CIA STARGATE release
CIA-RDP96-00788R001600340003-6
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.
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:
NSA
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-C48-83
S.NOFORN 1
Cy 1 of 1 cy, Report 1024/8303/01
NOTHING FOLLOWS
SECTION B - ROUTING
I ACKNOWLEDGE RECEIPT OF THE MATERIAL DESCRIBED HEREON
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
1.
12.
3.
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 CF DOCUMENT(S) ACKNOWLEDGED
DOCUMENTISI 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 3984, 1 Jul 79
EDITION OF 1 NOV 72 IS OBSOLETE.
Approved For Release 2000/08/08 : CIA-RDP96-00788R001600340003-6
*