CIA-RDP96-00788R000100280002-0

Approved For Release 2000/08/07 : CIA-RDP96-00788R000100280002-0
30 S GOVERNMENT PRINTING OFFICE. 1974 -- 558 . 057
CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD
DATE
For use of this form, see AR 380-5; the proponent agency is the Office. Assistant Chief of Staff for Intelligence.
SECTION A . GENERAL
To:
FROM:
DATE RECEIVED
ACTION OFFICE'S'
SUSPENSE DATEIS)
REGISTER OR CONTROL
CONTROL. LOG
OP FILE NO
CLASSIFI-
CATION
NUMBER OF
COPIES
DESCRIPTION ( Type. File Ref .. Unclassified Subject
or Short Tade and Number of Endorsements/ Incls)
DATE OF
DOCUMENT
ORIGINATOR
CL-009-83
Cy 1 of 1, Report CL-842 and 851/8125/06.
NOTHING FOLLOWS
SECTION B - ROUTING
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
1.
D
2.
3.
4.
MATERIAL DESCRIBED HEREON HAS BEEN:
DESTROYED
TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 380-5)
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 D - REPRODUCTION AUTHORITY
NUMBER OF COPIES TO BE REPRODUCED
-
AUTHORIZED BY
DATE
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
RECEIPT OF DOCUMENT(S) ACKNOWLEDGED
DOCUMENT(S) HAVE NOT BEEN RECEIVED
TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED
DATE
PRINTED NAME GRADE OR TITLE
SIGNATURE
COMMENTS Approved For Release 2000/08/07 : CIA-RDP96-00788R000100280002-0
€
SECTION C . DESTRUCTION CERTIFICATE (Check appropriate block)