Francesco/who-killed-jfk huggingface dataset:
[104-10162-10247.pdf — page 11]
# SECRET-11-k. Subject is aware that the story of his *"imigration"* to the USA is also weak. He tried to explain this away by stating that he *"got cut by mistake"*, that he was permitted to go *"to hide the Soviet shame surrounding the Cuban crisis"*, that *"someone had committed an error"*, etc. He admitted that there exists no other explanation as to why the Soviet government would have permitted him to leave the USSR as, in the eyes of the Soviet government, he was a full fledged and responsible Soviet citizen who had no genuine or legitimate claim to American citizenship. As a result, Subject is unusually sensitive to this topic.5. CONCLUSION:a. In the opinion of the undersigned, Subject should not be considered for either ABSCREEN or ABEXPLORE despite the fact both his English and Russian are native.b. On the basis of the interview, the undersigned feels that, Subject is less than frank and that he is prevaricating. Moreover, there exist innumerable items in Subject's tale which are indicative both that he worked as a recruited agent of the KGB (and its predecessor organizations) in the USSR and that he left the USSR only through and with the intercession of the KGB.6. It should be underscored that because of the unique and sensitive cover used by the undersigned, no attempt was made to resolve the various contradictions, to challenge Subject on any of his statements, or to pursue certain points of their logical conclusion. The foregoing was obtained in the form of an interview and no real attempt could be made, given the cover, to delve more deeply into the suspicious aspects of Subject's background.![signature of PETER P. KAPUSTA]PETER P. KAPUSTAChief, SR/O/AC# SECRET
[104-10162-10247.pdf — page 12]
# PERSONAL HISTORY STATEMENTINSTRUCTIONS1. 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 an end of form in 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 DATA1. NAME (Last, First, Middle) A. ARCHER2. AGE 463. SEXX MALEFEMALE4. HEIGHT 6'00"5. WEIGHT 195#6. COLOR OF EYES blue7. COLOR OF HAIR brown8. TYPE COMPLEXION light9. TYPE BUILD heavy10. SCARS (Type and Location) Deep scar (1"x2") on left part of forehead11. OTHER DISTINGUISHING PHYSICAL FEATURES None12. CURRENT ADDRESS (No., Street, City, Zone, State and Country) 260 Marshall Court, Long Branch, New Jersey13. PERMANENT ADDRESS (No., Street, City, Zone, State and Country) 260 Marshall Court, Long branch, New Jersey. Tel:201-222-559214. CURRENT PHONE NO. 201-222-359215. OFFICE PHONE NO. & EXT. LE2-070016. LEGAL RESIDENCE (State, Territory or Country) New Jersey17. NICKNAMES None18. OTHER NAMES YOU HAVE USED None19. INDICATE CIRCUMSTANCES (Including Length of Time) UNDER WHICH YOU HAVE EVER USED THESE NAMES. NA20. IF LEGAL CHANGE GIVE PARTICULARS (Decree and by What Authority). NA## SECTION II POSITION DATA1. INDICATE THE TYPE OF WORK OR POSITION FOR WHICH YOU ARE APPLYINGRussian language linguist2. INDICATE THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL ACCEPT (You will not be considered for any position with a lower entrance salary). $10,000 annually3. DATE AVAILABLE FOR EMPLOYMENT 2 weeks after4. INDICATE YOUR WILLINGNESS TO TRAVELX OCCASIONALLYFREQUENTLYCONSTANTLYOTHER:5. INDICATE YOUR WILLINGNESS TO ACCEPT ASSIGNMENT IN THE FOLLOWING LOCATIONS (Check as many as apply):   WASHINTON, D.C.   X ANYWHERE IN U.S.   OUTSIDE CONTINENTAL U.S.   CERTAIN LOCATIONS ONLY (Specify):6. INDICATE WHAT RESERVATIONS YOU WOULD PLACE ON ASSIGNMENTS OUTSIDE THE WASHINGTOPossibility of schooling for children
[104-10162-10247.pdf — page 13]
