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This document is a contract amendment from the CIA, dated January 21, 1957, that alters the payment terms for a report related to the United States Government.

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The image is a decorative header for a web page. On the left, an elaborately depicted, metallic vault door with various gears and dials is prominent. A luminous blue light emanates from the right side of the vault door. The text "THE BLACK VAULT" is displayed in large, stylized white font against a dark background with a blue glow. Below this title, white text explains that the document was obtained from "The Black Vault," an online database of declassified government documents, specifically the MKULTRA/Mind Control Collection. The text also provides a URL for accessing the collection. .. -'?~ . • -. .. ..;.~ ·:--·.-- , - -..;,; ~~.:._ ...... ;;-:::;.:-:.."'!"'~ ;::._~~~- ... - ~ .,..;..__-... ----·- - - - , - ----- ------.....-.. -...- --· -• --· .· ~ - , -. ··~ .... --.-1 • . <..""' • i -~ . Date: i .\· I .., . J~ -· ', i l ' 1 Dr. ·;· ·:: __ .:.·~-..,_~-··. : -\·· · -- · " - " ~~ - • . ' • •. • I • • • t · • • Dea.r · ·.·. · -~ -:--4 ... ___ . ----··-. ---- ---- nofc:-cnc~ is :n:.dc to your Ct-l:t:-~et -.::!.t~ t!lt. ~"nlte1 ~t~tC!\ C~~-r.,.~:-"'!T!':. as r~presenteu by t.Ue Ct:ni:ralla!.ciiigcnce .i•f_c:ucy, c ..: :;,ctivts .:1 J.•:.~h.l.c..J)•l·:::.-1. ;· Effective Zl January 1957, Ehid contract is amended by deletin~ the third sentence of pa.rngrnph one (1) entitled 11Compenc::&.tion" which reads: 11Upon the satisfactory completion end submission of said report you wUl receive£. $300 payn1ent." I .. · and eubstitltting in lieu thereof the followin!; sentence: "Upon the eubmission o! a satief~.ctory progresl!l report, you will receive the remain~er of said fee." .All other ter1ns and conditions o£ "the contract, as amended, remain in full force z.nd effect. . .· . .. ~<-; .:: .. .. -- ,,.,:: ... ...·· -.; . ! .. : ·.f•. . . ' . ! . ' . : . . :. ';'.:, . . ! · . ;~ . : : :" ~ " ~ ~<= ~. )* . ·• ACCEPTED::~ :. ' · ... . -~. ~ : ; : . . . ···' ···. . : •. •· '"!'·-..: , . .. . . .,. .· i ; · · ' . ., : . . .. .. ~ ·-··;~.::-~ - .. . -~· ,,·.·. --.~ ; -~ ... ,• : .. ~. . ,·_ . -... ;.• .· ·•. ... - .: ... ·wtTNESS: - •, ·,· . 7':·:·:)-.:~~~~:J_:;::. . ~ ... ,:~~~~···~~~:i:~'~-.~--~~~~-- ~-:-7- ·. -~- -; :: ' · ~. ~ ...· ; .. ---:- ...' -~ .:-.·";.-:~ '!'.""':::·~. -.. ~~-..~ -~-::-~-.:,~·--:"'· : · . : - ::·<:·· -"':.''"-.;-~-: ~:.=-.. -~: ... ·-""l '_.·~·-·.·~·~ .. . .; . ._,. -.:.:.--!'~.- -~<> ··:· ~~: ··: . . ,. . . . ; . ~ · .. . ' . , . . -:.~ . . -: ~ · . " ....' r , · . : ·, This page is a typed official document with handwritten annotations and an official stamp. A circled number "380" is written in the top right corner. The date "18 Jan 1957" is handwritten on the right side of the page. There are empty lines designated for signatures below fields labeled "ACCEPTED:", "WITNESS:", and "BY Special Contracting Officer". The document itself appears to be a contract amendment from the Central Intelligence Agency. - ::·<:·· -"':.''"-.;-~-: ~:.=-.. -~: ... ·-""l '_.·~·-·.·~·~ .. . .; . ._,. -.:.:.