CIA-RDP96-00789R002100150021-0

Approved For Release 2001/03/07 : GIA-RDP96-00789R002100150021-0
DATE:
8 Feb 79
GRILL FLAME VOLUNTEER SECURITY AGREEMENT
SGFOIA3
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!
1. (U) I, ANN E. DJUPMAN
SSAN :
understand that the highly sensitive and classified miormation i nave or
am about to receive as part of the GRILL FLAME Program belongs to the
United States Government. I understand that disclosure of this information
is punishable under Title 18, Section 798, U.S.C. "Disclosure of Classified
Information," June 1948 as amended.
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2. (U) I do solemnly swear that I will never divulge, publish, or reveal
by word, conduct, or by any other means GRILL FLAME classified information
or knowledge, except in the performance of my official duties, and as
specifically authorized in writing in each case by the appropriate agency
of the United States Government.
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3. (U) I understand that no change in my assignment or employment will
relieve me of my obligation under this agreement and that the provisions
of this agreement will remain binding upon me even after the termination
of my services with the United States Government.
4. (S) I take this obligation of my own free will, without any menta.l
reservation or purpose of evasion. I understand that as a GRILL FLAME
volunteer the fact that I possess psychic abilities is classified and I
cannot divulge this fact by word, conduct, or by any other means.
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WITNESS :
SIGNED :
ann Y Djupman ILT
..
NAME, RANK/GRADE
NAME, RANK/GRADE
902d MI Gp
IIPD/ITAL/INSCOM
UNIT/ORGANIZATION
UNIT/ORGANIZATION
POSITION
POSITION
TI officer
Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150021-0
Chederick H. aleates

.
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Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150021-0
DATA REQUIRED BY THE PRIVACY ACT OF 1974
(5 U.S.C. 552a)
:
1.
Authority :
National Records Act, 44 U.S.C. 3102; E.O. 9397, Numbering
System for Federal Accounts Relating to Individual Persons, November 22, 1943.
2.
Principal Purpose:
To maintain a record of those individuals who have
or have had access to GRILL FLAME information through the use of their name
and/or Social Security Number.
3.
Routine Uses: The Social Security Number is to be used to identify the
individual, and the information is to be retained strictly within the Program.
4.
Mandatory or Voluntary Disclosure:
Information is disclosed on a
voluntary basis, but withholding information will render it impossible to
grant an individual access to or participation in the Program.
2
Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150021-0