[104-10227-10000.pdf — page 3]
TOP SECRETINCI ASSIFIED when blank-TOP SECRET when attached to Top Secret Document-Automatically downgraded to SECRET when filled in-form is detached from controlled document.CONTROL AND COVER SHEET FOR TOP SECRET DOCUMENTDOCUMENT DESCRIPTION|                       |              || --------------------- | ------------ || Source                | SR           || Doc. No.              | XAAZ-17241/1 || Doc. Date             | 11 MAY 1964  || Copy No.              | # Repro 2    || Number of Pagos       | 28           || Number of Attachments |              |REGISTRY|                        |              || ---------------------- | ------------ || CIA Control No.        | 191722A      || Date Document Received | 15 JUN 1976  || Logged By              | ![signature] |ATTENTION: This form will be placed on top of and attached to each Top Secret document received by the Central Intelligence Agency or classi- fied Top Secret within the CIA and will remain attached to the document until such time as it is downgraded, destroyed, or transmitted outside of CIA. Access to Top Secret matter is limited to Top Secret Control personnel and those individuals whose official, duties relate to the matter. Top Secret Control Officers who receive and/or release the attached Top Secret material will sign this form and indicate period of custody in the left- hand columns provided. Each individual who sees the Top Secret document will sign and indicate the date of handling in the right-hand columns.| REFERRED TO                | RECEIVED              | RELEASED    | SEEN BY |             |      |           |             |      || -------------------------- | --------------------- | ----------- | ------- | ----------- | ---- | --------- | ----------- | ---- || Office                     | Signature             | Date        | Time    | Date        | Time | Signature | Office/Div. | Date || DDP(TSCO)                  | ![signature] B. Lwigg | 15 JUN 1976 |         | 15 JUN 1976 |      |           |             |      || RC+101C Herglens fone      |                       |             |         |             |      |           |             |      || Scott Briefenndye          |                       |             |         |             |      |           |             |      || DDO/1500                   | ![signature] B Lwigg  | 19 JUN 1976 |         | 19 JUN 1973 |      |           |             |      || 10/15                      |                       |             |         |             |      |           |             |      ||                            | ![signature]          | 19 jun -18  |         | 19 Jun -18  |      |           |             |      || AC/CI(N)                   |                       |             |         |             |      |           |             |      || DDO/1500                   | ![signature] B. Lwigg | 20 JUN 1976 |         | 20 JUN 1976 |      |           |             |      || RCI/OLC                    |                       |             |         |             |      |           |             |      || Breckenridgece Lubrielson! |                       |             |         |             |      |           |             |      || 1000/1500                  |                       |             |         |             |      |           |             |      |NOTICE OF DETACHMENT: When this form is detached from Top Secret material it shall be completed in the appropriate spaces below and trans. mitted to Central Top Secret Control for record.| DOWNGRADED               | DESTROYED                | DISPATCHED (OUTSIDE CIA) || ------------------------ | ------------------------ | ------------------------ || TO                       | TO                       | TO                       || By (Signature)           | By (Signature)           | By Signature)            || WITNESSED BY (Signature) | WITNESSED BY (Signature) | WITNESSED BY (Signature) || OFFICE                   | OFFICE                   | OFFICE                   || DATE                     | DATE                     | DATE                     |FORM 26 USE PREVIOUS EDITIONS.6-64 (OP-1)TOP SECRETEXCLUDED FROM AUTOMATIC DOWNGRADINGAND DECLASSIFICATION(40)TOP SECRET