104-10129-10002
2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992
14-00000
DO NOT USE THIS SPACE
ISSUED BY
THIS DATE (Fill In)
PERSONAL HISTORY STATEMENT
August 31, 1961
INSTRUCTIONS
1. Answer all questions completely or check appropriate box. If question is not applicable, write "NA". Write "Un-
known" only if you do not know the answer and it cannot be obtained from personal records. Use blank space at
end of form for extra details on any question for which you have insufficient space.
2. Type, print or write carefully; illegible or incomplete forms will not receive consideration.
3. Consider your answers carefully. Your signature at the end of this form will certify to their correctness. Careful
completion of all applicable questions will permit review of your qualifications to the best advantage.
SECTION 1
GENERAL PERSONAL AND PHYSICAL DATA
1. FULL NAME (Last-First-Middle)
2. AGE
33 YEARS 8 MONTHS X MALE
RODRIGUEZ, EMILIO AMERICO
4. HEIGHT 5. WEIGHT
6. COLOR OF EYES
7. COLOR OF HAIR'
BROWN
BLACK
B. TYPE COMPLEXION
3. SEX
FEMALE
9. TYPE BUILD
MEDIUM
5FT. 10IN. 150lbs.
10. SCARS (Type and Location)
NONE
11. OTHER DISTINGUSHING PHYSICAL FEATURES
NONE
12. CURRENT ADDRESS (No., Street, City, Zone, State and Country)
.
9361 S.W. 178 ST.
PERRINE 57, FLA.
U.S.A.
14. CURRENT PHONE NO.
Cedar 5-8341
17. NICKNAMES
15. OFFICE PHONE NO. & EXT.
N.A.
RUDDY
13. PERMANENT ADDRESS (No., Street, City, Zone, State and
Country) AND PHONE NO.
89361 S.W. 178ST.
PERRINE 57, FLA.
4. S.A.
PHONE:
(Cedar 5-8341
16. LEGAL RESIDENCE (State, Territory or Country)
Florida
U.S.A.
NONE
18. OTHER NAMES YOU HAVE USED
EUGENIO
GONZALEZ,)
19. INDICATE CIRCUMSTANCES (Including Length of Time) UNDER WHICH YOU HAVE EVER USED THESE NAMES.
FROM APRIL 1960 TO PRESENT IN HAVANA, CUBA AND MIAMI, FLA. AS UNDERCOVER NAME
20. IF LEGAL CHANGE, GIVE PARTICULARS (Where and by What Authority).
SECTION II
N.A.
POSITION DATA
1. INDICATE THE TYPE OF WORK OR POSITION FOR WHICH YOU ARE APPLYING
CONTRACT
AGENT
2. INDICATE THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL
ACCEPT (You will not be considered for any position with a lower
entrance salary).
3. DATE AVAILABLE FOR EMPLOYMENT
$ 9,600.00
CONTRACT
Already Signed
4. INDICATE YOUR WILLINGNESS TO TRAVEL
FREQUENTLY
CONSTANTLY
OTHER:
OCCASIONALLY
5. INDICATE YOUR WILLINGNESS TO ACCEPT ASSIGNMENT IN THE FOLLOWING LOCATIONS (Check (X) each item applicable)
WASHINGTON, D.C.
IX ANYWHERE IN U.S. X CERTAIN LOCATIONS ONLY (Specify):
☑
OUTSIDE CONTINENTAL U.S.
6. INDICATE WHAT RESERVATIONS YOU WOULD PLACE ON ASSIGNMENTS OUTSIDE THE WASHINGTON, D.C. AREA.
ADEQUATE PAY AND LIVING CONDITIONS FOR
SELF AND FAMILY
FORM 444 USE PREVIOUS EDITION.
11-58
-1
4 51
(4)
14-00000
- 2 -
SECTION IN
1. DATE OF BIRTH
JAN. 27, 1928
BIRTH
CITIZENSHIP
2. PLACE OF BIRTH (City, State, Country)
HAVANA СИВА
1
4. CITIZENSHIP ACQUIRED BY
5. DATE NATURAL-
IZED
MARRIAGE ☑ OTHER (Specify): NATURA. DECEMBER 15, 1949
7. COURT ISSUING NATURALIZATION CERTIFICATE
U.S. DISTRICT COURT OF EASTERN DIST. OF LOUISIANA
☑
9. HAVE YOU HELD PREVIOUS NATIONALITY
YES
NO
3. PRESENT CITIZENSHIP (Country)
U.S.A.
