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c,,VERNMENT PRINTING OFFICE: 1974 --558 0S7
CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD DA T f.
or use of thi's form, see AR 380~5; the proponent agency is I~e Office. Assistant Chief of Staff for Ini~lliqenre. FE&
SECTION A - GENERAL
TO; FROM:
RE C-E-(V-f--D- -A-(---I'iO-N OFF IC L(S I SUSPENSE DATE00 REGISTER OR CON?-POL No
CONTROL. LOG CLASSIFI- NUML II R OF DF" CRIPTIUN I'Y)),. Fit, Ref. (ba-l-,lilled Std,wcf DAT F Ot
OP FILL NO, CAI ION COtlIES w sh-( 1,111c,ind Numb"? o/ DOC- U lM L N T OP IG I NA T 0 R
CL-010-83 S/NOFOR I Cy I of I cy, Report CL-990/8211/08 .... I.: .............
.......... ....... .................. N01-11INC FOLL0145 ............... ...... ...........
SECTION B - ROUTING
TO COPY NO. DA I I- PRIN-1 ED NAME
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SECTION C - DESTRUCTION CERTIFICATE (Check uppr,,prial', "locki
MATERIAL DESCRIBED HEREON HAS BEEN:
        r3ESTROYED FORN IN HALF AND PLACED IN A ci-AssinED WASTE CONTAINER (A.R
fi5A:r E i;~INTED NAME OF CUSTODIAN OR REP
(57FICE SYMBOL: IGNATURE
DESTRUCTION RECORD NO. DATE
~Z(~E -OR c6p--Y-'~ ETE
NUMBER OF COPIES -TO BE REPRODUCED
PRIN FEE) NAME OF CERTIF YING/DESTH. OFF
PRINTED NAME OF WITNESSING OFFICIAL
SECTION D - REPRODUCTION AUTHORITY
AUTHORIZED RY
'~,IGNATURF.
SIGNATURE
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DRECEIPT OF E)O(.-.:UMENT(S) ACKNOWLEDGED DOCUMENT (S) HAVE NOT REEN RECEIVED
DTRACIER ACTION. SIGNED RECEIPT FOR MAI FILIAL, DL:',CPIHED ABOVE HAS NOT BEEN RECEIVE[),
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DATE PRIN TIED NAME. GNADL OR I I I LE
COMM~NTS
Approved For Release 2000/08/08 : CIA-RDP96-00788ROO160022,
                        DA FORM 3964, 1 Nov 72 H, PLACES DA F URNIS f 203, 1 SEP 58 f 204. 1 )AN 60: 63 1, 1 MAR 62 AND
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