Approved For Release 2000/08/6'7 : CIA-RDP96-00788ROO1200280016-3
   DATE / ~
   GRILL FLAME SECURITY AGREEMENT
    I El-rr- understand that the highly
   " sitive and classified il-r-mat,
   s
   en ion I have, or are about to
   receive as part of the GRILL FLAME Program belongs to the
   United States Government. I understand that the disclosure
   of this information is p"nishable under Title 18, Section
   798, - U.S.C.j, "Disclosure of Classified Information," June 1948,
   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 my
   official" duties, and as specifically authorized in writing
   in each case by the appropriate agency'of the United States
   Government.
   I,understand that no change in my assignment or emgloyment
   will relieve,me of my obligation under this agreement and
   that the provision's of this agreement will remain. binding
   upon me even after the termination of my services with the
   United States Gove
   rnment.
   I'take this obligation;of my..own- free will, without. any mental.
   reservation or purpose' of evasion.
                           DATA REQUIRED BY THE PRIVACY ACT OF.,1974
                                   (5 U.S.C.. 552a)
   1. Authority: National Records Act, 44 U.S.C. 3102; E.O.
   9397, Numbering System for Federal Accounts Relating to
   Individual Personsl, November 22, 1943.
   2. Principal Purpose% To maintain a record of'those individ-
   uals who have or have had access to GRILL FLAME information
   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 on a voluntary basis, but withholding information
   will render it impossible to grant an individual access to
   or participation in the Program.
   Approved For Release 2000/08/07-:--C IA-RDP96-00788 ROO 1 20-02-800-1-U-

   
   Approved For Release 2000/08/07 : CIA-RDP96-00788ROO1200280016-3
   GRILL FLAME SECURITY AGREEMENT CONTINUATION PAGE'
   DATE qrV
   .WITNESS:. SIGN
   NAME,, RANK GRADE NAMEO, RANK/GRADE
   A%c-Sq1-
             L4v\.
   o
   f ~ . . . ~ & ~&,) ~,,> 2-~
   UNIT/ORGANIZATION UNIT/OftGANIZATION
   :L~s LIT^-N 6Q-#,LL F-4-4~E
                                 Pm
   POSITION
   SG1H
                                  2
   Approved For Release 2000/08/07 CIA-RDP96-00788ROO1200280016-3