Approved For Release 2004/pa/O-*ACIA--RDP96-00788RO01 200280042-4
  DATE ~ o)
  GRILL FLAME SECURITY AGREEMENT
  S CA A-~ 10 understancl that the highly
  sensl-t-l-ve and classified 1-n&-r-j~-ation 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
  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 thi s obl i gation of . my...own - f ree wi 11,, wi thout. any menta 1
  reservation or purpose of evasion.
                      DATA REQUIRED BY THE PRIVACY ACT OF 1974
                                  (5 U.S.C., 55 2a)
  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 Purpose.- 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 Program.
  Approved For Release 2000108107-: CIA-RDP96-00788RO.01-20.02.8.0042-.4.,-..--.,.,,---.,.I

  
     Approved For Release 2000/08/07: CIA-RDP96-00788 ROO 1200280042-4
     GRILL FLAM SECURITY AGREEMENT CONTINUATION PACE
     DATE 'Y-
              WITNESS:
     GRADE
          ORGANINA-Ty-off
     )IM, MWX ITP,
     POSITION
     SIGNED
     ~N* r~ MIS
     NAMEr RANK/GRADE
     lops
     UNIT/ORGANIZATION
     POSITION
     Approved For Release 2000/08/07 CIA-,RbP96-00788ROO1200280042-4