Approved For Release 2000/08/07 :,CIA-RDP96-00788 ROO 1200280028-0
    DATE:
     GRILL FLAME SECURITY AGREEMMT
    15?
    I understand that the highly sensitive
    and classified !on I have,, or all about- to receive as part of the,
    GRILL FIJuME Program belongs to the United. States Government. I understand
    that disc-Losure of -this information is punishable under Title 18, Section
    798, U.S.C. "Disclosure of Classified Information," June .1948 as amended.
    I do solenaily swear that I will never di-r3LIge, publish, or reveal by word,
    conduct, or by any other i-rieins 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 employment will relieve me of
    my obligation under this agreement and -that the provisions of this agreement
    will remain binding upon me even after the termination of my services with
    the United, Stateq Government.
    I t-ake this obligation of my oim free will, without any mental reservation
    or pur-r..)ose 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
    Syster, -for Federal Accounts Relating -to Individual Persons, November 22, 194,3.
    2. Principal Purpose: To maintain a record of those individuals 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 Progrom.
    4. Mandatlory 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 Progr:-am.
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       GRILL FLIME SECURITY AGREEMENT CONTIVUATION PAGE
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       NAME, , RANK/t7ji-ADE
       A 1) ~q. Z MY-9 ~n ,_rlrlo GANIZATION ~ T-
       UN..['.P/ORC',A.'J\TIZATIOD,F
       C7-g~ cc
       POSITION
       POSITION
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