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104-10110-10696 JFK Assassination Records Archives 1 (09/26/1972)

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104-10110-10696 :2022 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992


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                                                             -  y,  DATE RECEIVED
T0   -    Support  Case, Section, Clearance   Support Branch  !7 ¶         RCIE
          Personnel  Security  Division


SUBJECT:  Request  for Contact  Security  Approval.
                                                                   Y  '

REOUESTER                                             OFFICE -                  EXTENSION




                               AIB  DATA FURN ISHED BY REQUESTER *'C    . t4    N

SUBJECT'S NAME (Last. First, Middle)                               DATE OF BIRTH




PLACE OF BIRTH


EMPLOYER -


CLEARANCES/OTHER                       ---






LEVEL REQUESTED TF , -      CONFIDENTIAL                    SECRET


          SECUR ITY CHECKS         RECO   PSI                       RESULTS E


OS INDICES                                                -                               °


.SC          S   .     1 -,


OTHER             e.

                                   i       s                        DATE
                            ACTION TAKEN


CONTACT SECURITY APPROVAL/CONFIDENTIAL


CONTACT SECURITY APPROVAL/SECRET


OTHER     s
         cSA/.


/.


Approv     Of cialfo




        C/ PSD/os


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