Apobf6lflPbPQGVAW2UCCM&GABJWYM*EkMW-00788RO                                               V4N0  
 For use                                                 4-1   
 of this                                                       
 form,                                                         
 iito                                                          
 AR 3WS;                                                       
 the proponent                                                     
 agency                                                        
 is the                                                        
 Office,                                                       
 Assistant                                                     
 Chief                                                         
 of Staff                                                      
 for Intelligence.                                                     
                                                               

 SECTION                                                       
 A - GENERAL                                                     
                                                               

 TO:                                 FROM:                     
                                                               

 DATE RECEIVED       ACTION              SUSPENSE DATE(S)     REGISTER
                 QFFICE4S)             I                   OR    
                 I                                       CONTROL
                                                         NO.   
                                                               

 CONTROL. CLASSIFFNUMBER DESCRIPTION                          DATE  
 LOG      CATION OF     (Type.                           OF    ORIGINATOR
 OR FILE         COPIES File                             DOCUMENT
 NO,                    Ref.                                   
                        Unclassified                                
                        Subject                                
                        0 1'                                   
                        Short                                  
                        Tille                                  
                        and                                    
                        Number                                 
                        of                                     
                        IndorseynentslIncls)                                
                                                               

 CL-003-82S/NOFOMI      Cy 1                                   
                        of                                     
          ................2,                                     
 .........              report                                 
                        CL-972/8210/01                                
                        W11                                    
                        Exhibit                                
                        ..............................                                
                        ..........                                
                        NOTHING                                
                        FOLLOWS...                                
                        .........                                
                                                               

 SECTION                                                       
 8 - ROUTING                                                     
 I_ACKNOWLEDGE                                                     
 RECEIPT                                                       
 OF THE                                                        
 MAT-EhIAL                                                     
 DESCRIBED                                                     
 HEREZM                                                        
 'to COPY                                                      
 NO. DATE                                                      
 PRINTED                                                       
 NAME                                                          
 SIGNATURE                                                     
                                                               

                                                               
                                                               

 2.                                                            
                                                               

 3.                                                            
                                                               

 4.                                                            
                                                               

 5.                                                            
                                                               

 SECTION                                                       
 C - DESTRUCTION                                                     
 CERTIFICATE                                                     
 (Check                                                        
 appropriate                                                     
 block)                                                        
                                                               

 MATERIAL                                                      PAGE OR
 DESCRIBED                                                     COPY NO
 HEREON                                                        
 HAS BEEN:                                                     
 C3 DESTROYED                                                     
 F-1 TORN                                                      
 IN HALF                                                       
 AND PLACED                                                     
 IN A                                                          
 CLASSIFIED                                                     
 WASTE                                                         
 CONTAINER                                                     
 (AR 380-5)1                                                     
                                                               

 OFFICE          DATE   PRINTED                     SIGNATURE      
 SYMBOL                 NAME                                   
                        OF                                     
                        CUSTODIAN                                
                        OR                                     
                        REP                                    
                                                               

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

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

 SECTION                                                       
 D - REPRODUC71ON                                                     
 AUTHORITY                                                     
                                                               

 NUMBER                 AUTHORIZED                     ATE        
 OF COPIES              BY                                     
 TO BE                  7                                      
 REPRODUCED                                                     
                                                               

 SECTION                                                       
 E - AECEIPT/TRACER                                                     
 ACTION                                                        
 (Check                                                        
 appropriate                                                     
 block)                                                        
                                                               

 [:]RECEIPT                                                     
 OF DOCUMENT(S)                                                     
 ACKNOWLEDGED                                                     
 DOCUMENT(S)                                                     
 HAVE                                                          
 NOT BEEN                                                      
 RECEIVED                                                      
 [:]TRACER                                                     
 ACTION:                                                       
 SIGNED                                                        
 RECEIPT                                                       
 FOR MATERIAL                                                     
 DESCRIBEDABOVE                                                     
 HAS NOT                                                       
 BEEN                                                          
 RECEIVED.                                                     
                                                               

 DATE            PRINTED                            T~ATURE      
                 NAME,                                         
                 GRADE                                         
                 OR                                            
                 TITLE                                         
                 -                                             
                                                               

 r7E                                                           
                                                               
 
 
 







D A FORM 3M, I Jul 79 EDITION OF I NOV 72 IS OBSOLETE. U.S.GPO:1980-0-319-M
 Approved For Release 2000/08/08 : CIA-RDP96-00788ROO1600100004-1