“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,”
“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 ”
“....... CAUSE ... NA. PRESENT, Oil LAST, ADDRESS Same as applicant _ (St and Number: (City) (State) (Country) City, Mississippi, DATE OF BIRTH 15 May 1927 PLACE OF BIRTH Morgan(City) «State) UcA ... - (Country) IF BORN OUTSIDE V. S. INDICATE DATE AND PLACE OF ENTRY M C”
“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”
“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. ”
“When was the deceased born? Month. 10 Day 2. In what State or foreign country did the deceased have his fixed, permanent home when he died?! 3. (a) Did the deceased ever serve in 19 military or naval service of the United States? Year Texas 39 Yes No If “Yes,” answer”
“STATE COUNTRY TYPE AND LOCATION OF SERVICE (IF KNOWN) SECTION 9. EDUCATION Tuscaloosa High School Tuscaloosa, Alabama USA. SCHOOL [ADDRESS CITY STATE COUNTRY FROM DEGREE Sept 1940 TO DATES. ATTENDED JUNE 1941 CITY STATE COUNTRY Des Moines, Iowa USA SCHOOL ADDRES”
“BUSINESS FOR I CORRESPONDENCE : • Sa-ooL, OTHER wiTh. . BAYES. SUB:ECTS OF SPECIAL STUDY Aviation CR RESEARCH WORKS VOCATIONAL QUALIFICATIONS LICENSE, CERTIFICATE, ETC. WHAT FOREIGN LANGUAGES DO YOU SPEAK FLUENTLY S: •& READ yes WRITE yos U.S. MILITARY FROM: TYPE OF DI”
“ADDRESS SCHOOL * 00000k CITY STATE COUNTRY Celinn Tennessee USA DATES FROM Y0 DEGREE ATTENDED 1925 1036 SCHOOL Junior andHugh ADDRESS CITY STATE COUNTRY School Liang 8: Tipton Oklahoma USA DATES FROM TO DEGREE ATTENDED. 1926 1936 IS Diploma COLLEGEniversityof ADDRESS C”
“14-00000 I 'UU C: RELATIVES *;« •1* LN COUNTRIES €: (i,n,r A00655 Hone 15. FOREIGN LASGCAG55 (es-pnes :tem :9 on Fo-n $° . :___________ Save and solassie the extent of ynum comrstence, f.c. Excellent, 3 , Pair 8, ng s ■ C. mgite D. SFEN . UNDERS* ND- Spsnich Ereallan”
“1 4-00000 1 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 Tyre ' Place of Lisue Date of Issue / SEC. 2. PHYSICAL DESCRIPTION I Medium 32 Male HEIGHT 6'001 WEIGHT . 185 Gray AOE”
“14-00000 a < 1 I • I SECTION VI _______________________ SPECIAL QUALIFICATIONS AND INTERESTS __________________ 1. INDICATE ANY #RITINO, GIVE DETAILS INCLUDING TITLES or Boons on ARTICLES. At so NAMES or PUBLISHERS AND PUBLICA- TION DATES. Articles 013 Industrial semoe”
“PRESENT, OR LAST, ADDRESS 210 California Avenue, (St. and Nunter) (t.ty+0 - Loland, Mississippi. (State) (CAundy) USA DATE OF BIRTH-1895 PLACE OF BIRTH USA IF BORN OUTSIDE U. S. INDICATE DATE AND PLACE OF ENTRY -... HA_____ CITIZENSHIP J WHEN ACQUIRED?.... Birth _WHERE? _”
“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”
“1 4-00000 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 TIN Place or Issue Date of Issue SEC. 2. PHYSICAL DESCRIPTION AGE 24 SEX male HEIGHT 5'11'1 WEIGHT 165 EYES HAIR COM”
“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”
“(Clty) • State (Country) US DATE OF BIRTH Nov. 20,..126PLACE OF BIRTH Rock Springs, “yoming. USA . (Cl) Stele) (Country) IF BORN OUTSIDE C. S. INDICATE DATE AND PLACE OF ENTRY NA CITIZENSHIP USA ____ WHEN ACQUIRED - Birth............WHERE? ... : . • icu (State) (Country) ”
“FROM TO FROM June'to Fib'+g 620 Arlington St. Tamaquay Pa., ol.S.A. TO State Country FROM FROM Oct 42 June 46 Militar 1039 TO. 172 TO 207 y LehiServi g h S c t e ., - Tome Tamaqua, address Pr., sume U.S.A. as above 12265 1935 104 Lehigh St., Tamuyus, Pr. 3.”
