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104-10120-10028 JFK Assassination Records Archives 1 (05/16/1976)

handle is hein.jfk/jfkarch72586 and id is 1 raw text is: 1104-10120-10028 W f 2022 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992 PERSONNEL SECURITY PWEDGE AND NAME CHECK INFORMATION RELEASE In L_ -N\ . 19,4, , National Agency Name on the Subject with the following results: 'L3 ted P - POSITIVE N - NEGATIVE rn~ ~ As a duly accredited representative of the Requesting Agency named above, I understand that all personnel security information released to me concerning the Subject by review of his file, by memoranda, by copies of reports, or by any other means is furnished in strict confidence in connection with my official duties. Accordingly, I hereby pledge the following: 1. The information is for official United States Government use only and will be handled in accordance with its classification. 2. The information, the source thereof, the identity of informants, and the collection methods will not be divulged nor disseminated to anyone, except officials of the Requesting Agency named above on a strict need- to-know basis. 3. The information will not be divulged in any hearing or board action without the prior written consent of the Releasing Agency. J SIGNATU E FOR OFFICIAL USE ONLY DATE NC\ (4- 12-47) Al)-4 -, , NAME OF SUBJECT (Last, First. Middle) REQUESTING AGENCY DATE DATE OF BIRTH PLACE OF BIRTH DATE OF REOU T REMARKS: FBI ONI ACSI STATE PASSPORT CSC HCUA OSI OSI/4 I&N AGO DODCI FORM 2 89 usE P rEVIOUS EDITION 10-69 - r )11_

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