Approved For Release 2001/04/02 : CIA-RDP96-00788ROO1200010091-9
 DATE J71.))j e
 GRILL FLAME SECURITY AGR2EMENT
      0@
 10, understand that the highly
 e ss ed 3-Eio'
 s
 ns t a cla s _iiiition I have, or are about to
 receive as part of the GRILL FLAME Program belongs to the
 United States Government. I understand that the disclosure
 of this information is punishable unde@r 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 wordo conduct, or by any other means such classified
 information or knowledge, except in the performance of -my
 official" duties, and as specifically authorized in writing
 in each case by the appropriate agency'of the United States
 Government.
 I.--understand that no change in my assignment or employment
 will relieve me of my obligation under this agreement and
 -that the provision's of this agreement will remain. binding
 upon me even after the termination of my services with the
 United States Government.
 I'take this obligation of my..own. free will, without. any mental.
 reservation or purpose of evasion.
                     DATA REQUIRED BY THE PRIVACY ACT OF 1974
                                  (5 U.S.C_ 552a)
 1. Authority: National Records Act, 44 u.s.c. 3102; E.O.
 9397, Numbering System for Federal 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 Dtsclosure: 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 2001/04/02 CIA-RDP96-00788ROO1200010091-9

 

Approved For Release 2001/04/02 : CIA-RDP9§-00788RO01200010091-.9
GRILL FLAME SECURITY AGREEMENT CONTINUATION PAGE
DA7 kE
WITNESS:
SIGNED:
RjU;I-E, RANK/GRADE NAMk GRADE
Ab C, 1@tj -s -aJ)Vl I A; r
'0-N -1-T76 -R(j -A- Vf -7,Tff 0 -N UNIT/6P-,Gkt4-f'ZATION
li-OSITION POSIYION
2
Approved For Release 2001/04/02 CIA-RDP96-00788ROO1200010091-9