“crianchrrtatha TSus — - •——A 4 a-a —— n’g No7/wojfcGa thute Be ICovER. (* *40-72 9. Viv ; 010 gist SUDAtT FORM 1323450/ ASreediNccovrE 21 RESPONSIBILITY. Go 0... A 0.78 Ita EAA. careSORY 1j (CATEGORY IL. .J _- jsuoMir FORM 2588 FOR HOSPITALIZATION CARD REMARKS ANG/on R”
“(3) (j)(1) installation ☐ 9. Name of CIA employee (b) (3) ☐ 10. File number (b) (3) ☐ 11. Pseudonym (b) (3) ☐ 12. Cryptonym (b) (3) ☐ 13. Internal organizational data (b) (3) ☐ 14. Name of an FBI agent ☐ 15. FBI file number (b) (2) ☐ 16. Privacy of other individual (b) (6) H (j)(”
“0 0 0 3 20 i out forms, where were you born, this type of thing, biographic 21 type thing. These forms would be passed to our people who would 22 look at the forms and based on previous experience or what 23 they might have been doing, and they felt that perhaps they 24”
“200U 3 20. out forms, where were you born, this type of thing, biographic- 21 type thing. These forms would be passed to our people who would 22 look at the forms and based on previous experience or what 23 they might have been doing, and they felt that perhaps they 24 mi”
“J1 K1 Exemptions and Provisions claimed to protect the following: FOIA PA 1. Classification (b) (1) (k) (1) 2. Information from liaison with a Foreign Government (b) (3) (j) (1) 3. Information pertaining to a liaison,. (b)(3) (j) (1) ■ relationship with a Foreign Governmen”
“May BE SHORN DURING INVESTIGATION? c. 15 SUBJECT AsAnE or 0,5, GOVERNMENT urERFST IN HIMT X D, IS SUBJECT Amane or CIA UNTERPST IN HIM X €. INDICATE AN’S LIMITATIONS ON COVERAGE IN THE INVESTIGATION OF GUBJECT. F. SUGGEST "covrn PRETEXT co BE ueso IN CONDUCTING PERSONAL ”
“1 4-00000 1 1 1 1 1 1 1 SECRET _FIELD REASSIGNWENT QUESTIONNAIRE TRANSMITTAL ISTRCCrtovs 47 -1 A Thie coestionnaire io Peeignod to previle ieferestion for eonsiderotion by Powquorters in plionene n, Isel supervisor in the ?iel4 will ensue ionnsire io co-pleted”
“DURING INVESTIGATION? / 8. CIA INTEREST May BE see* DURING INVESTIGATION? C. IS SUBJECT AWARE OF U.S. GOVERNMENT INTEREST IN wim? I X D. IS SUBJECT AWARE or CIA INTEREST IN Win? €. INDICATE ANY LIMITATIONS ON COVERAGE IN THE INVESTIGATION OF SUBJECT. F. SUGGEST "COVER ”
“CONFIDENTAL (when filled in) Control PROCESS SHEET FOR DOMESTIC CONTACT SERVICE COLLECTIONS 15-45-31 RC o copr CASE ro wanDfoj PILO OFFICE NumnER o. *112 13 16 39. 0. in 2 4 i ad 26 • ze 30 V *4 ye ND ARE 0-31144 627.0-1 MO. 4 Possible Identification and Surveillanc”
“INDIVIDUAL NO. 9 S C 1. cowerwro wire 6 G € O 6. insurricirut ;ratr 7 e i o ORGANIZATION NO. 8 9 M I S J. METHOD OF COLLECTION USSR ONLY RESPONSIVE TO SPECIFIC EVALUATION EXCHANGES REQUESTED FROM REQUIREMENTS A interview (CHECK ONE) Trip Report NO TO USSR Other Docu”
“operation, it is normally expected that a complete and realistic statement of specific duties may be reported in Section 8. However, the nature, source, purpose or dispo- sition of information or operations will not be included. On the other hand, the position titles ond descri”
“Initiate and develop contacts and operations in the Washington diplomatic and foreign press communities, encompassing all the major world geographical areas. Handle recruited agents resident in the Washington area. Establish and maintain self in commercial cover role, Perform”
“in any FI project. Subject subsequent to clearance and hire will be considered by the Project for possible re-assignment into more responsible work. Appropriate security clearance up-grading will be hen requested.---- ----------------------------------- 4. INVESTIGATION AND C”
“8 Fretar 201 Silject-countrier, projects exi s t for il involved in. all project That CIA MM PMMN amort GroeN espto. FinanceDERI nDi EDRect Rent El Blnthetey UN Il be a crypt file Logistic -sautomobiles, c bothing, supplies D0 ILAD11 Communication - able Eolta”
“.1 4-00000 SECRET (When Filled In) 4-61-88 PROCESS SHEET FOR DOMESTIC CONTACT SERVICE COLLECTIONS FOR FIELD use ONLY FOR HEADOUARTEPS USE ONLY A. FIELD 81 REPORT C-REQ. CODE E. RECEIVED CASE OFFICE NUMBER — -- -- -- 19 12 13 14 19 NUMBER mo.i Da ve A fl 4 OTHER pi U ”
“PERSONNEL RECORDS AND REPORTS.. 155 Figure Title Page 1. DISTINGUISHED INTELLIGENCE CROSS............... .......... 94.1 2. DISTINGUISHED INTELLIGENCE MEDAL................................... 94.1 3. INTELLIGENCE STAR ........................................................”