6. NATURALIZATION CERTIFICATE NO.
8. ISSUED AT (City, State, Country)
#6799255)
LA.
New ORLEANS
10. IF YES, GIVE NAME OF COUNTRY
СИВА
11. GIVE PARTICULARS CONCERNING PREVIOUS NATIONALITY.
Cuban BY BIRTH
12. HAVE YOU TAKEN STEPS TO CHANGE
PRESENT CITIZENSHIP
YES
☑
NO
13. GIVE PARTICULARS
N.A.
14. IF YOU HAVE APPLIED FOR U.S. CITIZENSHIP, WHAT IS PRESENT STATUS OF YOUR APPLICATION (First Papers, Etc.)?
N.A.
16. PORT OF ENTRY
15. DATE OF ARRIVAL IN U.S.
JUNE6 1961
MIAMI, FLA.
18. LAST U.S. VISA (No., Type, Place of Issue)
RESIDENT
SECTION IV
+
U.S. EMBASSY IN HAVANA, CUBA
EDUCATION
17. ON PASSPORT OF WHAT COUNTRY
SWISS PROTECTIVE PASSPORT
19. DATE VISA ISSUED
Nov. 1942
1. CHECK (X) HIGHEST LEVEL OF EDUCATION ATTAINED
LESS THAN HIGH SCHOOL GRADUATE
HIGH SCHOOL GRADUATE
TRADE, BUSINESS, OR COMMERCIAL SCHOOL GRADUATE
TWO YEARS COLLEGE OR LESS
OVER TWO YEARS OF COLLEGE NO DEGREE
BACHELOR'S DEGREE
GRADUATE STUDY LEADING TO HIGHER DEGREE
MASTER'S DEGREE
DOCTOR'S DEGREE
2. ELEMENTARY SCHOOL
2. ADDRESS (City, State, Country)
HAVANA
СИВА
3. DATES ATTENDED (From-and-To)
1. NAME OF ELEMENTARY SCHOOL
COLEGIO DE LA SALLE)
Sep. 1934
to Nov. 1942
YES
3. HIGH SCHOOL
4. GRADUATE
NO
1. NAME OF HIGH SCHOOL
ALCEE FORTIER HIGH SCHOOL
3. DATES ATTENDED (From-and-To)
Nov. 1942
1. NAME OF HIGH SCHOOL
to
2. ADDRESS (City, State, Country)
NEW ORLEANS, LA.
4. GRADUATE
NO
June 1945
☑
YES
2. ADDRESS (City, State, Country)
3. DATES ATTENDED (From-and-To)
YES
4. GRADUATE
NO
4. COLLEGE OR UNIVERSITY STUDY
NAME AND LOCATION OF COLLEGE OR UNIVERSITY
SUBJECT
MAJOR MINOR
Biology?
DATES ATTENDED
DEGREE
REC'D
TO
FROM
DATE
REC'D
SEM/QTR
HOURS
(Specify)
TULANE UNIVERSITY OF LouisIANA Bychology Chemistry 1945 1948 B.S. June 1948 Sem has.
1948-1952
TULANE UNIVERSITY OF LOUISIANA Spanish Portuguese 1949 1952
TULANE UNIVERSITY OF LOUISIANA Spanish French 1952 1954
SECTION IV CONTINUED TO PAGE 3
M.A. JUNE 1952 Sem hes.
NONE
N.A. Sem hrs.
14-00000
SECTION IV CONTINUED FROM PAGE 2
5. SF A GRADUATE DEGREE HAS BEEN NOTED IN ITEM 4 WHICH REQUIRED SUBMISSION OF A WRITTEN THESIS, INDICATE THE TITLE
OF THE THESIS AND BRIEFLY DESCRIBE ITS CONTENT.