# SECTION III CITIZENSHIP1. CATE OF BIRTH 2. PLACE OF BIRTH (City, State, Country)   Dec.4, 1917 Brooklyn, New York4. CITIZENSHIP ACQUIPED BYBIRTH MARRIAGE OTHER (Specify):7. COURT ISSUING NATURALIZATION CERTIFICATENA3. PRESENT CITIZENSHIP (Country)   U. S. A.5. CATE NATURAL- 6. NATURALIZATION CERTIFICATE NO.   IZED   NA   NA8. ISSUED AT (City, State, Country)   NA9. HAVE YOU HELD PREVIOUS NATIONALITY 10. IF YES, GIVE NAME OF COUNTRYYES NONA11. GIVE PARTICULARS CONCERNING PREVIOUS NATIONALITY. While I was living in Moscow, the Russian government considered me as a Russian citizen, even though I had never handed in an application for Soviet citizenship. Due to this, and because I was in a rush to leave the country, I arrived xxx on a Soviet foreign passport. In the U. S. Embassy in Moscow I filled in simultaneously two applications for entry into the U. S. A. : one as an immigrant and the other as an American citizen. I received a Nonquota K-2(1) visa dated Sptember 10, 1952. After arrival the Board of Appeals of the Dept. of State reinstated my native-born citizenship.12. HAVE YOU TAKEN STEPS TO CHANGE 13. GIVE PARTICULARS    PRESENT CITIZENSHIP    YES    NO14. IF YOU HAVE APPLIED FOR U.S. CITIZENSHIP, WHAT IS PRESENT STATUS OF YOUR APPLICATION (First Papers, Etc.)?NA15. DATE OF ARRIVAL IN U.S. 16. PORT OF ENTRY 17. PRESENT CITIZENSHIP OF WHAT COUNTRY    Sept. 26, 1952 N. Y. U. S. S. R.18. LAST U.S. VISA (No., Type, Place of Issue) 19. DATE VISA ISSUED    K-2(1), Moscow, U. S. S. R. Sept. 10, 1952# SECTION IV EDUCATION1. CHECK (X) HIGHEST LEVEL OF EDUCATION ATTAINEDLESS THAN HIGH SCHOOL GRADUATE OVER TWO YEARS OF COLLEGE - NO DEGREEHIGH SCHOOL GRADUATE X BACHELOR'S DEGREETRADE BUSINESS OR COMMERCIAL SCHOOL GRADUATE GRADUATE STUDY LEADING TO HIGHER DEGREETWO YEARS COLLEGE OR LESS DOCTOR'S DEGREE2. ELEMENTARY SCHOOL1. NAME OF ELEMENTARY SCHOOL 2. ADDRESS (City, State, Country)   P. S. 39 Bronx, N. Y.3. DATES ATTENDED (From-and-To) 4. GRADUATE   1928 to 1932 YES NO3. HIGH SCHOOL1. NAME OF HIGH SCHOOL 2. ADDRESS (City, State, Country)   No. 327 Moscow, U. S. S. R.3. DATES ATTENDED (From-and-To) 4. GRADUATE   1934 to 1936 YES NO1. NAME OF HIGH SCHOOL 2. ADDRESS (City, State, Country)   NA NA3. DATES ATTENDED (From-and-To) 4. GRADUATE   NA YES NO4. COLLEGE OR UNIVERSITY STUDY| NAME AND LOCATION OF COLLEGE OR UNIVERSITY | SUBJECT  | DATES ATTENDED | DEGREE REC'D | CATE REC'D | SEM. QTR. HOURS (Specify) || ------------------------------------------ | -------- | -------------- | ------------ | ---------- | ------------------------- || Moscow Automobile & Highway Institute      | MAJOR CB | FROM 1936      | TO 1941      | BS         | 1941                      || Moscow, U. S. S. R.                        | MINOR    |                |              |            |                           |SECTION IV CONTINUED TO PAGE 5
[104-10162-10247.pdf — page 15]