“dma may be reported in Section B. However, the nature, source, purpose or dispo- sit-un of information or operations will not bo Included. On the other hand, the position titles and description of specific duties of certain other employees may jeopardize security and should not”
“means; CSCI dissemination through regular liaison channels, or memorandum). Following the subject o f the document there is an appropriate excerpt from the document. 3. An asterisk in the column headed by (A) indicates that the lead originated in CIA, either in the field or headq”
“Subject is going to be assessed for use in future oporational needs of Station. INVESTIGATIVE COVER IS OR WILL SUBJECT BE AWARE OF U.S. GOVERNMENT INTEREST IN HIMT IS OR WILL SUBJECT BE AWARE OF CIA INTEREST IN HI INDICATE SPECIAL LIMITATIONS OR COVERAGE DESIRED IN THE SECURITY O”
“agency to the USSR. The case officer told Subject that this information could be forwarded to the Station through the LNPURE officer and assured him that his cooperation in supplying such infor mation would not involve him in a series of escalating intelligence assignments. ”
“service Information pertaining to a foreign liaison relationship • Information which would/esrt identify the source 9Informat ion pe retaining to a source 3 Information pertaining to intelligence methods ) Location of CIA overseas installation ) Location of unacknowledged domest”
“1 Aljevwgn/asind‘7 SUB-SOURCE (Nome,‘T o. Organizer Addioss)< ", INDIVIDUAL NOR W‘*z *7*3 v* ‘ $ ele camsince •tri 0 mhauPrit a a Sts 09 OnGANIZATIONING. MA J. METHOD OF COLLECTION- EVALUATION. :“USSR ONLY: RIS-CHSIVE TO SPECIFIC ‘ EXCHANGES REQUESTED FROM \(CHECK ONE”
“al means; CSCI dissemination through regular liaison channels, or memorandum). Following the subject of the document there is an appropriate excerpt from the document. 3. An asterisk in the column headed by (A) indicates that the lead originated in CIA, either in the field or hea”
“L ( @ CIA - State Dept. Utegration Fig Korf cover - »hu S.D. employees are avere that EIA amp. is in fact amplrjed de More integrated covie where a person would do a full-time S.A. job &, 0200 al"dLIeepA joffiob Wheel a c i a l un unbekrasownstwelltoasnesta ofdeepS. D.cov”
“1 4-00000 GtL1 MAJOR CATEGORIES IUEAT SAT E20 :or 1. Orientation in basic principles of clandestine a activity. 2 30 1/ 2. Knowledge of clandestine services cauand structure and organisation. 5 14 25 J., Knowledge of Agency and clandestine services regulations and admin”
“SECRET. SECTjOm.vh: OPERATIOAL USE - CONTACT Of/um/ec was • 1 uSeotom CONTACTLDYBEFORT Abi Chid “Ac Tiv it• 46.0fcAznt-es ENGAGED AND fef -t O’ inten. NAT:***-***/*****--*--*-"----*.:- . N.A. " w e s - n il , »•. INDICATE: now AND ♦ a oe »<ow SUBJECT OBTAINS INFORMAtiOn. ”
“!S J. METHOD CF COLLECTION USSR CNLY . EVALUATION EACHANGES RESPONSIVE TO SPECIFIC REQUESTED FROM REQUIREMENTS .X Interview Trip Repcin - - CHECK ONE) 190 TO USSR . Other Document FIELD COmmEnTs Other (specify below) HEADQUARTERS COMMENTS FROM USSR IRS f 1 P ”
