)
TOTAL DIRECT MATERIAL
......................
"'?"?'??'??'??'?????
2. MATERIAL OVERHEAD 3 (Rate %X $ base= )
3. DIRECT LABOR (Specify)
ESTIMATED
HOURS
RATE/
HOUR
EST
COST (S)
....................
TOTAL
DIRECT LABOR
.............
..............
.................
...................:...
..... . .................
4. LABOR OVERHEAD (Specify department or cost center)3
O.H. RATE
X BASE =
EST COST (S)
....................
TOTAL LABOR OVERHEAD
.....
......................
5. SPECIAL TESTING (Including field work at Government installations)
EST COST !S)
................... .
::::::::??~?????????
....................
TOTAL SPECIAL TESTING
.......................
6.. SPECIAL EQUIPMENT (If direct charge) (Itemize on Exhibit A)
7. TRAVEL (If direct charge) (Give details on attached Schedule)
EST COST (S)
....................
i
e. TRANSPORTATION
b. PER DIEM OR SUBSISTENCE
....................
TOTAL TRAVEL
.................
""""""""'?'???'
...................... .
8. CONSULTANTS (Identity -purpose -rate)
EST COST (S)
:;
...................
TOTAL CONSULTANTS
.......................
9. OTHER DIRECT COSTS (Itemize on Exhibit A)
10. TOTAL DIRECT COST AND OVERHEAD
11. GENERAL AND ADMINISTRATIVE EXPENSE (Rate % of cost element Nos. ) 3
12. ROYALTIES 4
13. TOTAL ESTIMATED COST See Part Two-
,-Contrac
tual
14. FEE OR PROFIT Provisions No
. ESU
-
15. TOTAL ESTIMATED COST AND FEE OR PROFIT
This proposal is submitted for use in connection with and in response to (Describe RFP, etc.(
and reflects our best estimates as of this date, in accordance with the instructions to offerors and the footnotes which follow.
TYPED NAME AND TITLE Philip J. O'Donnel].'
Manager
SIGNATU
NAME OF FIRM
SRI International
DATE OF SUBMISSION
]97$ SEP 9-9-
FORM
DD1 APR 66
A REPLACES EDITION OF t JAN 67, WHICH IS OBSOLETE.
634ppro~4ed For Release 2003/09/10: CIA-RDP96-00792R000100140026-4
 ITEM DESCRIPTION (See footnote 5)
I. HAVE THE DEPARTMENT OF DEFENSE, NATIONAL AERONAUTICS AND SPACE ADMINISTRATION, OR THE ATOMIC ENERGY COM-
MISSION PERFORMED ANY REVIEW OF YOUR ACCOUNTS OR RECORDS IN CONNECTION WITH ANY OTHER GOVERNMENT PRIME
CONTRACT OR SUBCONTRACT WITHIN THE PAST TWELVE MONTHS?
NAME AND ADDRESS OF REVIEWING OFFICE (Include ZIP Code)
Defense Contract Audit Agency, SRI Resident
415 326-6200, X2089
E
XpPbTdye6UPOiORUMMSG BBO.( O%tk@cltr&I i'OP96,A 'bW92ROOD4004 o*)
1 EST COST ($)
YES NO If yes, identify on a separate page.
III. DO YOU REQUIRE GOVERNMENT CONTRACT FINANCING TO PERFORM THIS PROPOSED CONTRACT?
J YES NO it yes, identify., t_J ADVANCE PAYMENTS El PROGRESS PAYMENTS OR D GUARANTEED LOANS
IV. DO YOU NOW HOLD ANY CONTRACT (or, do you have any independently financed (IR & D) projects) FOR THE SAME OR SIMILAR WORK
CALLED FOR BY THIS PROPOSED CONTRACT?
YES ? NO If yes, identify
V. DOES THIS COST SUMMARY CONFORM WITH THE COST PRINCIPLES SET FORTH IN ASPR, SECTION XV (See 3-807.2 (c) (2))?
[M YES NO If no, explain one separate page.
1. The purpose of this form is to provide a standard format by
which the offeror submits to the Government a summary of in-
curred and estimated cost (and attached supporting information)
suitable for detailed review and analysis. Prior to the award
of a contract resulting from this proposal the offeror shall,
under the conditions stated in ASPR 3-807.3, be required to
submit a Certificate of Current Cost or Pricing Data (see ASPR
3-807.3(e) and 3-807.4).
2. As part of the specific information required by this form, the
offeror must submit with this form, and clearly identify as such,
cost or pricing data (that is, data which is verifiable and fac-
tual and otherwise as defined in ASPR 3-807.3(e)). In addition,
he must submit with this form any information reasonably requir-
ed to explain the offeror's estimating process, including;
a. the judgmental factors applied and the mathematical
or other methods used in the estimate including those
used in projecting from known data, and
b. the contingencies used by offeror in his proposed
price.
3. When attachment of supporting cost or pricing data to this
form is impracticable, the data will be specifically identified
and described (with schedules as appropriate), and made
available to the contracting officer or his representative upon
request.