EL
EPITETO EN LAS OBRAS DE BERCEO (DO NOT REMEMBER EXACT TITLE). A DETAILED
STUDY 
OF THE MANY 
USES OF THE EPITHET IN
BERCEO'S WORKS, A 12TH CENTURY WRITER,
Including A CROSS-REFERENCE LISTING OF ALL EPITHETS AS SHOWN IN HIS WRITINGS.
6. TRADE, COMMERCIAL AND SPECIALIZED SCHOOLS
STUDY OR SPECIALIZATION
NAME AND ADDRESS OF SCHOOL
FROM
TO
MONTHS
N.A.
7. MILITARY TRAINING (FULL TIME DUTY IN SPECIALIZED SCHOOLS SUCH AS ORDNANCE, INTELLIGENCE, COMMUNICATIONS, ETC.)
NAME AND ADDRESS OF SCHOOL
STUDY OR SPECIALIZATION
FROM
TO
MONTHS
8. OTHER EDUCATIONAL TRAINING NOT INDICATED ABOVE.
SECTION V
1. LANGUAGE
(List below each language in
which you possess any degree
of competence. Indicate your
proficiency to Read, Write or
Speak by placing a check (X)
in the appropriate box(es).
Spanish
PORTUGUESE
FRENCH
N.A.
N.A.
FOREIGN LANGUAGE ABILITIES
COMPETENCE IN ORDER LISTED
R-Read, W-Write, S-Speak
HOW ACQUIRED
EQUIV-
ALENT
TO
NATIVE
FLUENCY
FLUENT
BUT
OBVIOUSLY
FOREIGN
ADEQUATE ADEQUATE LIMITED
FOR
FOR
KNOW-
RESEARCH TRAVEL
LEDGE
NATIVE
OF
COUNTRY
PRO-
LONGED
RES
IDENCE
CONTACT ACADEMIC
(with STUDY
(all
parents,
etc.)
levels)
RWSRWSRWSRWSRWS
ITALIAN
2. IF YOU HAVE CHECKED "ACADEMIC STUDY" UNDER "HOW ACQUIRED", INDICATE LENGTH AND INTENSIVENESS OF STUDY.
FROM 1949 to 1954 StuDIED THE ROMANCE LanguagES AT THE GRADUAte
LEVEL
3. IF YOU HAVE INDICATED FLUENCY FOR A LANGUAGE HAVING SIGNIFICANT DIFFERENCES IN SPOKEN AND WRITTEN FORM, EX-
PLAIN 
YOUR COMPETENCE THEREIN.
N.A.
4. DESCRIBE YOUR ABILITY TO DO SPECIALIZED LANGUAGE WORK INVOLVING VOCABULARIES AND TERMINOLOGY IN THE SCIEN-
TIFIC, ENGINEERING, TELECOMMUNICATIONS, MILITARY, AND OTHER SPECIALIZED FIELDS.
FAMILIAR WITH SCIEntific AND ENGINEERING
TERMINOLOGY IN SPANISH.
5. IF YOU HAVE NOTED A PROFICIENCY IN LANGUAGE, WOULD YOU BE WILLING TO USE THIS ABILITY IN ANY POSITION FOR WHICH
YOU MIGHT BE SELECTED?
☑ YES
NO
-3.
14-00000
4.
SECTION VI
GEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL
1. LIST BELOW ANY FOREIGN REGIONS OR COUNTRIES IN WHICH YOU HAVE TRAVELLED OR GAINED KNOWLEDGE AS A RESULT OF
RESIDENCE, STUDY OR WORK ASSIGNMENT. INDICATE TYPE OF KNOWLEDGE SUCH AS TERRAIN, HARBORS, UTILITIES, RAIL-
ROADS, INDUSTRIES, 
POLITICAL PARTIES, ETC.
NAME OF
REGION OR COUNTRY
Сива
DATES OF
RESIDENCE
OR TRAVEL
DATES AND
PLACE OF STUDY
KNOWLEDGE ACQUIRED BY
WORK
RESI-
DENCE TRAVEL STUDY ASSIGN
MENT
TYPE OF
SPECIALIZED KNOWLEDGE
HAVANA + VECINITY. POLITICAL
ECONOMIC SOCIAL STRUCTURE
COMMERCE - IMPORTATIONS, 1954-1961
N.A.
