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104-10120-10646 JFK Assassination Records Archives 1 (3/23/1976)

handle is hein.jfk/jfkarch39232 and id is 1 raw text is: 104-10120-10646


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      1. I acknowledge  that by virtue of my  duties I have  been  exposed   to or  the recipient
of classified information, which, in itself, or by the implications drawn  from it, is highly sen-
sitive and its unauthorized disclosure or negligent handling  could adversely affect the interests
of the United  States.  I am  aware  that the unauthorized  disclosure of  classified information
is prohibited by  the Espionage   Laws  (18 U.S.C., Sections 793,  794 and  798)  and  that a vi-
olation of these laws  may  subject me  to prosecution by  the U. S. Government.

     2. I hereby  reaffirm my  pledge  that I will never publish or  reveal by  any  means  such
information.   I agree  further that I do  not now,  nor will I ever, possess any right, interest,
title or claim whatsoever  to  such information.   I recognize the full and vested property right
of the  United States in such  matters.

     3. 1 certify that I have surrendered and  no  longer have in my  possession or custody  any
classified information or material acquired  as a  result of this association.

     4. I further acknowledge   and  agree  that  I have  a continuing  individual responsibility
to the United  States Government   for the protection of such information and  that the termina-
tion from  this relationship with my  employer  and/or  the United  States Government   does not
relieve me of my  obligations under  this oath or any other previously executed  Secrecy  Agree-
ments.   I understand  that I will not be relieved of these obligations except when   specifically
advised  in writing by the sponsoring  activity of the U. S. Government.

     5. I understand  that this oath may   be retained  by the U.  S. Government   for its future
use in any manner  within the scope of this oath.

     6. I take this obligation freely, without any  mental  reservation or  purpose  of  evasion
and  in the absence  of  duress.          .


NAME  OF WITNESS (Type or Print)           NAME (Type or Print)


             Theodore M. Anderson                             Clare Booth Luce
 SIGNATURE OF WITNESS                            SIGNATURE

                                                              AdImin   Debrief
 REMARKS                                         NAME & ADDRESS OF AFFILIATION
                                                              WH/PFIAB
                                                   SOCIAL SECURITY NUMBER:
                                                              064-18-3062
                                                 DATE
                                                              23  March 76


OR'  2442


(12)


                                                  The Privacy Act, Public Law 93-579, requires that
                                                  Federal agencies inform individuals when they are
                                                  asked to provide their Social Security Account Num-
                                                  her (SSN) whether the disclosure is mandatory or
                                 *.            ~voluntary, by what authority such number is solic-
                                                 ited and what uses will be made of the SSN. Dis-
             \a ) N~t~L       meclosure by you of you             SN is voluntary. The au-
                                                 thority for this solicitatio is Executive Order 9397.
                                                 The SSN is used as an id ntifier in removing your
                                                 atharized accesto te   esignated Special Proj.
TERMINATION        SECRECY    AGREEMENT            'ct(s). Fai t 'ivif v. 5Nmay delay t
                                                 processing required/n access authority removal.

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