Francesco/who-killed-jfk huggingface dataset:
[104-10224-10001.pdf — page 131]
MYROSLAVY ANDREW MAKS SYMECAPOL 30, 1917FM. 171 - Experience 18-3Enclosure Ro. 3. Page 1During the period 1964 through 1956, I was assigned by Army Attache System, G2 Intelligence, Departement of the Army, to conduct, direct, establish photographic center and perform specific photographic assignments in Ethiopia, Africa.Mission and TasksDuring this period I directed and participated in photography of selected areas, equipments, training film, and selected subjects.I modified and planned the inststietion of photographic equipments that were faced with sitnations of excessive heat in some instances and of severe low temperatures in others. These conditions were also subject to abnormal influences.It was essential that I had a thorough familiarity with the mission objectives that would permit me to plan the photographic recording and reporting on film within a minimara of interference with programa operating sequences. This required me to particigde with operating officials, engineers, scientists, as a member of the team in order to detine the capabilities and limitation of cameras and equipment to the total planning of the specific program. This broad knowledge permitted me to utilize my abilities, imagination, and creative ability to fully develop the photographic aspects.I determined the kind of fiim, position, camera coverage, background, etc. developed-messablond schedules based on moision requirements,priorities, manpower, and the degraphic aspects.I reviewed quantity and quality of work performed by means of visual inspection and by discussions with ican leaders, partic ularly where problem arcas existed or the mission was and resursuel scope and objectives.I was responsible for the procurement of photographic equinenert end supplies necessary for the ession d russion. Tids responsPhitly also included the repair and maintenance of all ecuperea's in vse.
[104-10224-10001.pdf — page 132]
MYROSLAW ANDREW MAKSYAHECAPRIL 30, 1917FIM. 171 - Experience 18-3Enclosure Ho. 3, Page 2I braintained progress charts for all tacks, programs, missions, that indicated the status of installation, filming, reproduction actions for cach task/program.I directed tire reproduction phases of the foregoing filming as indicated in Enclosure No. 2.Artistic SegmentsI exercised artistic and creative ability in using photography as a means of communication of information, historical, splendor, etc., to fulfill educationi, military, informational objectives.I exerciond control of the sdtings, acilone of the event to be photographed. Iuggested actions/behavior of principils; selected backgrounds; rehersed actions prior to photographing orents.TrainingI conducted orientation and briefing courses for U. S. personel in basic-advanced photography and basic-advanced laboratory techniques.Accomplishments - Acknowledgements(1) Transmittal of Medallion to Myroslaw A. Maknymice, U. S. Army, G2:"it is a genuine pleasure to forward herewith a gold medallion which His Imperial Liajesty, Haile Selassic 1, Emperor of Ethiopia, sent to the American Embassy berewith the desise that it be transmitted to you by the Charge diAffaires, said that he wished you to have it as a token of his appreciation of your work.Since high recognition reflects very honorkly on your period of talents. It is a fine recomiendition of your professi ahore in Ethiopia and is a fine recomiendition of your professional talents. His Imperial Majesty and family to add my own congratriations to those of success in your carcer."The Foreigoa calities for continued TF. DAVIS, LT CC, U. S. Army : American Embassy, Addis Ababa Order of the
[104-10224-10001.pdf — page 133]
Enclosure No. 3, Page 3(2) Letter of Appreciation - Service Department to Department of the Army:"Whether this is information whether you can appropriately pass this letter on to officials concerned in the Department of Defense I do not know. But I do want to write of the strongest sort of commendation of the work of Master Sergeant Myroslav A. Maksymiec, Sergeant Maksymiec, was associated in the Office of the Army Attache here in Addis Ababa, particularly for the purpose of photographic coverage.It would please me if you would be able to forward this letter of mine to appropriate officials in the Defense Department. I know that Colonel Ivan D. Townsend, who was the Army Attache here during practically all of Sergeant Maksymiec's service, would agree with me both in my estimate of the Sergeant's usefulness and efficiency and in seeing to it that this letter of commendation be endorsed in the Department.At the present time Sergeant Maksymiec is assigned in the photography laboratory in the Pentagon. Undoubtedly he is making a fine contribution there. I do know that he was of vast importance to our total American operation here in Ethiopia, not only military, while he was stationed with the Army Attache in Addis Ababa. He is a competent, cooperative, and persistent workman in attaining desired goals. His photographic output is way above average, both in quantity and quality. The Army Attache system, based on my observation of Sergeant Maksymiec's work in Ethiopia, stands in very great debt to him."Joseph SimonsonUnited States AmbassadorAmerican Embassy, Addis Ababa,Ethiopia, April 17, 1957
