“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”
“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 ”
“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 ”
“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 ”
“(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)(”
“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”
“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”
“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”
“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”
“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) (”
“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”
“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”
“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”
“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”
“CODE PUBLIC RELATIONS . - SECTION H . cawrowy PStUDOPM _ScoN@-2 019 C UBA 015 P second country Nmest’ 12 tmo COUNT** nererest : io P. ACRON Dtykia d.11 12a. COMMENTS CIT: USA 229 M S Processed COPY iSIGNAtuM 88764i 201- eda KOHAMN CHABOT BSRICTTD ‘n ves No res w”
“PERSONNEL RECORDS AND REPORTS.. 155 Figure Title Page 1. DISTINGUISHED INTELLIGENCE CROSS............... .......... 94.1 2. DISTINGUISHED INTELLIGENCE MEDAL................................... 94.1 3. INTELLIGENCE STAR ........................................................”
“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”
“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”
“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”
“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”
“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”
“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”
“.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 ”
“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”
“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”
“ves w* 9. 2. 1 OCCUPATION/POSITION OCC/PCS. cone ■ 9. 1 SECTION II. CRYPTONYM PSEVLONM SECTION III COUNTRY or CISIDNC9 19. ACTION DESK - 11.5 ucond county wrasse 12. THIRD COUNTRY INTEREST 12e. COMMENTS PUNCHED COPY PERMANENT CHMOT RIGTRICTID PAS IONAfUAS 191098 201”
“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”
“) 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”
“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”
“especially CE operational activity against the RIS. Maintains liaison with CIC. Referent for CE matters. ' ■ SECTION III (To be cospieted at headquartcra only) DO NOT COMPLETE - FOR HEADQUARTERS USE ONLY Bronson Tweedy AUTHENTICATION OF pEPOST AID SIGNATURES !, 3. Will”
“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 ”
“K1 L SIGNATURE OF DO/IMS/FPLG REVIEWING OFFICER Exemptions and Provisions claimed to p rotect the f ollowing: Ε.Ο. 12356 1. Classification FOIA (b) (1) PA (k).(1) 2. Informat ion from lia ison with a Foreign Gove rnment (b) (3) (j)(1) 3. Information pertaining to a liaison (b) (3”
“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”
“ov isions c laimed to protect the following: Ε.Ο. 12356 1. C lassifi cation FOIA (b) (1) PA (k) .(1) 2 . Information from liaison with a Foreign Government (b) (3) (j)(1) 3. Information pertaining to a liaison (b ) (3) (j) ( 1) rel ationship with a Foreign Government 4. Informati”
“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”
“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”
“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 ”
“A. U.S. GOVERNMENT INTEREST MAY BE S^RN DURING INVESTIGATION? X S. CIA INTEREST MAY BE SHOWN DURING INVESTIGATION? J c. is SUBJECT AWARE OF U.S. GOVERNMENT * SREST IN HIM? X 0, IS SUBJECT AWARE OF Ct a INTEREST *% HW2 X €. DICATE ANY LIMITATIONS ON COVERAGE 9* THE INVESTI”
“13-00000 . C ON FI DE NTIAL APPENDIX A Information to Be Furnished on Individuals Reported by the Central Intelligence Agency to the Secret Service . 1. Identification Data - to the extent available to CIA, name or names of individual (including prior legal names, ali”
“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”
“OTHER/MISC 6 • GE 0 S. COMBINED wie ORGANIZATION NO. B.s o 6. ISUFFICIGT INTEREST 8 ♦t. METHOD OF COLLECTION wlt s EVALUATION USSR ONLY RESPONSIVE TO SPECIFIC EXCHANGES REQUIREMENTS REQUESTED FROM (CHECK ONE: LXIDTERviEw TRIP REPORT NO . 1 TO USSR yon OTHER DO”
“which w/could identify the source Information pertaining to intelligence methods 12) Location Locat ion of CIA overseas installation of unacknowledged domestic installation Name of CIA employee. ) File number ° 2 Q Pseudonym® Cryptonyms XJ Internal organizational data ”
“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”
“SECRET PRO 60. PERSONAL RECORD OCESTIOSNAIRE PART 1I - OPERATIONAL INFORMATION DISPATCH mo. HMIA-33865 * INSTRUCTIONS 10 CASE OFFICER 1. This form suet he fitted in by the case officer or appropriate eetbority en the bosin of the best available san focoelien. I t is -of ”
“!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 ”
“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”
“Via-Preo Serre Industries OCCUPATON/POSITION / CFTONY SECTION II PHRUDONTIA OCC/PCS. cope 1, SECTION III (2a.1: WH/3AN . COUNTRY or RESIDENCE 10. • ACTION DESK 11. SECOND CO.or MMIf 12. THIRD coUTIY INTEREST COMMENTS PR PUNCHED 201- 205712 unner FMANENT CHANGE R”
“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. ”
“5-17 1. OTS Memo Receipt (CONFIDENTIAL) (I-T) 2. Procedures for Obtaining Alias Documents and Disguises 16 Apr 75 CONFIDENTIAL 3. Procedures from D01-240-4, 25 Nov 74 signed by Win. Nelson SECRET 4. U.S. Document Request Form SECRET 5. Clandestine Service Inst. 240-4 - 23 ”
“SECRET 11-20-50 (When Filled In) PROCESS SHEET FOR DOMESTIC CONTACT SERVICE COLLECTIONS - 15-45-3 • fon FIELD use oiLY FOR HEADQUARTERS USE ONLY A. FIELD OFFICE B: REPORT - NUMBER Lingg:cope 000 D. CASE - NUMBER 5. RECEIVED 97ldvn REPORT wo, RKI- OTHER MO - 0a5”