datamatters24/research-document-archive huggingface dataset:
Approved For Release 2001/03/07
: CIA-RDP96-00789R0021 001 5001 1-1
PROJECT CENTER LANE
SECURITY TERMINATION STATEMENT
I,
the undersigned,
fully realize the importance to the National
Security of
the requirement
for the safeguarding of classified defense information.
In the
fulfillment
of this
obligation,
I
certifiy that:
a.
I
understand the appropriate provisions
of the Espionage Laws
and
Federal
Criminal
Statutes
applicable to the safeguarding of classified defense
information or material.
b.
I
have surrendered
and
no longer have
in my possession
or custody any
classified defense information or material
concerning Project CENTER LANE
(U).
c.
I
will
not communicate or transmit
in any manner,
classified
defense
information concerning Project
CENTER
LANE
(U), to any unauthorized
person or
agency.
d.
I
will
report
to the Assistant Chief of Staff,
Intelligence,
HQ, Depart-
ment
of the Army,
or his authorized representative, without delay,
any incident
wherein
an attempt
is made by
an unauthorized person to solicit classified
defense information concerning Project CENTER
LANE
(U).
e.
I
have received
an
oral
debriefing.
^
13 JUL.&3
(signature)
(date)
LTC Robert
J.
Jachim
(name
-
printed)
XfOSGDM
(position
- organization/firm)
SGFOIA3
ocial
Security Account Number)
WITNESS:
Act'g CENTER LANE Project Onager
{position
- organization/firm)
Approved For Release 2001/03/07
: CIA-RDP96-00789R0021 001 5001 1-1
Approved For Release 2003/09/09
: CIA-RDP96-00789R0021 001 50006-7
DEBR I E F I NG AGREEMENT
1.
I
hereby
reaffirm
my
acknowledgement
of
being
briefed
on
the
DIA
SUN
STREAK
Project,
the
text
of which appears
on
the reverse
of
this
form.
2.
I
certify
I
have
surrendered
and
no
longer
have
in
my
possession
or
custody
any classified
information
or
material
acquired
as
a
result
of
this
ascocia tion
.
3.
I
further
acknowledge
and
agree
I
have
a continuing
individual
respon-
sibility
to
the United States Government
for
the protection
of such
infor-
mation
and
termination
of
access
to
information
concerning
this
project
does
not
relieve
me
of
my
obligations
under
this
oath
or
any
other
previously executed
agreements
or
those
imposed
by
law.
4.
I
take
this
obligation
freely,
without
any
mental
reservation
or
purpose
of evasion
and
in absence
of duress.
SIGNATURE OP DERRIEFER
SIGNATURE OF ACKNOWLEDGER
DATE
;
AUTHORITY:
PRIVACY ACT STATEMENT
U.S.C.
8012;
U.S.C.
3101
and
EO
9397.
PRINCIPAL
PURPOSE:
FOR
GRANTING
ACCESS
TO
A
CLASSIFIED
PROJECT
AND
TO
AUTHORIZED ACCESS TO PROJECT DOCUMENTATION .
ROUTINE
USE:
TO
RECORD
PROJECT
ACCESS.
USE
OF
SSN
IS
NECESSARY
TO MAKE
POSITIVE IDENTIFICATION OF THE
INDIVIDUAL AND RECORDS.
DISCLOSURE
IS
VOLUNTARY:
FAILURE
TO
PROVIDE
THE
INFORMATION AND
SSN WILL
RESULT
IN ACCESS BEING DENIED.
Approved For Release 2003/09/09
: CIA-RDP96-00789R0021 001 50006-7
Approved For Release 2001/03/07
: CIA-RDP96-OO789gO^1O^^0/(2 /<f$V
STATEMENT OF CONSENT
I.
OlPSlzPt/ tO' MCMOaJ£FA G<L£-
a3 a participant in the INSCOM
GRILL FLAME Project
(IGFP)
do hereby give my consent
IAW AR 381-17
to the
tape recording, monitoring and transcribing of all session interviews
conducted as an integral part of the
IGFP.