2. INDICATE THE PURPOSE OF VISIT, RESIDENCE, OR TRAVEL IN EACH OF THE REGIONS OR COUNTRIES LISTED ABOVE.
TO WORK MANAgeR
AS Assistant District Manager 
for Century Electric Co., IN
IN HAVANA, Cuba. June 1961 AS
of theiR HAVANA Office,
change
LATER REMAINED IN CubA FROM MARch 9960 to
PRINCIPAL Agent for C.I.A...
3. UNITED STATES PASSPORT NUMBER AND EXPIRATION DATE, IF ISSUED.
PASS. No:1095961
Expired: Sept. 2 1960 (NOT RENewed)
SECTION VII
1. TYPING (wpm)
2. SHORTHAND (wpm)
50
N.A.
TYPING AND STENOGRAPHIC SKILLS
GREGG
3. SHORTHAND SYSTEM USED CHECK (X) APPROPRIATE ITEM
SPEEDWRITING
STENOTYPE
OTHER (Specify):
2. INDICATE OTHER BUSINESS MACHINES WITH WHICH YOU HAVE HAD OPERATING EXPERIENCE OR TRAINING (Comptometer,
Mimeograph, Card Punch, Etc.
).
MIMEOGRAPH, ADDING MACHINE, CALCULATOR, DICTATING MACHINE.
SECTION VIII
SPECIAL QUALIFICATIONS
1. LIST ALL HOBBIES AND SPORTS IN WHICH YOU ARE ACTIVE OR HAVE ACTIVELY PARTICIPATED. INDICATE YOUR PROFICIENCY
IN EACH.
FISHING, HUNTING, SWIMMING (GOOD UNDERWATER RESISTANCE), PHOTOGRAPHY
(BLACK & 
WHITE AND 
COLOR), MUSICAL (PLAY SEVERAL INSTRUMENTS BY EAR), FLYING,
Bowling,
Chess.
Average
IN ALL OF THE ABOVE.
2. INDICATE ANY SPECIAL QUALIFICATIONS RESULTING FROM EXPERIENCE OR TRAINING WHICH MIGHT FIT YOU FOR A
PARTICULAR POSITION OR TYPE OF WORK.
TEACHING AND ADMINISTRATIVE EXPERIENCE Secured AT THE UNIVERSITY
LEVEL AND IN FOREIGN TRADE MANAGEMENT RESPECTIVELY. Also
CAPACITY TO CARRY OUT
INDEPENDENT RESEARCH AT THE GRADUATE LEVEL.
3. EXCLUDING BUSINESS EQUIPMENT OR MACHINES WHICH YOU MAY HAVE LISTED IN ITEM 2, SECTION VII, LIST ANY SPECIAL
SKILLS YOU POSSESS RELATING TO OTHER EQUIPMENT AND MACHINES SUCH AS OPERATION OF SHORTWAVE RADIO (Indi-
cate CW speed, sending and receiving), OFFSET PRESS, TURRET LATHE, SCIENTIFIC AND PROFESSIONAL DEVICES.
FAMILIAR WITH GENERAL SCIENTIFIC APPARATUS AS MAY BE PRESENT
IN A MEDICAL RESEARCH LABORATORY. BECKMAN Spectophotometry.
holk
(DID ONE YEAR RESEARCH AT TULANE MEDICAL SCHOOL))
!
SECTION VIII CONTINUED TO PAGE 5
14-00000
= SECTION VIII CONTINUED FROM PAGE 4
4. 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, ETC.?
☑ YES ☐ NO
5. IF YOU HAVE ANSWERED "YES" TO ABOVE, INDICATE KIND OF LICENSE AND STATE ISSUING LICENSE (Provide License Registry
Number, if known).
Student Pilot Certificate N° S-293957
)
6. FIRST LICENSE OR CERTIFICATE (Year of Issue)
2-18-54
7. LATEST LICENSE OR CERTIFICATE (Year of Issue)
N.A.
