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# US ARMY REQUEST FOR NATIONAL AGENCY CHECK(AR 386-130)2. CONTROL OFFICE: DOD NAC Center, PO Box 4. Fort Holabird. Md. 212193. LAST NAME FIRST NAME MIDDLE NAME ALIAS(ES) NICKNAMES CHANGED NAME   FROMER, David Reed1.  DATE OF REQUEST    18 Jan 674. SOCIAL SECURITY NO.   564-58-81377. SERVICE NUMBER5. DAY, MONTH, YEAR OF BIRTH   21 July 19426. PLACE OF BIRTH   Chicago, Cook, Illinois8. RELATIVE'S NAMES9. DATE AND PLACE OF BIRTH10. PRESENT ADDRESS11. CITIZENSHIPa. FATHERIrving Fromer12 Jul 1913Cincinnati, Ohio13 Rhonda WayMill Valley, Calif.U. S.b. MOTHER (maiden name)Katherine Rhodes31 Dec 1909Estherville, Iowa13 Rhonda WayMill Valley, Calif.U. S.c. SPOUSE (maiden name)None12. RESIDENCES (List all from 16th birthday or during last 15 years, whichever is shorter)| a. FROM | b. TO | c. NUMBER AND STREET     | d. CITY       | e. STATE  || ------- | ----- | ------------------------ | ------------- | --------- || 1950    | 1960  | 1932 Cabrillo St.        | San Francisco | Calif.    || 1960    | 1961  | 2450 Bencroft Way        | Berkeley      | Calif.    || 1961    | 1962  | 881 Clayton St.          | San Francisco | Calif.    || 1962    | -     | 219 N. Basset            | Madison       | Wisconsin || 1963    | -     | 215 Lake Lawn Ave.       | Madison       | Wisconsin || 1964    | 1884  | 3827 University Ave.     | Madison       | Wisconsin || 1965    | 1966  | EMPLOYM435/W: North Ave. | San Francisco | Calif.    || a. FROM            | b. TO    | c. EMPLOYER                           | d. PLACE              || ------------------ | -------- | ------------------------------------- | --------------------- || Dec 1959           | Dec 1959 | Paul Dler Bookstore                   | San Francisco, Calif. || Summer '60         | 1960     | San Francisco Council Camp Fire Girls | San Francisco, Calif. || 1961               | 1961     | Fairmont Hotel                        | San Francisco, Calif. || 1961               | 1962     | Foster's Restaurant                   | Madison, Wisconsin    || Summer 1962 & 1963 |          | Madison Board of Education Rec.       | Madison, Wisconsin    || Fall 1962          |          | Clark Service Station                 | Madison, Wisconsin    |14. LAST CIVILIAN SCHOOL| a. FROM | b. TO   | c. NAME                 | d. PLACE           || ------- | ------- | ----------------------- | ------------------ || 1966    | Present | University of Wisconsin | Madison, Wisconsin |15. ITEM ("Yes" answers are expanded in Remarks)| YES | NO  |                                                                           || --- | --- | ------------------------------------------------------------------------- ||     | X   | a. IS THE SUBJECT AN ALIEN OR A NATURALIZED CITIZEN OF THE UNITED STATES? ||     | X   | b. ANY FOREIGN CONNECTIONS, INTERESTS, EMPLOYMENT OR MILITARY SERVICE?    ||     | X   | c. ANY FOREIGN TRAVEL OTHER THAN FOR THE UNITED STATES?                   ||     | X   | d. EMPLOYMENT BY A FIRM HAVING A CLASSIFIED US GOVERNMENT CONTRACT?       ||     | X   | e. FORMER US GOVERNMENT EMPLOYMENT OR MILITARY SERVICE?                   || X   |     | f. ANY QUALIFICATION OF DD FORM 398 OR DD FORM 98?                        ||     | X   | g. ANY ARREST OR COURT RECORD?                                            |16. REMARKS (If additional space is needed, continue on plain paper)Item 12. 1966 to Present 13 Rhonda Way, Mill Valley, California1966 to Present 140 Langdon Street, Madison, WisconsinItem 13. Oct 65 50 June 66 Cooks Cupboard, 1718 Walls St., Chicago, IllinoisEmployer: Bob Geroge Reason: Return to S. F.Item 15. Registrant refused to execute DD Form 98 and explained in the remarks section. Also refused to answer Item 17 and answered affirmatively Item 19 and explained in the remarks section. Refused to be fingerprinted also. (NC)17. CONTROL OFFICE USEnac completed.FOR THE DIRECTOR: FEB 1 8 1967(6353-6004)18. FROM:HEADQUARTERS, USAINTCATTN: ICOP-III-31Fort Holabird, Md. 21219FINGERPRINT CARD FD 258 MUST BE ATTACHEDNW 88613 Docld:34528584 Page 2