SIGNATURE RECIRD AND COVER SHEET

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP83-00764R000100090130-9
• Release Decision: RIPPUB
• Original Classification: T
• Document Page Count: 1
• Document Creation Date: December 9, 2016
• Document Release Date: July 30, 1998
• Sequence Number: 130
• Publication Date: September 12, 1949
• Content Type: FORM

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Approved Foelease 2001/ 83-0076n4~000100090130-9
S I GNATURE RECOf2D AiJO Ct7VER SHEET
DOCUMENT DESCRIPTION ~ REGISTRY
SOURCE: ~G
DATE OF DOCUMENT: IZ S?=~t ~~ 9
COPY NUMBER (S) : $ 6j S~VV
NUMBEN DF PAGES: I o DOCUMENT N0.
NUMBER OF ATTACHMENTS: L - o~
CIA CONTROL NUMDER: ~u ( ~ ~
DATE DOCUM '~ ~ ~"~
~ LOGGED BY: ,1 25X1
ATTENTION: THIS FORM WILL BE ATTA HED 0 EACH TOP SECRET DOCUMENT RECEIVED BY THE CENTRAL INTELLIGENc;E
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 DUTSIDE OF CIA. ACCESS TD TOP SECRET MATERIAL IS LIMITEp
TD 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 TDP
SECRET DOCUMENT AND THE DATE OF HANDLING SHOULD BE INDICATED IN THE RIGHT-HAND COLUMNS.
REFERRED TO
RECEIVED
RELEASED
SEEM BY
OFFICE
SIGNATURE
DATE
TIME
DATE
TIME
NAME 8 OFFICE SYMBOL
DATE
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NOTICE OF D
ETACHMENT
WHEN THIS FORM IS DETACHED FRDM TOP SECRET MATERIAL IT WILL BE COMPLETED IN THE APPROPRI-
ATE SPACES DELOW AND TRANSMITTED TO CENTRAL T,OP SECRET CONTROL FOR RECORD.
the Top Secret material detached from this form was:
DOWNGRADED t3y;
DESTROYED (51GNATURE7
DISPATCHED (OUTSIDE CIA) T0:
IOFFiCE'I IDATEI
Approved For Release 2001/08/2 I~~DR83-007648000100090130-9
FORM NO. 38_13 PREVIOUS EDITIONS NOT TO Bc USED
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