8. 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.).
N.A.
9. INDICATE ANY DEVICES WHICH YOU HAVE INVENTED AND STATE WHETHER OR NOT THEY ARE PATENTED.
N.A.
10. LIST PUBLIC SPEAKING AND PUBLIC RELATIONS EXPERIENCE.
IN COLLEGE AND AS A JUNIOR EXECUTIVE IN FOREIGN TRADE
,
11. LIST ANY PROFESSIONAL, ACADEMIC OR HONORARY ASSOCIATIONS OR SOCIETIES IN WHICH YOU ARE NOW OR WERE FORMERLY
A MEMBER. LIST ACADEMIC HONORS YOU HAVE RECEIVED.
HONOR
Phi Sigma Iota, National Honor Society of Romance Languages.
American Association of Teachers of Spanish and
Portuguese.
Graduate Scholarships offered by the state of Louisiana and Tulane University.
(UNDER WHICH I DID FIVE YEARS OF GRADUATE WORK)
HONORARY MENTIONS AND MEDALS.
SECTION IX
1
EMPLOYMENT HISTORY
NOTE: (LIST LAST POSITION FIRST.) Indicate chronological history of employment for past 15 years. Account for all periods
including casual employment and all periods of unemployment. Give address and state what you did during periods of
unemployment. List all civilian employment by a foreign Government, regardless of dates. In completing item 9, "De-
scription of Duties" consider your experience carefully and provide meaningful, objective statements.
1. INCLUSIVE DATES (From and To By Mo. and Yr.)
Hery1954
-
Oct. 1960
3. ADDRESS (No., Street, City, State, Country)
2. NAME OF EMPLOYING FIRM OR AGENCY
CENTURY ELECTRIC COMPANY)
1806 PINE ST., ST. LOUIS, MO., USA.
4. KIND OF BUSINESS
MANUFACTURER OF MOTORS, GENERATORS, ETC.
6. TITLE OF JOB
Assitant DISTRICT MANAGER
5. NAME OF SUPERVISOR ARNESTO N. RODRIGUEZ, Dist. Mug
MR. Charles C. White, Expet MANAGER.
MR. Charles C. WhiNE
7. SALARY OR EARNINGS
$ 1,000
8. CLASS. GRADE(If Federal Service)
PER MORTH (AHO)
9. DESCRIPTION OF DUTIES TO PROMOTE AND SERVICE THE SALE OF CENTURY MOTORS, GENERATORS,
AND RELATED EQUIPMENT IN THE TERRITORY OF CUBA, AND TO COOPERATE IN COLLECTIONS
WHEN NECESARY. TO MANAGE THE HAVANA DISTRICT SALES OFFICE IN FULL RESPONSABILITY IN
THE ABSENCE OF THE DISTRICT MGR. TO LOOK AFTER THE INTEREST OF CENTURY ELEC. CON IN CUBA
PRESENT CONDITIONS IN CUBA AND ACCEPTANCE ASSIGNMENTS
10. REASONS FOR LEAVING
AS PRINCIPAL AGENT IN CUBA FOR C.I.A.
SECTION IX CONTINUED TO PAGE 6
14-00000
3
i
SECTION IX CONTINUED FROM PAGE 5
1. INCLUSIVE DATES (From and To By Mo. and Yr.)
FEB. 1950
2. NAME OF EMPLOYING FIRM OR AGENCY
کو
MARCH 1954 TULANE UNIVERSITY
3. ADDRESS (No., Street, City, State, Country)
(ST. CHARLES ST., NEW
4. KIND OF BUSINESS
COLLEGE
6. TITLE OF JOB
Graduate Asst.
2
9. DESCRIPTION OF DUTIES
ORLEANS I LA.
U.S.A.
5. NAME OF SUPERVISOR
DR. John E. Englekirk, CHAIRMAN Sp. Dept.
7. SALARY OR EARNINGS
$ 700
8. CLASS. GRADE (If Federal Service)
[PER MONTH (D)
Монтир
TEACHER OF BEGINNER AND INTERMEDIATED SPANISH IN THE
COLLEGE LEVEL. TO ASSIST WITH REGISTRATION AND DEPARTAMENTAL FUNCTIONS.
