“completed by the Principal Subject. b. Two original I-131 forms completed by the Principal Subject’s spouse c. One N-470 form completed by the Principal Subject. SECRET”
“Central Office - I2NS. Alien Reg.# V4iA o + 1.—«V •S .- Citizenship# Issued at 9 NW 88613 Docld:34529121 Page 3”
“affirming his identity.. .. If such individual is an alien. lawfully admitted for permanent residence, his or her alien registration number must be also provided. Before we may begin processing your request, we must receive from you a notarized statement as explained above. T”
“14-00000 rear * SECRET PART III 1-—- NOTE: DETACH THIS PORTION OF FORM AKD DISTRIBUTE SEPARATELY sea • 6741 1%. SOCIAL SECURITY NO. 2 00 8-5884Z IF SOCIAL SECURITY NO. IS NOT AVAILABLE. HAVE FORM 4O. $5-5. 20. CITIZENSHIP "APPLICATION FOR SOCIAL SECURITY ACCOLMTS," COM”
“DEPENDENTS OTHER THAN SPOUSE RELATIONSHIP DATE AN D PLACE Of BIRTH CITIZENSHIP PERMANENT ADDPESS ADD 1. OFLErs ADD 2: orucre FOR 2-60 444n SECRET. (8-5:8”
“14-00000 E 24 II / I 6 Not r. List three persons living in the Bated State • Territories of the United States who are Nor related to ves and who have definite knowledge of your quelfi otione and fitness for the powition fee when h wou n trot. Lo not repent names of superviso”
“Elprily0.55 8 65 Por SIN 4 Ave Mia Ela USE 62 -N n $1 th 7 LAST FOREIGN RESIDENCE OF MORE THAN ONE YEAR I NOT SHOWN ABOVE .K. INCLUDE INFORMATION REQUESTED A50,E, -t_3.- I eagect Pad de sir sero HEY APPLICANT’S EMPLOYMENT LAST FIVERYEARS kiF NONE, 30 STATE) 5.0B6 LI”
“DEPENDENT CHILDREN AND DEPENDENTS OTHER THAN SPOUSE HAVE RELATIONSHIP DATE A D PLACE of BIRTH C: TIZENSHIP PERMANENT ADCRESS ADO I. DELETE ADO 2. DELETE FORM 444n use pervious SECRET In wood won e-e-out 1 t-31) 7-69 01fi0n$”
“IS THE SUBJECT AN ALIEN OR A NATURALIZED CITIZEN OF THE UNITED STATES? R X b. ANY FOREIGN CONNECTIONS, INTERESTS. EMPLOYMENT OR MILITARY SERVICE? /y c. ANY FOREIGN TRAVEL OTHER THAN FOR THE UNITED STATES GOVERNMENT? X d. EMPLOYMENT BY A FIRM HAVING A CLASSIFIED US GOVERNMEN”
“PROFESSIONAL DEVICES. ETC. 4. if you HI a LICENSiD on CLatifito wtwere OF ANY reaps on PROFESSION (Pilot, Electrician, Radio Operator, Teacher Lawyer. CPA. medicel Technician, etc.), INDICATE rot KIVD of License on CERTIFICATE. NAME or ISSUING STATE. aNt REGiStav NomBER, if i”
“IS THE SURDECT AN ALIEN OR A NATURALIZED CITIZEN OF THE UNITED STATES? b. ANY FOREIGN CONNESTIONS, INTERS EMPLOYMENT OR MILITA ICE? C. ANY FOREIGN TRAILL OTHER THAN FOR THE UNITED STATES JOVERNMENY, V d. EMPLOYMENT B A EUR AVIMO A CLASSIFIED US QOYERNMONY CONTRACT? 0. FORMER”
“0006 •060 26 ’ Residence Oc) address 6•00 26 Occupation or business • o< • €00 26 d Business or employment address • 0 0 26 e) Citizenship status •• e 6 0606 0 • o 26 Ie Alien.............< • 0 26 .II. Naturalized citizen III. Native-born citizen ••• (f) Nationality back”
“the best of my knowledge arid belief, and are made in good faith. / False statement on this application is punishable by Law (U. S. Code, wo SIGNATURE OF APPLICANT ■ (Sign your name in INK (one given, matial de raitials, acd surname). If female, Title 18, Section 80). / pre”
“-53- 1 65 1 63 3121 N # 22 Ct. 8 61 1 65 > IPH LAST FORSoN RESIDENCE OF MORE TEN ONE YEAR IF NOT SHOWN ABOVE APPLICANTS EMPLOYMENT LAST FIVE YEARS. (IF NONE so STATE) Chusband INCLUDE ALL INFORMATION REQUESTED ABOVE LIS T PRESENT EMPLOYMENT FIRST. FROM 2a Tray try68 ”
