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![handle is hein.jfk/jfkarch19479 and id is 1 raw text is:
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YIA MMZ DC O
kL J SECRET
S. AUIMT RECORD
nstructiers for Divisions edStrffs;
1. Fill in and Sign onI line 11.
2. Use bock of form for sa o~itional commen~fits.
I
DOCUVENT DESCRIPTION (Circle If appropriate) (30 CHARACTERS) DAY MONTH YEAR
CAsLt FORM
2 LETTKR
O R AIRORAM
FROM/ORIGINATOR (20 CHARACTERS) TO!RECIPIENT (SD CHARACTERS)
3
CLASS WHEFE REFERRED BY (10CHARACTEIS) DDO ? DO PILE NUMBER (20 CHAtACTERSi
SUBJECT (80 CHARACTERS)
DAY MONTH YEAR
TYPE DATE
OF A L OF
6 REVIEW REVIEW
Determinations:
A. Release in full text E. Sustain initial denial in toto
7 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)
DEFER DEC15ION To t 10 CHARACTfs JCOORDINATE WITH (1 04ARACTEF5) CLASS
8
SIGNATURE OF DO/IMS/FPLG REVIEWING OFFICER
EXEMPTIONS AND PROVISIONS CLAIMED (40 CHARACTERS)
9 VAIA e PA E.O. 12065
81 82 83 84 85 86 87C 8 JI JIB JIC Ki
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)(b)(c)
3. Information pertaining to a liaison (b) (3) (j)(l)(b)(c)
relationship with a Foreign Government
4. Information which would/could identify the (b)(3) (j)(1) (b)
source
5. Information pertaining to a source (b)(3) (j)(1)(b)
6. Information pertaining to intelligence me ds (b)(3) (j)(1)Cb)
7. Location of CIA overseas installation (b)(3) (j)(1)(b)
) 8. Location of unacknowledged domestic (b)(3) (j)(1)(b)
installation
9. Name of CIA employee (b) (3) (j)(1) (b)
' '10. File number (b) (3) (j) (1) (b)
11. Pseudonym (b) (3) (j) (1) (b)
12. Cryptonym. (b) (3) (j) (1) (b)
13. Internal organizational data (b)(3) (j)(1)(b)
14. Name of an FBI agent (b)(7)Cc) (j)(1)(b)
5. FBI file number .. (b)(2) (j)( )(b)
6. Privacy of other individual (b) (6.) (b)
17. Does not pertain to request
19. Other (Spedify in line 11)
REMARKS (IF OTHER WAS CHECKED ABOVE) (40 CHARACTERS)
SIGNATURE/OFFICE OF DO COMPONENT REVIEWING OFFICER
REMARKS *160 CHARACTERS)
This Form Is Unclassified Unless The Classification is Checked
and The Information below is completed.
o DECL ]REVW
ORG EXT](ViewImageLocal?handle=hein.jfk/jfkarch19479&div=1&collection=&method=preview&ext=.png&size=3)