[104-10193-10069.pdf — page 35]
# SECRET(When Filled In). (1-71)THIS DATE# PERIODIC SUPPLEMENT# PERSONAL HISTORY STATEMENTINSTRUCTIONSThis form provides the means whereby your official personnel records will be kept current. Even though it duplicates information you have furnished previously, it will be necessary for you to complete Sections I through VI in their entirety. You need complete Section VII through 1111 only if there has been a change since you entered on duty with the organization or if you believe the item requires more complete coverage than you have previously reported.# SECTION I## GENERAL1. FULL NAME (Last-First-Middle)   BURKE William Patrick Jr.2. CURRENT ADDRESS (No., Street, City, Zone, State)   6300 St. Charles Ave., New Orleans 18, La.3. PERMANENT ADDRESS (No., Street, City, Zone, State)   6300 St. Charles Ave., New Orleans 18, La.4. HOME TELEPHONE NUMBER   Thrinbrook 7-24855. STATE, TERRITORY, POSSESSION OR COUNTRY IN WHICH YOU NOW CLAIM RESIDENCE   Louisiana# SECTION 1## PERSON TO BE NOTIFIED IN CASE OF EMERGENCY1. NAME (Last-First-Middle) PREFERABLY RESIDING IN U.S.   BURKE Mrs Frances Kittredge2. RELAT.1 ON SHIP   Wife3. HOME ADDRESS (No., Street, City, Zone, State, Country).   6300 St. Charles Ave., New Orleans 18, La.4. BUSINESS ADDRESS (Vo., Street, City, Zone, State, Country). INDICATE NAME OF FIRM ON EMPLOYER, IF APPLICABLE   none5. HOME TELEPHONE NUMBER   Thrinbrook 7-24856. BUSINESS TELEPHONE NUMBER   none7. BUSINESS TELEPHONE EXTENSION   none8. IN CASE OF EMERGENCY, OTHER CLOSE RELATIVES (Spouse, Mother, Father) MAY ALSO BE NOTIFIED. IF SUCH NOTIFICATION IS NOT DESIRABLE BECAUSE OF HEALTH OR OTHER REASONS, PLEASE SO STATE.   none# SECTION 1111. CHECK (X) ONE:   SINGLE MARRIED WIDOWED SEPARATED DIVORCED ANNULLED2. FURNISH DATE, PLACE AND REASON FOR ALL SEPARATIONS. DIVORCES OR ANNULMENTS   Never separated, divorced nor marriage annulled---WILLIAM F JREMPLOYEE SERIAL NO. 01775COMPLETED BY EMPLOYERX YESTELEPHONE EXT. 2271SECRET (WHEN FILLED IN)DO NOT FOLD, STAPLE, SPINDLE, OR MUTILATE| WHERE SERVICE WAS PERFORMED | PCS-1 TOY-2 ENTER NO1 | DATES FROM | TO   | SERVICE AS CIVILIAN-1 MARY | RESPONSIBLE US GOVT. DEPT. OR AGENCY | DO NOT WRITE IN COLUMN || --------------------------- | --------------------- | ---------- | ---- | -------------------------- | ------------------------------------ | ---------------------- || Territory of Hawaii         | 310                   | 1 05 45 10 | 45 2 | US Marine Corpo            |                                      | 540                    |---INSTRUCTIONSTHIS FORM MUST BE RETURNEDWHETHER YOU HAVE HAD OVER-SEAS SERVICE ON NOT.PLEASE READ CAREFULLY IN.STRUCTIONS ON ACCOMPANYINGCARD, THEN FILL OUT THIS FORNAS ACCURATELY AS POSSIBLA---IF ADDITIONAL SPACE IS NEEDED CHECK HEREHousewifeAND ASK YOUR ADMINISTRATIVE OFFICER FOR SUPPLEMENTAL CARDS(unemployed, last two employers)SECRET orNot employed. Once employed by Town & Country., N.O.La.20. EMPLOYER'S OR BUSINESS ADDRESS (No., Street, City, State, Country)    not employed---FORM 4446 USE PREVIOUS EDITIONS.4-57# SECTION 111 CONTINUED TO PAGE 2# SECRET1> [Figure] Handwritten note with the following text: 1958 doc, Per'l HISTORY STATEMENT w/atto