[104-10227-10000.pdf — page 127]
# TOP SECRETUNCI ASS' 10 when blank-TOP SECRET when attached to Top Secret Document-Automatically downgraded to SECRET when filled in forth 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 Pages       | 28           || Number of Attachments |              |REGISTRY|                        |              || ---------------------- | ------------ || CIA Control No.        | 191722A      || Date Document Received | 15 JUN 1978  || 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 downgrades. Jestroyed, 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 ind cate period of custody in the left- hand columns provided. Each individual who sees the Top Secret document will sign and indicate the date of handiing in the right-hand columns.| REFERRED TO                                  | RECEIVED                | RELEASED    | SEEN BY   |             |             |      || -------------------------------------------- | ----------------------- | ----------- | --------- | ----------- | ----------- | ---- || Office                                       | Signature               | Date Time   | Date Time | Signature   | Office/Div. | Date || DDP(TSCO)                                    | ![signature of B. Ligg] | 15 JUN 1978 |           |             |             |      || DC=10LC Kisbisfne Scott Birlekenndye         |                         |             |           |             |             |      || DDO/1500                                     | ![signature of B. Ligg] | 19 JUN 1978 |           | 19 JUN 1973 |             |      || SA/D/S/0/0                                   | ![signature]            | 19 Jun 18   |           | 19 JUN 15   |             |      || DDO/TSCO  DCI/OLC  Breckenridgeer Gabrielson | ![signature of B. Ligg] | 20 JUN 1976 |           | 20 JUN 976  |             |      || 000/1000                                     |                         |             |           |             |             |      |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             |                          || By (Signature)           | BY (Signature) | BY Sgnature)             || WITNESSED BY (Signature) |                |                          || OFFICE DATE              | OFFICE DATE    | OFFICE DATE              |FORM 26 USE PREVIOUS EDITIONS (OP-1)TOP SECRETEXCLUDED FROM ATOMATIC DOWNGRADING AND DECLASSIFICATION