SIGNATURE RECORD AND COVER SHEET

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP59-00882R000200070028-0
• Release Decision: RIPPUB
• Original Classification: T
• Document Page Count: 1
• Document Creation Date: November 17, 2016
• Document Release Date: July 27, 2000
• Sequence Number: 28
• Publication Date: February 18, 1954
• Content Type: FORM

SIGNATURE RECORD AND COVER SHEET
DOCUMENT DESCRIPTION
REGISTRY
SOURCE
CIA CONTROL NO.
DOC. NO.
DATE DOCUMENT RECEIVED
DOC. DATE
18 Rob
291:54
25X1 A
.
_
COPY NO. 3- 4
D
NUMBER OF PAGES
NUMBER OF ATTACHMENTS
ATTENTION: This form will be attached to each Top Secret document received by the Central Intelligence Agency or classified Top Secret
within the CIA and will remain attached to the document until such time as it is downgraded, destroyed, or transmitted outside of
CIA. Access to Top Secret material is limited to those individuals whose official duties relate to the material. Each alternate or assist-
ant Top Secret Control Officer who receives and/or releases the attached Top Secret material will sign this form and indicate period of
custody in the left-hand columns provided. The name of each individual who has seen the Top Secret document and the date of han-
dling should be indicated in the right-hand columns.
REFERRED TO
RECEIVED
RELEASED
SEEN BY
OFFICE
SIGNATURE
DATE
TIME
DATE
TIME
NAME AND OFFICE SYMBOL
DATE
OGC
NOTICE OF DETACHMENT: When this form is detached from Top Secret material it shall be completed in the appropriate spaces below and
transmitted to Central Top Secret Control for record.
THE TOP SECRET MATERIAL DETACHED FROM THIS FORM WAS:
BY (Signature)
DOWNGRADED ^
DESTROYED ^
DISPATCHED (OUTSIDE CIA) TO
Amoroued Eor Release 9000109106 - CIA-PDP-
OFFICE DATE
Im-00889RO00200OZ0~2M
JANM19No- 52 38-1
TOP SECRET