SIGNATURE RECORD AND COVER SHEET

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP83-00764R000100090128-2
• Release Decision: RIPPUB
• Original Classification: T
• Document Page Count: 1
• Document Creation Date: December 9, 2016
• Document Release Date: July 30, 1998
• Sequence Number: 128
• Publication Date: September 19, 1949
• Content Type: FORM

Approved For Reellease 2001/ -00764RU0 100090128-2
SIGNATURE RECORD AND COVER SHEET
DOCUMENT DESCRIPTION
REGISTRY
S O U R C E :
DATE OF DOCUMENT: /9-( ''9
COPY NUMBER (S): s Jtis
NUMBER CF PAGES: / ~1 DOCUMENT NO.
NUMBER OF ATTACHMENTS;
2
C I A CONTROL NUMBER: ,~'r, 3'
DATE DOCUME VED: 00e~
LOGGED BY:
25X1A9a
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 SECR.ET MATERIAL IS LIMITED
TO THOSE INDIVIDUALS WHOSE OFFICIAL DUTIES RELATE TO THE 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.
REFERRED TO
RECEIVED
RELEASED
SEEN BY
OFFICE
SIGNATURE
DATE
TIME
DATE
TIME
NAME & OFFICE SYMBOL
DATE
25X1A9a
NOTICE OF
DETACHMENT
WHEN THIS FORM IS DETACHED FROM TOP SECRET MATERIAL IT WILL BE COMPLETED IN THE APPROPRI-
ATE SPACES BELOW AND TRANSMITTED TO CENTRAL TOP SECRET CONTROL FOR RECORD.
The Top Secret material detached from this form was:
DOWNGRADED BY:
DESTROYED (SIGNATURE)
DISPATCHED (OUTSIDE CIA) TO:
(OFFICE) (DATE)
Approved For R 3-00764R000100090128-2