“FALSE STATEMENT ON THIS FORM CAN BE PUNISHED BY FINE OR IMPRISONMENT OR BOTH (See U. S. Code, title 18, section 1001) 40115 Jan DATE Cyr K Hayashi 5 Oct 1966 21. THIS SECTION TO BE COMPLETED BY AUTHORITY REQUESTING INVESTIGATION BRIEF DESCRIPTION OF DUTY ASSIGNMENT AND”
“Address) INDIVIDUAL NO. $ S |O C 4. OT E* miscm 6 € O s. COMBMED ettie 7 a 0 6. MSUFFic Eut INTEREST ORGANIZATION NO. M 1 S N. METHOD OF COLLECTION USSR ONLY EVALUATION RESPONSIVE TO spEclnC EXCHANGES REQUESTED snow CHECK ONE) REQUIREMENTS :INTERVIEW TRIP REPORT NO T”
“ADMINISTRATIVE INFORMATION OF WHICH HE IS COGNIZANT. . " 65-2.* -4. SUBJECT WAS INSTRUCTED THAT INFORMATION PERTAINING TO INTELLIGENCE OPERATIONS. SOURCES‘AND METHODS PECULIAR TO THE AGENCY MAY NOT BE DIVULGED TO PERSONS IN OTHER GOVERNMENT AGENCIES. EVEN THOUGH SUCH PERSONS A”
“14-00000 'SECRET ____PRQ hQ. PERSONAL RECORD QUESTIONNAIRE PART II - OPERATIONAL INFORMATION 01sPar;= vo INSTRUCTIONS ro CASE OFFICER I. This forw oust be filled in by the cvse officer or soptoprsate authority on the basis of the best available in for-ution It 43 not t”
“fills-eo CONFIDENTIAL (when filed in) : axgerogrisp-pargem-gwenwrois-ommake PROCESS SHEET FOR DOMESTIC CONTACT SERVICE COLLECTIONS F 9G t.0 Fet 1. corn •nnamrep : v. t,ICR o tax : 4 ,2 04 co 0-3-1-1-4. -6 27 o: 74 $* NO. t'1 Possible Identification and Surveillanc”
“INTEREST max »c SHOWN DURING INVESTIGATION? ? ,C. is SUBJECT AwARt or U.S. GOVERNMENT INTEREST IM MINI ») X p. is SUBJECT AMARE er CIA INTEREST IM Hrut t. INDICATE ANY LIMITATIONS ON COVERAGE IM THE INVESTIGATION or SUBJECT. ale r. SUGGEST "covra ParText” TO st usto IM ”
“) Informat ion from a foreign liaison service 1 )Lnformat lon pertaining to a foreign liaison relationship ) Information which would/could identify the source go on ) Information pertaining to a source . J Information pertaining to intelligence methods. yolocation of CIA of”
“Information pertaining to a source (b) (3) (j) (1) 6. Information pertaining to intelligence methods (b) (3) (j)(1) 7. Location of CIA overseas installation (b) (3) (j) (1) = 10 installation 9. Name: 10; File number 8. Location of unacknowledged domestic of CIA employee (b) (3) (”
“0 •. ISUFFRizOT INTEREST 7 B tlo ORGANIZATION NO. & -1.I- Mi’s J. METHOD OF COLLECTION USSR ONLY I EVALUATION EXCHANGES RESPONSIVE TO SPECIFIC REQUESTED FROM REQUIREMENTS (CHECK ONE) Interview Trip Report I NO TO USSR Other Document a. Other (specify below) FROM USS”
“cryptonym or alias? 8. Previous foreign residence—generally discussed. I. Current employment status and contemplated Agency status 9. Language abilities with particular reference to language(s) in under cover if different from current status, i.e., Staff Employee, digenous to ”
“realistic statement of specific duties may be reported in Section B. However, the nature, source, purpose or dispo- sition of information or operations’ will riof be included. On the other hand, the position titles and description of specific duties of certain other employees m”
“SECRET (When Filled In) 4-61-88 PROCESS SHEET FOR DOMESTIC CONTACT SERVICE COLLECTIONS FOR FIELD USE ONLY •OR MEDOUARTE PI USA ONLY C-PEG.CODE D. CASE €. RECEIVED A. FIELD B. REPORT Iale,•".( OFFICE NUMBER 13 NUMBER MO. DA,e A 1 2 >14 s a 1o 00 FC 0 *6187112/10/20,129 22 ”
