104-10180-10124 * Uo OCTMLY ROUTING AND RECORD SHEET ( ounctassipigeo = wa ‘a CONFI, aTIAL (] SECRET SUBJECT. [Ouse __ Contract Information & Check List - FROM, Chief, 48/4/Personnel,,” 29M gers, Eye tl ad it TO: (Giger aengrenes, room number, end buckdongp 26 JUL {961 | OPPCER $ i COMMENTS (Number each comment te show from whos EETIALS 4 Hao [os Draw @ tine Gcrosa column after each comempnt.) Ci F | ie E Your Signature, please, as . J Contract Approving Officer. K , . | ro CASS CrricER es t. Chief, WE/Z/Support 3. Contract Fersonnel Divn., 8125 Eve Bldg. lutlylel - jor | | | egret —— ws 75 DElOHIL e. & P14 b- Kept pe EY¢ 13. 7 nes ee oe a : 6 feccl iA 7) | sath edhe 3/ Xe \— sl ~~ PEt i Pape d2este < gerne c eee (else O10 “ES CJ secret = ((]) CONFIDENTIAL «CJ TATRA ra UNCLASSIFIED Cott
14-00000 shoe . wee ake went” : . ‘GBccmore Late OFF HOSE Cie lsion os CONTRACT INFORMATIGN AND CHECK LIST ale SURES STs eee | Be Ge Seohefer 00 fA phacabfe Foreare eoetg eras arf TR copiers fey Preparetscn af cmd ¢ eet SECTACN 6 4 fe aeeE CJ Penaee {gd teee 28. PROFECT TH. PF meng er EVAL tore PREVEOUS CLA PSELOCurI CH aLtases @ FMD eIDVAL AS BEEN ENGALTD HY CHA OR ETS ALLE OD ACTIVITIES I% SOME CAPACETY 719m To ees CONTRACT, ig] ves [ % 38 (C8 pes, degceabe and include detee —-4 and aseliery.) O% Stare Fou Ps SECURTTY CLleaeance (Pree and datey | 74. MED ICEL COE AMANTE @. COMTMACT #4 7O BE BRET TES 10. PROPOSED CATEGORY (Contract! egen?, contract eapleyes, ete.) ®. GhOOVTDUAL BEAL WISE LAOS CONTROLLED “CONDE HONS §.€.. BEGULAR OFFICE HOURS ABAY FRO’ SUBIECT*S HOME APD PERFORSTD YROCH THE TUPLAVESIOM OF & STAFF EMPLOYEE C8 STAFF AGENT | vee (2 "oO PERSONAL DATA 12. 18 MOT U.S. CHTIZEW, BHDOVIOUAL 1S A PLAMAS MENT RESIDENT ALIER Gomme ogy Cc « oO s wanenec’ on) sipoces, CU] sewunces [77] seh anares co orvesces 46. NUMBER OF DEPERDEMTE ¢ for émciuding individued) $8. INDOEVIDYAR $8 MELATED TO A STATE EMPLOYEE. STAFF AGENT O@ Ald ENOUYEDYUAL CURAERTLY WORKING FOR THE AGEMCY On Sone RELATIONSHIP AND AGES capacety | ves [4] RELATIONSH SECTION 44 Five (5)s wife and four childrea U.S. MILETARY STATUS SECTION (44 4F RETERED, INDICATE CATEGORY (Longevity, combet dia- 20. RESERVE . 2%. VETERAN a2. ability, service disehiiity non-combat } nit a a oe _. 23. BRANCH OF SER dee 24. YANK OR GRADE 2%. ORAFT ELEGEBLE 24, DRAFT DEFERMERT OBTAINED Cc] vee [yee By CIA fo] ves [Hh ve SECTION iv COMPENSATION 27. BASIC SALARY 28. POST DIFFERENT EAL 20. COVER (Rreaddoen, If any) $9,600 uA RA a Pires I xtse | fae SECTION V ALLOAANCES (NORMALLY GRANTED ONLY YO RESIDENTS OF THE UNITED STATES} 3f. QUARTERS 32. POST | 33. GtMER 34. COVER (Breeidoen, if any} ‘ wa 30, FEDERAL PAa wi TeHCLO ING SECTION VI TRAVEL 38. WITH DEFENCE NPS 35. TYPES [} vcs (CT vowrstic openattowas Foneion ovraariauae ves TT) we E a ARSPCATES Viaiccd to 6 a7. beet DO BE SHIPPED S7a, HE TO BA STORED 36. PERSONAL WEHOCKE To BE SH EPPED 34. USEO FOP OPERATICNAL TRAVEL = ao res [| so | ves [xe 40. §F wATs OLPENDE NTS STATE RELATIONSHIP, CITIZENSHIP, AGE AND DATE OF aiatn obs 37 yre old, U.S. yrs old, U.S. 3 yrs old, U.S. wife <\_ 40, OAvwE mT AND ACCOUNTABILITY Sia Sf te CONFORMANCE BET . €be e8Gghalre gag CL. } coves OaLIttes gue Peecaecers SECTION Wil OPERATIONAL EXPENSES Te me a ee ee -- 4&4 OfeEe 42. Pyacwage OF sur camatick Op. CaPCavalawes? c Yes__ _t Xes_ es ee be CORTCK MERC E etts | ey SS. FAMLNT 24D BCOSNTASTRAPY atey af x “ree aeenetsaes y } (0 rd roe SECRET , oa aan 204 Qt Pesotere aeatiter "see 8 PALESERS B48 HH AacanesEs
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