“4-00000 7%."* CV-XP -1 "PERSONAL RECORD OBESTTOWNAIRE■ XAAZ 15877 PART I - BIOGRAPHICAL ENFOEMATION 45 /PRO,15 MICROFILMED Instruction: 1. Write cleirly.. 2. Answer all questions completely. If queJUN 1201964 -33- not apply, write, "not applicable" 3% At tach blank pa”
“Living.......... . DATE OF DECEASE . CAUSE.................... PRESENT, OR LAST, ADDRESS 402 Pine St. Bainbridge, Ga. I- g. S.A.. Bt. & No. City State ‘Country DATE OF BIRTH March 24, 1875 PLACE■ OF BIRTH Bainbridge Cy . Ga. State . U. S.A. Country .. CITIZENSHIP U.S. ”
“14-00000 SEC. 18. GIVE THREE NEIGHBORS AT YOUR LAST NORMAL RESIDENCE IN THE U.S. — (Give residence and business addresses where possible.) Street and Number City State 1. Mr. J. Stanley Davis: BUS. ADD. 3 Englewood Place, Albany, I.Y. Res. add. 90 State St • , Albany*- L.Y”
“LEGAL CHANGE, GIVERPARTICULARS (WHERE,WHEN AND BY WHAT AUTHORITY)“ • aivdo •. •. DATE OF-BIRTH - - - PLACE OF BIRTH CITY i,h - STATE - COUNTRY - Mar. 19, 1911 New York City, - New York, .U.S.A. PRESENT CIRiKSHTP- ACOUTRED GV:. 3 US.--- B18FALA MARRIAGE L NATURALIZATION o= B”
“Street, City, State, Country) 300 OAKUM ST. EDENTON, N.C., U.S.A.9. DATE OF DEATH 10. CAUSE OF DEATH 8. LIVING > < YES NO N.A. N.A. 11. CURRENT ADDRESS (Give laat addreea, if deceased) 9361 S.W. 178 St., PERRINE 57, FLA. U.S.A. 12. DATE OF BIRTH 13. PLACE OF BIRTH (City,”
“not while in the Armed Porcon sive number, date, and place of issuance of American passport.) See employment with Department of State at Bogota, Colombia, Mexico city and - Caracas, Venezuela. 26. FOREIGN LANGUAGES (Nome and indicate the patent of your competence, i.t. Excel”
“14-00000 SEC. 21. CHRONOLOGICAL “05, (Conti) EMPLOYER TITLE OF Jou ADDRESS .. Ht & No. City State Country YOUR DUTIES AND SPECIALTY.. KIND OF BUSINESS: NAME OF SUPERVISOR. FROM: . TO:. . SALARY $ PER REASONS FOR LEAVING EMPLOYER TITLE OF JOD ADDRESS 01. & No. c”
“AAS3**,0A ***** 4 DS #63 SCHIN BALTIMORE, MD, USA "SEC. 12. EDUCATION ELEMENTARY SCHOOL Or DATES ATTENDED McDONOGH 430-34-37 -Dofrss.o- PIKESVILLE, MD, USA YES _______ GRADUATE Gantry mON SCHOOL LOYOLA HIGH MONTREACH, LON MONTREAL, QUE, CANADA ADDRESS State Co”
“14-00000 7. ’ SECRET Authorized Staff only 23. LIST SPECIAL SKILLS, HOBBIES AID ABILITIES. (Fadio, Photography, etc.). No hobbies. Special ability lies in salesmanship and the establishment and maintenance of personal contacts necessary to career. 29. FINANCIAL STATUS: ”
“City, State, Country) American Embassy, La Paz, Bolivia 10 9. DATE OF DEATH 10. CAUSE OF DEATH 8. LIVING X yes NO II. CURRENT ADDRESS (Give last address, I/ deceased) 08 (2828 Connecticut Ave., N.W., 12. DATE OF BIRTH #203) Washington 8- D. C. 13. PLACE OF BIRTH (City S”
“721 E. IF BORN OUTSIDE V. S. WHEN DID YOU FIRST ARRIVE IN THIS COUNTRY? NA. PORT or ENTRY: ----------------- ON PASS PORT or WHAT COUNTRY: LAST U. S. VISA __ NA_ (Number) (Type) (Place of issue) (bite e foods) SEC. 2. PHYSICAL DESCRIPTION .1 AGE 24.11 ,sEx Male - BRIGH”