I understand that all of my
session interviews are tape recorded.
I further understand that these
tape recordings are subject to being monitored and/or transcribed by third
parties not otherwise involved
in the session interviews.
In conjunction with my consent to the above,
I also waive any claim or right
of ownership to all tape recordings,
and transcripts made,
or which have been
made,
in conjunction with
IGFP.
I understand that these tape recordings
and transcripts are the property of the United States Government.
I execute this written consent to formalize my previous verbal consent to the
above;
having given my verbal consent to the above when
I became
a partici-
pant in the
IGFP.
DATA REQUIRED BY THE PRIVACY ACT
OF 1974
(5 U.S.C.
552a)
1.
Authority:
National Records Act,
44 U.S.C.
3102;
E.0.
9397,
Numbering
System for Federal Accounts Relating
to Individual Persons,
November
22,
1943.
2.
Principal Purpose:
To maintain a record of those individuals who have
consented to the recording, monitoring
or transcribing
IGFP session interviews.
3.
Routine Uses:
The Social Security Number
is to be used to identify
the
individual,
and the information is to be retained strictly, within the Program.
4.
Mandatory or Voluntary Disclosure:
Information
is disclosed on
a voluntary
basis,
but withholding information will render
it impossible to grant an
individual access to or participation
in the Program.
WITNESS:
SGFOIA3
Name,
Rank/Grade
jso/
ME-
&/>
Unit/Organization
.Tin
*
Position
SIGNED:
h#//qs£0//
Unit/Organization
Positidh
Approved For Release 2001/03/07
: CIA-RDP96-00789R0021 001 5001 0-2
A : CIA- . 4509 pproved For Release 2001/03/07 : CIA-RDP96-00789R002100450049,2 / 950 STATEMENT OF CONSENT 1, VOSEAY Ww, MCH ONEA CCE as a participant in the INSCOM GRILL FLAME Project (IGFP) do hereby give my consent IAW AR 381-17 to the tape recording, monitoring and transcribing of all session intervieuvs conducted as an integral part of the IGFP. I understand that all of my session interviews are tape recorded. I further understand that these tape recordings are subject to being monitored and/or. transcribed by third parties not otherwise involved in the session interviews. In conjunction with my consent to the above, I also waive any claim or right of ownership to all tape recordings, and transcripts made, or which have been made, in conjunction with IGFP. I understand that these tape recordings and transcripts are the property of the United States Government. I execute this written consent to formalize my previous verbal consent to the above; having given my verbal consent to the above when I became a partici- pant in the IGFP. DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C. 552a) 1. Authority: National Records Act, 44 U.S.C. 3102; E.0. 9397, Numbering System for Federal Accounts Relating to Individual Persons, November 22, 1943. 2. Principal Purpose: To maintain a record of those individuals who have consented to the recording, monitoring or transcribing IGFP session intervievs. 3, Routine Uses: The Social Security Number is to be used to identify the individual, and the information is to be retained strictly. within the Program. 4. Mandatory or Voluntary Disclosure: Information is disclosed on a voluntary basis, but withholding information will render it impossible to grant an individual access to or participation in the Program. WITNESS: | SIGNED: SGFOIA3 Aptcleurk bb Gilera 1-7 Name, Rank/Grade a , ocialL pecuriLy rc oo ocla ber JSS2, joa ME bp , ALOCSOPS. PMT, Hp SLO Unit/Organization Unit/Organization seoé RK Lslpet Lg Positi Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150010-2 ame, Rank/Grad
Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150011-1 PROJECT CENTER LANE SECURITY TERMINATION STATEMENT I, the undersigned, fully realize the importance to the National Security of the requirement for the safeguarding of classified defense information. In the fulfillment of this obligation, I certifiy that: a. I understand the appropriate provisions of the Espionage Laws and Federal Criminal Statutes applicable to the safeguarding of classified defense information or material. b. I have surrendered and no longer have in my possession or custody any classified defense information or material concerning Project CENTER LANE (U). c. I will not communicate or transmit in any manner, classified defense information concerning Project CENTER LANE (U), to any unauthorized person or agency. d. I will report to the Assistant Chief of Staff, Intelligence, HQ, Depart- ment of the Army, or his authorized representative, without delay, any incident wherein an attempt is made by an unauthorized person to solicit classified defense information concerning Project CENTER LANE (U). e. I have received an oral debriefing. Rrlochuen 13 Das signature date LTC RoperT J, JACHIM name - printed H® DoscoM (position - organization/firm) cnn onl Account Number) WITNESS: Gin (date) FREDERICK H, ATWATER ‘(name - printed) Act's CENTER LANE ProvecT MANAGER (position - organization/firm) Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150011-1 SGFOIA3
SGFOIA3 Approved For Release 2001/03/07 : CIA-RDP96-00789F 9021001909 122/970 STATEMENT OF CONSENT I, FERNAML A Cauca as a participant in the INSCOM GRILL FLAME Project (IGFP) do hereby give my consent IAW AR 381-17 to the tape recording, monitoring and transcribing of all session interviews conducted as an integral part of the IGFP. I understand that all of my session interviews are tape recorded. I further understand that these tape recordings are subject to being monitored and/or transcribed by third parties not otherwise involved in the session interviews. In conjunction with my consent to the above, I also waive any claim or right of ownership to all tape recordings, and transcripts made, or which have been made, in conjunction with IGFP. I understand that these tape recordings and transcripts are the property of the United States Government. I execute this written consent to formalize my previous verbal consent to the above; having given my verbal consent to the above when I became a partici- pant in the IGFP. DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C. 552a) 1. Authority: National Records Act, 44 U.S.C. 3102; £.0. 9397, Numbering System for Federal Accounts Relating to Individual Persons, November 22, 1943. 2. Principal Purpose: To maintain a record of those individuals who have consented to the recording, monitoring or transcribing IGFP. session interviews. 3. Routine Uses: The Social Security Number is to be used to identify the individual, and the information is to be retained strictly. within the Program. 4. Mandatory or Voluntary. Disclosure: Information is disclosed on a voluntary basis, but withholding information will render it impossible to grant an individual access to or participation in the Program. WITNESS: . SIGNED: yy Lcd i VA Eeacpareg ase GS-72 Name, Rank/Grade ; . Name, Rank/Grade Social monn = am = = SGFOIA3 of SS0, 702" ALG — 206A sAtwsCilt Unit/Organization Unit/Organization Torr CKFren Bosition Position Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150012-0
Approved For Release 2001/03/07
: ClA-RDPOe-OOySOI^JglOOI^OpI^^/^
STATEMENT OF CONSENT
I.
/) G /> U\///iS
as a participant
in the INSCOM
GRILL FLAME Project
(IGFP)
do hereby give my consent
IAW AR 381-17 to the
tape recording, monitoring and transcribing of all session interviews
conducted as an integral part of the
IGFP.
I understand that all
of my
session interviews are tape recorded.
I further understand that these
tape recordings are subject to being monitored and/or transcribed by third
parties not otherwise involved in the session interviews.
In conjunction with my consent to the above,
I also waive any claim or right
of ownership to all tape recordings,
and transcripts made,
or which have been
made,
in conjunction with IGFP.
I understand that these tape recordings
and transcripts are the property of the United States Government.
I execute this written consent to formalize my previous verbal consent to the
above;
having given my verbal consent to the above when
I became a partici-
pant in the
IGFP.
DATA REQUIRED BY THE PRIVACY ACT
OF
1974
(5 U.S.C.
552a)
1.
Authority:
National Records Act,
44 U.S.C.
3102;
E.0.
