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

handle is hein.jfk/jfkarch39231 and id is 1 raw text is: 104-1120 -10645             *




         MED  INDOCTRINATION AGREEMENT                                          J
                                                                   Do Not Reprodue

              I have  been  advised   of  the procedures to follow in order to 4etermine
         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       \-fl/PFIAB

Witnessed   by

                                                                                03


                                          SECRET
                                       (when filled in)



  CThe P-rivacy Act, Public Law 93-579, requires that Federal agencies inform
  inividuals when they are asked to provide their Social Security Accoumt
  !A.ber (SSN) whether the disclosure is mandatory or voltntary, by what authority
  such nerber is solicited and uhat uscs will be made 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.

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