TERMINATION SECRECY AGREEMENT
CIA-STARGATE
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This document is a termination secrecy agreement from the US Army Intelligence and Security Command regarding classified sensitive information related to the Grill Flame program. The agreement acknowledges that the unauthorized disclosure of this information is prohibited by the Espionage Laws and the Internal Security Act, and a violation may result in prosecution. The individual signing the agreement pledges to never publish or reveal the information and acknowledges the property rights of the United States in such matters. They also certify that they no longer have any classified Grill Flame information in their possession and have a continuing responsibility for its protection. The document may be retained by the US Government for future use. The Privacy Act requires individuals to be informed about the collection and use of their Social Security Account Number (SSN), and providing the SSN is voluntary but necessary for removing authorized access to classified information.
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Body: Approved For Release 2000/08/07 : CIA-RDP96-00788R001200290003-6
DEPARTMENT OF THE ARMY .
US ARMY INTELLIGENCE AND SECURITY COMMAND
FORT GEORGE 0. MEADE, MARYLAND 20755
TERMINATION SECRECY AGREEMENT
CLASSIFIED SENSITIVE GRILL FLAME INFORMATION
1'.I acknowledge that by virtue of my duties, I have received or been
exposed to classified sensitive Grill Flame information, the'unauthorized
disclosure or negligent handling of which could adverse.y.affect.the
interests of the. United States-Government. I:am aware that the unauthorized
disclosure of classified information is--prohibited by the Espionage..
Laws (Title 18, U.S. Code, Sections 792-798) and the Internal Security Act
of 1950, Section 19, P. L. 831, (81st Congress) and that a violation of
these laws may subject me to prosecution by the U. S. Government.
2. I hereby reaffirm--my pledge that I will:never -publish ....or..reveal-by
any means classified sensitive ,Grill Flame information. I agree further
that I do not now, nor will I ever, possess.any.ri.ght, interest,. title or
claim whatsoever to such information.--I recognize the full. and vested
property:right of the United States in such matters.
3. I certify that I have surrendered and no longer have in my possession
or custody any classified= Grill Flame information or material acquired
as a result of this association.
4. I further acknowledge.: and agree that I have a continuing individual.
responsibility to the United States Government for the protection of
classified sensitive Grill-Flame information and that the termination from
this relationship with my employer and/or the United States Government does
not-relieve me of my obligations under this agreement or any other previously
executed Secrecy Agreements. I understand..-that T ,will notbe;relieved of
these obligations except when specifically advised in writing by the
sponsoring activity of the U. S. Government.
5. I understand that this document may be retained by the U`. S. Government
for its future use in any manner within the scope of this agreement.
6. I take this obligation freely, without any mentalreservation or purpose
of evasion and in the abse.nce?..of.duress.
DATE ,2A
WITNESS' SIGNATURE
SIGNATURE
PRINTED NAME & SSN (See Reverse) S G F OIA3
YyL-Z?-l5 , G-/C-~ F7 7
Ap0U,W&Por k /98/07: CIA-RDP96-OoT88R601 200290003-6 ( VS
vbe,4 _P/_ ) 7-/"-e / 1),~f C 0 129 L-77_ /U-5-T
Approved For Release 2000/08/07 : CIA-RDP96-00788R001200290003-6
The Privacy Act, Public Law 93-579, requires that
Federal Agencies inform individuals when they are asked to
provide their Social Security Account Number (SSN) whether
the disclosure is mandatory or voluntary, by what authority
such number is solicited, and what uses will be made of the
SSN. Disclosure by you of your SSN-is voluntary. The
authority for this solicitation is Executive Order 9397.
The SSN is used as an identifier in removing your authorized
access-to classified information. Failure to provide this
SSN may-delay the ?processing-.required in accessing authority
removal.- .
Approved For Release 2000/08/07 : CIA-RDP96-00788R001200290003-6