9397,
Numbering
System for Federal Accounts Relating to Individual Persons,
November
22,
1943.
2.
Principal Purpose:
To maintain a record of those individuals who have
consented to the recording, monitoring or transcribing
IGFP session interviews.
3.
Routine Uses:
The Social Security Number
is to be used to identify the
individual,
and the information
is to be retained strictly within the Program.
4.
Mandatory or Voluntary Disclosure:
Information is disclosed on
a voluntary
basis,
but withholding information will render it impossible to grant an
individual access
to or participation in the Program.
WITNESS:
SIGNED:
/a-
Name,
Rank/Grade
SGFOIA3 gmpm
SociaJ^ecurS^JumDer
SSO,
Unit/Organization
AT
siti
Position
SGFOIA3
USrfJ& - 'US#
Unit/Organization
Approved For Release 2001/03/07
: CIA-RDP96-00789R0021 001 5001 2-0
aS aaron | Approved For Relea oun se 2004 a) A-R : “CIA-RDP96-0 ORCON /NOFORN 0789R002100150016-6 INFORMATION ABOUT REMOTE VIEWING FOR PARTICIPANTS electronic sensing devices at or focused at the target site; nor does it involve classical photo interpretation of photographs obtained: from overhead or oblique: means. 2. (S-ORCON) RV has been performed by certain individuals successfully and we are confident other 4ndividuals can do it too. 3. (S-ORCON ) The general outline of RV procedures is at paragraphs six and seven of the AMSAA RV Protocol. | 4. (S-ORCON ) You as a remote viewer may perform one or more types of RV. 5. (S-ORCON) The maximum frequency you may pe asked to perform: RV is two sessions per day, but no more than three sessions per week... 6. (S-ORCON) You may choose not to perform RV at a particular time without prejudice to further participation in this task, or you may discontinue participation permanently at any time without any prejudice. 7. (S-ORCON ) The purpose of this project is: a. To establish @ program using psychoenergics for. — intelligence applications. b. Specifically, utilizing that field of psychoenergics referred to as Remote Viewing. Approved For Release 2001/03/07 : 8. (S-ORCON ) There is no evidence of any adverse physical, psychological and/or social effects on the remote viewer from participation in this activity. CLASSIFIED BY: MSG HQDA (DAMI-ISH) WASH DC atd 7Jul78 REVIEW ON: 7 Jul 98 ecehye pee a ee
Approved For Release pata : CIA-RDP96-00789R002100150016-6 10. (S-ORCON) The confidentiality of your participation in RV will be maintained according to paragraph 14 of the protocol. Signature bate 7 I was present during the explanation referred to above, as well as the participant's opportunity for questions, and hereby witness the participant's signature. gnature Dat arn Approved For Release eee : fi | ae 00150016-6 a
v
Approved For Release 20(M>r
*IA-RDP96-00789R0021 001 5001 6-6
ORCON/NOFORN
IOTorma
(S ORCON)
Remote Viewing ^^characteristics of a
!
i®;°bv wbie»
a Person per° ^
it does not
involve any
!,.iiss’..5
,rM2rs.s
- “
i1; t00
'
of RV procedures
is
at
.
(S-ORCON)
The
AMSAA RV Protocol,
paragraphs six
perform one or
.
(S-ORCON)
vou as
a remote v
more types of
RV.
ashed to
5 .
(S-ORCON)
The maximum *^“°yb£\o more than three
perform RV xs xwu
=>
sessions per week.
rV
a
particular^ime^without^preiudice^to pa
*
b 4cipation
Cpermanently
S SyMmfiitholt any prejudice.
(S-ORCON)
The purpose of this project
is.
^
a .
to establish a program using psychoenerg
inteliigence application
psychoenergics
„
specifically,
utilizing that field
P
referred to
as Remote Viewing.
physical
rexeric
adverse physxcar,
8 .
