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# SECTION XVII1. FULL NAME (Last-First-Middle)(Arnett, Carl Raymond) 065. STATE OTHER NAMES HE HAS USEDRayFATHER-IN-LAW2. LIVING*YES* NO3. DATE OF DEATH4. CAUSE OF DEATHINDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH HE HAS EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS FORM TO RECORD THIS INFORMATION.6. CURRENT OR LAST ADDRESS (No., Street, City, State, Country) 08(4505 Washington St., Milwaukie, 22) Oregon7. DATE OF BIRTHJanuary 2, 19098. PLACE OF BIRTH (City, State, Country)Minot, North Dakota9. CITIZENSHIPU.S. of America10. IF BORN OUTSIDE U.S. - DATE OF ENTRYNA11. PLACE OF ENTRYNA12. FORMER CITIZENSHIP(S) (Country(ies))NA13. DATE U.S. CITIZENSHIP ACQUIREDNA14. WHERE ACQUIRED (City, State, Country)NA15. OCCUPATIONWarehouse Foreman16. PRESENT EMPLOYER (Give last employer, il Father-in-Law is deceased or unemployed)(Rudy Wilhelm Inc), Portland, Oregon# SECTION XVIII1. FULL NAME (Last-First-Middle)(Tompkins, Alma Dean) 065. STATE OTHER NAMES SHE HAS USEDAlma Dean Arnett 06MOTHER-IN-LAW2. LIVING*YES* NO3. DATE OF DEATH4. CAUSE OF DEATHINDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH SHE HAS EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS FORM TO RECORD THIS INFORMATION.6. CURRENT OR LAST ADDRESS (No., Street, City, State, Country) 08(13920 S.E. Portland View Place, Portland 36,) Oregon7. DATE OF BIRTHMay 4, 19108. PLACE OF BIRTH (City, State, Country)Portland, Oregon9. CITIZENSHIPU.S. of America10. IF BORN OUTSIDE U.S. - DATE OF ENTRYNA11. PLACE OF ENTRYNA12. FORMER CITIZENSHIP(S) (Country(ies))NA13. DATE U.S. CITIZENSHIP ACQUIREDNA14. WHERE ACQUIRED (City, State, Country)NA15. OCCUPATIONHomemaker16. PRESENT EMPLOYER (Give last employer, if Mother-in-Law is deceased or unemployed)NA# SECTION XIXRELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (1) LIVE ABROAD, (2) ARE NOT U.S. CITIZENS OR (3) WORK FOR A FOREIGN GOVERNMENT| 1. FULL NAME (Last-First-Middle)                | 2. RELATIONSHIP         | 3. AGE                  || ----------------------------------------------- | ----------------------- | ----------------------- || None to my knowledge                            |                         |                         || 4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES | 5. EMPLOYED BY          | 8. DATE OF LAST CONTACT ||                                                 |                         |                         || 6. CITIZENSHIP (Country)                        | 7. FREQUENCY OF CONTACT |                         || 1. FULL NAME (Last-First-Middle)                | 2. RELATIONSHIP         | 3. AGE                  || ----------------------------------------------- | ----------------------- | ----------------------- ||                                                 |                         |                         || 4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES | 5. EMPLOYED BY          | 8. DATE OF LAST CONTACT ||                                                 |                         |                         || 6. CITIZENSHIP (Country)                        | 7. FREQUENCY OF CONTACT |                         || 1. FULL NAME (Last-First-Middle)                | 2. RELATIONSHIP         | 3. AGE                  || ----------------------------------------------- | ----------------------- | ----------------------- ||                                                 |                         |                         || 4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES | 5. EMPLOYED BY          | 8. DATE OF LAST CONTACT ||                                                 |                         |                         || 6. CITIZENSHIP (Country)                        | 7. FREQUENCY OF CONTACT |                         || 1. FULL NAME (Last-First-Middle)                | 2. RELATIONSHIP         | 3. AGE                  || ----------------------------------------------- | ----------------------- | ----------------------- ||                                                 |                         |                         || 4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES | 5. EMPLOYED BY          | 8. DATE OF LAST CONTACT ||                                                 |                         |                         || 6. CITIZENSHIP (Country)                        | 7. FREQUENCY OF CONTACT |                         |# SECTION XIX CONTINUED TO PAGE 13