[104-10224-10001.pdf — page 134]
MYROGLAW ANDREW MAKSYMIECAPRIL 30, 1912FG. 171 - Experience 12-3Enclosure No. 3, Page 4(3) Letter of Appreciation. Corps of Engineers, U. S. Army MapService to Department of Army - Intelligence:"During his recently competed tour of duty in the office of theArmy Attaché, Ethiopia, M/Sgt. Myroslaw A. Maksymice, was able tomake an outstanding contribution to the Engineer intelligence and photo-graphy holdings on that country. The material he acquired and gave tothe Engineers for reproduction was of quality and quantity far exceedingthat which has normally been received from similar sources.Considering the nature of the country in which M/Sgt. Maksymiec-served, the material acquired could only have been obtained as a result ofan enterprising-persistent, and determined effort on his part.A great number of the photographs taken by M/Sgt. Maksymicehave been retained by the Engineers to be used in Engineer intelligencestudies. Favorable comments following his debriefing were due largelyto the accurate and current information supplied by him.Since satisfaction of Engineer requirements undoubtedly con-stituted only part of the overall action of the Attache, Ethiopia, M/Sgt:Maksymice's alertness and enthusiasm towards collection of materialsof Engineer interest are greatly appreciated. He has made an invaluablecontribution to the Engineer Intelligence and mapping effort.It is requested that this letter be made a part of M/Sgt. Maksymiec'sofficial records."/s/ J. D. ABELLColonel, Corps of EngineersCommanding
[104-10224-10001.pdf — page 135]
# MOTORLAW ANDREW MANSTATECAO SU, 1917UM. 171 - Copovi nee 18-1Endlowe No. 1. Paga 1During the period 1950 through 1:38, I Was the Suprimofor Chief of Photographic Laboratory for the Department of the Army,American Embassy, London, England.MissionDirect the technical operations of Technical Photographers and Photo-graphic Laboratory Technicians. Operations included all of EuropeanTheater.TrainingI conducted regular seminars on all aspects of photography and photolaboratory techniques top peccomeOperationsI performed the basic operations as indicated in Experience 18-3–Mission-Tasks and Artistic Segments, In addition to the foregoing 1supervised specialists and technicians, efforts in high volume reproductionof film that averaged over a million feet (black/white/color) of motionpicture film.Equipment utilized was the latest Eastman-Kodak, Boll and Howell,and Houston Fearless printing and processing equipment.In directing this effort I worked in close coordination with motionpicture producers in the planning and organizing the photographic aspectsof specific task/program. It was my duty to plan work and securethetically perfect photographs that will permit achieve attainment ofjudgment in varying processes, also in the utilization of equipment that transcendedthe normal processes and procedures in order to produce effects thatwould spotlight the task/program objectives which the photograph wasdesigned to produce.
[104-10224-10001.pdf — page 136]
APAG 20, 1977FA. Unassigned case 15-4Commendations(1) The Foreign Service of the United States of America: Office of the Air Attaché; American Embassy, London, England.201-Maksymice, Myroslaw A. (Ent)1.  I wish to offer my appreciation to you for the part you played in accomplishing the highly-classified project assigned to you within the allotted period of time.2.  Your superior efforts in completing this project have materially benefited the Office of the Air Attaché. The responsality you have assumed, in addition to the long hours of work required during this period, deserves the highest praise.(2) TO: Master Sergeant Myroslaw A. MaksymiceArmy AttachéOffice of theAmerican EmbassyLondon, EnglandJACK W. WOODBrig. Gen., USAVAir Attaché1.  The Army Attache has informed me of the outstanding summer in which you have performed your duties and has commended your services to me as deserving special recognition. Therefore, as you complete this tour of duty in the Army Attache System I wish to express to you my appreciation for the commandable manner in which you performed your duties.2.  Since your assignment to the London office in August 1950, you have performed all assigned duties in a superior manner. The nature of your duties often required that you work on many occasions at night and on normal non-working days, which you cheerfully did with utmost willingness. This continued demonstration of loyalty to duty reflects creditably upon yourself and the Attache System.