--!'~.- -~<> ··:· ~~: ··: . . ,. . . . ; . ~ · .. . ' . , . . -:.~ . . -: ~ · . " ....' r , · . : ·, . ..... ~ ., . ~ . . . · . . · . . . . ~ . ~ : ~ ! . · . , . ..; ~-:·;;·. . ~. ... ·•·.. , · . . ···''!. ......: : . . : .. ·,· # .. . ,,·. .. --. ~- . · . - . ' ;; :. . · ..... -·- .. ::;-~ . - .... --·::.""":"-·. .. - ~ ...· .-··:· ·:--·- ---------- ----· - ..-..':.. -----------------------------·----~-·­ ... . - . b . 0 . ·• ., T. . . ,.; ·:. ,'' . . .. - • i I .. ··-- .. : , I :.. i •;. ... I .. : .. -· ··-r_-- -~ --.--.-.'(~ Dr. .. :_ ~-- •·'-···. I .· ... ,_· ~c:.r Dr. :. . _ I i . " • : "·.ue -.:..-,.-.:.,-."..~..·.~,-..-,a~ . , . . , . . _ . g ._ ., ,t \ · J -- ~ ·w~,,... , • , • . . . . , , . . . .. . . . & . .. . . . . . . . w .. . . . . .. . ~ . .. ~ -- · - - - - ~ = - - · · - - - -. · . · ., - - " ·_ ·· .. _• : - - ~ · " ~ : - .. · .. Cc~& · . - , t . . . o .. - . , ~ ; - ., - .t+ . . - ... · ... - - - : . - . .. . .. , - _ - , · . - ." - . A~onc::y, hereby CO:ltr~!:l ~-i~ 1":?u !or the &ubm.:.uasio.u ol z=. medical rej.·Ort, the Sl!.b}•!c:t mi!~ter o! v:h!ch :!!;:.~ d;:: v:ill be made k1:un~:n to yo-.1, uncic:r the follov..n6 tcr::l£ ~d ec::l~tio~u: -.. 'i ' ; . 1. Com-ocn:;r.tion. In!~ co:tsider~ti.on for the ·Zl!bmiosion o£ .cilit1 I report, you ~r.ll o~ paid a $500 !~e. Two r.'l!nd.reci Q.Qlla:r:. ($200) c! o:dd fee The document is a typed letter on lined paper, with a header indicating it is from the United States Government, represented by the Central Intelligence Agency. There are no photographs, diagrams, forms, or tables visible. The document contains several handwritten annotations and marks, including a signature at the bottom right which is partially obscured. There are also some small, hand-drawn symbols near the top of the page, possibly test marks or stamps, and a large vertical line down the right side of the page that could indicate routing or filing. Small portions of the text are obscured by what appear to be redactions, particularly at the bottom of the page. rej.·Ort, the Sl!.b}•!c:t mi!~ter o! v:h!ch :!!;:.~ d;:: v:ill be made k1:un~:n to yo-.1, uncic:r the follov..n6 tcr::l£ ~d ec::l~tio~u: -.. 'i ' ; . 1. Com-ocn:;r.tion. In!~ co:tsider~ti.on for the ·Zl!bmiosion o£ .cilit1 I report, you ~r.ll o~ paid a $500 !~e. Two r.'l!nd.reci Q.Qlla:r:. ($200) c! o:dd fee . , '\v'.Jl be p:dd you U?O::l t.~e executi'Jn of this contract by tlus Contracting O!Cicer.; . Ur..,n the e3tia£actory completion aDd submic:oion o! JJDid report you will . ; · .- r-::~h·e c $300 payment. l~o t..:ec.ercl incornt: tax will oe "'i~c:l~ i~l#:::.l. ~· • fee, but it will be yoc.r respcnsibility to report such income u:1der e::ist:ing ! Fcdera..l i:1come t~ laws and recuJ.ations. The Centr.:ll Intelligence Agency f ntantls ready to a.ssir~t·you eB to the method to~ follow·_ed i:1 reporting this . iI j' iee on y~~ Federal income ttu: return iD order to preserve se.curity. _.. -.::.:; .· ........... ·.•. 