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2. Use bock of form for any additional comments.
DOCUMENT DESCRIPTION (Circle if oppropr ete] 130 CHARACTERS% DAY MONTH YEAR
CABLE FORM
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I ?& AIRGRAM
FROM/ORIGINATOR (3D CHARACTERS) TO/RECIPIENT (30 CHARACTERS)
CLASS WHERE LOCATED(10CHARCT5) REFERRED BY 110CHARACTErI 000' 0 FILE NUMBER (20 CHARACTERS)
SUBJECT (80CHARACTERS)
DAY MONTH YEAR
TYPE DATE
OF I A L OF.
REVIEW REVIEW
Determinations:
A. Release in full text E. Sustain initial denial in toto
B. Release in sanitized form F. Sustain initial release of
C. Deny in toto of sanitized version
D. Defer decision to (Specify in line 8) _____ G. Release additional information
H. Coordinate with (Specify in line 8)
_____NEW
DEF- DECmC D I10 CHARACTEPI COORDINATE WITH 10 oARACTEF) CLSS
SIGNATURE OF DO/IMS/FPLG REVIEWING OFFICER
EXEMPTIONS AND PROVISIONS CLAIMED (40 CHARACTERS)
FOIA PA E.O. 12356
S 82 83 84 8S 86 87C 9 J1 Ji At KS
Exemptions and Provisions claimed to protect the following:
FOIA PA
1. Classification (b)(1) (k)(1)
2. Information from liaison with a Foreign Government (b)(3) (j)(1)
3. Information pertaining to a liaison (b)(3) (j) (1)
relationship with a Foreign Government
4. Information which would/could identify the . (b)(3) -(j)(1)
source
5. Information pertaining to a source (b) (3) (j) (1)
6. Information pertaining to intelligence methods (b)(3) (j) (1)
7. Location of CIA overseas installation (b)(3) (j) (1)
8. Location of unacknowledged domestic (6) (3) (j)(1)
installation
9. Name of CIA employee (b)(3) (j) (1)
10. File number (b) (3) (j) (1)
11. Pseudonym (b)(3) (j) (1)
12. Cryptonym (b) (3) (j) (1)
13. Internal organizational data (b) (3) (j) (1)
14. Name of an FBI agent (b)(7)(c) (j) (1)
15. FBI file number (b) (2) (j) (1)
16. Privacy of other individual (b) (6) (b)
17. Does not pertain to request
19. Other (Specify in line 11)
REMARKS (IF OTHER WAS CHECKED ABCVE: (40 CHARACTERS)
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