“14-00000 • StcriOmvi SPECIAL J.A1FICKTIOMS AND INTERESTS tel Pi talks CLONING TITLe 01 800. % Un Anficuet. *140 NAMIS or PuBLIS-tRS Areto Punt ICa iton DATES. None 29, SPECIAL SKILLS. ApiLltris, w0BIlt such as #A01O, -QTdmAPHY; LIc. None SECTION VII MILITARY SERVICE ”
“5 0 0 -G 2 0 SEC. 18. GIVE THREE NEIGHBORS AT YOUR LAST NORMAL RESIDENCE IN THE U.S. — (Give . . residence and business addresses where possible.). Street and Number cny State 1. BUS. ADD. ___ :_________-____ RES. ADD. 2. BUS. ADD. RES. ADD. 3. . BUS. ADD. RES. ADD. ”
“BIRTH CB 25, 1848 PLach or nigtu JACKSON, TENN IF BORN OUTSIDE U. S. INDICATE DATE AND PLACE OF ENTRY NA CrrizeNsmm-z SA WHEN ACQUIRED?BIRTH - WHERE... * *i (CHty) iStato) Country) 8. OCCUPATION HRY -Last surtorERNEARAILE 3 its”
“- • RELATIONSHIP -.AGE CITIZENSHIP ADDRESS STREET AND NUMBER CITY STATE. COUNTRY. TYPE AND LOCATION of SERVICE (IF KNOWN) X se ths frustrate 2 1 4 9 NAME RELATIONSHIP AGE CITIZENSHIP • ADDRESS STREET AND NUMBER CITY STATE COUNTRY 'TYPE AND LOCATION OF SERVICE (IF kN”
“thidtahliladwdnicakislbetle-tiecslieks. / Case Authorized Staff only 21. POLITICAL ORIENTATION. TO WHAT CLUBS, ORGANIZATIONS, LABOR UNIONS, PARTIES, OR SOCIETIES HAS HE BELONGED? Republican. Never a member of any club, organization, union, party or society. 22. SOCIAL ”
“(2) E. IF BORN OUTSIDE U. S. WHEN DID YOU FIRST ARRIVE IN THIS COUNTRY! - PORT OF ENTRY!.... . ON PASS PORT OF WHAT COUNTRY! ____ LAST U. S. VISA ___ (Type) (Number) (Place of Issue) (Date of lnsuo) SEC. 2. PHYSICAL DESCRIPTION AGE... -SEX —... HEIGHT ..... WEIGHT ... ”
“14-00000 3 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 Numter Tyre Place of Dasite Date of Issue SEC. 2. PHYSICAL DESCRIPTION AGE SEX HEIGHT WEIGHT EYES HAIR COMPLEXION SCARS BUI”
“(City. State. Country) 10 March 1945 Cleveland, Ohio 6. HIS (or her) ADDRESS BEFORE MARRIAGE (No., Street, City. State, Country) r- 13610 - Benwood Ave., Cleveland, Ohio, U.S.A. 7. LIVING S- DATE OF DEA TH .9. CAUSE OF DEA TH x.* ’’ so 7 to. CURRENT ADDRESS (Give last add”
“4-00000 PLEASS RSAD INSTRUCTION SNFET BEFORE PREPARING THIS FORW UV office vision oso WHD STATEMENT OF FEDERAL CIVILIAN AND MILITARY SERVICE TO 1 ! FEDERS Ctviti Am SERVICE FFG:% wit IMS AGENCY amp FOLLOW in REVERSE CNRCNOLOG1C4 eRpr) IROM TO TOTAL GEPVICE. AGENCY LOCAT”
“COMPONENT FROM (Date) TO (Date) TYPE DISCHARGES OR SEPARATIONS-GRADE AND SERVICE NO. 9. EDUCATION (Account for all civilian schools and 'military academies. Do not include service schools') MONTH AND YEAR GRADUATE NAME AND LOCATION OF SCHOOL DEGREE FROM— TO- YES NO 1947 19”
“4-00000 rlaasu 28AD twstavcrtom SuERt RKFOSE raretso pts zovu ILV Cabral STATEMENT OF FEDERAL CIVILIAN AND MILITARY SERVICE 745 0*310% FEDERAL CIVIL! AS SERVICE ,#1014 wIh Hir AGENTY AmD 10119W • WEVENSt C OGICA ORt F) 509 10 TOTAL Sloat61 AC0NC8 LOCATION ec, (-*,• .-nA.”
