[104-10129-10002.pdf — page 0]
# 2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992PERSONAL HISTORY STATEMENTINSTRUCTIONSTHIS DATE (Fill In) AUGUST 31, 19611.  Answer all questions completely or check appropriate box. If question is not applicable, write "NA". Write "Unknown" only if you do not know the answer and it cannot be obtained from personal records. Use blank space at end of form for extra details on any question for which you have insufficient space.2.  Type, print or write carefully; illegible or incomplete forms will not receive consideration.3.  Consider your answers carefully. Your signature at the end of this form will certify to their correctness. Careful completion of all applicable questions will permit review of your qualifications to the best advantage.SECTION I GENERAL PERSONAL AND PHYSICAL DATA| 1. FULL NAME (Last-First-Middle) | 2. AGE                   | 3. SEX           |                  |                    |               || -------------------------------- | ------------------------ | ---------------- | ---------------- | ------------------ | ------------- || RODRIGUEZ, EMILIO AMERICO        | 33 YEARS 8 MONTHS X MALE | FEMALE           |                  |                    |               || 4. HEIGHT                        | 5. WEIGHT                | 6. COLOR OF EYES | 7. COLOR OF HAIR | 8. TYPE COMPLEXION | 9. TYPE BUILD || 5FT. 10IN.                       | 150 lbs.                 | BROWN            | BLACK            | RUDDY              | MEDIUM        |10. SCARS (Type and Location)NONE11. OTHER DISTINGUSHING PHYSICAL FEATURESNONE| 12. CURRENT ADDRESS (No., Street, City, Zone, State and Country) | 13. PERMANENT ADDRESS (No., Street, City, Zone, State and Country) AND PHONE NO. |                                                   || ---------------------------------------------------------------- | -------------------------------------------------------------------------------- | ------------------------------------------------- || 9361 S.W. 178 ST. PERRINE 57, FLA. U.S.A.                        | 9361 S.W. 178 ST. PERRINE 57, FLA. U.S.A. PHONE: (CEDAR 5-8341)                  |                                                   || 14. CURRENT PHONE NO.                                            | 15. OFFICE PHONE NO. & EXT.                                                      | 16. LEGAL RESIDENCE (State, Territory or Country) || CEDAR 5-8341                                                     | NA.                                                                              | FLORIDA U.S.A.                                    || 17. NICKNAMES                                                    | 18. OTHER NAMES YOU HAVE USED                                                    |                                                   || NONE                                                             | EUGENIO GONZALEZ                                                                 |                                                   |19. INDICATE CIRCUMSTANCES (Including Length of Time) UNDER WHICH YOU HAVE EVER USED THESE NAMES.FROM APRIL 1960 TO PRESENT IN HAVANA, CUBA AND MIAMI, FLA. AS UNDERCOVER NAME20. IF LEGAL CHANGE, GIVE PARTICULARS (Where and by What Authority).N.A.SECTION II POSITION DATA1.  INDICATE THE TYPE OF WORK OR POSITION FOR WHICH YOU ARE APPLYINGCONTRACT AGENT| 2. INDICATE THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL ACCEPT (You will not be considered for any position with a lower entrance salary). | 3. DATE AVAILABLE FOR EMPLOYMENT || ----------------------------------------------------------------------------------------------------------------------------------------- | -------------------------------- || $ 9,600.00                                                                                                                                | CONTRACT ALREADY SIGNED          || 4. INDICATE YOUR WILLINGNESS TO TRAVEL                                                                                                    |                                  || OCCASIONALLY FREQUENTLY X CONSTANTLY OTHER:                                                                                               |                                  |5. INDICATE YOUR WILLINGNESS TO ACCEPT ASSIGNMENT IN THE FOLLOWING LOCATIONS (Check (X) each item applicable)WASHINGTON, D.C. X ANYWHERE IN U.S. X CERTAIN LOCATIONS ONLY (Specify):OUTSIDE CONTINENTAL U.S. X6. INDICATE WHAT RESERVATIONS YOU WOULD PLACE ON ASSIGNMENTS OUTSIDE THE WASHINGTON, D.C. AREA.ADEQUATE PAY AND LIVING CONDITIONS FOR SELF AND FAMILY