Approved For Release 2001/03/07: CIA-RDP96-00789ROO210015
      DATE / A
      . ZZM
      GRILL FLAME SECURITY AGREEMENT
                                    , understand that the highly
      tion I have, or are about to
      s e n 4st A MrdMc @l af@f @@t @?r n a
      receive as part of the GRILL FLAME Program belongs to the
      united States Government. I understand that the disclosure
      of this information is p"nishable under Title 18, Section
      798, 'U.S.C., "Disclosure of Classified Information,," June 1948,,
      as amended.
      I do solemnly swear that I will never divulge, publish, -or
      reveal, by word, conduct? or by any other means such classified
      information or knowledge, except in the performance of ray
      official" duties, and as specifically authorized in writing
      in each case by the appropria'te agency'of the United States
      Government.
      I,understand that no change in my assignment or emFiloyment
      will relieve-me of my obligation under this agreement and
      .that. the provision* 9 of this agreement will remain. binding
      upon me even after the termination of my services with the
      United States Government.
      1%take this obligatio'n of my-own,free wille without, any mental.
      reservation or purpose of evasion.
                          DATA REQUIRED BY THE PRIVACY 'ACT OF 1974
                                    (5 U.S.C.- 552a)
      1. Authorityt National Records Act, 44 U.S.C. 3102; E.O.
      9397, Numbering System for-Federa 1 Accounts Relating to
      individual Personsl, November 22, 1943.
      2. Principal Purpose: To maintain a record of those individ-
      @uals 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 Program.
      4. Mandatory 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 Program.
      Approved For Release 2001/03/07 ~-.C]AnRDP96-00789ROO2100150054v4r--..-

      

      Approved For Release 2001/03/07: CIA-RDP96-00789ROO21001,50054-4
      GRILL FLAME SECURITY AGREEMENT CONTINUATION PAGE'
      DATE /cit
      .WITNESSi. SIGNED:
      NAME,, RANK/GRADE NAME fCyANK/GR-ADE,
                                                 eb A111jr
      UNIT/ORGANIZATION URIT/ RGANIZATION
      trtz I Lk kAm
      oe
                                04,01@
      POSITION
                               Approved For Release 2001/03/07: Cl
      A-RDP96-00789ROO2100150054-4