[104-10224-10001.pdf — page 137]
MYROSLAW ANDREW MAKSYMIECAPRIL 30, 1917FAL. 171 - Experience 18-4Enclosure No. 4, Page 33. My best wishes to with you for continued süccess in future assignments.4. A copy of this letter is being forwarded to The Adjutant General for inclusion in your officiel 201 fole and copies will accompany your next efficiency report.MAJ GEN. R. C. PARTRIDGEDepartment of the ArmyOffice of the Assistant Chief of Staff,G-2, IntelligenceWashington, 25, D. C.
[104-10224-10001.pdf — page 138]
MYROSLAV ANDREW MANSTHECAPRIL 20, 1917FAM. 171 - Education 140 and 140Enclosure No. 5, Page 1Advanced Photography - 9 semester hoursEnglish - 3 semester hoursPublic Speaking - 3 semester hoursHistory - Africa - 3 semester hours1965 - Present - American University, Washington, D.C.1963 - Photography - Eastman Kodak Co., Rochester, New York1950 - Military Intelligence School "Photography", Ft. Holabird, Maryland1947 - Russian Language, Intelligence School, Monterey, CaliforniaIntelligence Training:School of PhotographySchool of Advanced PhotographySchool of Photography - Camera RepairSchool of Photography - Electronic Systems Repair
[104-10224-10001.pdf — page 139]
ATTACH Sher of FOLDER here:Know ref questions opletely and flyGS-9 Physical Scientist Manchester Wash., D.C.New HampshireCOL John D. Townsend First Army-G3-Bdgrs., Fort George Military IntelligenceMeade, MarylandMr. Richard E. Swing 513 Carron Avenue ScientistRockville, MarylandGEN John Willems (Rei) 7813 Lake Adlon Drive Military IntelligenceSan Diego, California23. VETERAN PREFERENCE A. Have you served on active duty in the United States military armed of the Unated States?    If "Yes", complete items B through F below:B. Dates (From to) Branch Serial or Service Number1941-1961 U.S. Army RA-20140533ANSWER ITEMS 24 THROUGH 33 BY PLACING AN "X" IN THE PROPER COLUMN24. Are you a citizen of the United States?If "No", give country of which you are a citizen25. Before answering this question read item 25 in the attached instructions    A. Are you now, or within the last ten years have you been a member of:    (1) The Communist Party, U.S.A., or any subdivision of the Communist Party, U.S.A. ?    (2) An organization that advocates the overthrow of the constitutional form of government of    the United States by force or violence? [If your answer to either (1) or (2) is "Yes", write in space    below the name of organization or organizations, the dates of your membership, and your understanding of the aims and purposes of the organization at the time of your membership]B. If your answer to item A(1) or A(2) is "Yes", write your answer across to the following questions on plain sheet of paper26. To ensure that you are not placed in a position where your private interests conflict with your public    duties, are you indebted or do you have any financial obligations which would make you subject to pressure from any source?    If your answer is "Yes", explain27. Within the last five years have you been fired from any job for any reason?28. Within the last five years have you quit a job after being notified that you would be fired for any reason?