# SECTION VI GEOGRAPHY: AREA KNOWLEDGE AND FOREIGN TRAVEL1. LIST BY GEOGRAPHICAL AREA (E.G. REGIONS OR COUNTRIES) THE AREAS TO WHICH YOU HAVE GAINED KNOWLEDGE AS A RESULT OF RESIDENCE, TRAVEL OR WORK ASSIGNMENT. INDICATE IF KNOWLEDGE WAS GAINED AS A RESULT OF RESIDENCE, TRAVEL STUDY ABROAD, WORK ASSIGNMENT, MILITARY DUTY OR OTHER MEANS (SPECIFY). LIST ALL REGIONS, PROVINCES, POLITICAL PARTS, ETC.| NAME OF REGION OR COUNTRY    |     |     |     |     || ---------------------------- | --- | --- | --- | --- || TYPE OF KNOWLEDGE            |     |     |     |     || DATES OF RESIDENCE OR TRAVEL |     |     |     |     || DATES AND PLACE OF STUDY     |     |     |     |     || RESIDENCE                    |     |     |     |     || TRAVEL STUDY                 |     |     |     |     || WORK ASSIGNMENT              |     |     |     |     || Moscow, U.S.S.R.             |     |     |     |     || acquainted with              |     |     |     |     || 1935 to 1942                 |     |     |     |     ||                              |     |     |     |     || X                            |     |     |     |     ||                              |     |     |     |     || town and environs            |     |     |     |     || as per arent resident        |     |     |     |     ||                              |     |     |     |     |2. INDICATE THE PURPOSE OF VISIT, RESIDENCE, OR TRAVEL IN EACH OF THE REGIONS OR COUNTRIES LISTED ABOVE. Arrived in U.S.S.R. together with parents during crisis and remained to graduate college in 1937. Impossible to leave during WW II and only after seven years of repeated applications was allowed to leave, in 1952.3. UNITED STATES PASSPORT NUMBER AND EXPIRATION DATE IF ISSUED.NA# SECTION VII TYPING AND STENOGRAPHIC SKILLS1. TYPING| WORDS PER MINUTE |     |     |     || ---------------- | --- | --- | --- || 10-15            |     |     |     || GREGG SHORTHAND  |     |     |     || SPEEDWRITING     |     |     |     || STENOTYPE        |     |     |     || OTHER 'Specify': |     |     |     |2. INDICATE OTHER BUSINESS MACHINES ON WHICH YOU HAVE HAD OPERATING EXPERIENCE OR TRAINING 'Comptometer,   Micrograph, Card Punch, etc.'   calculators# SECTION VIII SPECIAL QUALIFICATIONS1. LIST ALL HOBBIES AND SPORTS IN WHICH YOU ARE ACTIVE OR HAVE ACTIVELY PARTICIPATED. INDICATE YOUR PROFICIENCY IN EACH:chess - average proficiency.swimming - for pleasure2. INDICATE ANY SPECIAL QUALIFICATIONS RESULTING FROM EXPERIENCE OR TRAINING WHICH MIGHT FIT YOU FOR A PARTICULAR POSITION OR TYPE OF WORK. On the basis of my twenty years of experience I could manage, edit and translate information in the field of CA and NZ, published in Russian, or vice versa.3. EXCLUDING BUSINESS EQUIPMENT OR MACHINES WHICH YOU MAY HAVE LISTED IN ITEM 2, SECTION VII. LIST ANY SPECIAL SKILLS YOU POSSESS RELATING TO OTHER EQUIPMENT AND MACHINES SUCH AS OPERATION OF SHORTWAVE RADIO (Indicate Code speed, sending and receiving.) OFFSET PRESS, TURRET LATHE, SCIENTIFIC AND PROFESSIONAL DEVICES.NASECTION VIII CONTINUED TO PAGE 5
[104-10162-10247.pdf — page 17]
