CIA STARGATE release
CIA-RDP96-00788R001900170002-3
Opens with: CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD
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1 page, machine transcribed from the CIA’s released scan.
Approved For Release 2000/08/08 - CIA-RDP96-00788R001900170002-3 CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD For use of this form, sea AR 380-5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence. DATE SECTION A - GENERAL TO: ACSI 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-043-83 S/NOFORN 1 Cy 1 of 1 cy , Report CL-1018/8305/01 .. NOTHING FOLLOWS SECTION B - ROUTING I ACKNOWLEDGE RECEIPT OF THE MATERIAL DESCRIBED HEREON TO COPY NO. DATE PRINTED NAME SIGNATURE 1. 2. 3. 4. 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 DOCUMENTISI 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SIGNATURE Approved For Release 2000/08/08 : CIA-RDP96-00788R001900170002-3 DA FORM 3864, 1 Jul 79 EDITION OF 1 NOV 72 IS OBSOLETE. 4 U.S.GPO:1980-0-319-059