14-00000
104-10110-10295
TO:
(Check)
2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992
NOTIFICATION OF ESTABLISHMENT OR CANCELLATION
OF OFFICIAL COVER BACKSTOP
x CHIEF, CONTROL DIVISION, OP
CHIEF, CONTRACT PERSONNEL DIVISION, OP
DATE
".
25 FEB 77
140
FILE NO.
3190
SS NUMBER
069-24-3134 RETURN TO CIA
EMPLOYEE NUMBERkground Use Only
007667
Do Not Reproduce
ID CARD NUMBER
CHIEF
ATTN:
LA (OPERATING COMPONENT FOR ACTION)
REF
Form 2458 dated
STATUS
४ STAFF
OFFICIAL
COVER
CANCELLED
CONTRACT
SUBJECT
BUSTOS S-VIDELA, CHARLOTTE
DEPA
KEEP ON TOP
TOP 
OF FILE WHILE COVER IN EFFECT
ESTABLISHMENT OF OFFICIAL COVER (BLOCK RECORDS)
X
☑
BASIC COVER PROVIDED'.
EFFECTIVE DATE
OPERATIONAL COVER PROVIDED
FOR
TDY.
CANCELLATION OF OFFICIAL COVER (UNBLOCK RECORDS)
EFFECTIVE DATE:
SUBMIT FORM 3254
(HHB 20-7)
W-2 TO BE ISSUED
SUBMIT FORM 642 IMMEDIATELY TO CHANGE TELEPHONE
LIMITATION CATEGORY TO CATEGORY:
(HHB 20-7)
OTHER (Specify)
8
SUBMIT FORM 642 IMMEDIATELY TO CHANGE TELEPHONE
LIMITATION CATEGORY TO CATEGORY
(RHB 20-7)
EAA: CATEGORY 1
CATEGORY 11
x
SUBMIT FORM 3254
W-2 TO BE ISSUED.
(HHB 20-11)
97.
X
SUBMIT FORM 1322 FOR ANY CHANGE AFFECTING THIS
COVER. (HR 240-2e)
SUBMIT FORM 1323 FOR TRANSFERRING COVER
RESPONSIBILITY. (HR 240-2e)
EAA. CATEGORY 1
8
☑
CATEGORY II
✗ SUBMIT FORM 2688 FOR AGE HOSPITALIZATION CARD
REMARKS AND/OR COVER HISTORY
27 Aug 51-Aug 62-Hgs-Overt
Aug 62-Jul 67-Egs-DAC] 99
Jul 67-10 Aug 72-Mexico-State-Nominal 94
1 Sep 72-27 Jun 74-Ags-DAC94
28 Jun 74-10 Nov 76-Trinidad-State-Int. 16-3
11 Fov 76-26 Feb 77-Egs-State-Intd 99
27 Feb 77-8
-Has State-Romina Jag
DISTRIBUTION:
COPY 1 CD. OR CPD
COPY 2
COPY S
COPY 4
COPY 5
OPERATING COMPONENT:
:OS/SRD
OC-0/0/TFB
CCS-
RP/TW
FORM
6.75 1551 USE PREVIOUS
RETURN ALL OFFICIAL DOCUMENTATION TO CCS
SUBMIT FORM 2688 FOR
HOSPITALIZATION CARD.
DO NOT WRITE IN THIS BLOCK
CHIEF, OFFICIAL COVER BRANCH COVER AND COMMERCIAL STAFF
SECRET
E-2, 1MPDET CL BY: 006687:
13-20
9:BR