[104-10195-10002.pdf — page 172]
# SECRETCONTRACT INFORMATION AND CHECK LISTCASE OFFICERRuth L. PailDIVISIONTELEPHONE EXTENSIONFor contract infoDATEJuly 192SECTION 1GENERAL1. NAMEPRELOD TRUE2A. PROJECTMA3. ALLOTMENT NO.   3254-128-10004. SLOT NO.   200Thomas B. CADASIK2B. PERMANENT STATIONParis, France3A. FUNDSXUU5. PREVIOUS CIA PSEUDONYM OR ALIASES   James H. Konicott (P)   John P. Reynolds   William, John P. Martin (A) Staff Employ since 1996. INDIVIDUAL HAS BEEN ENGAGED BY CIA OR ITS ALLIED ACTIVITIES IN SOME CAPACITY PRIOR TO THIS CONTRACT. [X] yes [] no (If yes, describe and include dates and salary.)7. SECURITY CLEARANCE (Type and date) A7A. MEDICAL CLEARANCEREQ'D NOT REQ'D8. CONTRACT IS TO BE WRITTEN IN STERILE FORM I.E... "U.S. GOVERNMENT" [X] yes [] no9. INDIVIDUAL WILL WORK UNDER "CONTROLLED CONDITIONS" I.E., REGULAR OFFICE... HOURS AWAY FROM SUBJECT'S HOME AND PERFORMED UNDER THE SUPERVISION OF A   STAFF EMPLOYEE OR STAFF AGENT10. PROPOSED CATEGORY (Contract agent, contract employee, etc.)    Staff AgentSECTION 11PERSONAL DATA11. CITIZENSHIP    U.S.12. IF NOT U.S. CITIZEN, INDIVIDUAL IS A PERMANENT RESIDENT ALIEN13. AGE    3014. DATE OF BIRTH (Month, day, year)    January 20, 192415. LEGAL RESIDENCE (City and state or country)    Alexandria, Virginia16. CURRENT RESIDENCE (City and state or country)    Alexandria, Virginia17. MARITAL STATUS (Check as appropriate)SINGLE MARRIED DIVORCED ANNULLED SEPARATED18. NUMBER OF DEPENDENTS (Not including individual) RELATIONSHIP AND AGE    Three - Wife, age 34    Daughter, age 8    Daughter, Age 1119. INDIVIDUAL IS RELATED TO A STAFF EMPLOYEE, STAFF AGENT OR AN INDIVIDUAL CURRENTLY WORKING FOR THE AGENCY IN SOME CAPACITY.    RELATIONSHIP [] yes [X] noSECTION 111U.S. MILITARY STATUS20. RESERVE    NA21. VETERAN    Yes22. IF RETIRED, INDICATE CATEGORY (Longevity, combat disability, service disability non-combat)23. BRANCH OF SERVICE    U.S. Army24. RANK OR GRADE25. DRAFT ELIGIBLE    [] yes [X] no26. DRAFT DEFERMENT OBTAINED BY CIA [] yes [] noSECTION IVCOMPENSATION27. BASIC SALARY28. POST DIFFERENTIAL    Pay entitlement equating    to GS-14 (step 5) including pronitas pay29. COVER (Breakdown, if any)30. FEDERAL TAX WITHHOLDINGCOVER CIAX yes X yesno noSECTION VALLOWANCES (NORMALLY GRANTED ONLY TO RESIDENTS OF THE UNITED STATES)31. QUARTERS32. POST    In accordance with regulations33. OTHER34. COVER (Breakdown, if any)SECTION VITRAVEL35. TYPES    Domestic operational    Foreign operational36. WITH DEPENDENTS    [] yes [X] no37. HHE TO BE SHIPPED    [X] yes [] no37A. HHE TO BE STORED[] yes [X] no38. PERSONAL VEHICLE TO BE SHIPPED    [] yes [X] no39. TRANSPORTED VEHICLE TO BE USED FOR OPERATIONAL TRAVEL    [X] yes [] no40. IF WITH DEPENDENTS STATE RELATIONSHIP, CITIZENSHIP, AGE AND DATE OF BIRTH    Wife, U. S. Citizen, age 34, DOB 13 June 1930    Daughter, U. S. Citizen, age 8, DOB 5 September 1953    Daughter, U. S. Citizen, age 11, DOB 5 September 195041. PAYMENT AND ACCOUNTABILITY WILL BE IN CONFORMANCE WITH COVER POLICIES AND PROCEDURESSECTION VIIOPERATIONAL EXPENSES42. PURCHASE OF INFORMATION    As authorized43. ENTERTAINMENT    As authorized44. OTHER    As authorized45. PAYMENT AND ACCOUNTABILITY WILL BE IN CONFORMANCE WITH