# SECTION IX CONTINUED FROM PAGES1. INCLUSIVE DATES (From and To - By Mo. and Yr.)   Nov., 1952 to Dec., 19622. NAME OF EMPLOYING FIRM OR AGENCY   Steeling, Lord-Wed and Van Suetendale3. ADDRESS (No., Street, City, State, Country)   35 E. 20 St.4. KIND OF BUSINESS   Site planning5. NAME OF SUPERVISOR   Frank McGowan6. TITLE OF JOB   Jun. CE7. SALARY OR EARNINGS   $150 per week8. CLASS GRADE (If Federal Service)   NA9. DESCRIPTION OF DUTIES   Grading, site planning for high schools10. REASONS FOR LEAVING    Improving possibilities of further advancement---1. INCLUSIVE DATES (From and To - By Mo. and Yr.)   1952 to Sept., 19622. NAME OF EMPLOYING FIRM OR AGENCY   U.S.S.R. Chamber of Commerce3. ADDRESS (No., Street, City, State, Country)1. Kuibysheva 6, Moscow, U.S.S.R.4. KIND OF BUSINESS   Foreign trade5. NAME OF SUPERVISOR   Miss Postnova6. TITLE OF JOB   Free-lance translator and editor7. SALARY OR EARNINGS   $333 per month8. CLASS. GRADE (If Federal Service)9. DESCRIPTION OF DUTIES   Reports for International Congresses, trade publications, manuals, dam projects, road-building and construction machinery manuals, articles on building materials, metallurgy. (Russian to English)10. REASONS FOR LEAVING    Repatriation---1. INCLUSIVE DATES (From and To - By Mo. and Yr.)   1956 to Sept., 19622. NAME OF EMPLOYING FIRM OR AGENCY   Foreign Trade Publishing House3. ADDRESS (No., Street, City, State, Country)   Moscow, U. S. S. R.4. KIND OF BUSINESS   Foreign trade5. NAME OF SUPERVISOR   Mr. Kedvedyev6. TITLE OF JOB   Free-lance translator and editor7. SALARY OR EARNINGS   $300 per month8. CLASS. GRADE (If Federal Service)9. DESCRIPTION OF DUTIES   Trade publications, road-building and construction machinery manuals. (Russian to English)10. REASONS FOR LEAVING    Repatriation---1. INCLUSIVE DATES (From and To - By Mo. and Yr.)   Jan., 1956 to Aug., 19582. NAME OF EMPLOYING FIRM OR AGENCY   Scientific-Research Institute of Construction & Road-Building Machinery3. ADDRESS (No., Street, City, State, Country)   Frunze Embankment, house No. unknown, Moscow, U.S.S.R..4. KIND OF BUSINESS   Machinery research and foreign trade5. NAME OF SUPERVISOR   Ir. Ratner6. TITLE OF JOB   Senior engineer7. SALARY OR EARNINGS   $130 per month8. CLASS. GRADE (If Federal Service)SECTION IX CONTINUED TO PAGE 7
[104-10162-10247.pdf — page 18]
SECTION IX CONTINUED FROW PAGE 69. DESCRIPTION OF DUTIESSupervision of five translators. Head of tra slators Bureau. Kanagement, editing and translating from Russian to English of construction and road-building machinery manuals, trade publications.10 REASONS FOR LEAVINGCompletion of translations into English1. INCLUSIVE DATES (From B. Mo. and Yr)Mar., 1950 to Feb.,19552 NAME OF EMPLOYING FIRM OF AGENCYBauman Boro Road Repair Dept.3 ADDRESS (No. Street City Stame Castery)Spartakovsky Ul. 9, Moscow, U. S. S. R.4. KMC BUSINESSRoad & sewer maintenance5. NAME OF SUPERVISORFr. Artamonov6. TITLE OF JODSenior engineer7. SALARY OR EARNINGS100 per month8. CLASS. GRADE (If Pederel Service)9. DESCRIPTION OF DUTIESEngineering supervision of repair jobs, surveying, designing of small streets and sewers, planning, contact with factories for paving jobs, estimates.10. REASONS FOR LEAVINGReduction of forces1. INCLUSIVE DATES (From B. Mo and Yr)July 1949 to Feb.195012. NAME OF EMPLOYING FIRM OR AGENCYHighway construction Dept.3 ADDRESS (No. Street. City. State, Country)Warsaw Highway, house No. unknown, Koscow, J. S. S. R.4. KIND