“14-00000 6 SEC. 12 EDUCATION ELEMENTARY scwcOL Whitman School ADDRESS BROCKTON, MASS, U.S.A DATES ATTENDED. 1928-1437 GRADUATESYES _ HIGH SCHOOL Pe ADDRESS BROCKTON, MASS, U.S.A. BROCSTON HIGH SCHOOL City State Country DATES Y. 1937-194 E CUIVERSITY ATTENDED 1 .. GRAD”
“00000- 4 **9 *7 423X9045) 6 *0 9 7 *2 SEC 12. EDUCATION ELEMENTARY SCHOOL 1ADDRESS NYC- Drony__ New Yo k— City State Country DATES ATTENDED.1926-1932 ____ — GRADUATE? Yes HIGH SCHOOL De Witt Clinton ADDRESS Bronx. LTC Ct State Country DATES ATTENDED 1932-1935 GRADUAT”
“tes?". There was nothing further in this file which would bear on the question of loyalty. Education AGNES T. CONDON, Registrar of the evening school, City College of New York, 139th Street and Convent Avenue, New York City, advised that the records disclosed the employee had ent”
“CITY STATE COUNTRY wrar * * a * y : TYPE AND LOCATION: OF SERVICE (ir KNOWNT. NAME RELATIONSHIP AGE CITIZENSHIP ADDPISS STRE ET AND NUMBER CITY STATE COUNTRY TYPE AND LOCATION OF SERVICE (IF KNOWN) JECTION_9.EDUCATION___ ______ ____ -___________________ ‘WOOL t - AboR”
“14-00000 1 SEC. 15. HAVE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN FROM ANY POSITION? HAVE YOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH YOU DESIRE TO EXPLAIN’ GIVE DETAILS: NOT APPLICABLE SEC. 16. GIVE FIVE CHARACTER REFERENCES - IN THE U.S. — WHO KNOW YOU INTI MATE”
“deceased) / NA 9 11. 15 MODE ST, FAIRFAX, VIRGINIA DATE OF BIRTH Country) 12. PL ACE OF B18 14 (City. State. 13 August 1927 13. ROANOKE VIRGINIA IF BORN OUTSIDE U.S.DATE OF ENTRY 14. PLACE OF ENTRY NA NA 15. CITIZENSHIP (Country) 14. DATE ACQUIRED 17. WHERE ACQUIRED ”
“(Including service in the Armed Services of . For. eign/powee) - .. . a VES HO IF.ANSWER IS "VES" GIVE DETAILS UNDER ITEM #37. 25. OUTLINE YOUR TRAVELS OR RESIDENCE ABROAD GIVING.DATES. PURPOSE, AND PLACES. caf not whild’in the’Armed Forcee: give number, date, and place of i”
“1 4-00000 € - 14 . SECTION XXII CLUBS, SOCIE ME S. AND OTHER ORGANIZATIONS NOTE: Lt *1 names and atrnueen of all clube, ,i« jeties, dies, employer groups afiense of any bind (Include membership sei, ne nuppoef of, any otgenizattors having he de arters or brom h in a /rcom ”
“1 4-00000 SEC. 18. GIVE THREE NEIGHBORS AT YOUR LAST NORMAL RESIDENCE IN THE U.S. — (Give residence and business addresses where possible.) Btreet and Number City State 1. MISS ILGA E. HERRICK BUS. ADD. RES. ADD. 232 BELMONT AV, BRECK TON MASS MRS. FRANK B. YATES 2. Lan”