1 . ~. &.ecution o! Doeum.ent&. Il, 1::1 the perform.3llce o! services uneer 1 ~:: co:!::~ct. 1"C't\ c.s~ume the cn~tnciy o! Government funds or take title .o! I t ·~cord 'to property e! any 1:16.1-ure wl&atzic,.::vc:- iii.n:! whc~•-==- zi=t:, 'C"::::.:!l ~ · property h:l.B in fnct b~en pw:-cnaseci with XllCmes of the 'U.S. Goverm::lel4t, ·;r, j you hereby recognize ·and e.eknowledge the e::dstence oi a t%u.at relationship, : I ! either e:!!?ress or const:-uc:tive, and you aeree to execu.te whatever c!oew:::.e:ts f;, may be ~quire.c..l by CIA to evidence thio rel2ticnwp. ; .. :.·- . . . ': {~; _,. i aa~ ·:Yo~-~re noi ~-;mploye~··of the t1nlted: S~es ~v~rmncnt '·;·_, I·~ .. un:ier this agreement and ..a .re·_ no.t, _e·_ _ ntitl·.e. d to ::ny benefits normally in:id.ent vi · ~~.. :· :->-. .. . - ~--.-.. ... . ·· ;_\ . · ·: . : ~:,~~employee_ ~:.atus~ ~- .\;~L. . .· _> ~. ~~- i~R~ : ~ • ,· . • .I· . • • ' : • .':~~~~--~. :~:-.-:~~ ..·. '_··:~ ; I 4·. ·Secre?}'. You will be :re~red to keep !o:ever secret this contract-·· - ~ -~- - mr..r i end all information whi:h you obtain by reason hereof (umess released ':-:. ........ . in writing by CIA :fro:n cucb obliz;nti.on), with fcll k:lowled.ze that vio:.~U:2:1 _ 7 · .~. ··.:. •'. . of such secrecy m:!.y cubject you to cri::U=.~ p:-ocecutio:1 u:1der the .Z::;;:!~::.=-::~ ·· . .. .. ~ . Lnwo. dated This document page appears to be a contract or agreement form, with typed text and handwritten annotations. It includes spaces for signatures and witness statements, labeled "Dr.", "WITNESS:", and "APPROVED:". There is text indicating "CENTRAL INTELLIGENCE AGENCY" and a designation "Special Contracting Officer", suggesting it's an official document. No photographs, diagrams, or detailed experimental procedures are visible, but there are numerous small black ink smudges and dots scattered across the page, possibly from the copying or handling process. Some lines of text appear to be partially obscured by faint vertical lines, potentially from a previous document or binding. whi:h you obtain by reason hereof (umess released ':-:. ........ . in writing by CIA :fro:n cucb obliz;nti.on), with fcll k:lowled.ze that vio:.~U:2:1 _ 7 · .~. ··.:. •'. . of such secrecy m:!.y cubject you to cri::U=.~ p:-ocecutio:1 u:1der the .Z::;;:!~::.=-::~ ·· . .. .. ~ . Lnwo. dated Z5 June 1948, as ::unended, an:l ot.'lor a.P?Ucab!e la\"1& ~~ rczu.• laiions. : ·· ... · · · · .. :!~:.:'. • · ...... :: .... ·•.: • .•: ~ .. .: . -~ '":.:·.'.:·· '·;-.- -• ~•~.! · . : : · " ; '! ~ , ... • •· f • • ~~<... • : -h :,;.. I • . • .·:,~: '··:;;·•; · ~:, . _ . - i, : , , . •· ··,··.·· ~~·-t,_-:-~. . ..; .' • 5. b:t'l"".:.::~cnz. . htit:r.:::tic~s receiv.:!:! by ycu !::n.1'1 pAin r.:.-!:""!" ~·: ~-....- .. · .. ·,· .. ·-t traicing or cberwJ.sa ·zu-e e. pz..rt of this c~:trc:.:t and a:-:: inco:-;;.o:-.:.ted. !-.e-.c!.:a, pro-.r.Lc!cd t!ta.t uuch inst::uci:ic:l& ::&.:c ~ot i:o:o.nzi&tent w.iill tile termo ll.O:::o~ci• . . .. ·.·· • . ·;; ' . . . .... . . ·,_·...,i . 6;, .u~cl!t.~o-rl,;:~J c~:~.i-tn-:~~ts. No promi8es or commitments ~T- . ~ . •· c • . •• - -: : - - •; : • - • ~ t . ... • . - · - • ~ . . .• . · . • ;. . _ ·• f , • · . .. • .. • .. • . ~ : - .. - ... .. . , . . • - . - ... ' - -'• . · .. ., , _ . . - ~ w · ~ · ~ · . · , -, . ' , "- ~ = · •~ - \ ~ : . .. . . w. -:. ~ . . . . " . '; . 1 , f . t i . - . : . . . , , - . . _ . . .. . ,4_ .... .- . ;; . 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