FORM 610 (EF)
8-98
USE PREVIOUS
EDITIONS
APPROVED FOR
TTXTr'lr A CCY]2YAT71//L26Z
UNCLASSIFIED//F,UO
RELEASE^DATE:
28-Dec-2009
CL BY:
CL REASON;
DECL ON:
DRV FROM:
(b)(3)
UNCLASSIFIED//F\U
CIO/IMS 0042-02
9 May 2002
MEMORANDUM FOR: Deputy Executive Director
Deputy Director for Intelligence
Deputy Director for Operations
Deputy Director for Science and Technology
Chief Financial Officer
Chief Global Support
APPROVED FOR
RELEASE^DATE:
03-Sep-2008
~EUicEtic
F
SECURITY REGULATIONS CERTIFICATION
Date -- y
I CERTIFY THAT I HAVE READ THE SECURITY REGULA-
TIONS MANUAL OF THE CENTRAL INTELLIGENCE AGENCY.
I UNDERSTAND THESE REGULATIONS AND WILL ABIDE BY
THEIR PROVISIONS.
0-14 UV _
NAME (typed or printed)
APPROVED FOR
RELEASE DATE:
03-Sep-2008
OUTSIDE ACTIVITY APPROVAL ROUEST
AND FORWARD ORIGINAL AND 3 COPIES T
CTOR OF SECURITY;
division or office head and securityofficer where assigned)
Staff,
NAM AOE OF EMPLOYEE (Print or
type)
(b)(2).:
(b)(3)
(b)(6)
CIA INTEE USE ONLY
(Class When Filled In)
FROM:
(b)(3)
(b)(6)
Standard Form 513
Rev. August 1954
Promulgated
By Bureau of the Budget
Circular A-32
CLINICAL RECORD .I CONSULTATION SHEET
.5cue/4 i5 off" 1% EYe
EYE CLINIC
39223
DATJ N, 2 Q 196
PLACE OF CONSULTATION
^DEDSIDE DON CALL.
l~ Nan/e
2PHTHALM0 LO
APPROVED FOR RELEASE^DATE:
1 O-Nov-2008
SIGNATURE AND TITLE A7
TERMINATION SECRECY OATH ---
J
I,
CN on ~' lG1S, becoming dissociated
with the ograms in the
ealize that by virtue of my duties with t 'nose programs have
been the recipient of information and intelligence which concerns the
present, and future security of the United States of America. I am
aware that the unauthorized disclosure of such information is
punishable under the Espionage Laws.
TERMINATION SECRECY AGREEMENT
1. I acknowledge that by virtue of my duties I have been exposed to or the recipient
of classified information, which, in itself, or by the implications drawn from it, is highly sen-
sitive and its unauthorized disclosure or negligent handling could adversely affect the interests
of the United States. I am aware that the unauthorized disclosure of classified information
is prohibited by the Espionage Laws (18 U.S.C., Sections 793, 794 and 798) and that a vi-
APPROVED FOR
RELEASE^DATE:
03-Sep-2008
CONFI TIAL
(Whe illed In)
TERMINATION SECRECY AGREEMENT
(b)(1)
(b)(2)
(b)(3)
(b)(6)
1. I, John W. Debe 1 iuS , am about to terminate my association with
the Central Intelligence Agency.. I realize that, by virtue of my duties with that agency, I have
been the recipient of information and intelligence that concern the present and future se-
curity of the United States of America.
TERMINATION SECRECY AGREEMENT
1. I acknowledge that by virtue of my duties I have been exposed to or the recipient
of classified information, which, in itself, or by the implications drawn from it, is highly sen-
sitive and its unauthorized disclosure or negligent handling could adversely affect the interests
of the United States. I am aware that the unauthorized disclosure of classified information
is prohibited by the Espionage Laws (18 U.S.C., Sections 793, 794 and 798) and that a vi-
NAME OF SUBJECT
DEBELIUS, John W.
REASON FOR INTERVIEW
Retirement 1 June 1973
PERMANENT ADDRESS
APPROVED FOR
RELEASE DATE:
03-Sep-2008
(b) (2)
(b)(3)
(b)(6)
1. ALL PHASES OF SECURITY WITH RESPECT TO SUBJECT'S RESPONSIBILITY TO THE ORGANIZATION WERE FULLY AND COM-
PLETELY DISCUSSED.
2. SUBJECT WAS ADVISED THAT ALL INFORMATION RECEIVED AND COMPILED BY THE AGENCY IS OFFICIAL DATA. AND IS THE
FOIA
