Approved For Release 2001/04/02 : CIA-RDP96-007 001200010 5 C@_
 DATE
 GRILL FLAME SECURITY AGREEMENT
           Understand that the highly
 sensitive and classified information I have, or are about to
 receive 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
               "Disclosure of Classified Information," June 1948,
 -U.S.C.,
 798,
 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.
 I.-understand that no change in my assignment or emp'loyment
 will relieve-.me of my obligation under this agreement and
 that the provision's of thi's 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, withoutany mental
 reservation or purpose of evasion.
                    DATA REQUIRED BY THE PRIVA CY 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, 194-3.
 2. Principal Purpose: To maintain a record of those individ-
 uals who have or have had access to GRILL FLA-ME 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 Program.
 Approved For Release 2001/04/02: CIA-RDP96-00788ROO1200010055-9

     Approved For Release 2001/04/02 : CIA-RDP96-00788ROO1200010055--9,,
     GRILL FLAME SECURITY AGREEMENT CONTINUATION PAGE
     DATE '2-1
                                       WITNESS:. SIGNED:
                                      L7 Z.'-'
     4'@7 e.R
     NAM-1-RANK/GRADE N RANK/GRADE
     NAM @N,
     4-K,,- "T t@.s &D
                                                /4-7
     ugrTJORGANizATION UNIT/OROANIZATION
     COK Cv7t, CL- t#M 4F
     POSITION @OSI2tION
     2
     Approved For Release 2001/04/02 CIA-RDP96-00788ROO1200010055-9