SIGNATURE RECORD AND COVER SHEET

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP61S00750A000600090052-8
• Release Decision: RIPPUB
• Original Classification: T
• Document Page Count: 1
• Document Creation Date: December 23, 2016
• Document Release Date: February 27, 2013
• Sequence Number: 52
• Publication Date: June 27, 1956
• Content Type: FORM

Declassified in Part - Sanitized Copy Approved for Release 2013/02/27 :
CIA-RDP61 S00750A000600090052-8
IGNATURE RECORD AND COVER SHEET
DOCUMENT DESCRIPTION
REGISTRY
SOURCE
0/ft
S
CIA CONTROL NO.
DOC. NO.
. '?
+4 t
w
Timan of je
DATE DOCUMENT RECEIVED
DOC. DATE
ar
are 27 111
COPY NO.
LOGGED BY
NUMBER OF PAGES
23 p es
NUMBER OF ATTACHMENTS
3 tact
ATTENTION: This form will placed toP thon and attached to each Top Secret document received by the Central Intel-
ligence Agency classified Top Secret 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 matter is limited to Top Secret Control
personnel and those individuals whose official duties relate to the matter. Top Secret Control Officers who receive
and/or release the attached Top Secret material will sign this form and indicate period of custody in the left-hand
columns provided. Each individual who sees the Top Secret document will sign and indicate the date of handling in the
right-hand columns.
REFERRED TO RECEIVED
RELEASED
SEEN BY
OFFICE
DATE
TIME
DA
TE
TIME
SIGNATURE AND OFFICE
OAT25X1
AT.
~.O
25X1
11
T
TAIN
OR DESTROY
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.
DOWNGRADED
DESTROYED
DISPATCHED (OUTSIDE CIA)
TO
BY (Signature)
TO
BY (Signature)
WITNESSED BY (Signature)
BY (Signature)
DATE DATE OFFICE
Declassified in Part - Sanitized Copy Approved for Release 2013/02/27 - i : I-1110m, I
DATE
;'L j
TV "Iff
FORM N _.
1 APR S'S CIA-RDP61 S00750A000600090052-8 TOP SECRET (40)