10. REASONS FOR LEAVING
TO ACCEPT ABOVE POSITION
1. INCLUSIVE DATES (From and To By Mo. and Yr.)
JUNE 1949
-
JQNE1950
3. ADDRESS (No., Street, City, State, Country)
INTERNATIONAL
4. KIND OF BUSINESS
LANGUAGE
6. TITLE OF JOB
2. NAME OF EMPLOYING FIRM OR AGENCY
BERLITZ SCHOOL OF Languagez
TRADE MART, NEW ORLEANS, LA, U.S.A.
SCHOOL
PROFESSOR
9. DESCRIPTION OF DUTIES
5. NAME OF SUPERVISOR
$
MR. HALL, DIRECTOR
7. SALARY OR EARNINGS 8. CLASS. GRADE (If Federal Service)
3.00 | PER GR. (Eff.)
TO TEACH THE SPANISH LANGUAGE BY THE BERLITZ METHOD
10. REASONS FOR LEAVING
TO ACCEPT Above
POSITION AND PURSUE
AN ADVANCED DEGREE
1. INCLUSIVE DATES (From and To By Mo. and Yr.)
JAN. 1949
-
June 1949
3. ADDRESS (No., Street, City, State, Country)
TULANE AVE., NEW ORLEANS, LA.
4. KIND OF BUSINESS
MEDICAL
6. TITLE OF JOB
SCHOOL
Medical Research Technician
2. NAME OF EMPLOYING FIRM OR AGENCY
TULANE UNIVERSITY MEDICAL SCHOOL
4.5.A.
5. NAME OF SUPERVISOR
DR.
Woo
7. SALARY OR EARNINGS
$ 200.00
PER MONTH
8. CLASS. GRADE (If Federal Service)
9. DESCRIPTION OF DUTIES IN CHARGE OF SPECTROPHOTOMETRIC ANALYSIS IN THE CARDIO-
VASCULAR RESEARCH, Laboratory.
10. REASONS FOR LEAVING
CONCLUSION OF RESEARCH
1. INCLUSIVE DATES (From and To By Mo. and Yr.)
3. ADDRESS (No., Street, City, State, Country)
5
4. KIND OF BUSINESS
6. TITLE OF JOB
2. NAME OF EMPLOYING FIRM OR AGENCY
5. NAME OF SUPERVISOR
7. SALARY OR EARNINGS 8. CLASS. GRADE (If Federal Service)
$
=
PER
SECTION IX CONTINUED TO PAGE 7
14-00000
9. DESCRIPTION OF DUTIES
5
10. REASONS FOR LEAVING
SECTION IX CONTINUED FROM PAGE 6
1. INCLUSIVE DATES (From and To By Mo. and Yr.)
2. NAME OF EMPLOYING FIRM OR AGENCY
3. ADDRESS (No., Street, City, State, Country)
4. KIND OF BUSINESS
5. NAME OF SUPERVISOR
6. TITLE OF JOB
7. SALARY OR EARNINGS
8. CLASS. GRADE (If Federal
Service)
6
1$
PER
9. DESCRIPTION OF DUTIES
7
10. REASONS FOR LEAVING
1. INCLUSIVE DATES (From and To By Mo. and Yr.)
3 ADDRESS (No., Street, City, State, Country)
2. NAME OF EMPLOYING FIRM OR AGENCY
4. KIND OF BUSINESS
6. TITLE OF JOB
9. DESCRIPTION OF DUTIES
10. REASONS FOR LEAVING
5. NAME OF SUPERVISOR
7. SALARY OR EARNINGS
B. CLASS. GRADE (If Federal
Service)
$
PER
B. IF PRIOR SERVICE WITH THE FEDERAL GOVERNMENT IS NOTED ABOVE, INDICATE THE
NUMBER OF YEARS CREDITABLE TOWARD U.S. CIVIL SERVICE RETIREMENT, IF KNOWN.
9. HAVE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN FROM ANY POSITION.
HAVE YOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH YOU DESIRE TO EXPLAIN?
