CIA STARGATE release
CIA-RDP96-00788R001900240005-2
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.
ApprovedItion Relaxser 2000/08/08:101A-FOR96-00788R004900240005-2 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 OFFICEIS' 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-060-83 S/NOFORN 1 Cy 1 of 1 cy, Report HU-1035/8306/01 .NOTHING FOLLOWS SECTION B - ROUTING I ACKNOWLEDGE RECEIPT OF THE MATERIAL DESCRIBED HEREOR TC 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 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 GRADE OR TITLE SIGNATURE COMMENTS ---- DA FORM 3864, 1 Jul 79 EDITION OF 1 NOV 72 IS OBSOLETE. + U.S.GPO:1900-0-319-059 Approved For Release 2000/08/08 : CIA-RDP96-00788R001900240005-2