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## Claim Information Form### NameApplicant:Spouse:Children:### Claim Approved?| Option                     | Spouse's Filing | Reimbursement || -------------------------- | --------------- | ------------- || 12 Points (Total)          |                 |               || 15 Points Camp Duty        |                 |               || Other To Points            |                 |               || Base                       |                 |               || 125% Limit And Limit Since |                 |               |Date of Rate### THIS SPACE FOR 121 ARNG OFFICER ONLYYes Comp Duty NoI certify as a matter of record, through proof that the information is true and accurate, and I certify that the applicant is a member of:Vermont ARNG DateSignature
[104-10224-10001.pdf — page 142]
# SECRET## SECTION V GEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL| NAME OF REGION OR COUNTRY | TYPE OF SPECIALIZED KNOWLEDGE | DATES OF TRAVEL OR RESIDENCE | DATE & PLACE OF STUDY | KNOWLEDGE ACQUIRED BY CHECK (√) |        |       |            || ------------------------- | ----------------------------- | ---------------------------- | --------------------- | ------------------------------- | ------ | ----- | ---------- ||                           |                               |                              |                       | BEFORE SERVICE                  | TRAVEL | STUDY | ASSIGNMENT || Ethiopia                  | Intelligence                  | 1954 Oct 24 9 15 AM '68      |                       | √                               | √      |       | √          || Europe                    |                               | 1966-1968                    |                       |                                 |        |       |            |## SECTION VI TYPING AND STENOGRAPHIC SKILLS MAIL ROOM1. TYPING (SPEED) 2. SHORTHAND(SPEED) 3. INDICATE SHORTHAND SYSTEM USED – CHECK (X) APPROPRIATE ITEM: 4. OTHER (SPECIFY)□ GOVER □ SPEEDWRITING □ STENOTYPE □## SECTION VII SPECIAL QUALIFICATIONSPROVIDE INFORMATION ON HOBBIES, SPORTS, LICENSES, PUBLISHED MATERIALS OR DEVICES WHICH YOU MAY HAVE INVENTED.PHOTOGRAPHY, SCUBA DIVING, FISHING.## SECTION VIII MILITARY SERVICE CURRENT DRAFT STATUS1. HAS YOUR SELECTIVE SERVICE CLASSIFICATION CHANGED? 2. NEW CLASSIFICATION□ YES  √ NO3. LOCAL SELECTIVE SERVICE BOARD NUMBER AND ADDRESS 4. IF DEFERRED, GIVE REASON### MILITARY RESERVE, NATIONAL GUARD STATUSCHECK RESERVE OF GUARD ORGANIZATION TO WHICH YOU BELONG: □ ARMY □ MARINE CORPS □ COAST GUARD □ NATIONAL GUARD□ NAVY □ AIR FORCE □ AIR NATIONAL GUARD1. CURRENT RANK, GRADE OR RATE 2. DATE OF APPOINTMENT IN CURRENT RANK 3. EXPIRATION DATE OF CURRENT OBLIGATION4. CHECK CURRENT RESERVE CATEGORY: □ READY RESERVE □ STANDBY (active) □ STANDBY (training) √ ATTACHED □ DISCHARGED5. MILITARY MOBILIZATION ASSIGNMENT 6. RESERVE UNIT TO WHICH ASSIGNED OR ATTACHED### MILITARY SCHOOLS COMPLETED (Extended Active, Reserve Duty, or as Civilian)| NAME AND ADDRESS OF SCHOOL | STUDY OR SPECIALIZATION | DATE COMPLETED | RESIDENT         || -------------------------- | ----------------------- | -------------- | ---------------- || LANGUAGE + INTELLIGENCE    | Intelligence            | 1948 1950      | AGENCY SPONSORED |## SECTION IX PROFESSIONAL SOCIETIES AND OTHER ORGANIZATIONS| NAME AND CHAPTER               | ADDRESS (Number, Street, City, State, Country) | DATE OF MEMBERSHIP |      || ------------------------------ | ---------------------------------------------- | ------------------ | ---- ||                                |                                                | FROM               | TO   || 1. NATIONAL GEOGRAPHIC SOCIETY | WASHINGTON D.C.                                | 1948               | 1968 || 2. REGULAR ARMY SGT CLUB       | WASHINGTON D.C.                                | 1966               | 1968 |## SECTION X REMARKSDATE SIGNATURE OF EMPLOYEE10 Sept 1968 Reynoldine G. BellefeuilleSECRET
[104-10224-10001.pdf — page 143]
