SIGNATURE RECORD AND COVER SHEET

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-01617A000500220005-4
• Release Decision: RIPPUB
• Original Classification: T
• Document Page Count: 1
• Document Creation Date: November 9, 2016
• Document Release Date: July 24, 1998
• Sequence Number: 5
• Content Type: FORM

~. Sanitized - Approved For R s - DP78-0~17A000500220005-4
SIGNATURE RECORD AND COVER SHEET.
. ., ~ a F._
SOURCE:,,TIs '- C I A CONTROL NUMBER: ;~_,~`~ ~~
DATE OF DOCUMENT: ].2 ul 4J DATE DOCUMENT RECEIVED:
COPY NUMBER (S): LOGGED BY:
NUMBER OF PAGES: I W~t3~131 DOCUMENT NO.mexn0 'E~
OF ATTACHMENTS: AD RSeE
NUMBER
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 TIDE MATERIAL. EACH ALTERNATE OR ASSISTANT TOP SECRET
CONTROL OFFICER WHO RECEIVES AND/OR RELEASES THE ATTACHED TOP SECRET MATERIAL WILL SIGN THIS FORM AND INDI-
CATE 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 HANDLING SHOULD BE INDICATED IN THE RIGHT-HAND COLUMNS.
TSC.
NOTICE OF DETACHMENT
WHEN THIS FORM IS DETACHED FROM TOP SECRET MATERIAL IT WILL BE COMPLETED IN
ATE SPACES BELOW AND TRANSMITTED TO CENTRAL T,OP SECRET CONTROL FOR RECORD.
The Top Secrst material detached from this form was:
DOWNGRADED
DESTROYED
DISPATCHED (OUTSIDE CIA T0:
THE APPROPRI-'
(OFFICE) IDATEI
Sanitized -Approve 78-01617A000500220005-4