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# STATEMENT OF PERSONAL HISTORYINSTRUCTIONS: Read the certification at the end of this questionnaire before entering the required data. Print or type all answers. All questions and statements must be completed. If the answer is "None," so state. Do not misstate or omit material fact since the statements made herein are subject to verification. If more space is needed, use the Remarks section, item 20, and attach additional sheets if necessary. The information entered hereon is for official use only and will be maintained in confidence.1. (Print) FIRST NAME-MIDDLE NAME--MAIDEN NAME (If any)-LAST NAMEMR.MRS.MISSDAVID REED FROMER3. ALIAS(ES). NICKNAME(S). OR CHANGES IN NAME (Other than by marriage)None5. DATE OF BIRTH (Day, month, year)21 July 19422. STATUSCIVILIANMILITARY ON ACTIVE DUTY4. PERMANENT MAILING ADDRESS13 Rhonda Way, Mill Valley, Calif.PLACE OF BIRTH (City, County, State, and Country)Chicago, Cook, Illinois, USAPLACE CERTIFICATE RECORDEDRACEHEIGHTWEIGHTCOLOR OF EYESCOLOR OF HAIRSCARS, PHYSICAL DEFECTS, DISTINGUISHING MARKSCauc67"170BrownBrownScar above left eye6. DO YOU HAVE A HISTORY OF MENTAL OR NERVOUS DISORDERS? ☐ YES XX NO ARE YOU NOW OR HAVE YOU EVER BEEN ADDICTED TO THE USE OF HABIT FORMING DRUGS SUCH AS NARCOTICS OR BARBITURATES? YES ☑ ☑ιο ARE YOU NOW OR HAVE YOU EVER BEEN A CHRONIC USER TO EXCESS OF ALCOHOLIC BEVERAGES? YES XXNO IF THE ANSWER TO ANY OF THE ABOVE IS "YES." EXPLAIN IN ITEM 20.7. U. S.   CITIZEN   NATIVE   IF NATURALIZED, CERTIFICATE NO.   IF DERIVED, PARENTS CERTIFICATE NO(S).   DATE. PLACE, AND COURTYES8. ALIENNOREGISTRATION NONATIVE COUNTRYDATE AND PORT OF ENTRYDO YOU INTEND TO BECOMEA U. S. CITIZEN?YESNOMILITARY SERVICEARE YOU PRESENTLY ON ACTIVE DUTY IN THE U. S. ARMED FORCES DRAWING FULL PAY? YES NO IF "YES," COMPLETE THE FOLLOWING:GRADE AND SERVICE NO.SERVICE AND COMPONENTORGANIZATION AND STATIONDATE CURRENT ACTIVESERVICE STARTEDARE YOU PRESENTLY A MEMBER OF A U. S. RESERVE OR NATIONAL GUARD ORGANIZATION? YES NO IF "YES." COMPLETE THE FOLLOWING:GRADE AND SERVICE NO.SERVICE AND COMPONENTORGANIZATION AND STATION OR UNIT AND LOCATIONHAVE YOU PREVIOUSLY SERVED TOURS OF EXTENDED ACTIVE DUTY, DRAWING. FULL PAY, FROM WHICH YOU WERE DISCHARGED OR SEPARATED TO CIVILIAN STATUS? YES NO IF "YES." COMPLETE THE FOLLOWING:COUNTRYSERVICECOMPONENTFROM (Date)TO (Date)TYPE DISCHARGES OR SEPARATIONS-GRADE AND SERVICE NO.9. EDUCATION (Account for all civilian schools and military academies. Do not include service schools)| MONTH AND YEAR | NAME AND LOCATION OF SCHOOL | GRADUATE                                    | DEGREE |     |     || -------------- | --------------------------- | ------------------------------------------- | ------ | --- | --- || FROM-          | TO-                         | YES                                         | NO     |     |     || 1947           | 1949                        | Nettelhorst Elem. School, Chicago, Illinois | *      | X   | DF  || 1949           | 1950                        | La Casita Elem. School, Clovis, New Mexico  | *      | X   | DF  || 1950           | 1954                        | Argonne Elem. School, S.F., Calif.          | X      |     |     || 1954           | 1957                        | Presidio Of.High, S.F., Celff.              | X      |     |     || 1957           | 1960                        | Geo. Washington High School, S.F., Calif.   | X      |     |     |10. FAMILY (List in order given, parents, spouse, guardians, stepparents, foster parents, parents-in-law, former spouse(s) (if divorced give date and place), children, brothers and sisters, even though deceased. Include any others you resided with or with whom a close relationship existed or exists. It the person is not a U. S. citizen by birth, give date and port of entry, alien registration number, naturalization certificate number and place of issuance.)| RELATION AND NAME       | DATE AND PLACE OF BIRTH | PRESENT ADDRESS, IF LIVING | U. S. CITIZEN |     || ----------------------- | ----------------------- | -------------------------- | ------------- | --- ||                         |                         |                            | YES           | NO  || FATHER                  | 12 July 1913            | 13 Rhonda Way              | X             |     || IRVING FROMER           | Cincinnati, Ohio        | Mill Valley, Calif.        |               |     || MOTHER (Maiden name)    | 31 Dec 1909             | 13 Rhoda Way               | X             |     || Katherine Rhodes        | Estherville, Iowa       | Mill Valley, Calif.        |               |     || SPOUSE (Maiden name)    |                         |                            |               |     || None                    |                         |                            |               |     || OTHER (Specify) Brother | 11 May 1946             | 881 Cleyton St.            | X             |     || Jon Fromer              | Chicago, Illinois       | San Francisco, Calif.      |               |     || Sister                  | 15 Aug 1939             | 881 Clayton St.            | X             |     || Ann Spake               | San Francisco, Calif.   | San Francisco, Calif.      |               |     |378