SPECIAL ACCESS AND/OR BILLET APPROVAL
Agency: CIA
Originator: CIA
Document date: 07/13/1973
Document type: PAPER-TEXTUAL DOCUMENT

## Page 1

104-10120-10655

SPECIAL ACCESS AND/OR BILLET APPROVAL

(submit original"

and five copies

to CIB/SR&CD)

SUBJECT®S NAME (LaS

1004

DATE OF

BIRTH DE MATE

NO ADVANT

ORGANIZATIOI

Sity

POSITION

Wentbet

412148

CODE

APPROVED

CHIEL CID TIRUSTLE APPROPRIATE APPROVIN

Tco/ciAS

DATE?

AND

CONCURRING

PROVCD

ROVED

CONCUR

APPROVED

CONCUR

APPROVED

CONCURA

APPROVES

CONCURAS

APPROVED

ESPS/bURST

CONCUA

APPROVE

FILE WHEN

INITIALEDEY

DATE OF REQUEST

CODES

RUSE ONE AR

OFFICERS

COOR

CODE

QUESTED

AND

PHASE

GRANTED

FOLLOWING

SANHLAD

REQUESTER'S MAIL

ADDRESS (Room and Building)

CIB

INDEX SEARCH

TO:

CHIEF, PSD/ID 2 For action indicated)

OTHER

(specify) M

TO:

CIB

CASE NO:

SUBJECT

MEETS

ESTABLISHED

SECURITY CRITERIA

FOR SPECIAL

ACCESS(S) REQUESTED:

TO:

REQUESTER

SIGNATURE

A CHIEE

B 1

PATE Plan

PSD

DATE

SIGNATURE: '5

DATI

-SUBJECT

HAS

BEEN

APPROVED

ADVISE

"CIA DATE BRIEFED

ARRANGE WITH CIB FOR BRIEFING

CHIEF. CIE SIGNATURE

FORM 2018a

U S

8-72

---