IF YOUR ANSWER TO EITHER OR BOTH QUESTIONS IS "YES", GIVE DETAILS.
YES ☑ NO
YES ☑ NO
:
.7.
14-00000
SECTION X
1. ARE YOU REGISTERED FOR THE DRAFT UNDER
THE UNIVERSAL MILITARY TRAINING AND
SERVICE ACT OF 1948 (As amended)
4. IF DEFERRED, GIVE REASON
DIABETES
MELLITUS
CHECK (X) AS
APPROPRIATE
ARMY
NAVY
HAVE SERVED
.8-
MILITARY SERVICE
1. CURRENT DRAFT STATUS
YES
2. SELECTIVE SERVICE CLASSIFI
CATION
3. SELECTIVE SERVICE NO.
NO
4-F
16-45-28-53.
5. LOCAL DRAFT BOARD NO. OR DESIGNATION AND ADDRESS
N° 45, OrleaN PARISH, New Orleans, LA.
2. MILITARY SERVICE RECORD
1. CURRENT AND/OR PAST ORGANIZATIONAL MEMBERSHIP
MERCHANT NATIONAL AIR NAT'L FOREIGN ORGAN. OR MIL.
SERVICE (Specify):
MARINE
CORPS
AIR
FORCE
COAST
GUARD
MARINE
GUARD
GUARD
NOW SERVING -
2. BRANCH OR CORPS OF ABOVE CHECKED ORGANIZATION(S)
3. DATE SEPARATED FROM EXTENDED ACTIVE DUTY (Past service) 4. TOTAL LENGTH OF EXTENDED ACTIVE DUTY IN U.S. ARMED
5. DATE ENTERED
PAST SERVICE
ACTIVE DUTY -
7. RANK, GRADE OR
RATE
PAST SERVICE
CURRENT SERVICE
CURRENT SERVICE
FORCES (Past and current service)
6. TOTAL LENGTH OF ACTIVE DUTY IN FOREIGN MILITARY OR-
GANIZATION
8. SERVICE, SERIAL OR FILE NUMBER (If now serving, provide cur
frent number)
9. PRIMARY MILITARY OCCUPATIONAL
SPECIALTY (Mos or Designator) AND TITLE
10. SECONDARY MIL. OCCUPATIONAL
SPECIALTY (Moe or Designator) AND
TITLE
PAST SERVICE
PAST SERVICE
CURRENT SERVICE
CURRENT SERVICE
11. BRIEF DESCRIPTION OF MILITARY DUTIES (Indicate whether applicable to past or current service)
HONORABLE DISCHARGE
RELEASE TO INACTIVE DUTY
RETIREMENT FOR AGE
12. CHECK (X) TYPE OF SEPARATION FROM ACTIVE DUTY
RETIREMENT FOR SERVICE
RETIREMENT FOR COMBAT DISABILITY
UNDUE HARDSHIPS
OTHER:
RETIREMENT FOR PHYSICAL DISABILITY
13. CHECK (X) COMPONENT IN WHICH YOU SERVED
REGULAR
RESERVE (Including the National and Air National Guard)
OTHER (Including AUS)
1. DO YOU NOW HAVE
RESERVE STATUS?
YES
NO
2. ARE YOU NOW A MEMBER OFTHE
NAT'L. GRD. OR AIR NAT'L.
GRD.?
3. MILITARY RESERVE, NATIONAL GUARD AND ROTC STATUS
YES
3. ARE YOU NOW A MEMBER OF
THE ROTC?
