SENSITIVE ORIGINAL WITHHELD BY CIA
Originator: HSCA
From: CIA
Document date: 00/00/0000
Document type: FORM

## Page 1

JFK Assassination System

Identification Form

Agency Information

Date:

3/25/201

AGENCY:

RECORD NUMBER:

HSCA

180-10143-10149

RECORD SERIES: CIA SEGREGATED COLLECTION

AGENCY FILE NUMBER: 28-12-14

Document Information

ORIGINATOR:

HSCA

FROM:

TO :

CIA

TITLE: SENSITIVE ORIGINAL WITHHELD BY CIA

DATE: 00/00/0000

PAGES:

2

SUBJECTS :

CIA, FILES

DOCUMENT TYPE: FORM

CLASSIFICATION : Unclassified

RESTRICTIONS: 1A

CURRENT STATUS: Redact

'DATE OF LAST REVIEW: 02/03/1998

OPENING CRITERIA :

COMMENTS :

Box 18; Original document held by CIA.

Heleased under the John t. Kennedy

Assassination Records Collection Act of

1992 |44 USC 2107 Notel. Case#:Nw

bert Date: 12-014-2022

v9.1

NW 64578 Docld:32271953 Page 1

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## Page 2

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NW 64578

Docld:32271953 Page 2

180-10143-10149

RETURNTO CIA:

Bäckground Uso Cnly

Do Not Reproduce

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## Page 3

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NW 64578

Docld:32271953 Page 3

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