(UNTITLED)

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP60-00442R000100220004-6
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 1
• Document Creation Date: December 12, 2016
• Document Release Date: April 24, 2002
• Sequence Number: 4
• Publication Date: November 7, 1956
• Content Type: FORM

sy? _ orovedfor Release=2002/05/0 ,0442R000100220004-6
INSTRUCTIONS: Officer designations should be used in the "TO" column.. Under each comment a line should be drawn across sheet
and each comment. numbered to correspond with the number in the "TO" column. Each officer should initial(cJ 7cfc r ,, insufficient)
before further routing. This Routing and Record Sheet .shouild be -+--A to Re
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FORM N O. 61 Q RVJ??L~ s FOiird rI-Io APR HICH MAY BE USED.
]ROUTING AND RECORD SHEET
DATE
7 November 1956
O I FFICER'S TELEPHONE
NITIALS
i/ w~ sctcuy ut";.La1u aulu reppresen&
that the injuries sustained are
yr permanent and progressive and that
recovery therefrom is uncertain and.
indefinite, and in making this release
and agreement it is understood and
Aft, agreed that I/we rely wholly upon
my/oxzr own judgment, belief and
knowledge of the nature, extent and
duration of said injuries, and that
I/we have not been influenced to
any extent whatever in making this
release by any representations or
statements regarding said injuries,
or regarding any other matters, made
by the persons, firms or corporations
who are hereby released, or by any
person or persons representing him
or them, or by any physician or
surgeon by him or them employed".
For your information, the second
paragraph of the release mentioned.
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