Type .| § YAR NUMBER hs NEW DOCUNENE KELU AY iGPE pOre D351 if oppropricte) (30 HARACTERS) yy Caevcet “FORM : DAY MONTH YEAR. C1SPATCH LETTER H6cA bon daps FROM/ORIGINATOR (30 CHARACTERS) : : . : Ingtructions dor Divisions ond Stoffs: 1. Fill in ond Sign on line 1}, 2. Use back of form for any edditione!l comments. DOCUMENT.-DESCRIPTION (Circle — . = . oo WHERE LOCATED (10 CHARACTERS) aS SUBJECT (80 CHARACTERS) SovuretE REPO va ame? ©, ie oo PAseaiG Pony [uontn | vear | DATE ; OF E. Sustain initial denial in toto F. Sustain initial release of of sanitized version G. Release additional information Determinations: A. Release in full text B. Release in sanitized form Km C. Deny in toto : D. Defer decision to (Specify in line 8) H. Coordinate with (Specify in line 8) Cw SIGNATURE OF DO/IMS/ FPLG REVIEWING OFFICER +e FOIA , ©" BS BS B7C pats Jt «1 Exemptions and Provisions claimed to protect the following: E.0. 12356 | FOIA PA Xx 1. Classification (b) (2) (k) (1) ~ 2. Information from liaison with a Foreign Government (b) (3) (3) (1) vy «3. Information pertaining to a liaison (b) (3) (3) (1) : relationship with a Foreign Government i 4. Information which would/could identify the (b) (3) (3) ) : source a» - 5. Information pertaining to a source ‘ (b) (3) (3) (2) < 6. Information pertaining to intelligence methods (b) (3) (3) (1) ee eee Location of CIA overseas installation~1p!- (b) (3) (3) () 10 8. Location of unacknowledged domestic. cour my (b) (3) (j)) =e - ee =] installation ‘ OR AaA 9. Name of CIA employee (b) (3) (3) (2) > | .-%-10. File number — 0b) 03) 09) CQ) ; | 11. Pseudonym- — aa (b) (3) -— GG) @) - else | 12. Cryptonym (ib) G3) GQ | o %“ 13. Internal organizational data . (b) (3) (5) (2) 4 "14. Name of an FBI agent (b) (7) (c) (5) (2) } Tlue«15. FBI file number (b) (2) (9) )-- a | =o ~ 46. Privacy of other individual - ; — (b) (6) = (b) - ee | 17. Does not pertain to request Other (Specify in line 11) REMARKS (IF OTHER WAS CHECKED ABOVE) (40 CHARACTERS) — PY | REMARKS (160 CHARACTERS) TA); rn SIGNATURE/OF FICK OF CO COMPONENT REVIEWING OFFICER * RO BERT Are GERALD Ftd 6 BROTHERS This Form te Unchessified Uniess The Clossification ts. Cheched 14 la “st f ~ 9 yi eas SO Se ond The Informotron below is completed. | | Box + - / O WEM mine, GERM pPECL OADR oan en a I M:
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