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104-10110-10291

2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992

0004U

NOTIFICATION OF ES: ADLISHMENT OR CANCELLATION

OF OFFICIAL COVER BACKSTOP

TO:

(Check)

CHIEF, CONTROL DIVISION, OP

CHIEF, CONTRACT PERSONNEL DIVISION, OP

X

CHIEF

ATIN:

(OPERATING COMPONENT FOR ACTION)

28 DECAMER 1977

85

JUMBEF

969-26-3139

EMPLOYEE

00766%

NUMBER

ID CARD

"ó;

3190

RETURN TO CIA

Background Use Only

DO Nor Reproduce

OFFICIAL

COVER

CANCELLED

STATUS

STAFF

CONTRACT

CONTINUED;

SUBJECT

BUSIOS- VIDEL!

I CHARLOTTE: 2,

DEPARTN

KEEP ON TOP OF FILE WHILE COVER IN EFFECT

ESTABLISHMENT OF OFFICIAL COVER (BLOCK RECORDS)

BASIC

COVER

PROVIDED:

BOD

EFFECTIVE DATE.

OPERATIONAL COVER PROVIDED

FOR

_ TDY.

_ OTHER (Specify)

SUBMIT FORM 642 INMEDIATELY TO CHANG5 TELEPHONE

LIMITATION CATEGORY TO CATEGORY

(HHB 20-7)

CANCELLATION OF OFFICIAL COVER (UMBLOCK RECORDS)

EFFECTIVE DATE:

FORM 3254

:W-2 TO BE ISSUED

(HHB 20-7)

SUBMIT

FORM 642 IMMEDIATELY TO. CHANGE TELEPHONE

LIMITATION CATEGORY TO CATEGORY!

(HHB 20-7)

EAA: CATEGORY. !

CATEGORY 18

RETURN ALL OFFICIAL DOCUMENTATION TO CCS

FORM 3254 Terri

(HHB 20-11) 1-

=94

_W-2 TO BE ISSUED.

SUBMIT FORM 2688 FOR

HOSPITALIZATION CARD.

SUBMIT FORM 1322 FOR ANY CHANGE AFFECTING THIS

DO NOT WRITE IN. THIS BLOCK .

COVER: (HR 240-20)

SUBMIT FORM 1323 FOR TRANSFERRING COVER

RESPONSIBILITY. (HR 240-20)

EAA. CATEGORY I

CATEGORY 11

X SUBMIT FORM 2688 FOR ATE HOSPITALIZATION CARD

REMARKS AND/OR COVER HISTORY.

SETECT WILL BE DENIED FOR ETINE PILION OF ECLONET DICEY FOR US GOVERNERVT

AT LICATIONS.

DISTRIBUTION:

COPY 1 - CD/TRB OR CPD

CONTROL

COPY 2- OPERATING COMPONENT

COPY 3 - O5/5RDE

COPY 4- OC/DO/TFB}

COPY S - CCS-FILE:

FORM 155 l Us.

477

VS/TW

Quan. Silly

CHIEF, OFFICIAL COVER BRANCH.

CENTRAL COVER STAFFE/!

SECRET. WN-SISM:

E-2., IMPDET CL BY: 021964

2.1514

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