[104-10220-10028.pdf — page 71]
# VISA ACTION REQUESTTO:FOREIGN SERVICE OF THE UNITED STATES OF AMERICA*   Office of Security 15/1-Department of State*   Immigration and Naturalidation Service atFROM:March 1, 1965Anconsul, VIAC VERACTION REQUESTED (Check only one)*   Security advisory opinion*   212(d)(3)(A) waiver*   Name check only*   Chind background check*   "Parakeet" name check*   visa Office (VO) - Department of StateIF SIMORSKAI WAIVER, INDICATE WHLINER*   Security - 212(a)(28)*   Other - 212(a)*   Recommended by consular officer*   Submitted at request of alien1. NAME OF APPLICANT (include aliases, maiden name; previous name, etc.)Orin, Kolando2. DATE OF BIRTH (mo, day, yr.)   April 10/19133. PLACE OF BIRTH (city, province, country)   Havana, Cuba4. PRESENT ADDRESS   2626 S. Sepalveda blvd., Los Angeles 64, Calif.5. DISTINGUISHING MARKS OF IDENTIFICATION   None6. SEX   Male7. MARTIAL STATUS   married8. ALIEN REGISTRATION NO. (if any)9. OCCUPATION (present and former, if pertinent, Include name and address of present employer)   Electronic Assembler - Packard Bell :lectronic Corp. 12333 W. Olympic Blvd., Los Angeles, 64, Calif.10. NATIONALITY (including former, if any)    CubanTYPE regular11. PASSPORT NO.    ISSUED BY.    DATE12. FATHER'S NAME    Rolando Utero13. MOTHER'S MAIDEN NAME    Maria A. Hernandez14. SPOUSE'S NAME (include maiden name)    Jessica Rinehart15. RESIDENCES OF 6 MONTHS OR MORE SINCE REACHING THE AGE OF 16 (years, street addresses, cities, countries)    Jan./64 - present = 2626 S. Sepulveda Blvd., Los Angeles, Calif.    Apr./63 - Jan./64 = 11111 National Blvd., Los Angeles, Calif.    Aug./60 - Par./63 = Communist Frisso, Lay of Pisa.    Apr./59 - Aug./60 = 655 27 st., Luyal, Florida    12/56 - Apt./59 = Ave. 37, 10212, Marianao, Havana, Cuba.    6/56 - 1956 = Private school, America Arias School16. RELATIVES IN U.S. (names, street addresses, cities, states)    Mrs. Margot Hernandez, 2626 S. Sepulveda Blvd., Los Angeles, 64, Calif. (Mother)17. PURPOSE OF ENTRY (give details in narrative statement if pertinent)    To reside.18. ANTICIPATED DATE AND PORT OF ARRIVAL, LENGTH OF STAY AND DESTINATION OR ITINERARY IN U.S.19. TYPE OF VISA CONTEMPLATED (visa symbol, no. of entries and validity period)    immigrant visa (D-1)20. REFERENCE TO PREVIOUS CORRESPONDENCE21. APPLICANT TO BE ACCOMPANIED BY (give name, date and place of birth, nationality and relationship)22. REMARKS*   No record*   Security Info attached*   No derogatory Information*   Other (see remarks)N.D/ 25 March/65FILE IN 201-28484For Name check only, forward original and 6 copies to SY. (Compiste items 1 through 18 only)For China background check, forward original and 1 copy to SY. Attach photo with alien's name in chinese chacters. (Complete Items 1 through 18 only)For "Parakeet" name check, security advisory opinion, or 212(d)(3)(A) waiver action forward original and a copies to VO. (See instructions on reverse of last page for preparation of narrative statement to accompany security advisory opinion and 212(d)(3)(A) waiver actions)For 212(dx3)(A) waiver actions directed to INS abroad, forward ennal and 3 copy. (See instructions on reverse of last page for preparation el accompanying narrative statement)Use additional sheet for any item for which Insufficient space is provided.FORM3-64 FS-493> [Figure: A stamp on the document indicates "NO OBJECTION TO DECLASSIFICATION AND/OR RELEASE OF THIS DOCUMENT 7. MAR 1965"]