CIA STARGATE release
CIA-RDP96-00788R001900420004-3
Opens with: For use of this form, ase AR 380-5; the proponent agency is the Office,
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1 page, machine transcribed from the CIA’s released scan.
For use of this form, ase AR 380-5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence. SECTION A - GENERAL TO: INSCOM 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 C1-071-83 6/NOFORN 1 Cy 1 of 1 cy Report HU-1050/8313/01. NOTHING FOLLOWS. .. 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 1 TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED. DATE PRINTED NAME, GRADE OR TITLE SIGNATURE COMMENTS SECTION B - ROUTING I ACKNOWLEDGE RECEIPT OF THE MATERIAL DESCRIBED HEREON TO COPY NO. DATE PRINTED NAME SIGNATURE 1. 2. 3. A. 5. DA FORM 3984, 1 Jul 79 EDITION OF 1 NOV 72 IS OBSOLETE. Approved For Release 2000/08/08 : CIA-RDP96-00788R001900420004-3*U.S.GPO:1980-0-319-059