Document Type: 
Document Number (FOIA) /ESDN (CREST): 
Release Decision: 
Original Classification: 
Document Page Count: 
Document Creation Date: 
November 4, 2016
Document Release Date: 
December 7, 1998
Sequence Number: 
Case Number: 
Publication Date: 
January 19, 1982
Content Type: 
PDF icon CIA-RDP96-00788R001200010062-1.pdf105.34 KB
Approved For Release 200'1/04/02 : CIA-RDP96-00788R001200010062-1 DATE /9J/HJ Ma I " W,1114 1 0, I owltI , understand that the highly seas and classified in ormation I have, or are about to receive as part of the GRILL FLAME Program belongs to the United States Government. I understand that the disclosure of this information is punishable under Title 18, Section 798,'U.S.C., "Disclosure of Classified Information," June 1948, as amended. i do solemnly swear that I will never divulge, publish, or reveal by word, conduct, or by any other means such classified information or knowledge, except in the performance of my official" duties, and as specifically authorized in writing in each case by the appropriate agency'of the United States Government. I?understand that no change in my assignment or employment will relieve-me of my obligation under this agreement and that the provision's of this agreement will remain. binding upon me even after the termination of my services with the United States Government. I ' take this obligation of,own free will, without, any mental. reservation or purpose of evasion. DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C.. 552a) 1. Authority: National Records Act, 44 U.S.C. 3102; E.D. 9397, Numbering System for Federal Accounts Relating to Individual Personsl, November 22, 1943. 2. Principal Purpose: To maintain a record of those individ- uals who have or have had access to GRILL FLAME information through the use of their name and/or Social Security Number. 3. Routine Uses: The Social Security Number is to be used to identify the individual, and the information is to be retained strictly within the Program. 4. Mandatory or Voluntary Disclosure: Information is disclosed on a voluntary basis, but withholding information will render it impossible to grant an individual access to or participation in the Program. Approved For Release 2001/04/02 : CIA-RDP96-00788R001200010062-1 Approved For Release 2001/04/02 : CIA-RDP96-00788R001200010062-1 GRILL FLAME SECURITY AGREEMENT CONTINUATION PAGE DATE 19 J 4,,r 112 2- WITNESS:. LTA. Ror'. Z X41 " SGFOIA3 SIGNED: -_~ ssAu I I~ -, IJ $ Zan, ( bVAME, RANK GRADE _ NAME, ii-AN BADE NoCSOPS - HUMWWr RGAXN II Z A,T I ON 6 -P270 UNIT ORt;ANI ZZATI ON GRILL PLA1,4E. PRci, Ezr r ~~.~ -Cruet P POSITION ~11A-~)ACt POSITION - r. ..~_~. Approved For Release 2001/04/02 : CIA-RDP96-00788R001200010062-1