SECRET(When Filled In)QUALIFICATIONS SUPPLEMENT TO PERSONAL HISTORY STATEMENTREAD INSTRUCTIONS CAREFULLY BEFORE COMPLETING TYPE OR PRINT AVOID USING LIGHT COLORSSECTION I|                |                      |       |                        |                                  || -------------- | -------------------- | ----- | ---------------------- | -------------------------------- || 1. TEMP SER NO | 2. NAME              | 3 SEX | 4 DATE OF BIRTH        | 5 SCHED GRADE/STEP               || 435055         | MAKSYMIEC HYROSIAM-A | M     | 04/30/17               | 53-09-04                         || 6 SO           | 7. POSITION TITLE    |       | 8 OFFICE OF ASSIGNMENT | 9 LOCATION (County, City, State) || IP             | D A/E TECH           |       | ENPIC                  | WASH., D. C.                     |SECTION II AGENCY OVERSEAS SERVICE| AREA                | AGENCY OVERSEAS SERVICE | TYPE TOUR | FROM | TO  || ------------------- | ----------------------- | --------- | ---- | --- || NO OVERSEAS SERVICE |                         |           | 120' | 10  |SECTION III EDUCATION| DEGREE                      | MAJOR FIELD | COLLEGE | YEAR || --------------------------- | ----------- | ------- | ---- || NO COLLEGE DEGREE ON RECORD |             |         |      |![logo of secret document] SECRET8 & AUG ENTD(4311)
[104-10224-10001.pdf — page 144]
SECRETSECTION IIIEAST HIGH SCHOOL ATTENDEDWASHINGTONADDRESS: (City, State, County)DISTRICT OF COLUMBIACOLLEGE OR UNIVERSITY STUDYNAME AND LOCATION OF COLLEGE OR UNIVERSITYJAVIER SPRING, MARYLANDMONTGOMERY JUNIOR COLSUBJECTENGLISHYEARS ATTENDED FROM:SEPT 19661714HIGH SCHOOL CERTIFICATEGRADUATEYEAR RECEIVEDNO SEM/QTR HRS (Specify)1-SEM35 HR-HRSIF A GRADUATE DEGREE HAS BEEN INDICATED ABOVE WHICH REQUIRED SUBMISSION OF A WRITTEN THESIS, INDICATE THE TITLE OF THE THESIS AND BRIEFLY DESCRIBE ITS CONTENT.NONENAME AND ADDRESS OF SCHOOLTRADE, COMMERCIAL AND SPECIALIZED SCHOOLSSTUDY OR SPECIALIZATIONFROMTONO OF MONTHSNONENAME AND ADDRESS OF SCHOOLOTHER NON AGENCY EDUCATION OR TRAINING NOT INDICATED ABOVESTUDY OR SPECIALIZATIONFROMTONO. OF MONTHSNONEAGENCY-SPONSORED EDUCATIONSpecify which, if any, of the education shown in Section III was Agency sponsored.NAME AND ADDRESS OF SCHOOLUS DEPARTMENT OF AGRICULTURE GRADUATE SCHOOLSTUDY OR SPECIALIZATIONCOLOR PHOTOGRAPHY AND COLOR PRINTINGFROMJAN 1964SEPT 1965TONO OF MONTHSYEAR 3 SEMHRSYEAR 3 SEM. HRSSECRET- 2 -
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# SECRETSECTION IVGEOGRAPHIC AREA KNOWLEDGE AND FORTION TRAVELSECTION V1. TYPING (WPM).2. SHORTHAND (WPM):3. INDICATE SHORTHAND SYSTEM USED. CHECK APPROPRIATE ITEM:*   GREGG*   SPEEDWRITING*   STENOTYPE*   OTHER. Specify: NONE4. INDICATE OTHER BUSINESS MACHINES WITH WHICH YOU HAVE HAD OPERATING EXPERIENCE OR TRAINING (comptometer, mimeograph, card punch, etc)NONESECTION VISPECIAL QUALIFICATIONS1.  LIST ALL HOBBIES AND SPORTS IN WHICH YOU ARE ACTIVE OR HAVE ACTIVELY PARTICIPATED. INDICATE YOUR PROFICIENCY IN EACH.PHOTOGRAPHY, SWIMMING, ICE SKATING, (WELL)2.  