CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD

• Document Type: CREST
• Collection: STARGATE
• Document Number (FOIA) /ESDN (CREST): CIA-RDP96-00788R001600160003-6
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 1
• Document Creation Date: November 4, 2016
• Document Release Date: May 17, 2000
• Sequence Number: 3
• Content Type: FORM

CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD
For use of this form, see AR 38A-S; the proponent agency is the Office, AssislanI Chief of Staff for Intelligence.
DATE
SECTION A - GENERAL
TO:
FROM:
DATE RECEIVED
ACTION QFFICE(S)
SUSPENSE DATE(S)
REGISTER OR CONTROL Np
CONTROL. LOG
OR FILE NO.
CLASSIFI-
CATION
NUMBER OF
COPIES
DESCRIPTION i Type. File Ref. Unclassified Subject
or Short Title and Number of indorsements/!ncls)
DATE OF
DOCUMENT
ORIGINATOR
CL-015-83
..........
S/NOFOR
.......
1
...e...
Cy 1 of 1 cy Report CL-996/8210/043 ....
........NOTHING FOLLOWS...............
.......
..........
SECTION 8 - ROUTING
I A KNOWLEDGE RECEIPT -OF THrMATERI L D .S RIBED HE EWFT-
TO COPY NO. DATE PRINTED NAME SIGNATURE
2.
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r-
4.
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3
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL DESCRIBED HEREON HAS BEEN: PAGE OR COPY NO
0 DESTROYED ? TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 384.1)
OFFICE SYMBOL DATE PRINTED NAME OF CUSTODIAN OR REP SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CLRTIFYING/DESTR. OFF.
SIGNATURE
PAGE OR COPY NUMBER
DATE
PRINTED NAME OF WITNESSING OFFICIAL
SIGNATURE
SECTION D - REPRODUCTION AUTHORITY
NUMBER OF COPIES TO BE REPRODUCED
AUTHORIZED BY
DATE
SECTION E - IECEIPT/TRACER ACTION (Check appropriate block)
oRECEIPTOF DOCUMENT(S) ACKNOWLEDGED ? DOCUMENT(S) HAVENOT BEEN RECEIVED
TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED .ABOVE HAS NOT BEEN RECEIVED.
DATE ]PRINTED NAME, GRADE OR TITLE SIGNATURE
COMMENTS Approve or a ease 2 108108 . CIA-R-131-9,5-00788
D A FORM IM&A
1 J
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