CIA STARGATE release
CIA-RDP96-00788R001600270002-5
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.
"Approved For Release 2000/08/0€ CLASSIFIED DOCUMENT XECOURIFABRITYOFEXGAB001600270002-5FE For use of this form, see AR 380-5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence. 28 April 1983 SECTION A - GENERAL TO: CIA 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-029-83 S/NOFORN 1 Cy 1 of 1 cy Report 1010/8302/08 NOTHING FOLLOWS SECTION B - ROUTING I ACKNOWLEDGE RECEIPT OF THE MATERIAL DESCRIBED HEREON TO COPY NO. DATE PRINTED NAME SIGNATURE 1. 2. 3. 5. 1 SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block) 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 DATE PRINTED NAME, GRADE OR TITLE SIGNATURE COMMENTS EDITION OF 1 NOV 72 IS OBSOLETE. # U.S.GPO:1980-0-310-059 DA FORMABuroved For Release 2000/08/08 : CIA-RDP96-00788R001600270002-5 PAGE OR COPY NO