“Residence address 000 •• 26 Occupation or business • • • € 26 seshpeuka speli-eniiatew^fe^r^^^^^^#^^ c) d) Business or employment address • • 26 e) Citizenship status e«* 0 26 I. Alien • • • 26 II. Naturalized citizen• 26 III. Native-born citizen 26 Nationality backgrou”
“or roTRY 1.4. PLACE of ENTRY 15 CiTiZENSHiP (Country) 16. GATE Acquito Tir. wurag CQulafo (Catr. State, Country) U.S. 18- CuPATION :9 PRESENT (MPLOY 9 (A:aa oenos noloyer, or if spouse tt Housewife unemployed, Ist 8 to e-ployefs) to. EMPLOYER’S ew BUSINESS ADDaess (No.. S”
“OR VIMN Ct.Mef hiAT.Me FOP MrfTAGf (W NAVAL 20 rout Answer is * Yes. " give complete details in ftam 39 Agrnry: D Sraditun (t3A*WI*1 TU O’nt 9 tasirm, tsmdoe ate sieno numbers R«p which answers eppir) irtMiK) _*e *A) Settoward Sant. J If move @ apicr* Is squired, use sepcr ”
“DISORDERS? YES XXNO ARE YOU NOW OR HAVE YOU EVER BEEN ADDICTED TO THE USE OF HABIT FORMING DRUGS SUCH AS I NARCOTICS OR BARBITURATES? YES NO ARE YOU NOW OR HAVE YOU EVER BEEN A CHRONIC USER TO EXCESS OF ALCOHOLIC BEVERAGES? ANSWER TO ANY OF THE ABOVE IS "YES." EXPLAIN IN ITEM ”
“to n e A.. * er SECTION *98 BROTHERS AND SISTERS sre FULL RM PLACE or BIRT NATIONALITY aT alefu” • • or BIPTH omlereonl A mM I wstniidales "SUesEDET Citizenships beLa •» Asr b*bt-ga de SISTER (Identify brother, of sister and jive bis, or her, present address) sow fre”
“give date ofpublication) DOCUMENT NO. 19133 Custodian 2. Name of Person as Shown on Evidence Born- Age Birthday at Which Age Shown Date Recorded Last Nearest Next Not Given- Name of Father Age Name of Mother Age Not Shown Not Shown Person Having Custody, Relationship ”
“of birth (Cay. State, Country) (2), 3 Cimsenship (Country) • Address (Number, Street, Coty. State, Covatry) - / Type and location of service fit knowe) % j I Nemo tlov - for - b.ddie) 2 Belaherab-p 3 Date of birth 4 Place of birth (City. Srate. Country) (3) $ Citserahip (C”
“b. Scope of investigations 26 (1) Background • a* • .......... €0000 26 (a) True name and aliases *444 4400® 26 b) Residence address 26 c) Occupation-or business ©•0• 444 26 a) Business or employment address # e) Citizenship status 0.000... 00000 26 26 I. Alien e € « 26 ”
“14-00000 I J28.00L3 YOUR IINANCIAL POSITION PERMIT D1SCMA-GL OF ALL CLB13 %- b. IF NO: RESIDING ABROAD WAVE YOU teLs PAID CyNEUT XYI : hen I’r *NC n.t 3 ";* ser P *%: Gel 57:6 9 "EN ” dADP 5:7 MIE EN ::! Y1 A J.J. INCSAL "As? JVE3 Co0 IF ANSTE? NAMES Or CRUITORS, AMOUNTS”
“OF THE U. S OR OF A FOREIGN GOVERNMENT: 1. NAME. N.A. RELATIONSHIP e AGE.. crrizkNsui". ADDRESS .... (5€. and Number) ■ (019) (State) (Constry) TYPE AND LOCATION Or SERVICE UP KNOWN) 2. NAME.... .... RELATIONSHIP.... AGE . CifizENsuP ... ADDRESS lilt, at Number): (Cn”
“YORKIT. N. Y. ISTHIS INDIVIDUAL AUTHORIZED TO MARE DECISIONS any, who cert mink o such decisions in case of emergency.) ON YOUR DEHAL-M tie No gice name and eidrees of perecn, 20 * NO TES NO. DOES THIS INDIVIDUAL KNOW THAT HE HAS BEEN DESIGNATED AS YOUR EMERGENCY ADDRE”
“DEPENDENTS OTHER THAN SPOUSE NAME RELATIONSHIP DATE AND PLACE OF BIRTH CITIZENSHIP PERMANENT ADDRESS apo. 1. DELETE ADD' 2. DELETE FORM 444n 3um 1 yee SECRET 1coouli" -“*= -* 717-‘7 (4-$1}. 10-68 13’”
“status............ 26 J. . Alien......... 26 II. Naturalized citizen.. 26 III. Native-born citizen.. 26 (f) Rationality background.. 26 8) Military record........... . 27 11 Close relatives in armed forces..... 27 i) Identification record " (Security flash notice FD-165).”