“14-00000 —0— SEC. 13. NAMES OF 5 PERSONS WHO KNOW YOU SOCIALLY IN THE UNITED STATES. NOT REFER ENCES OR EMPLOYERS—(Give business addresses where possible) 1. NAME: iaQ i. / acciti ADDRESS: .; il. .*., .. icon, ..C. 81. & No.‘ City ‘ State 2. NAME:. .G. J11. ADDRESS: *int”
“GIVE DETAILS INCLUDING TITLES OF DOOKS OR ARTICLES, ALBO WAGs of PuaIPHERS AND PUERICA. TION DATES. Subject wrote articles for "The Western Voice" and the "College of Teachers" Periodical. 25. SPECIAL SKILLS. ABILITIES, HOBBIES SUCH AS RADIO, PHOTOGRAPHY, ETC. Hunting SECTION VII”
“60 (2) d -SEC. 12. EDUCATION DS #63- I :-BALTIMORE, ND, USA „- MODONOGH SChiADERE Sie 1930-34-37 ELEMENTARY SCHOOL - S PIKESVILLE, MD, USA . - City City. diste L • Cmnuy - -DATES ATTENDED 1937-1940 YES I. -QUADUAT?:? - "ry ‘: LOYOLA HIGH, 808 MONTREACH., HIGH SCHOOL”
“h 4-00000 10 FROM TO City or Bection Country Purpose FROM City or Bection Country Purposes FROM TO City or Bection Country Purpose • B. LAST U.S. PASSPORT — NUMBER, DATE, AND PLACE OF ISSUE: NONE HOW MANY OTHER U.S. PASSPORTS HAVE YOU HAD? None GIVE APPROXIMATE ”
“T 15. LIST ALL RESIDENCES FROM 1 JANUARY 1937 MONTH AND YEAR STREET AND NUMBER CITY STATE OR COUNTRY FROM— TO— 1942. 1949 2817 Pine Grove Street Chicago Illinois 1949 1950 Edwards Street Clovis New Mexico 1950 1960 1932 CabrillS Street San Francisco California 1960 1961 ”
“-----------------------------------------2DBi-t-iso-antum 9A- 1 - 1965 .1COOEMPLOYMBND (Ws ad ormiadyeirthday or during last 15 years. whowrea/ Oshorter/ 4100 1959 a. FROM LTO C. EMPLOYER : - d. PLACE Dec 1959 Paul Dler Bookstore San Francisco, Calif. Summer ‘oC San Francisc”
“14-00000 19. Indique lodos los carnets do identidad quo tione, oon fechas, numoros, lugar donde fueron expedidos y fecha hasta que sean validos. US Parspout At Isaned at Buenos Anca; Argentina 20. Religion. Es miembro de alguna orden religiosa? Catholie 21. Afiliaciones ”
“prvetise, r.u wr individual, with officen 3r -he Coral Park nuslefig, until 1 entered military service in 1 4%. ky inecc-e during that period varied Ler ven five !? eirho houssre dcddera. I wer cr setive esty in the . rrfre deree fi Senrrmber 1 -1 o Lecer ler 1945. "Hi’e T *e”
“14-00000 -5/PRO/_ 5 29. (Continued) 30. Has subject done any writing? Give details including titles of books, articles, publishers, dates. Yes, newspaper work generally and playyriting specifically. No plays published but one- Teh Show Job produced, also written under con”
“applicable_________________ -____________ ._____________ DATE OF BIRTH PLACE OF BIRTH CITY STATE ------ Coumray 15 March 1915__ Auburn. New York U,3.A. PRESENT CITIZENSHIP ACQUIRED BY: U.S.A. BIRIHL XI MASRIAGE NATUPALIZALION L== NATURALIZATION NUMBER DATE ISSUED NAME OF CO”