4. The format for the "Cost Elements" is not intended as
rigid requirements. These may be presented in different
format with the prior approval of the contracting officer if
required for more effective and efficient presentation. In all
other respects this form will be completed and submitted
without change.
5. By submission of this proposal,offeror, if selected for
negotiation, grants to the contracting officer, or his author-
ized representative, the right to examine, for the purpose of
verifying the cost or pricing data submitted, those books,
records, documents and other supporting data which will
permit adequate evaluation of such cost or pricing data, along
with the computations and projections used therein. This
right may be exercised in connection with any negotiations
prior to contract award.
I Enter in this column those necessary and reasonable costs
which in the judgment of the offeror will properly be incurred
in the efficient performance of the contract. When any of the
costs in this column have already been incurred (e.g., on a
letter contract or change order), describe them on an attached
supporting schedule. Identify all sales and transfers between
your plants, divisions, or organizations under a common con-
trol, which are included at other than the lower of cost to the
original transferror or current market price.
2 When space in addition to that available in Exhibit A is
required, attach separate pages as necessary and identify in
this "Reference" column the attachment in which information
supporting the specific cost element may be found. No stand-
ard format is prescribed; however, the cost or pricing data must
be accurate, complete and current, and the judgment factors
used in projecting from the data to the estimates must be staled
in sufficient detail to enable the contracting officer to evaluate
the proposal. For example, provide the basis used for pricing
materials such as by vendor quotations, shop estimates, or
invoice prices; the reason for use of overhead rates which de-
part significantly from experienced rates (reduced volume, a
planned major rearrangement, etc.): or justification for an in-
crease in labor rates"(anticipated wage and salary increases,
etc.). Identify and explain any contingencies which are included
in the proposed price, such as anticipated costs of rejects and
defective work, or anticipated technical difficulties.
.? Indicate the rates used and provide an appropriate explana-
tion. Where agreement has been reached with Government rep-
resentatives on the use of forward pricing rates, describe the
nature of the agreement. Provide the method of computation
and application of your overhead expense, including cost
breakdown and showing trends and budgetary data as neces-
sary to provide a basis for evaluation of the reasonableness
of proposed rates.
4 If the total royalty cost entered here is in excess of $250
provide on a separate page (or on bb Form 783, Royalty
Report) the following information on each separate item of
royalty or license fee: name and address of licensor; date of
license agreement; patent numbers, patent application serial
numbers, or other basis on which the royalty is payable; brief
description, including any part or model numbers of each con-
tract item or component on which the royalty is payable; per-
centage or dollar rate of royalty per unit; unit price of contract
item; number of units; and total dollar amount of royalties.
In addition, if specifically requested by the contracting officer,
a copy of the current license agreement and identification of
applicable claims of specific patents shall be provided.
5 Provide a list of principal items within each category in-
dicating known or anticipated source, quantity, unit price,
competition obtained, and basis of establishing source and
reasonableness of cost.
 ExApbTaVe6uPP@AR"L11 a~~~P~108E~5 : ~QIaLf~PJP~B~o~ 2 h na a~in _~s
HAVE THE DEPARTMENT OF DEFENSE, NATIONAL AERONAUTICS AND SPACE ADMINISTRATION, OR THE ATOMIC ENERGY COM-
MISSION PERFORMED ANY REVIEW OF YOUR ACCOUNTS OR RECORDS IN CONNECTION WITH ANY OTHER GOVERNMENT PRIME
CONTRACT OR SUBCONTRACT WITHIN THE PAST TWELVE MONTHS?
NAME AND ADDRESS OF REVIEWING OFFICE (Include ZIP Code)
Defense Contract Audit Agency, SRI Resident
TELEPHONE NUMBER/ EXTENSION
415 326-6200, X2089
YES LX] NO If yes, identify on a separate page.
ADVANCE PAYMENTS El P P L O
CALLED FOR BY THIS PROPOSED CONTRACT? F-] YES
financed (iR & D) projects) FOR THE SAME OR SIMILAR WORK
NO It yes, identify
DOES THIS COST SUMMARY CONFORM WITH THE COST PRINCIPLES SET FORTH IN ASPR, SECTION XV (See 3-807
i-N YES tI NO It no, explain on a separate page.
I. The purpose of this form is to provide a standard format by
which the offeror submits to the Government a summary of in-
curred and estimated cost (and attached supporting information)
suitable for detailed review and analysis. Prior to the award
of a contract resulting from this proposal the offeror shall,
under the conditions stated in ASPR 3-807.3, be required to
subnmit a Certificate of Current Cost or Pricing Data (see ASPR
3-807.3(e) and 3-807,4).
2. As part of the specific information required by this form, the
offeror must submit with this form, and clearly identify as such,
cost or pricing data (that is, data which is verifiable and fac-
tual and otherwise as defined in ASPR 3-807.3(e)). In addition,
he must submit with this form any information reasonably requir-
ed to explain the offeror's estimating process, including:
a. the judgmental factors applied and the mathematical
or other methods used in the estimate including those
used in projecting from known data, and
h. the contingencies used by offeror in his proposed
price.
3. When attachment of supporting cost or pricing data to this
form is impracticable, the data will be specifically identified
and described (with schedules as appropriate), and made
available to the contracting officer or his representative upon
request.
