CLEARANCE SHEET FOR TERMINATION OF CONTRACT PERSONNEL
Originator: CIA
Document date: 08/30/1963
Document type: PAPER - TEXTUAL DOCUMENT

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

OSE ONLY

ROUTING AND RECORD SHEET

SUBJECT: (Optional)

FROM:

EXTENSION

NO.

DATE

TO: (Officet idesignation, room number, and

building)

DATE

RECEIVED

OFFICER'S

INITIALS

FORWARDED

4-E-21 AGR

Dief

2.

5.

6.

7.

8.

9.

10.

11.

Chay seo

OMMENTS (Number each comment to show from who

to whom.

Draw a line across column

itter each comment

Copy of termination

Clearance sheet for

roger forg

Your decord.

'Toralen

RETURN TO CIA

Background Use Only

Do Not Reproduce

12.

13.

14.

15.

'..M

610 USE PRENS

PREVIOUS

SECRET

CONFIDENTIAL

INTERNAL

USE ONLY

UNCLASSIFIED

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SECRET

CLEARANCE SHEET FOR TERMINATION OF CONTRACT PERSONNEL

DATE

THIS FORM MUST BE SIGNED AND SUEMITTED IN. DUPLICATE

PERSONAL DATA

NAME (Last, Firat, Middle - true or proudonym)

OFFICE AND BRANCH OF ASSIGNMENT

Crozier, RoBs L.

Spectal Affalrs Staff

LOCAL

ADDRESS

PERMANENT ADDRESS

Apt.

9 1607 So 26th St Arlington Va

Same

PERMANENT STATION OR BASE

POSITION OR FUNCTIONAL TITLE

Hashington D.C.

Ops Officer

CONTRACT DATA

DATE CONTRACT EFFECTIVE

DATE CONTRACT LAST RENEWED

DATE CONTRACT EXPIRES

1 June 1957

original contract

contract for

REASON FOR CONTRACT TERMINATIONIndefinIte term

indefinite tern

30 #uG.1963

DATE OF CONTRACT TERMINATION

28 November 63

RESIGNAT ION

COMPONENT

FINANCE

INTERNAL STAFF OR DIVISION CLEARANCES (Add or doleto as applicablo)

CLEARED BY

DATE

б/ 30/03)

LOGISTICS

PERSONNEL

042

CONTRACT APPROVING OFFICER

DATE

TIME

CLEARS AS

is Orancis

SCHEDULE OF INTERVIEWING OFFICES

(OFFICES NOT REQUIRING INTERVIEW WILL SO INDICATE)

SCHEDULE

INTERVIEWING OFFICIAL

LOCATION

atredy trifed

CLEARED POSS

Ieladur

DATE

OFFICE •

CENTRAL

COVER

DIVISION

OFFICE

OF SECURITY

SSD

OFFICE

OF PERSONNEL

CPD

REMARKS (Please

initial)

necessing

130/63

Cug, 30,

STAFF OR DIVISION AND BRANCH OF ASSIGNMENT

SAS/EOR

YOU FORM

9.59 | 609

SAS/CONTRAM ADDROVING ORFTER

SECRET

(9)

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