SIGNATURE RECORD AND COVER SHEET

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP80R01731R000800160029-0
• Release Decision: RIPPUB
• Original Classification: T
• Document Page Count: 1
• Document Creation Date: December 14, 2016
• Document Release Date: June 17, 2003
• Sequence Number: 29
• Content Type: FORM

roved For Release 2 6 X-RDPP80RO1731 R000800160029-0
SIGNATURE RECORD AND COVER SHEET
DOCUMENT DESCRIPTION
REGISTRY
OURCE
CIA CONTROL NO.
36128
OC. NO.
DATE DOCUMENT RECEIVED
DOC. DATE
OPY NO. 3y--
LOGGED BYi
CUMBER OF PAGES
dhl
CUMBER OF ATTACHMENTS
none
JTENTION: This form will be attached to each top secret document received by the central intelligence agency or classified top secret
ithin the CIA and will remain attached to the document until such time as it is downgraded, destroyed, or transmitted outside of
IA. Access to top secret material is limited to those individuals whose official duties relate to the material. Each alternate or assist-
rat top secret control officer who receives and/or releases the attached top secret material will sign this form and indicate period of
+. etody in the left-hand columns provided. The name of each individual who has seen the top secret document and the date of han-
[ing 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
IC Area
TSControl
Executive
~e~lstry
-
- --
DCx
Li LLB. L`.{i i.,...
i. 14 7
~41.ih iit -
tl
- DATE:_ 1.$& E
REV1EWEHI
'40TlCE OF DETACHMENT: When this form is detached from top secret material it shall, be completed in the appro riat
transmitted to central top secret control for record. p STAT d
THE TOP SECRET MATERIAL DETACHED FROM THIS FORM WAS:
BY (Signature)
DOWNGRADED CI
DESTROYED 0
DISPATCHED (OUTSIDE CIA) TO
46-1 4ft * 4
OAM NO
OFFICE
DATE
F
.
'; N 1950
Approved For Release 2003/06/26 : CIA-RDP80R01731 R000800160029-0