Approved For Release 2001/04/02 : C IA-RDP96-00788 ROO 1200010001 -8
         1--@
         DATE: r)
         GRILL FLI-ME SECURITY AGREEMENT
         1, understand that the highly sensitive
         and@classffied information I have, or a?4 about to receive as part of the'
         GRILI. FLA14F, Program belongs to the United States Government. I understand
         that disclosure of this information is punishable under Title 18, Section
         798, U.S.C. "Disclosure of Classified Information," June 191L.8 as amended.
         I do solemnly swear that I will never divulge, publish, or reveal 'by word,
         conduct, or by any other means such classified information or knowledge,
         except in the performance of ny official duties,.and as specifically
         authorized in writing in each case by the appropriate agency of the United
         States Government.
         T understand that no change in my assignment or employment will relieve me of
         my obligation under this agreemenb and that the provisions of this agreement
         will remain binding upon me even after the termination of my services.with
         -V,b(,- United States Government.
         I takethis obligation of my own free will, without. any mental reservation
         or purpose oA. evasion.
                           DATA REQUIRED BY THE PRIVACY ACT OF 1974
                                        (5 U.S.C. 552a)
         1. Author-it-y- Natlon,,.:@l Records Act, 44 U.S.C. 3102; E.O. 9397, Nlunberi-ag
         System for Federal Accounts Relating to Individual Persons, November 2P, lC943-
         2. Principal Pur7-)ose: To maintain a record of those individuals who have
         or have had access to GRILL FLAME, infori-.iation through the use of their name
         and/or Social Security Number.
         3. Routine Uses: The Social Security Number is to be used to identify the
         individual, and the information is to be retained strictly within the Program.
         4. Mandatory or Voluntary Disclosure: Information is disclosed oil a
         voli,intar- basis, but withholding information will render it impossible to
         j
         grant an individual access to or participation in the Program.
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             Approved For Release 2001/04/02 : CIA-RDP96-00788ROO1200010001-8
        GRILL MrllfP SECURITY AGREEMENT CONTINUATION PAGE
        DATF@@,@
             WITNESS:
        Vz
        GRADE
        NAME,I@W&@GODE,@
        -9N-I T-/ (5 R CTIVI @@Z N. P 10
        'TA) g toq
                                          0: i Lt -,q @c
                                        POSITION
                                         SIGNED:
                                            7
        AKE, RANK/G-RADE
             T@-NIT/ORGANIZATION
        Tj@ull
        SGIA
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