OF BUSINESSManulactre of concrete5. NAME OF SUPERVISORDo not remember6. TITLE OF JOBLaboratory assistant7. SALARY OR EARNINGS60 PERmonto2. CLASS. GRADE II Faceral Service)8. DESCRIPTION OF DUTIESLaboratory testing of concrete and concrete components.10 REASONS FOR LEAVINGReduction of forcesE. IF PRIOR SERVICE BITH THE FEDERAL GOVERNMENT IS NOTED ABOVE, INDICATE THE NUMBER OF YEARS CREDITABLE TOWARD U.S. CIVIL SERVICE RETIREMENT. IF KNOWN.NA8. MADE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN FROM ANT POSITIONYES NO9. HAVE YOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH YOU DESIRE TO EXPLAINYES NOIF YOUR ANSWER TO EITHER OR BOTH QUESTIONS IS "YES", GIVE DETAILS
[104-10162-10247.pdf — page 20]
Section XII3. Nina Shchogoleyva Ecisejeva4. None5. Apr. 12, 19406. Moscow, USSR7. 12 Bolshaya Pionerskaya, Moscow, USSR8. Unknown 9. NA 10. NA11. 12. 1915 13. Moscow, USSR 14. USSR    14 to 25 - NA3. Eugenie Volsova4. None5. 19506. Moscow, USSR7. Dormitories of Medical College8. Unknown 9. NA 10. NA11. Unknown12. 1924    14 to 25 - NA 13. Moscow, USSR 14. USSR3. Rose Minkina Arron4. None5. 1954 6. Moscow, USSR7. Station Taininskaya, Pogranichnaya Ul. 9, Moscow Province, USSR8. Deceased 9. Mar. 24, 1961 10. Blood clot in brain11. 29 Pyatritskaya Ul., Moscow, USSR12. 1924 13. Unknown 14. USSR    14 to 25- NA
[104-10162-10247.pdf — page 22]
# SECTION XII CONTINUED FROM PAGE 914. IF BORN OUTSIDE - S - CATE OF ENTRY    July 15, 194916. FORMER CITIZENS:P.5) "Countryf bes"    Displaced person19. OCCUPATION    Housewife15. PLACE OF ENTRY    New York17. DATE U.S. CITIZENSHIP 18. WHERE ACQUIRED (City, State, Country)    ACQUIRED    May 16, 1955 Freehold, New Jersey20. PRESENT EXPLOYER (Also give toemer amployes, or if spouse Aceased or unemployed give last two ergicyers)    NA21. EMPLOYER'S CABESS ADDRESS (No. Street. City. Stase. Country)22. DATES OF MILITARY SSACE (From end to - 3y 100. and Yr)23. BRANCH OF SERVICE    NA24. COUNTRY WITH WHICH MILITARY SERVICE AFFILIATED    NA25. CETAILS OF OTHER GOVERNMENT SERVICE. U.S. CR FOREIGN# SECTION XIII CHILDREN AND OTHER DEPENDENTS1. PROVIDE THE FOLLOWING INFORMATION FOR ALL CHILOPEN AMO DEPENDENTS| NAME            | FELATIONSHIP | CATE AND PLACE OF SOTH           | CITIZENSHIP | ADDRESS                         || --------------- | ------------ | -------------------------------- | ----------- | ------------------------------- || Bella Anron     | wife         | Poland, 1927                     | U. S. A.    | 200 Marshall St. Long Branch, J || Michael Aaron   | son          | Moscow, USSR, April 4, 1955      | U. S. A.    | Same                            || Joe Kincberg    | son          | Bielefeld, Germany June 26, 1949 | U. S. A.    | Same                            || Steven Mincberg | son          | Long branch, .... June 20, 1957  | U. S. A.    | Same                            |2. NUMBER OF CHILDREN 'Including step- children and adopted WHO ARE UNMARRIED. UNDER 215. OF AGE. AND NOT SELF-SUPPORTING.   33. NUMBER OF OTHER DEPENDENTS Including spoшее, parente, ecep-perenza, saser, etc.) WHO DEРЕЧО ОЧ YOU FOR AT LEAST SET OF THEIR SUPPORT, OR CHILDREN OVER 21 745. OF AGE PHO ARE NOT SELF-SUPPORTING.   