DOCUMENT SERVICE REQUEST
Agency: CIA
Originator: CIA
To: HOLMES, RUSSELL
Document date: 12/7/76
Document type: PAPER - TEXTUAL DOCUMENT

## Page 1

Date: 12/15/04

JEK ASSASSINATION SYSTEM

IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : CIA

RECORD NUMBER : 104-10068-10182

RECORD SERIES : JFK

AGENCY FILE NUMBER

: 80T01357A

DOCUMENT INFORMATION

AGENCY ORIGINATOR : CIA

FROM : HOLMES, RUSSELL

TO :

TITLE : DOCUMENT SERVICE REQUEST

DATE : 12/07/1976

PAGES: 1

SUBJECTS : DOCUMENTS-CIA

Released under the John

Kennedy

Assassination Recorda

Collection Act of 1992

(44 USC 2107 Note)

Cased:NW 53199 Date:

06-08-2017

DOCUMENT TYPE : PAPER

CLASSIFICATION : SECRET

RESTRICTIONS:

1B

CURRENT STATUS : RELEASED IN PART PUBLIC - RELEASED WITH DELETIONS

DATE OF LAST REVIEW : 10/21/93

COMMENTS : JFK12 : F16: 1993.10.21.14:44:20:370022

[R] - ITEM IS RESTRICTED

104-10068-10182

HH 53199 DocId: 32348339

Page 1

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## Page 2

-SECRE

(When Filled In)

IP CONTRO

(Filled in by IP/FILES)

DOCUMENT SERVICE REQUEST

FROM: (Requester's name) OR AFFIX REQUESTER GUMMED LABEL

RUSSELL

HOLmES

AM 288 CATTH: BARBARA DOOLO

TO:

DATE

DATE OF REQUEST

BRANCI

2 DEC

176

ROOM

NO.

cI/ 0G

INITIALS

2CY3

INSTRUCTIONS

PHONE NO

6349

60376

RCD .

FWD .

IP/FILES

DT-6

VARS

1. Use this form to request files and/or documents

from IP/FILES.

(Not to be used in lieu of Form

REQUESTER

Include badge number and

station in "FROM"

block if

gummed label has not been issued.

3: Indicate type of charge:

IP/FILES

DT-6

Temporary

Permanent

4

4. Indicate

source

of

reference:

5

Document reference from IP/Index.

SUBJECT (must be furnished)

Document reference from source other

than IP/Index.

HQ FILE NUMBER

DOCUMENT SYMBOL

AND NUMBER

DOCUMENT

(To be completed by

67-6-52/3

OSSA -12974

1963-1900 FC; A

8.51

Gene duplicate

pavalable)

201-762806

ONHA 28474

Cless duplicate apesise i warble

DEC

5ьH,1e

10,5$870 Hotd 32318339 Paye 2

SEGRET

CL. BY: 007622

(38)

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