PENTAGON RESERVED CARPOOL VALIDATION CERTIFICATE

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP85-00988R000600060022-7
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: December 16, 2016
• Document Release Date: December 2, 1998
• Sequence Number: 22
• Publication Date: July 1, 1976
• Content Type: FORM

Approved For Release 2005/06/$$NT DP85-00988R000600060022-7
RESERVED CARPOOL VALIDATION CERTIFICATE
I CERTIFY THAT I ACTIVELY PARTICIPATE AS A MEMBER OF A RESERVED CARPOOL. I UNDERSTAND
THAT ACTIVE PARTICIPATION MEANS THAT I RIDE TO AND FROM WORK AS A MEMBER OF THE CAR
POOL (EXCEPT WHEN ON LEAVE OR OTHER SITUATIONS THAT WOULD PRECLUDE TRAVEL WITH THE CAR
POOL ON ANY GIVEN DAY) FOR A DISTANCE OF AT LEAST ONE MILE. FURTHER, I UNDERSTAND
THAT TO FALSIFY MY PARTICIPATION IN THE CARPOOL, I WILL BE SUBJECT TO A FINE OF UP TO
$50.00 OR IMPRISONMENT UP TO 30 DAYS OR BOTH AND THAT ADMINISTRATIVE ACTION WILL BE
TAKEN TO REVOKE MY PARKING PRIVILEGE AT THE PENTAGON FOR A PERIOD OF NOT LESS THAN
6 Months.
RESERVED CARPOOL VALIDATION CERTIFICATE, SIGNED BY EACH MEMBER, MUST BE SUBMITTED BY
THE PRINCIPAL MEMBER IN PERSON TO THE CENTRAL PARKING CONTROL OFFICE, ROOM 1E686, ON
THE INITIAL CARPOOL PERMIT ISSUANCE DATE, PRIOR TO RECEIPT OF PERMIT AND EVERY 6
MONTHS THEREAFTER. FAILURE TO DO SO WILL RESULT IN REVOCATION OF RESERVED CARPOOL
PARKING PRIVILEGES. SUPPLIES OF THE VALIDATION CERTIFICATE ARE AVAILABLE AT THE
CENTRAL PARKING CONTROL OFFICE, ROOM 1E686.
OSA FORM 613 (REV)
July 1976
GOVERNMENT PROPERTY
DO NOT FOLD, SPINDLE OR MUTILATE
NAME LAST FIRST MI
DEPT
DIV
PHONE NO
ROOM #
DATE & SIGNATURE
PRINCIPAL MEMBER WILL BE ON LIN
E ONE
2
3
4
5
6
7
8
9
Each six month period will be covered by a different color validation certificate.
Approved For Release 2005/06/22 : CIA-RDP85-00988R000600060022-7