Approved For Release 2000/08/08 : CIA-RDP96-00789ROO2100270006-4 CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD DATE For us* of this form, so* At 380-5: ?be proponent agency is the Office, Assistant Chief of Staff for Intelligence.- 0174t7 SECTION A - GENERAL To- FROM: 0- DATE RECEIVED ACTION OFFICE(S) SUSPENSE DATEIS) REGISTER OR CONTROL NO. CONTROL LOG CLASSIFf- NUMBEROF DESCRIPTION (Type. File Ref. Unclassified Subject DATE OF OR FILE NO. CATION COPIES or Short Title and Number of Indotientents1fircls) DOCUMENT ORIGINATOR _7 00,10z - -- /7 Cll,' /- 07 ,AJ1A E 'A-~ Aows --------------- SECTION B - ROUTING I ACKNOWLEDGE RECEIPT OF THE MATERIAL OESCRISED HEREON TO COPY NO. DATE PRINTED NAME SIGNATURE 2. 3. 4. 5. SECTION C- DESTRUCTION CERTIFICAYE (Check appropriate block) MATERIAL DESCRIBED HEREON HAS BEEN: PAGE OR COPY NO ED DESTROYED 0 TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 380-5)1 OFFICE SYMBOL DATE PRINTED NAME OF CUSTODIAN OR REP SIGNATURE DESTRUCTION RECORD NO. DATE PRINTED NAME OF CERTIFYING/DESTR. OFF. SIGNATURE PAGE OR COPY NUMBER DATE PRINTED NAME OF WITNESSING OFFICIAL SIGNATURE - SECTION 0 - REPRODUCTION AUTHORITY NUMBER OF COPIES TO BE REPRODUCED. -1 1 AUTHORIZED BY DATE SG11 SECTIO14 E - RECEIPTITRACER ACTION (Check appropriate block) ffircl-OPT OF DOCUMENT(S) ACKNOWLEDGED M DOCUMENT(S) HAVE NOT SEEN RECEIVED [3TRACER ACTION: SIGNED REt-clOr ae'tO &A&-rgrothi APnVF WAq NOT RFFN RFr.FFVED. DATE ~M. 90 COMMENTS Re- r"Wes., D A FORM XW,'1'JUl 79 -G7P.0. 1986-162-374 4