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![handle is hein.jfk/jfkarch48428 and id is 1 raw text is: 104-10418-1O331]
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9PtMTNT D ESCRIPTION (Circle if appropriete) (30 CHARACT E RS)
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REPORT
FORM
LETTER
A R GRAM
FROM/ORIGINATOR (30 CHARACTERS)
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DAY MONTH YEAR
40 ~
TO.'RECIPIENT (30 CHARACTERS)
CLASS WHERELOCATED (100iARACTEFS) REFERRED BY (00CHARACTERS) DDO I DO FILE NUMBER (20 CHARACTERS)
SUBJECT (SO CHARACTERS)
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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 j B. Release in sanitized form F. Sustain initial release of
C. Deny in toto of sanitized version
D. Defer decision to :Specifyinline8) __ G. Release additional information
H. Coordinate with (Specify in line 8)
DEFER DECSKN TO 110 CHARACTERS) COORDINATE WITH 110 O*ARACTEF) CNEWS
SIGNATURE OF DO/IMS/FPLG REVIEWING OFFICER
EXEMPTIONS AND PROVISIONS CLAIMED (40 CHARACTERS)
FOIA PA E.O. 12065
9 0 ' z18yB4 85 B6 87C 8 J11 JIB JIC 1(1
Exemptions and Provisions claimed to protect the following:
FOIA PA
1. Classification - / (b)(1) (k)(1)
2. Information from li i ison with /a Foreign Government (b)(3) (j)(1)(b)(c)
L . Information pertaining to a liaison (b)(3) (j)(1)(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 methods (b)(3) (j)(1)(b)
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)
1___0. File number (b)(3) (j)(1)(b)
11. Pseudonym (b)(3) (j)(1)(b)
12. Cryptonym_3 (b)(3) (j)(1)(b)
L1. Internal organizational data (b)(3) (j) (1) (b)
14. Name of an FBI agent (b)(7)(c)(j)(1)(b)
15. FBI file number (b)(2) (j)(1)(b)
16. Privacy of other individual (b)(6) (b)
17. Does not pertain to request
19. Other (Specify in line 11)
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REMARKS (IF OTHER WAS CHECKED ABOVE) (40 CHARACTERS)
SIGNAYV4/E/FFICE OF CO COMPONENT REVIEWING OFFICER
REMARKS (160 CHARACTERS)
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