(S-ORCON)
There ^^^fects on the remote viewer
frorn^P ar t icipat ion
in this activity.
CLASSIFIED BY:
vrATi A
f Tl MlffT — T RH
REVIEW ON:
Jul 98
Approved For Release 2001/03/07
:
6-00789R0021 001 5001 6-6
Approved For Release 2001/03/07
: CIA-RDP96-00789R0021 001 5001 6-6
10.
(S-ORCON)
The confidentiality of your participation
in RV will be maintained according to paragraph
14 of the
protocol
.
I was present during the explanation referred to above,
as well as the participant's opportunity
for questions,
and
hereby witness the participant’s signature.
Approved For Release 2001/03/
A-£DP96-00789R0021 001 5001 6-6
; Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150017-5 GRILL FLAME SECURITY AGREEMENT « I, FA WAUWD A. O Min , understand that the highly sensitive and classified information I have, or ap} about to receive as part of the GRILL FLAME Program belongs to the United States Government. I understand that disclosure of this information is punishable under Title 18, Section 798, U.S.C. "Disclosure of Classified Information," June 1948 as amended. I do solemnly swear that I will never divulge, publish, or reveal by word, conduct, or by any other means such classified information or knowledge, except in the performance of my official duties, and as specifically authorized in writing in each case by the appropriate agency of the United States Government. I understand that no change in my assignment or employment will relieve me of my obligation under this agreement and that the provisions of this agreement will remain binding upon me even after the termination of my services with the United States Government. I take this obligation of my own free will, without any mental reservation or purpose of evasion. a DATA REQUIRED BY THE PRIVACY ACT OF 1974 (5 U.S.C. 552a) 1. Authority: National Records Act, 4h U.S.C. 3102; E.0. 9397, Numbering System for Federal Accounts Relating to Individual Persons, November 22, 1943, 2. Principal Purpose: To maintain a record of those individuals who have or have had access to GRILL FLAME information through the use of their name and/or Social Security Number. 3. Routine Uses: The Social Security Number is to be used to identify the individual, and the information is to be retained strictly within the Program. 4. Mandatory or Voluntary Disclosure: Information is disclosed on a voluntary basis, but withholding information will render it impossible to grant an individual access to or participation in the Program. Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150017-5 meen ee ee Se
Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150017-5 . EE FLAME SECURITY AGREEMENT CONTINUATION PAGE WITNESS : a & Me ran S108: Leta att. G Llrcuert ANAL E. <PIUEMA fA Z , - NAME, RANK/GRADE 4. a He Sm otha OOS S/S MPD //TAc L7 ~ ° J LMSC UNIT/ORGANIZATI UNIT/ORGANIZATION a EL Of beats / _ 2O-f7E POSITION POSITION Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150017-5 BOND OT TOE OMY
Approved For Release 2001/03/07
: CIA-RDP96-00789R0021 001 5001 7-5
MTE
;
L /''t/rycf
GRILL FLAME SECURITY AGREEMENT
I > / C.d.
teJteliLl'L
> understand that the highly sensitive
and classified information
I have,
or af^ about to receive as part of the
GRILL FLAME Program belongs to the United States Government.
I understand
that disclosure of this information is punishable under Title
18, Section
798,
U.S.C.
"Disclosure of Classified Information," June 1948
as amended.
I do solemnly swear that
I will never divulge, publish,
or reveal by word,
conduct, or by any other means
such classified information or knowledge,
except. in the performance of my official duties,
and as specifically
authorized in writing
in each case by the appropriate agency of the United
States Government.
I understand that no change
in my assignment or employment will relieve me of
my obligation under this agreement
and that the provisions of this agreement
will remain binding upon me even after the termination of my services with
the United States Government
I take this obligation of my own free will, without any mental reservation
or purpose of evasion.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
(5 U.S.C.
552a)
1.
Authority:
National Records Act,
44 U.S.C.
3102;
E.O.
9397, Numbering
System for Federal Accounts Relating to Individual Persons, November
22,
1943.
