F                                                              
4=59(f                                                         
ISYDOMM                                                        
001 bUUUZ                                                      
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83                                                             
                                                               

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of this                                                        
form,                                                          
see, AN                                                        
SMS; the                                                       
proponenf                                                      
agency                                                         
is tho                                                         
Office,                                                        
Assistonf                                                      
Chief                                                          
of Staff                                                       
for InI                                                        
Fo,                                                            
                                                               

SECTION                                                        
A - GENERAL                                                     
                                                               

                                    FROM:                      
0.                                                             
TO:                                                            
T                                                              
                                                               

ACSI                                                           
                                                               

                                                        CONTROL
CATE REHIVE       ACTION             6~TEISI             REGISTER
                 QFFICEIS)                                 N Q..  
                                                               

                                                               
                                                               

CONTROL.  CLASSIFI-NUMBERDESCRIPTION                          DATE   
LOG              OF    (Type.                           OF     ORIGINATOR
                       File                                    
                       Ref,                                    
                       Unclassified                                 
                       Subject                                 
                                                               

OR FILE   CATION COPIESor Short                          DOCUMENT
NO.                    Title                                   
                       and                                     
                       Number                                  
                       of                                      
                       Indw-sententslIncls)                                 
                                                               

1--041-083S/NOFORI     Cy 1                             ...................
                       of                                      
                       1 Cy                                    
                       Report                                  
                       CL-1016/B305/01                                 
                       ....                                    
                                                               

.....................................                          ...................
                       NOTHING                                 
                       FOLLOWS                                 
                       ...........                                 
                                                               

SECTION                                                        
9 - ROUTING                                                     
                                                               

                              -1                               
                              44                               
                              _0W                              
                              E                                
                              D                                
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                              E                                
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                              C                                
                              I                                
                              _E__T_E_R_                           
                              -D'-t                            
                              FM                               
                              ~I                               
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                              AER                              
                              ~9T                              
                              0                                
                              r                                
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                              4                                
                                                               

TO               COPY  DATE   PRINTED               SIGNATURE       
                 NO,          NAME                             
                                                               

                                                               
                                                               

                                                               
                                                               

2L                                                             
                                                               

                                                               
                                                               

                                                               
                                                               

SECTION                                                        
C - DESTRUCTION                                                     
CERTIFICATE                                                     
(Check                                                         
appropriate                                                     
block)                                                         
                                                               

J- _6iiIEW16                                                     
Hiii~j~'HAS                                                     
BEEN:                                                          
'PAGE                                                          
OR COPY                                                        
NO                                                             
?~i:FEFi~[A                                                     
                                                               

DESTROYED                                                      
TORN IN                                                        
HALF AND                                                       
PLACED                                                         
IN A CLASSIFIED                                                     
WASTE                                                          
CONTAINER                                                      
(~~38~15)                                                      
                                                               

DATE PRINTED                                                     
NAME OF                                                        
CUSTODIAN                                                      
OR REP                                                         
SIGNATURE                                                      
                                                               

_                                                              
ETRUC~ION                                                      
RECORD                                                         
NO. DATE                                                       
PRINTED                                                        
NAME OF                                                        
CERTIFYING/DESTR.                                                     
OFF. SIGNAT                                                     
5E                                                             
                                                               

_6~~Tli                                                        
~iRINTED                                                       
~4AMi                                                          
OF OFFICIAL                                                     
SIGNATURE                                                      
                                                               

SECTION                                                        
0 - REPRODUCTION                                                     
AUTHORITY                                                      
-                                                              
---                                                            
                                                               

--                                                             
_:F5_6T__                                                      
Fi-                                                            
KUMEIER                                                        
67F E5PIEi                                                     
E REP                                                          
CIEZED                                                         
AUTHORIZED                                                     
BY                                                             
                                                               

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

(I]RECEIP-T                                                     
01 DOCUMENT(S)                                                     
ACKNOWLEDGED                                                     
DOCUMENTfS)                                                     
HAVE NOT                                                       
BEEN RECEIVED                                                     
                                                               

OTRACER                                                        
ACTION                                                         
SIGNED                                                         
RECEIPT                                                        
FOR MATERIAL                                                     
DESCRIBED                                                      
ABOVE                                                          
HAS NOT                                                        
BEEN RECEIVED.                                                     
                                                               

DATE WR                                                        
TED NAME.                                                      
GRADE                                                          
OR TITLE                                                       
                                                               

COMMENTS                                                       
                                                               









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