“PROVINCE OR STATE COUNTRY MONTH YEAR MONTH YEAR 1519 5.L. 19 SQUEIT STALER JLOJDA tefors 22 66 PRESENT TIME 2329 Hobo 6 Avca FNELTN FLCU01 Lajads 2 65 22 66 2852-S1132-CO8. LICLEI FLQXIPA tosofto 33 -62 eve 63 7323 15 13 Cat. SOUSE JLOUIDA Ladado 2 63 2 65 LAST FOREIGN N”
“14-00000 •. SECTION 11 _ CITIZENSHIP 8, io PwiSENT CitelnSaie It NArcOnALIfe A: miRtt AND avy UBS:OUEN1 CilZINSH!P6 (If dilfetent than Item to ) 12 PRESENT RESIDENCE (Indicate * ovn*7, tenant or sub-tenant) 3. PERMANENT AcORss (If different th tn Iten 12) 14 IF U.S. NAT”
“14-00000 teres e* Signatures to be applied by Subject: 1. Passport: Page three belcv picture on space provided. Regular pen and dark ink. No ball point pen. 2. Drivers Permit: ' Between entries 4 and 5 next to picture and turning document to write name from entry 5 to 4. ”
“XSNO ARE YOU NOW OR HAVE YOU EVER BEEN AOOICTEO TO THE USE OF HABIT FORMING DRUGS SUCH AS NARCOTICS OR BARBITURATES? YES XDuo ARE YOU NOW OR HAVE YOU EVER BEEN A CHRONIC USER TO EXCESS OF ALCOHOLIC BEVERAGES? YES ONO IF THE ANSWER TO ANY OF THE ABOVE IS "YES." EXPLAIN IN ITEM ”
“parent or guardian State .... From...... 19.... to ... d4omii" hints City or town.. lo he ivolet in that State? D Yes • No (Month) (Ve.) County From............... .... to... _______ (Month) Cy* > olzldi"WifA5 County. Blate, Feb 0. 19 you are a married women, fill in the fo”
“Be Filed. SUBJECT OF 201 (Last, First, Middio) 201- FORM (7-461 1 0-68 867 Phewious SECRET oncer a cavere mass ervot so•i*a. st”
“14-00000 torwosp.4 •. +R. • * sa, PLLATIVES RI BL000 04 MARRIAGE NOA RC 6IDI+ IN OTIG COUNTRIES ARI0N34iP secerss +5, LIST PRESENT OR romuge FOREIGN CONNECTIONS a. Business | a. furcovurut *4, pots YOUR PRESENT.FINANCIAL POSITION PERMIT DISCHARGE OF ALL CURRENT DEBTS?”
“14-00000 y,2v00-r0jrl1iNANClALlrstrinniPeryit mibonan CALL DERTG IN- 0,If %‘. DAdl HAVE YOU EVER s> ,e‘, 43:080 (0(07 AlY, ._Iso I, a*set. IS vor ,T4TL N*DP TTLM 03? THE A 0.5. 66M ‘ _ Jiit TI5", QNO IF 1% / SAME 3 or CE011045, AMOUNTS DUE 10 EACM, Aul, LATE, 09 WHICH THE I”
“DEPENDENTS STATE RELATIONSHIP, CITIZENSHIP, AGE AND DATE Of 9191 Same as (18) above 41. PavwENT ano accountaalLI BILL D! IN CONFORMANCE BiTw or ev t:veu SECTION vii OPERATIONAL IPENSES 6s puacmast er I04 43- IATAIRMENT Where applicth le where applicable operational equip”
“Naturalization Kervve Fons Approved - Bucket Bute. No. 43-23114 Form Approved - Budget Bureauip. 3-R3114”
“(State) i £69, - . US. 1. (CYes azeg D. PRESENT CITIZENSHIP _ :_ *__ BY BIRTH! BY MARRIAGE? (Country) T "BY NATURALIZATION CERTIFICATE NO.: ISSUED - ___ :___ _BY _ (Date) (Court) AT «om .40 .1. (State) 97770 (Country) HAVE YOU HAD A. PREVIOUS NATIONALITY? (Yen or No)”
“nJersey arva | : Social Security Number: 139-30-1035 ‘ 37 NW88296 Docld:32989574 Page 591 % ‘IT”
