SIGNATURE RECORD AND COVER SHEET

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP79B00970A000100010041-7
• Release Decision: RIPPUB
• Original Classification: T
• Document Page Count: 1
• Document Creation Date: December 12, 2016
• Document Release Date: July 31, 1998
• Sequence Number: 41
• Publication Date: November 13, 1953
• Content Type: FORM

SIGNATURE RECORD AND COVER SHEET
DOCUMENT DESCRIPTION
REGISTRY
CIA CONTROL NO.
SOURCE
72 19 ~
25X1A9a
DATE DOC. REC'D.
DOC. No.
3 '
Doc. Date
Copy No.
LOGGED BY
of es
NO. 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 OF-
EACH ALTERNATE OR ASSISTANT TOP SECRET CONTROL OFFICER WHO RECEIVES AND/OR
FICIAL DUTIES RELATE TO THE MATERIAL.
RELEASES THE ATTACHED TOP SECRET MATERIAL WILL SIGN THIS FORM AND INDICATE PERIOD OF CUSTODY IN THE LEFT-HAND COL-
UMNS PROVIDED. THE NAME OF EACH INDIVIDUAL WHO HAS SEEN THE TOP SECRET DOCUMENT AND THE DATE OF HANDLING SHOULD
BE INDICATED THE RLGHT=t"Q COLUMOS.
REFERRED TO RECEIVED RELEASED SEEN BY -
OFFICE
SIGNATURE
DATE
TIME
DATE
TIME
NAME OFFICE SYMBOL
DATE
(1 J
5X1A9a
QDX
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
TH TOP SECRET MATERIAL DETACHED THIS FORM WAS ___, BY (SIGNATUREI
DOWNGRADED
DESTROYED
DISPATCHED (OUTSIDE CIA) TO
OFFICE
DATE
Aoorov d For RpIpa_
Approved For R le se 2001/0 00 0001000100AJ a
FORM NO.
-
JAN 1950 3813