TERMINATION SECRECY AGREEMENT - CLASSIFIED SENSITIVE COMPARTMENTED INFORMATION
Originator: CIA
From: CHARLOTTE BUSTOS-VIDELA
Document date: 12/30/1977
Document type: PAPER - TEXTUAL DOCUMENT

## Page 1

104-10110-10026

2022 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992

TERMINATION SECRECY AGREEMENT

CLASSIFIED SENSITIVE COMPARTMENTED INFORMATION

1. I acknowledge that, by virtue

of my duties, I have received or been exposed

to classified sensitive compartmented information, the unauthorized disclosure or

negligent handling of which could adversely affect the interests of the United States

Government. I am aware that the unauthorized disclosure of classified information is

prohibited by the Espionage Laws (Title 18, U. S. Code, Sections 792-798) and the In-

tion of these laws day sybject me to prosecution by the Use

ternal Security Act of 1950, Section 19, P. L. 831, (8lst Congress) and that a viola-

Government.

2.

I hereby reaffim my pledge that I will never publish or reveal by any means

classified sensitive compartmented information.

interest, title or claim whatsoever to such infor-

mation.

I recognize the full and vested property right of the United States in such

matters.:

I certify that I have surrendered and

no longer have in my possession or

custody any classified compartmented

this association.

information or material acquired as a result of

4. I further acknowledge and agree that I have a continuing individual respon-

ployer and/or, the United States Government does not relieve me of my obligations under

this agreement or any other previously executed Secrecy Agreements. I understand that

I will not be relieved of these obligations except when specifically advised in writing

by the sponsoring activity of the U. S. Government.

1350

I understand that this document may be retained by the U. S. Government for

its future use in any manner within the scope. of this agreement.

6. I take this obligation freely,

without any mental reservation or purpose of

evasion and in the absence of duress.

-VV:

SIGNATURE

DATE

30 Du 1977

WITNESS' SIGNATURE

Cheater 3. Bustn-Viden

PRINTED NAME & SSN (See Reverse)

Collea

A. Spender

069-2413138

Charlotte Bustos-Videla

WITNESS' PRINTED NAME

ORGANIZATION

03

1s/'Ehonas A. Gaines] for

COMPARTMENTED SYSTEM/PROJECT ACCESS TERMINATED:

SI

CIA/ DDO/LA

RETURN TO CIA

Background Use Only

Do Not Reproduce

FORM 3968

377

---

## Page 2

14-00000

Ti..

The Privacy Act, Public Law 93-579, requires that

Federal Agencies inform individuals when they are asked to

provide their Social Security Account Number (SSN) whether

the disclosure is mandatory or voluntary, by what authority

such number is solicited, and what uses will be made of the

SSN. Disclosure by you of your SSN is voluntary.

The

authority for this solicitation is Executive Order 9397.

The SSN is used as an identifier in removing your authorized

an ice

access to classified information.

Failure to provide this

SSN may delay the processing required in accessing authority

removal.

---