CIA-RDP96-00788R001900070003-3

Approves ForRalensar2000/08/09 :GIAREBR6-00788R00)1900070003-3
For use of this form, ses AR 380-5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence.
31 MAY
1983
SECTION A - GENERAL
TO:
FROM:
DATE RECEIVED
ACTION OFFICE(S!
SUSPENSE DATE(SI
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-033-83
S/NOFORN
1
Cy 1 of 1 cy Report CL-1014/8304/01.
.. NOTHING FOLLOWS
SECTION B - ROUTING
I ACKNOWLEDGE RECEIPT OF THE MATERIAL DESCRIBED HEREON
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
1.
2.
83.
5.
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EDITION OF 1 NOV 72 IS OBSOLETE.
Approved For Release 2000/08/08 : CIA-RDP96-00788R001900070003-3.
₼ U.S.GPO:1980-0-319-059
Nik with the hơn ha so
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)