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104-10120-10645 JFK Assassination Records Archives 1 (4/1/1976)

handle is hein.jfk/jfkarch85676 and id is 1 raw text is: 104-10120-10645





         MED


2023 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992



                                                       _,,        _   _  _  _ . Ym;
INDOCTRINATION   AGREEMENT                             r
                                                   Do  iNot Reproduce


     I have  been  advised  of  the  procedures   to follow  in  order  to  etermine
the  identity  of  individuals   who  have  been approved   for  access  to(MED)        -
Restrictions,  the  current   Hazardous  Activities   Restrictions   and  how  to
resolve  questions   which  may  arise  under  this  agreement.

     I have  read  and understand the contents of this oath and voluntarily
affix  my signature   hereto   with  the full  knowledge   that this  oath  was
executed   for the  mutual  benefit   of myself  and  the  United  States
Government,   and  that  it will  be  retained  in  the files  of  the MCO  for
its  future  use or  for  reference   by me  at any  time  in the  future.


     In witness   whereof,


TRIGRAPHS:   [NED DjLI


             vIN      (ADU


I have


CBRI)


CET?


LEVEL     3


set  my hand  this  1st day  of  Apr.1976


(&D)


TYPED  NAME


Signature

  Clare  Booth Luce


GRADE/RANK            SERVICE


                            03
Witnessed   by  CMary  Louise  Odom)


SSN   064-18-3062


ORGANIZATION


WH/PFIAB


Cgnature,-of-Witness
                                03-


                                       SECRET
                                     (when filled in)



*n  Privacy Act, Public Law 93-579, requires that Federal agencies infonm
ir-ividuals when they are asked to provide their Social Security Accomt
:der   (SSN) whether the disclosure is andatory or voluntary, by what authority
sxh  ntmber is solicited and what uses will be made of the SSN. Disclosure by
ycu of your SSV is voluntary. The authority for this solicitation is Executive
Ord.ar 9397. The SS is used as an identifier in rquests for access certification.
Failure to provide your SSN may delay the processing required to obtain a
s:curity access certification.




                               .                 ...                            .,,.

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