Date
           Approved ForftRogu~iggiMB(IffteT!161ALRDPI-~9ZPP,~0?600320005.3
           me                                 InitialsDate
           office                                      
           symbol,                                      
           room                                      
           number,                                      
           T@                                      
           OYU*Adl@g,                                      
           AgencylPos                                      
                                                  

                                                  
                                                  

                                                  
                                                  

           4.                                      
                                                  

           5.                                      
                                                  

            Action         File           Note     
                                          and     
                                          Return     
                                                  

            Approval       For Clearance  Per     
                                          Conversation     
                                                  

            As Requested   For Correction Prepare     
                                          Reply     
                                                  

            Circulate      For Your Information See     
                                          Me      
                                                  

            Comment        Investigate   _Signature     
                                                  

            Coordination   Justify                
                                                  

           

                               SG1J
           114 _T*_
                   DO NOT use this form as a RECORD of epprovals concurrences, disposals,
                           clearances, and similar action@
           FROM: (Name, org. symbol, AgencylPost) Room No.-Bldg,
           Phone No.
                                              ApprovedWor Re1wseP20Q1X31,Q_T,: CIA-HORMOMMOW320005-3
           Prestribed GSA
           FPMR WINN) 101-11.206