CIA STARGATE release
CIA-RDP96-00788R001600100004-1
Opens with: For use of this form, see AR 380-5; the proponent agency is the Office,
Warning: text for all documents has not been verified. Errors are possible. Check the original by document ID on CREST.
1 page, machine transcribed from the CIA’s released scan.
Ap SISSEUIFDPRGUMENT 200000810 ABILITARE 10X56-00788R00+500100004-1 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 DATE(S) REGISTER OR CONTROL NO. CONTROL, LOG OR FILE NO. CLASSIFI- CATION NUMBER OF COPIES DESCRIPTION ( Type. File Ref .. Unclassified Subject `or Short Title and Number of Indorsements/Incls) DATE OF DOCUMENT ORIGINATOR CL-003-82 S/NOFORN 1 Cy 1 of 2, report CL-972/8210/01 W/1 Exhibit .... . NOTHING FOLLOWS. SECTION B - ROUTING I ACKNOWLEDGE RECEIPT OF THE MATERIAL DESCRIBED HEREON TO COPY NO. DATE PRINTED NAME SIGNATURE 1. 2. 3. A. 5. SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block) MATERIAL DESCRIBED HEREON HAS BEEN: PAGE OR COPY NO 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 DATE PRINTED NAME, GRADE OR TITLE SIGNATURE COMMENTS DA FORM 3964, 1 Jul 79 EDITION OF 1 NOV 72 IS OBSOLETE. # U.S.GPO:1980-0-319-059 Approved For Release 2000/08/08 : CIA-RDP96-00788R001600100004-1