“13-00000 D. % D. Legal Matters 1. Have you ever been disciplined or cited for a breach of ethics for unprofessional conduct by, or been the subject of a complaint to any court, administrative agency, professional association, disciplinary committee, or other professional ”
“OCCUPATION — LAST EMPLOYER t mIPLOYER’s OR BUSINESS ADDRESS -__ .__ **m .3 127 15 r6 GL & NO .. ;. CUy 3. + State. Country >.5 -n’e MILITARY SERVICE FROM -_TO. BRANCH OF SERVICE- . . Date #r . . - Date COUNTRY - DETAILS OF OTHER GOVT. SERVICE, vs. oz.rorGN”
“STATE May64 Sep66 905 E. 167 St. Bronx NY Sep66 May68 1201 University Ave. in response to Bounxeguest NY May68 Pres On post residence there are attached reports which gnnear { 0 prelate to the, sub 4.& quiry. FATHER 14. EMPLOYMENT (List all from 18th birthday or during pa”
“LIVING 4- DATE OF DEATH 9. CAUSE CF DEATH FOR Xlves so NA Nili”IA To*for 10. CURRENT ADDRESS (Give last address, il deceased) ■ 2121 Virginia Ave NW, Washington 7, D.C. quRirS..N.C 5 15 AUG 1958. sr. DATE OF BIRTH 12. PLACE OF BIRTH ( City. State, Country) DAsE 3 9/9/34 Cold ”
“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”
“21. MILITARY STATUS a. IF YOU HAVE BEEN I* THE ARMED FORCES on ‘* THE MERCHANT WA- L. SERY’CE 09 *9981 nc RIME IN WHAT SERVICE AND BRANCH DIC YOU SERVER (w.g. v.s. drey. Field Artillery) U. S. Marine Corps 0,7506 C. DATE OF ENTRY ON ACTIVE DUTY d. RATE 05 RANK AT TIME OF e. ”
“13-00.000 2. Have you ever been investigated, arrested, charged or held by any Federal, State, or other law enforcement authority for violation of any Federal, State, county or municipal law, t regulation or ordinance, other than a minor traffic offense? If so, provide detail”
“14-00000 PERSONAL RECORD QUESTIONNAIRE PART 1 - BIOGRAPHICAL INFORMATION INSTAUCT:OuS:1. 4e,te leaely.nneeenn 2. insoer ell muestrons. If question s 0 not applicable, write *N4” y. Attach blank noseq. ol si.fitionl vnace , % needed. SECTION 1 GENERAL PERSONAL AND PHYSICAL”
“CITIZENSHIP - WHEN ACQUIRED? _ WHERE? City State OCCUPATION LAST EMPLOYER -CON $”
“France Sept 1960 Aug 1962 312 Enmond Place Alexandria Va 22514 i‘1058 Cure *0. Feo 1955 10 ,9 -., Toi J UNITED STATES CITIZENSHIP. 10 SOCIAL SECURITY No 1 INDICATE WHETHER: - - 042 20 5339 - . (AMBY BIRTH [ ' (9) NATURALIZATION 11; MILITARY SERVICE (P. st or present) ..(”
“4-00000 6 SEC. 12. EDUCATION - , ELEMENTAL: S m.OL Chine Inland Mission’s: . , . ■ Public Public School School DATES ATTENDED _______ GRADUATE e* China 1 . 1925 - 1929 ADDRESS _ HIGH SCHOOL _ Yes. DATES ATrbsD ina Inland Mission GRADRiCo, Shantung, . China . S. ,”
“BIOGRAPHIC DATA CONTAINED THEREIN WAS IDENTICAL TO (S) 6E CRE -3- NW 50953 DocId: 32340852 Page 4”
“14-00000 , -3- . . 16. Describe your prosont physical condition, and state whether you have ung physical defect or infinity. Is your health and physical- condition such that you can serve in any cli-nto? (The right is reserved to ruquire the applicant to submit to a medica”
“1 4-00000 (6) SEC. 12. POSITION DATA A. KIND OF POSITION APPLIED FOR Administrative position with Latin America, Economist, Statistician, or temporarily as a _Stanographer.......................... ............. :.............................. B. WHAT IS THE LOWEST ANNUA”
“14-00000 SECTION VI SPECIAL QUALIFICATIONS AND INTERESTS 24.INDICafI ANY BRIIING. Clvf ui farLt INCLUDING TITLES 01 800*3 on ARTICLES. ALSO NAMES or Pom ISuERS as: ruscICl- TiOm Varts. / 25.SPFCIAL SKILL S, ABILITIES, momuifs SUCH AS 94010, PHOTOGRAPHY, ETC. One SECTIO”
