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DOC 0000017432
Page 53
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SIGNATURE
DOCUMENT DE$Cm?TiCN
SOURCE
C. DD/P/TSS
CIA CONTROL MO,
101077
DATE DOCUMENT RECEIVED
NUMBER OF PAGES
2
mSmbEROF ATTACHMENTS
101
0
? 7A
ATTENTION: This form will be attached to each Top gec«t document received by the Central Intelligence Agency or classified Top Secret
within
the CIA and will remain attached to the document until such time as it is downgraded, destroyed, or transmitted outside of
CIA.
Access to Top Secret materia! is limited to those individuals whose official duties relate to the material.
Each alternate or assist-
ant Top Secret Control Officer who receives and/or releases the attached Top Secret material will sign this form and indicate, period of
custody in the left-hand columns provided.
The name of each individual who has seen the Top Secret document and the date of han-
dling should be indicated in the right-hand columns. —-
-»
EFJEBRED TO
OFFICE
RECEIVED
.ftEl£A$€Q
|
SIGNATURE
DATE V
TIME
: DATE “ ^TIME-|
SEEN ST
NAME AND OFFICE SYMBOL
idyd
a-
\
iriiftVVrirTt r;
osity
f
,-4Bf475
-
un3~I377""™™_”
NOTICE Or DETACHMENT: When this form is detached from Top Secret material it shall be completed in the expropriate spaces below and
transmitted to Central Top Secret Control for record.
THE TCI' SECRET MATERIAL DETACHED FROM THIS FORM WAS:
BY {Signature)
OOVHKiRAPtD
~
DESTROYED
Tj
’
—————
’
.
’
DISPATCHED (OUTSIDE CIA) TO
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