“specific duties may be reported in Section 8. However, the nature, source, purpose or dispo- sition of information or operations will not be included. On the other hand, the position titles and description of specific duties of certain other employees may jeopardize security an”
“msurvicitur HTEREST 7 B 1 O ORGANIZATION NO. e 9 M 9 J. METHOD OF COLLECTION USSR ONLY RESPONSIVE TO SPECIFIC ' EVALUATION EXCHANGES REQUESTED FROM REQUIREMENTS Interview JTeip Report (CHECK ONE) NO D/Cksi ■ RECAI TO USSR Other Document Other (specify below) FROM U”
“organization, or association they represent; D) Forged business documents; E) Accommodation addresses (“residences of record” for anyone working under alias). 3. (S) Many of the specific forms of alias documentation represented in this package are identical to those used ”
“ument. 3. An asterisk in the column headed by (A) indicates that the lead originated in CIA, eith er in the field or headquarters.. 4. An abbreviation of a component of the U.S. Government in the column headed by (B) was othú than the : indicates that the originator of the lead w”
“CEvALUASIONS. va USSR ONLY. RESPONSIVEMO SPECIFIC % EXCHANGES REQUESTED PROM CHECK ONE: REQUIREMENTS. IINTERVIEW Phir RERomr NO rorUSSe OTHER DOCUMENTS _EJOTHER (specify blow) PROMUSSR ALIEN: 055 sovd INF CASEFOPFICER MEADQUART ERS € OMMENTS DIRECTED TO FIELD COMMENTS ”
“cessinconTOP SECRET (This form is to be used for material extracted from CIA—controlled documents.) - 303 - Pitched: Made an effort to recruit as an agent, asset or source. Production: Materials or information generated by an operation or project. Project: A group or se”
“RIMARY DESK INTEREST 12. 2ND COUNTRY INTEREST 124. 3RD COUNTRY INTEREST 時100 702 COMMENTS FORM 12-10 RETURN TO CIA Background Use Only Do Not Reproduce 03 201-275416 PERMANENT CHARGE RESTRICTED FILE SIGNATURE NW 65987 Docld:32405814 Page 1 ☐ ☐ SECRET (38) CS COPY 90”
“9 FOIA B1 B2 B3 B4 B5 B6 87C NEW CLASS PA BJ1 J1 ال K1 L SIGNATURE OF DO/IMS/FPLG REVIEWING OFFICER Exemptions and Provisions claimed to protect the following: Ε.Ο. 12356 1. Classification FOIA (b) (1) PA (k).(1) 2. Information from liaison with a Foreign Government (b) (3) (j)(1”
“the source ( ) Informat ion pertaining to a source ( ) Informat Lon pertaining to intelligence methods I Location . of CIA overseas installation i Location of unacknowledged domestic installation ( ) Name 0% CIA employee. ) File number J Pseudonym O Cryptonyms ) Internal”
“14-00000 SECRET (When Filled In) 4-61-88 PROCESS SHEET FOR DOMESTIC CONTACT SERVICE COLLECTIONS FOR FIELD USE ONLY Fon MEASGUARTERS USE owLr ‘FIELD B. REPORT "REO. CODE D. e. RECEIVED ALPORT *0. 1 NOMEER OFFICE NUMBER tt 12 saiain wo: DA. Ya. |A U 0_ 1 2 » 4 • 0 7 a C”
“dispo- sition of information or operations will not be included. On the other hand, the position titles and description of specific duties of certain other employees may jeopardize security and should not be fully reported on this form. in these cases, general statements of sp”