“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”
“LIVING 0. DATE OF DEATH 9. CAUSE OF DEA TH X "49 NO NA NA 10. CURRENT ADDRESS (Gave last address, if deceased) 5145 Rexton Lane, Dallas, Texas 1 . DATE OF BIRTN 12. PLACE OF BIRTH (Caty. State, Country) 28 Nov 1919 Houston, Texas 13. IF BORN OUTSIDE U.S -DATE OF ENTRY 14”
“ans Loulei-n 8 I.S.A 10 7967 racsu TIME 2694 nB a 7966 Fox 1967 1931 Fers. 2037 G. Street Pershing & a 7 964, Jul 1966 4009Blbs 9 a 1, If. Dane 196A 960 Aua. 968 2036 Rousseau St. 19 / 2 982 Se n—A. 1962 1. 1 LAST FOREIGN RESIDENCE OF MORE THAN ONE YEAR IF NOT SHOWN A”
“- • 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”
“14-00000 NT I (Continued) ranking ceprec 0a. ive- 3. Denartten i. of tint tc: at that pom. of 1: ferpat ion of interes : ia as I te ircedent 0* 1a.s of the United States cColob has :itl LCrs requerg liars wee; Covernment of the wilic vi Co tom . a c s Pepartneac c:. ecai”
“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”
“(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”
“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”
“DATE or DECEASE CAUSE 9/11/90 Route H 2, Wausau WIS., U.S.A. PRESENT, OR LAST, ADDRESS Town of Easton, Wis Sta No City Country DATE OF BIRTH. PLACE OF BIRTH Not Applicable IF BORN OUTSIDE U.S. INDICATE DATE AND PLACE Or ENTRY CITIZENSHIP WHEN ACQUIRED? WHERE? - City”
“Dallas, Texas." His service Serial Number is listed as AF 25988326; Social Security #463 62 2151; married Barbara Watson (dob 10-13-44) 8-28-66 in Wichita Falls, Texas, changing their residence to 3736 Glencoe, Apartment #117, Dallas, Texas 75206 (later moved to Apartment #2”
“SCHOOL GRADUATE OVER TWO YEARS OF COLLEGE - NO DEGREE HIGH SCHOOL GRADUATE BACHELOR’S DEGREE TRADE. BUSINESS. OR COMMERCIAL SCHOOL GRADUATE GRADUATE STUDY LEADING TO HIGHER DEGREE TWO YEARS COLLEGE OR LESS MASTER’S DEGREE DOCTOR’S DEGREE 2. ELEMENTARY SCHOOL 1. NAME OF ELEM”
“Eyes Blue Scars "V" shape scar inside left ring finger i Social Security No. 082-38-0042 Occup a tion Student entering junior year, Marymount College, Tarrytown, N. Y. (attended since Sept. 1969) 8/22/71 On SA WTDT2M J. 31/ad ct. Camden, NT. J. Filo Pbiindelists 52-7”
“-00000 SECTION VIII CONTINUED FROM PAGE 4 4. ARE YOU NOW OR HAVE YOU EVER BEEN A LICENSED OR CERTIFIED MEMBER OF ANY TRADE OR PROFESSION, SUCH AS PILOT, ELECTRICIAN, RADIO OPERATOR, TEACHER, LAWYER, CPA, MEDICAL TECHNICIAN, ETC.’,__ , LYes X]No S. IF YOU HAVE ANSWERED "YES””
“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. ”
“OR USE IN INDIVIDUAL PARAGRAPH EVALUATION FAIRLY RELIABLE OF SOURCE: 6615 Latta Street RECEIVED FROM COMPLETELY RELIABLE Dallas, Texas USUALLY RELIABLE NOV-1954 Formerly Pfc, RA 18 323 0892 J.F.S. RELIABILITY UNKNOWN SUMMARY OF INFORMATION NOT USUALLY RELIABLE UNRELIABLE. OF INFO”
“14-00000 2 E. IF BORN OUTSIDE U.S. WHEN DID YOU FIRST ARRIVE IN THIS COUNTRY? PORT OF ENTRY? ___ 1 ON PASSPORT OF WHAT COUNTRY? LAST U.S. VISA Numiter Type Place of Lnsite Date of Issue SEC. 2 PHYSICAL DESCRIPTION AGE __ 30 SEX Male HEIGHT 51 10 1/2" WEIGHT __ 168. ”
“14-00000 $;--• SECTION VIII CONTIN LED FROM PAGE 4 4. ARE rou NOW OR MAVE You EVER BEEN A LICENSED on CERTIFIED MEMBER oF ANY TRADE OR PROFESSION, SUCH AS PILOT. ELECTRICIAN. RADIO OPERATOR, TEACHER, LAWYER, CPA. ME DICAL TECHNICIAN, ETC." _* |YEs X.NO S. IF YOU HAVE ANSW”