TERMINATION SECRECY AGREEMENT
Originator: CIA
Document date: 03/23/1976
Document type: PAPER - TEXTUAL DOCUMENT

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RAIMEN TO C

Background Use

Do No: Reptort....

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

1164102

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

170 SI%

Tige Oriy

Federal agencies inform individuals when they

see so providences unity not Me

whether the disclosure is mandatory

voluntary,

by what authority such number

it solic-

ited and what uses

will be made of the SSN. Dis.

IDe Noti

TERMINATION SECRECY AGREEMENT

losure by you of

your 5SN is voluntary.

The

hority for this solicitation is Executive Order 9391

resignated Special

ect(s). Failure to provide yoor-J5N may delay the

processing required in access outhority removal.

1. I acknowledge that by virtue of my duties I have been exposed to or the recipient

of classified information, which, in itseit, or by the implications drawn from it, is highly sen-

sitive and its unauthorized disclosure or negligent handling could adversely affect the interests

of the United States. I am aware that the unauthorized disclosure of classified information

is prohibited by the Espionage Laws (18 U.S.C., Sections 793, 794 and 798) and that a vi-

olation of these laws may subject me to prosecution by the U. S. Government.

2. I hereby reaffirm my pledge that I will never publish or reveal by any means such

information. I agree further that I do not now, nor will I ever, possess any right, interest,

title or claim whatsoever to such information. I recognize the full and vested property right

of the United States in such matters.

3. I certify that I have surrendered and no longer have in my possession or custody any

classified information or material acquired as a result of this association.

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

to the United States Government for the protection of such information and that the termina-

tion from this relationship with my employer and/or the United States Government does not

relieve me of my obligations under this oath or any other previously executed Secrecy Agree-

ments. 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.

5. I understand that this oath may be retained by the U. S. Government for its future

use in any manner within the scope of this oath.

6. I take this obligation freely, without any mental reservation or purpose of evasion

and in the absence of duress.

NAME OF WITNESS (Type or Print)

Trik

Theodore M. Anderson

SIGNATURE OF WITNESS

REMARKS

24

(ZOD, PI, TO, ACR, MAI, BO)

NAME (Type or Print)

Clare Booth Luce

SIGNATURE

Admin Debrief

NAME & ADDRESS OF AFFILIATION

;

WH/PFIAB

SOCIAL SECURITY NUMBER:

064-18-3062

DATE

23 March 76

4-05 2442

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