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104-10120-10645 JFK Assassination Records Archives 1 (4/1/1976)

handle is hein.jfk/jfkarch10937 and id is 1 raw text is: 104-10120-10645


MED  INDOCTRINATION AGREEMENT


     I have   been  advised  of  the  procedures   to follow   in order  to  ldtermine
the  identity   of  individuals   who  have  been  approved   for access   t              -
Restrictions,   the  current  Hazardous   Activities   Restrictions and how to
resolve   questions   which  may  arise  under  this  agreement.

     I have  read  and  understand the contents of this oath and voluntarily
affix  my  signature   hereto  with   the full  knowledge   that  this  oath  was
executed   for  the mutual   benefit   of myself   and the  United   States
Government,   and  that  it  will  be  retained  in  the  files  of the  MCO  for
its  future  use  or  for  reference   by me  at any  time  in  the future.

     In witness   whereof,   I have  set  my  hand  this 1st  day  of  _prl976


TRIGRAPHS:



                                                   Signature


LEVEL     3


TYPED  NAME


Clare  Booth Luce


GRADE/RANK             SERVICE


SSN    064-18-3062


ORGANIZATION


Witnessed   by


0)


/


                                        SECRET
                                     (when filled in)



OThe P-rivacy Act, Public Law 93-579, requires that Federal agencies inform
i1ividuals .hen they are asked to provide their Social Security Accoumt
!A.ber (SSN) whether the disclosure is candatory or voltntary, by what authority
such nerber is solicited and uhat uscs will be mada of the SSN. Disclosure by
yu  of your SSN is volttary. The withority for this solicitation is Executive
Ordar 9397. The SSN is used as an Wientifier in rquests for access certification.
Failure to provide your SSN may delay the processing required to obtain a
curity  access certification.






               7                                           MR          M  T, IS
                       F.,                      .


WHf/PFIAB


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Do Not Reprodue

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