Approved For R"e 102:,ClA@KDP1;/_,C 788ROO1200010007-2
 00
 ^_#j DATE 29 MAMA 1982-
 GRILL FLAME SECURITY AGREEMENT
                      - 1 understand that the highly
 ' Pf-I-ed @in6rma
 and Oa@- a in
 sens3:1#)7e s e ormation I haveO or are about to
 receivY as part of the GRILL FLAME Program belongs to the
 United States Government. I understand that the disclosure
 of this information is punishable under Title 18, Section
 798,'U.S.C.,, "Disclosure of Classified Information," June 1948,
 as amended.
 I do solemnly swear that I will never divulge, publish, or
 reveal. by word, conduct, or by any other means such classified
 information or knowledge, except in the performance of my
 official" duties, and as specifically authorized in writing
 in each case by the appropriate agency'of the United States
 Government.
 1.,understand that no change in my assignment or employment
 will relieve..me of my obligation under this agreement and
 that the provision's of this agreement will remain-, binding
 upon me even after the termination of my services with the
 United States Government.
 I'take this obligation of my...own- free will, without. any mental.
 reservation or purpose of evasion.
                    DATA REQUIRED BY THE PRIVACY ACT OF 1974
                                 (5 U.S.C. 552a)
 1. Authority: National Records Act, 44 U.S.C. 3102; E.O.
 9397, Numbering System for Federal Accounts Relating to
 individual Personsl, November 22, 1943.
 2. Principal P-arpose: To maintain a record of those individ-
 uals who have or have had access to GRILL FLAME information
 through the use of their name and/or Social Security Number.
 3. Routine Uses: The Social Security Number is to be used
 to identify the individual, and the information is to be
 retained strictly within the Program. .
 4. Mandatory or Voluntary Disclosure: information is
 disclosed on a voluntary basis, but withholding information
 will render it impossible -to grant an individual access to
 or participation in the Ptogram.
 Approved For Release 2001/04/02 : CIA-RDP96-00788ROO1200010007-2

Approved For Release 2001/04/02 : CIA-RDP96-00788ROO1200010007-2
GRILL FLAME SECURITY AGREEMENT CONTINUATION PAGE
29 mNVxA 1989.
DATE
SGFOIA3
WITNESSt, VSIGNED3
              I? rS=6,S
-,R0Be"ZT JACA I H t@ @,ex, *erS
Nk4Bj, RANR7G -RA 1) E-- NAMEj, RANK/GRADE
@AQ '1k)Sfmm De.-T G WROG
UNIT/ORO TYA-T16ff-- UNIT 00GANIZATION
AM
 CLj=-2Y-/NPlS7-
P08ITION POSITION
                               2
Approved For Release 2001/04/02 CIA-RDP96-00788ROO1200010007-2