2.
Principal Purpose:
To maintain a record of those individuals who have
or have had access to GRILL FLAME information through the use of their name
and/or Social Security Number.
3.
.Routine Uses:
The Social Security Number
is to be used to identify the
individual,
and the information
is to be retained strictly within the Program.
4.
Mandatory. or Voluntary Disclosure:
Information
is disclosed on a
voluntary basis, but withholding information will render
it
impossible to
grant an individual access to or participation in the Program.
Approved For Release 2001/03/07
: CIA-RDP96-00789R0021 001 5001 7-5
Approved For Release 2001/03/07
: CIA-RDP96-00789R0021 001 5001 7-5
GRILL FLAME SECURITY AGREEMENT CONTINUATION PAGE
DATE
WITNESS
: (L~ /
iood
A
,
,
„
i
V
A
Ml£ 2
NAME, RANK/GRADE
L&~T'
NAME, RANK/GRADE
1 EhjL/ TstC- J
unTt/organizatiqn
- ZA'S(
d a stj
unit/organization
.'X_JL £
POSITION
Z7^ -
POSITION
Approved For Release 2001/03/07
: CIA-RDP96-00789R0021 001 5001 7-5
Approved F . >| A or Release : CIA-RDP96-00789R002100150063-4 10. (S-ORCON ) The confidentiality of your participation in RV will be maintained according to paragraph 14 of the protocol. A . Signature DAte - , I was present during the explanation referred to above, as well as the participant's opportunity for questions, and hereby witness the participant's signature. KGa. Ze. polgen7h ture” Date of - Ex Signa A Pproved For Release 2001/03/07 : CIA-RDP96-00789R002100150063-4 Qrenry
C Toye Approved For Release 2004103/07 :, GIA-RDP96-00789R002100150021-0 GRILL FLAME VOLUNTEER SECURITY AGREEMENT SGFOIA3 understand that the highly sensitive and classifi ave or am about to receive as part of the GRILL FLAME Program belongs to the United States Government. I understand that disclosure of this information is punishable under Title 18, Section 798, U.S.C. "Disclosure of Classified Information," June 1948 as amended. 2. (U) I do solemnly swear that I will never divulge, publish, or reveal by word, conduct, or by any other means GRILL FLAME classified information or knowledge, except in the performance of my official duties, and as specifically authorized in writing in each case by the appropriate agency of the United States Government. 3. (U) I understand that no change in my assignment or employment will relieve me of my obligation under this agreement and that the provisions of this agreement will remain binding upon me even after the termination of my services with the United States Government. 4. (S) I take this obligation of my own free will, without any mental reservation or purpose of evasion. I understand that as a GRILL FLAME volunteer the fact that I possess psychic abilities is classified and I cannot divulge this fact by word, conduct, or by any other means. WITNESS: SIGNED: NPD /ITACL/ INSCE2M UNIT/ORGANIZATION MA" UL Go UNIT/ORGANIZATION POSITION . —BOSTTION ; G Approved For Release 2001/03/07: CIA-RDP96-00789R002100150021-0 nee
EEE Ee Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150021-0 DATA REQUIRED BY THE PRIVACY ACT of 1974 (5 U.S.C. 552a) lL. Authority: National Records Aet, 4b U.S.c. 3102; E.0. 9397, Numbering System for Federal Accounts Relating to Individual Persons, November 22, 1943. 2. Principal Purpose: To maintain a record of those individuals who have or have had access to GRILL’ FLAME information through the use of their nane c and/or Social Security Number. 3. Routine Uses: The Social Security Number is to be used to identify the individual, and the information is to be retained strictly within the Progran. hy Mandatory or Voluntary Disclosure: Information is disclosed on a voluntary basis, but withholding information will render it impossible to grant an individual access to or participation in the Program. Approved For Release 2001/03/07 : CIA-RDP96-00789R002100150021-0