“Sec. le -- C'Pt Idren's Passport Sec. 13. - Obtained diploms From Pittsburgh H.S. while in the Army Through series of examinations given by the School Sec.14. Draft Classification: 4A (Draft-exempt at: present) Duties radioMecz. in 255 and voice Cav.M.P. operator. Trp.: M”
“25. Military service - dates, country, unit, rank, duty, where services performed, decorations, when discharged, why. Give details if ever prisoner of war .B. f 70 12 26. Present and post membership in organisations (professional, social, political, etc.) Lions Clubs. Ame”
“14-00000 SECTION 19. RESIDENCES FOR PAST 19 YEARS "" jacesiss 0%°1%5 FMPAFi7. 7 to th STREET,(itDes Moines Fowt, 48 FROM: :! * A*0 WUME0 f 117 STATE €09€ al * 1941 1943 STATE Counfar 1943 40th ST, De livings, Iowa, USA. FROM: TO: A0FESS STREET AND NUMBER 1944 1041 C”
“14-00000 23* . SECRET ■ ■ • ? IgNenjti tlen 96 ,. SECTION V CONTINUED FROM PAGE 7 "SSaduadogprotifurions o tu nich voe--l,dlaccrovts. NaNt or sty tulpe.n aoglai etrev.* Rigks Net’l Bink Wisconsin nt y St.NW, W shington DG 2, wavt 9.19 vou MAVO vou l,»i« BAN iM. on’ ”
“SECTION XXIV ADDITIONAL INFORMATION 1. DO YOU ADVOCATE OR HAVE YOU EVER ADVOCATED; OR ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF; YES OR HAVE YOU EVER SUPPORTED OR BEEN ASSOCIATED WITH ANY POLITICAL PARTY, INDIVIDUAL OR ORGAN - IZATION WHICH ADVOCATES OR TEACHES THE OVERTH”
“14-00000 10 OCT 1964 TO JAN 1945 NORtHErn Europe WAR SERVICE FROM City or Deetien Country FROMSEP 406yro OCT 1448 TOKYO, SENDAI JAPAN MILOCCUPATION City or Beeston - Country Purpeca FROM TO City or Gestion Country Purpose B. LAST US PASSPORT — NUMBER, DATE, AND PLAC”
“February 1961, #B10331, for a (37 ^period of varying from one day to three weeks to visit Bermuda, Bahamas, Jemica, Trinidad, British Guiana, .Guadeloupe, Barbados and Suriname for the purpose of business. RENEWED: At Miami, Florida on 12 May 1964, for a **go0n***,1 period ”
“14-00000 /T80/ 18. Relatives in service of any government, names and positions held. None. 19. List all official identity papers held with dates, numbers, place of issud U.S. Passport # 34 528 - Issued and duration of validity. Sea1953 Juna. Puerto Ricos 20. Religion”
“AUTHORITY) HOW LOWC? Not Applicable DATE OF BIRTH PLACE OF BIRTH (Iff STATE CouWIPY 1 March 1926 ACQUIRED BY:." PRESENT CITIZENCHIP MASON CITY -* IOWA USA U. S. BIPIH. MAERIAG MALZAL9N C- not apelica ble Not Applicable Not applicable NATURALIZATION CERTIFICATE LOCATI”