4. The format for the "Cost Elements" is not intended as
rigicl requirements. These may be presented in different
format with the prior approval of the contracting officer if
required for more effective and efficient presentation. In all
other respects this form will be completed and submitted
without change.
5. I3y submission of this proposal, offeror, if selected for
negotiation, grants to the contracting officer, or his author-
ized representative, the right to examine, for the purpose of
verifying the cost or pricing data submitted, those books,
records, documents and other supporting data which will
permit adequate evaluation of such cost or pricing data, along
with. the computations and projections used therein. This
right may be exercised in connection with any negotiations
prior to contract award.
I Fritter in this column those necessary and reasonable costs
which in the judgment of the offeror will properly be incurred
in the efficient performance of the contract. When any of the
costs in this column have already been incurred (e.g., on a
letter contract or change order), describe then on an attached
supporting schedule. Identify all sales and transfers between
your plants, divisions, or organizations tinder a common con-
trol, which are include(] at other than the lower of cost to the
original transferror or current market price.
2 When space in addition to that available in Exhibit A is
required, attach separate pages as necessary and identify in
this "Reference" column the attachment in which information
supporting the specific cost element may. be found. No stand-
ard format is prescribed; however, the cost or pricing data must
be accurate, complete and current, and the judgment factors
used in projecting from the data to the estimates must be stated
in sufficient detail to enable the contracting officer to evaluate
the proposal. For example, provide the basis used for pricing
materials such as by vendor quotations, shop estimates, or
invoice prices; the reason for use of overhead rates which de-
part significantly front experienced rates (reduced volume, a
planned major renrrangernent, etc.): or justification for an in-
crease in labor rates"(anticipated wage and salary increases,
etc.). Identify and explain any contingencies which are included
in the proposed price, such as anticipated costs of rejects arid
defective work, or anticipated technical difficulties.
3 Indicate the rates used and provide an appropriate explana-
tion. Where agreement has baen reached with Government rep-
resentatives on the use of forward pricing rates, describe the
nature of the agreement. Provide the method of computation
and application of your overhead expense, including cost
breakdown arid showing trends and budgetary data as neces-
sary to provide a basis for evaluation of the reasonableness
of proposed rates.
4. If the total royalty cost entered here is in excess of $250
provide on a separate page (or on DD Form 783, Royalty
Report) the following information on each separate item of
royalty or license fee: name and address of licensor; date of
license agreement; patent numbers, patent application serial
numbers, or other basis on which the royalty is payable; brief
description, including any part or model numbers of each con-
tract item or component on which the royalty is payable; per-
centage or dollar rate of royalty per unit; unit price of contract
item; number of units; and total dollar amount of royalties.
In addition, if specifically requested by the contracting office'f,
a copy of the current license agreement and identification of
applicable claims of specific patents shall be provided.
5 Provide a list of principal items within each category in-
dicating known or anticipated source, quantity, unit price,
competition obtained, rand basis of establishing source and
reasonableness of cost.
proved For Release 2003/09/10 : CIA-RDP96-g0792R000100140026-4
 U.S GOVERNMENT PRINTING OFFICE: 1974 - 558 - 057
^I A
Fora e{ thi s f - - -- ---...,--.........-..... -Iml rf4 ILfrT KtQV KU-''..... ' -- .
orm, see AR 380.5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence.
SECTION A - GENERAL
MAJ STONER, DAMI-ISH
CONTROL, LOG
OR FILE NO.
NUMBER OF
COPIES
ATE
2 Oct 78
hand carried
DESCRIPTION (Type, File Ref., Unclassified Subject
or Short Title and Number of
Indorsements/fuels)
letter, w/SRI Proposal No. ESU 78-100
(3 cys) DD Form 633-4 (3 cys)
------NOTHING FOLLOWS----------
DATE OF
DOCUMENT
28Sep78
3. -
SECTION C- DESTRUCTION CERTIFICATE
MATERIAL DESCRIBED HEREON HAS BEEN: (Check appropriate block)
C7 DESTROYED
NUMBER OF COPIES TO BE REPRODUCED
^ TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 380_,0
PRINTED NAME OF CUS' DIAnI na o~
PRINTED NAME OF CERTIFYING/DESTR. OFF.
PRINTED NAME OF WITNESSING OFFICIAL
-SECTION D -REPRODUCTION AUTHORITY
AUTHORIZED BY
SIGNATURE
' SIC: IIATI loc
RECEI e - Ktl-tIPT/TRACER ACTION (Check appropriate block)
PT OF DOCUMENT(S) ACKNOWLEDGED
rr~~
FDAI TRA CIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEEN RECEIVEDI.S) HAVE NOT BEEN RECEIVED
E PRINTED NAME, GRADE OR TITLE
CLASSIFI-
CATION
Approved For Release 2003/09/10: CIA-RDP99=
DA FORM 3964, 1 Nov ]'1 REPLACES DA FORMS 1203, SEP 58: 1204, 1 JAN 60: 631, 1 MAR 62 AND
546, 1 OCT 63, WHICH ARC noc..