EXCLUDING BUSINESS EQUIPMENT OR MACHINES WHICH YOU MAY HAVE LISTED IN ITEM 4, SECTION V. LIST ANY SPECIAL SKILLS YOU POSSESS RELATING TO OTHER EQUIPMENT AND MACHINES SUCH AS OPERATION OF RADIO TRANSMITTERS - indicate CW speed, sending & receiving; OFFSET PRESS, TURRET LATHE, COP AND OTHER SCIENTIFIC & PROFESSIONAL DEVICESNONE3.  ARE YOU NOW OR HAVE YOU EVER BEEN A LICENSED OR CERTIFIED MEMBER OF ANY TRADE OR PROFESSION SUCH AS PILOT, ELECTRICIAN, RADIO OPERATOR, TEACHER, LAWYER, CPA, MEDICAL TECHNICIAN, PSYCHOLOGIST, PHYSICIAN, ETC. ?*   YES*   NONONE4.  IF YOU HAVE ANSWERED "YES" TO ITEM 3 ABOVE, INDICATE KIND OF LICENSE OR CERTIFICATION AND THE ISSUING STATE. 5. FIRST LICENSE/CERTIFICATE (year of issue)    MUNICIPALITY, ETC. Provide license registry number if knownNONE6. LATEST LICENSE/CERTIFICATE (year of issue)7.  LIST ANY SIGNIFICANT PUBLISHED MATERIALS OF WHICH YOU ARE THE AUTHOR (do NOT submit copies unless requested). INDICATE THE TITLE, PUBLICATION DATE, AND TYPE OF WRITING (non-fiction or scientific articles, general interest subjects, novels, short stories, etc.)NONE8.  INDICATE ANY DEVICES WHICH YOU HAVE INVENTED AND STATE WHETHER OR NOT THEY ARE PATENTEDNONE9.  PUBLIC SPEAKING AND PUBLIC RELATIONS EXPERIENCENONE
[104-10224-10001.pdf — page 147]
SECRET(When filled in)AGENCY EMPLOYMENT HISTORYSECTION VIII1. INCLUSIVE DATES From - to - by month & year) 2. LOCATION (Country, City,) 3. DIRECTORATE OFFICE OR DIVISION, BRANCH4. TITLE OF JOB 5. GRADES HELD IN JOB6. DESCRIPTION OF DUTIESNONE1. INCLUSIVE DATES From - to - by month & year) 2. LOCATION (Country, City,) 3. DIRECTORATE OFFICE OR DIVISION, BRANCH4. TITLE OF JOB 5. GRADES HELD IN JOB6. DESCRIPTION OF DUTIESNONE1. INCLUSIVE DATES From - to - by month & year) 2. LOCATION (Country, City,) 3. DIRECTORATE OFFICE OR DIVISION, BRANCH4. TITLE OF JOB 5. GRADES HELD IN JOB6. DESCRIPTION OF DUTIESNONESECRET-5-
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### SECTION VIII*SECRET**'When Filled In'*AGENCY EMPLOYMENT HISTORY (Cont'd)1. INCLUSIVE DATES (from-to-by month & year) 2. LOCATION (Country, City) 3. DIRECTORATE OFFICE OR DIVISION BRANCH4. TITLE OF JOB 5. GRADES HELD IN JOB6. DESCRIPTION OF DUTIESNONE1. INCLUSIVE DATES (from-to-by month & year) 2. LOCATION (Country, City) 3. DIRECTORATE OFFICE OR DIVISION BRANCH4. TITLE OF JOB 5. GRADES HELD IN JOB6. DESCRIPTION OF DUTIESNONE1. INCLUSIVE DATES (from-to-by month & year) 2. LOCATION (Country, City) 3. DIRECTORATE OFFICE OR DIVISION BRANCH4. TITLE OF JOB 5. GRADES HELD IN JOB6. DESCRIPTION OF DUTIESNONESECRET- 6 -
[104-10224-10001.pdf — page 149]
SECRETSECTION A1 PRESENT STATUS (Single, Married, Widowed, Separated, Divorced, Annulled Remarried SPECIFY):NONE2. NAME OF SPOUSE3. DATE OF BIRTH4. PLACE OF BIRTH (City, State, County)5. OCCUPATION6. PRESENT EMPLOYER7. CITIZENSHIP8. FORMER CITIZENSHIP(S)/COUNTRIES)9. DATE U.S. CITIZENSHIP ACQUIREDSECTION X| NAME                    | RELATIONSHIP | DATE AND PLACE OF BIRTH | DEPENDENT | PERMANENT ADDRESS                 || ----------------------- | ------------ | ----------------------- | --------- | --------------------------------- || WILLIAM. MAKSYMIED Sony | SON          | 1/30/60                 | YES       | 4718 ASBURY PLACE WASHINGTON D.C. || SHARON ANN MAKSYMIEL    | DAUGHTER     | 2/6/61                  | YES       | 4718 ASBURY PLACE WASHINGTON D.C. |SECTION XI| NAME AND CHAPTER | PROFESSIONAL SOCIETIES AND OTHER ORGANIZATIONS | DATE OF MEMBERSHIP || ---------------- | ---------------------------------------------- | ------------------ ||                  | ADDRESS (Number, Street, City, State, Country) | FROM TO            || NONE             |                                                |                    |DATE28 Sept 1967SIGNATURE OF EMPLOYEE