AWRO socum                                              EfOfj5-OOO3OOQA
  I InTYGSC4WP96-00788,l                                              -4     
  For use                                                        
  of this                                                        
  form,                                                          
  soo, AN                                                        
  380-5;                                                         
  the proponent                                                     
  agency                                                         
  is the                                                         
  Office,                                                        
  Assistant                                                      
  Chief                                                          
  of Staff                                                       
  for Intelligence.                                                     
                                                                 

  SECTION                                                        
  A - GENERAL                                                     
                                                                 

  TO-                                 FROM:                      
  lvq~ -Tlvsea'o~                                                     
  ".9 7-7x1;                                                     
  -T."q                                                          
  0 /?s                                                          
  -                                                              
                                                                 

  DATE RECEIVED       ACTION             SUSPENSE DATEAS)    REGISTER
                   OFFICE(S)                                OR     
                                                          CONTROL
                                                          NQ.    
                                                                 

  CONTROL.  CLASSIFI-NUMBER DESCRIPTION                         DATE   ORIGINATOR
  LOG       CATION OF     (Type.                          OF     
  OR FILE          COPIES File                            DOCUMENT
  NO.                     Ref.                                   
                          Unclassified                                
                          Subject                                
                          o r                                    
                          Short                                  
                          Title                                  
                          and                                    
                          Number                                 
                          of                                     
                          IndorsementslIncls)                                
                                                                 

            5                                             w'?'z  
            1A,1,         F i,~4                          4v     
                          4 A                                    
                          e4                                     
                          e -                                    
                          S                                      
                                                                 

                                                                 
                                                                 

  SECTION                                                        
  B - ROUTING                                                     
  -                                                              
  -                                                              
                                                                 

                                 57                              
                                 I                               
                                 ACKNOWLEDGE                           
                                 RECEIPT                           
                                 OF                              
                                 THE                             
                                 MATERIAL                           
                                 DESCRIBED                           
                                 HFRE                            
                                                                 

  TO               COPY   DATE   PRINTED                SIGNATURE       
                   NO.           NAME                            
                                                                 

                                                                 
                                                                 

  2.                                                             
                                                                 

  3.                                                             
                                                                 

  4.                                                             
                                                                 

  5.                                                             
                                                                 

  SECTION                                                        
  C - DESTRUCTION                                                     
  CERTIFICATE                                                     
  (Check                                                         
  appropriate                                                     
  bloch)                                                         
                                                                 

  MATERIAL                                                       PA E OR
  DESCRIBED                                                      COPY NO
  HEREON                                                         
  HAS BEEN:                                                      P ~YN 0
  [3DESTROYED                                                     
  OTORN                                                          
  IN HALF                                                        
  AND PLACED                                                     
  IN A CLASSIFIED                                                     
  WASTE                                                          
  CONTAINER                                                      
  (AR 380-5)                                                     
                                                                 

  OFFICE           DATE                               SIGNATURE       
  SYMBOL           PRINTED                                       
                   NAME                                          
                   OF                                            
                   CUSTODIAN                                       
                   OR                                            
                   REP                                           
                                                                 

  DESTRUCTION       DATE                               SIGNATURE       
  RECORD           PRINTED                                       
  NO.              NAME                                          
                   OF                                            
                   CERTIFYING/DESTR.                                       
                   OFF.                                          
                                                                 

  PAGE OR          DATE                               SIGNATURE       
  COPY NUMBER       PRINTED                            I          
                   NAME                               ---        
                   OF                                            
                   WITNESSING                                       
                   OFFICIAL                                       
                   I -                                           
                   I -                                           
                                                                 

  SECTION                                                        
  D - REPRODUCTION                                                     
  AUTHORITY                                                      
                                                                 

  NUMBER                  AUTHORIZED                     DATE       
  OF COPIES               BY                                     
  TO BE                                                          
  REPRODUCED                                                     
                                                                 

  SECTION                                                        
  E - RECEWVTRACER                                                     
  ACTION                                                         
  (Check                                                         
  appropriate                                                     
  block)                                                         
                                                                 

                                                                 
  RECEIPT                                                        
  OF DOCUMENT(S)                                                     
  ACKNOWLEDG                                                     
  D DOCUMENT(S)                                                     
  HAVE NOT                                                       
  BEEN RECEIVED                                                     
  E                                                              
  I; HAS                                                         
  NOT 13EEN                                                      
  RECOVED.                                                       
  0TRACER                                                        
  ACTION:                                                        
  SIGNED                                                         
  RECEIPT                                                        
  FOR MATERIAL                                                     
  DESCRIBED                                                      
  ABOV                                                           
                                                                 

                   "                                  [SIGNATURE       
  DATE             PRINTED                                       
  r                NAME.                                         
                   GRADE                                         
                   OR                                            
                   TITLE                                         
                   .'J                                           
                   - I                                           
                                                                 

  COMMENTS                                                       
  Approved                                                       
  For Release                                                     
  2000/08/07                                                     
  : CIA-RDP96-00788ROO0500030001-4                                                     
                                                                 
  
  
  







D A FORM 3964, 1 Jul 79 ewi i ivr4 ur- i muv /z izi utmvL-r. i It- A~~U.Z). ~.F.