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![handle is hein.jfk/jfkarch85673 and id is 1 raw text is: 1104-10120-10028
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2023 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:
I'3 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.
RELE SED BY (NAME]
FORM 2 89 usE P rEVIOUs EDITION
1069
JSIGNATU 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
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