SENSITIVE ORIGINAL WITHHELD BY CIA
Agency: HSCA
Originator: HSCA
To: CIA
Document date: 00/00/0000
Document type: FORM

## Page 1

JFK Assassination System

Identification Form

Agency Information

AGENCY: HSCA

RECORD,NUMBER: 180-10143-10135

RECORD SERIES: CIA SEGREGATED COLLECTION

AGENCY FILE NUMBER: 28-12-01

Document Information

ORIGINATOR: HSCA

FROM:

CIA

TO:

TITLE:

SENSITIVE ORIGINAL WITHHELD BY CIA

DATE:

PAGES:

SUBJECTS :

00/00/0000

7

CIA, FILES

DOCUMENT TYPE: FORM

CLASSIFICATION :

Unclassified

RESTRICTIONS :

Consulted

CURRENT STATUS :

Withhold

DATE OF LAST REVIEW:

08/14/1995

OPENING CRITERIA :

COMMENTS:

Box 18; Original document held by CIA.

v9.1

HH 53090

DocId: 32271939 Page 1

Date:

3/25/201

Released under the John

F. Kennedy

Assassination Records

Collection Act of 1992

144 USC 2107 Notel.

cased NHl 53090 Date:

06-07-2017

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## Page 2

SENSITIVE

Box 28

Falder

12

pages

ORIGINAL

Withheld

by

CIA

HH 53090

DocId: 32271939 Page 2

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