“(Lest-Piret-Middle) DATE OF BIRTH $0 056735 SECTION 11 EDUCATION HIGH SCHOOL LAST wian SCHOOL ATTENDED ADDRESS (City.Stato,Country) YEARS ATTENDED (Prom-To) GRADUATE • ves • •• COLLEGE OR UNIVERSITY STUDY suejtcr NO. SEM/OTR. mauE AND LOCATION OF COLLEGE 00 UNIVERSITY YE”
“14-00000 / Peru p.P.se Form Approved P.10.99 Budget Bureau No. 47-R071.7 DEPARTRIT of STATE ,4 ,4 ( (Psit) SUPPLEMENT TO STANDARD FORM 57 WAllien 7. Drce I. ‘AT. or AST* If more space ( • required, nee editiosal shepte of paper. Write on each sheet your nane, address an”
“the security index.‘- If the subject is in prison,the word "Imprisoned" shall be typed on the space provided on FD-122 d behind the words "MISCELLANEOUS (Specify)." The **n* a-*2to*6pt* -dkoegt-tiie6-,pw4 ‘rt* aand identity of the institution in which the subject is inc”
“STRICT AND mumege City PROVINCE OR STATE cousrev MONTH YEAR MOnTu YEAR 3650 Lowsinnd Ave Pkwy New Orleans Louisiang 3855 Louisiana Ave paly New Ci Leans Louisiana sobs Fern Stepet Newelylews LouswnD USA USA USA 12 7 67 66 66 perscut TIME 17 67 7 66 Hriy 65th Shve”
“AFFECTING THIS COVER. (NR:240-26) X SUBMIT FORM 1323 FOR TRANSFERRING COVER - RESPONSIBILITY (WR 240-20) x Clin NA EAA. CATEGORY CATEGORY II NA SUDMiT FORM 3688 FOR PITALIZATION CARD• smXWRs ANP/OR COVER HISTORY Subject will be denied for entire - period of employmen”
“14-00 30 • 10- L. , SEUTEt XA CONTINUED FROM PACK 9. 14. IF Bonn ourhor U.S DATE Gr serne £*% PLACE or etnY 14. ORMFAICITIZENSMIP1S) . Coutre(les)? 17. DATE U.S. CITIZENSHIP/18 WhE4E AQURfteir Rinte ACQUIRED! me (9. OCCUPATION 129. PREENft rL6fenT7a g, employer, or /l”
“14-00000 (2) E. IF BORN OUTSIDE U. S. WHEN DID YOU FIRST ARRIVE IN THIS COUNTRY:____ PORT OF ENTRY? --- ------------- ON PASSPORT OF WHAT COUNTRY?_____ / LAST U. S. VISA (Number) (Trre: (Place ii lasue) (Date of Inave) % + SEC. 2. PHYSICAL DESCRIPTION 22 F 8" AGE _. ”
“copies to SY. (Compiste items 1 through 18 only) For China background check, forward original and t copy to SY. Attach photo with atlen’s name in Chinese (Complete Items 1 through 18 only) ' For “Parakeet” name check, security advisory opinion, or M24x3/A> walveraction forward”
“P A* of glxti ( Cily. State, Country) er SALCA 150 13. ir vons ours:p€ ti../ of %*)* 4‘: acr or ENTaY f 120 (Country) ie. PA71 CIBLD 17- wren zrh CQulwib (City State Wants,} 1 14. OCCUPATION 19. PFISENT FVPlOYIR (klaa give lotmer opplov«t. or a f epoose 6 ceased a: vnenpl”
“THE OFFENSE OR VIOLATION, THE NAME AND LOCATION OF THE COURT OR PLACE OF HEARING, AND THE PENALTY IMPOSED OR OTHER DISPOSITION OF EACH CASE. •34• THFS RELAT!. 31 4 **} ( "THE VT-ES WHICH YOUMAY BECALLEDURSM TO TAKE OR WHEWNEWT NEGXmPUnilMer2DNXOMAtRYALTY 10 Me YES UNIT”
“DEVICES, ETC. 4. NA ir vou ARE A LICENSED OR CERTIFeTA 043S3 of ANY TRADE OR PR0:6S910% (Pilot. Slectrician, Badan Operator. Teacher Lawyer, CPA. Uedieat Technician, ezc.j. INDICATE THE RING of Licrust on CERTIFICATE, N ARE of i087 STATE, AND REGISTRY NUMBER IF RNORN, 3 F”