1# SECTION XIV FATHER (Give same information, for Stepfather and or Guardian on a separate sheets)1. FULL NAME (Last-First-ddle)   Philip (Pessha) Amron2. LIVING   YES3. DATE OF DEATH4. CAUSE OF DEATH5. STATE OTHER NAMES HE HAS USED   INDICATE 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 PROVIDEO ON PAGE 14 OF THIS FORM TO RECORD THIS INFORMATION.4. CURRENT ADDRESS- Give last address, if deceased (No., Street, City. State, Country)   1412 Ocean Drive, Apt. 11, Miani Beach, 1a.7. DATE OF BIRTH   18898. PLACE OF BIRTH (City, State, Country)   Gomel, Russia9. CITIZENSHIP   U. S. A.10. IF BORY OUTSIDE U.S. DATE OF ENTRY    190011. PLACE OF ENTRY    New York12. FORMER CITIZENSHIPISI Emertryll0017    Russia13. DATE US CITIZENSHIP    ACQUIRED Unknown14. HERE ACCURRED (City. State. Country)    un.cnown15. OCCUPATION    Retired16. PRESENT EMPLOYER (Give last employer, if Father in deceased or unemployed)    Self-employed17. EMPLOYER'S BUSINESS ADDRESS OR FATHER'S SUSINESS ACORESS IF SELF-EMPLOYED    Holiday Hills, Nolans Drive, Lake llopatcong, N. J.18. DATES OF MILITARY SERVICE (From-and-Tof 19. BRANCH OF SERVICE    NA20, COUNTRY21. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN    None
[104-10162-10247.pdf — page 23]
# SECTION XV## MOTHER1. FULL NAME (Last-First-Middle)   AROM BEATRICE2. LIVING   ☑ YES ☐ NO3. DATE OF DEATH   NA4. CAUSE OF DEATH   NA5. STATE OTHER NAMES SHE HAS USED   noneINDICATE CIRCUMSTANCES (including length of time) UNDER WHICH SHE HAS EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Name and by what authority. USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS FORM TO RECORD THIS INFORMATION.6. CURRENT ADDRESS - GIVE LAST ADDRESS, IF DECEASED (No., Street, City, State, Country)   1412 Ocean Drive, Apt. 11, Miami Beach, Fla.7. DATE OF BIRTH   18938. PLACE OF BIRTH (City, State, Country)   Shchedrin, Minsk Province, Russia9. CITIZENSHIP   Stateless10. IF BORN OUTSIDE U.S. - DATE OF ENTRY    Unknown11. PLACE OF ENTRY    Unknown12. FORMER CITIZENSHIP(S) (Country/ies)    Unknown13. DATE U.S. CITIZENSHIP ACQUIRED    NA14. WHERE ACQUIRED (City, State, Country)    NA15. OCCUPATION    Housewife16. PRESENT EMPLOYER (Give last employer, if Mother is deceased or unemployed)    NA17. EMPLOYER'S BUSINESS ADDRESS OR MOTHER'S BUSINESS ADDRESS IF SELF EMPLOYED    NA18. DATES OF MILITARY SERVICE (From-and-To)    NA19. BRANCH OF SERVICE    NA20. COUNTRY    NA21. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN    NA# SECTION XVI## BROTHERS AND SISTERS (Including Half, Step and Adopted Brothers and Sisters)1. FULL NAME (Last-First-Middle)   ARON ZENE2. RELATIONSHIP   brother3. CITIZENSHIP (Country)   U. S. A.4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)   22 Community Drive, West Long Branch, New Jersey5. LIVING   ☑ YES ☐ NO6. AGE   401. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. CITIZENSHIP (Country)4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)5. LIVING   ☐ YES ☐ NO6. AGE1. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. CITIZENSHIP (Country)4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)5. LIVING   ☐ YES ☐ NO6. AGE1. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. CITIZENSHIP (Country)4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)5. LIVING   ☐ YES ☐ NO6. AGE1. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. CITIZENSHIP (Country)4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)5. LIVING   ☐ YES ☐ NO6. AGE1. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. CITIZENSHIP (Country)4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)5. LIVING   ☐ YES ☐ NO6. AGE1. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. CITIZENSHIP (Country)4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)5. LIVING   ☐ YES ☐ NO6. AGE1. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. CITIZENSHIP (Country)4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)5. LIVING   ☐ YES ☐ NO6. AGE- 11 -
[104-10162-10247.pdf — page 24]
# SECTION XVII1. FULL NAME (Last-First-Middle)   MILSTEIN FR5. STATE OTHER NAMES HE HAS USEDNoneFATHER.IN.LAW2. LIVINGYES X NO3. DATE OF DEATH19414. CAUSE OF DEATHheart diseaseINDICATE CIRCUMSTANCES (Including length of time, UNDER WHICH HE HASEVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Whereand by what authority). USE EXTRA SPACE PROVIDED ON PAGE 15 OF THISFORM TO RECORD THIS INFORMATION.6. CURRENT OR LAST ADDRESS (No., Street, City, State, Country)Kosciuszko Square 12, Tomashuv-Maz, Poland7. DATE OF BIRTH Unknown 8. PLACE OF BIRTH (City, State, Country)Tomashuv-Maz., Poland10. IF BORN OUTSIDE U.S.-DATE OF ENTRYNA11. PLACE OF ENTRYNA9. CITIZENSHIPPolish12. FORMER CITIZENSHIP(S) (Countries)NA13. DATE U.S. CITIZENSHIP ACQUIREDNA14. WHERE ACQUIRED (City, State, Country)NA15. OCCUPATIONStorekeeper16. PRESENT EMPLOYER (Give last employer, if Father-in-Law is deceased or unemployed)Self-employed# SECTION XVIII1.  FULL NAME (Last-First-Middle)MILSTEIN MINDL5. STATE OTHER NAMES SHE HAS USEDNoneMOTHER-IN-LAW2. LIVINGYES X NO3. DATE OF DEATHUnknown4. CAUSE OF DEATHNazi conc. campINDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH SHE HASEVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Whereand by what authority). USE EXTRA SPACE PROVIDED ON PAGE 15 OF THISFORM TO RECORD THIS INFORMATION.8. CURRENT OR LAST ADDRESS (No., Street, City, State, Country)Unknown9. PLACE OF BIRTH (City, State, Country)Tomashuv-Maz., Poland12. IF BORN OUTSIDE U.S.-DATE OF ENTRYNA11. PLACE OF ENTRYNA9. CITIZENSHIPPolish12. FORMER CITIZENSHIP(S) (Countries)NA13. DATE U.S. CITIZENSHIP ACQUIREDNA14. WHERE ACQUIRED (City, State, Country)NA15. OCCUPATIONNA16. 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 GOVERNMENT1. FULL NAME (Last-First-Middle)GORELIK VOLODYA2. RELATIONSHIPuncle4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDESBobruisk, USSR5. EMPLOYED BYGovernment6. CITIZENSHIP (Country)USSR7. FREQUENCY OF CONTACT up to 1952once every 2-3 years8. DATE OF LAST CONTACTSeptember, 19523. AGE601. FULL NAME (Last-First-Middle)2. RELATIONSHIP4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES5. EMPLOYED BY6. CITIZENSHIP (Country)7. FREQUENCY OF CONTACT8. DATE OF LAST CONTACT3. AGE1. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. AGE4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES5. EMPLOYED BY6. CITIZENSHIP (Country)7. FREQUENCY OF CONTACT8. DATE OF LAST CONTACT1. FULL NAME (Last-First-Middle)2. RELATIONSHIP3. AGE4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES5. EMPLOYED BY6. CITIZENSHIP (Country)7. FREQUENCY OF CONTACT8. DATE OF LAST CONTACTSECTION XIX CONTINUED TO PAGE 13