YES
NO
NO
ARMY
NAVY
4. IF YOU HAVE ANSWERED "YES" TO ITEMS 1, 2 OR 3 ABOVE, CHECK COMPONENT MEMBERSHIP BELOW
MARINE CORPS
AIR FORCE
5. CURRENT RANK, GRADE OR
RATE
NATIONAL GUARD
AIR NAT'L. GUARD
COAST GUARD
ARMY ROTC
6. DATE OF APPOINTMENT IN CURRENT
RANK
READY RESERVE
B. CHECK (X) CURRENT RESERVE CATEGORY
9. PRIMARY MILITARY OCCUPATIONAL SPECIALTY (Mos or Desig-
nator) AND TITLE
11. BRIEF DESCRIPTION OF MILITARY RESERVE DUTIES
NAVY ROTC
AIR FORCE ROTC
INDICATE ROTC CATEGORY NUM-
BER
7. EXPIRATION DATE OF CURRENT RESERVE OBLIGA-
TION
STANDBY(Active)
RETIRED
10. SECONDARY MILITARY OCCUPATIONAL SPECIALTY (Mos or Deo-
ignatory AND-TITLE
STANDBY (Inactive)
12. ARE YOU CURRENTLY ASSIGNED OR ATTACHED
TO A RESERVE, NAT'L. GUARD OR ROTC TRAIN-
ING UNIT
14. HAVE YOU A MILITARY MOBILIZATION ASSIGN-
MENT?
YES
☑ NO
YES
NO
MONTHS
NA
NA
16. INDICATE TOTAL MILITARY SERVICE YEARS
FOR LONGEVITY PURPOSES INCLUD-
ING ACTIVE AND INACTIVE DUTY
13. IF YOU HAVE ANSWERED "YES" TO ITEM 12, GIVE UNIT OR AGENCY
AND ADDRESS
15. IF YOU HAVE ANSWERED YEST TO ITEM 14, GIVE UNIT OR AGENCY
AND ADDRESS
17. WHERE ARE YOUR SERVICE RECORDS KEPT1
14-00000
SECTION XI
1. ARE YOU ENTIRELY DEPENDENT ON YOUR SALARY?
FINANCIAL STATUS
2. IF YOUR ANSWER IS "NO" TO THE ABOVE, STATE SOURCES OF OTHER INCOME
N. A.
☑ YES
NO
3. BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS
NAME OF INSTITUTION
Whitney Nat. Bank of New Geleans
The Airpeet BANK of Miami
The RoyAL BANK OF CANADA
of
4. HAVE YOU EVER BEEN IN, OR PETITIONED FOR, BANKRUPTCY,
ADDRESS (City, State, Country)
New Orleans, LA., U.S.A.
Miami FLA., U.S.A.
HAVANA, CUBA.
YES
☑ NO
5. IF YOUR ANSWER IS "YES" TO THE ABOVE, GIVE PARTICULARS, INCLUDING COURT AND DATE(S)
N.A.
6. GIVE THREE CREDIT REFERENCES IN THE UNITED STATES
NAME
| Whitney Nat. BANK of New GRLEANS
D.H. HOLMES Ltd. (Department Store)
MAISON Blanche (Department Store)
ADDRESS (No., Street, City, State)
New Orleans, LA. U.S.A.
New Orleans, LA. U.S.A.
New Orleans, LA. U.S.A.
7. DO YOU RECEIVE AN ANNUITY FROM THE UNITED STATES OR DISTRICT OF COLUMBIA GOVERNMENT UNDER ANY RETIREMENT
ACT, PENSION, OR COMPENSATION FOR 
MILITARY OR NAVAL SERVICE?
8. IF YOUR ANSWER IS "YES" TO THE ABOVE QUESTION, GIVE COMPLETE DETAILS
YES
NO
N.A.
9. DO YOU HAVE ANY FINANCIAL INTEREST IN, OR OFFICIAL CONNECTIONS WITH NON-U.S. CORPORATIONS OR BUSINESSES; OR IN
OR WITH U.S. CORPORATIONS OR BUSINESSES HAVING SUBSTANTIAL FOREIGN INTERESTST
YES
☑ NO
SECTION XII
(If answer "YES", fumich details on separate sheet.)
MARITAL STATUS
1. PRESENT STATUS (Single, Married, Widowed, Separated, Divorced, or Annulled) SPECIFY:
2. STATE DATE, PLACE, AND REASON FOR ALL SEPARATIONS, DIVORCES OR ANNULMENTS
WIFE, HUSBAND
OR FIANCE:
3. NAME
N.A.
MARRIED
If you have been married more than once- including annulments - use a separate sheet for former wife or
husband giving data required below for all previous marriages. If marriage contemplated, fill in appropriate
information for fiance.
(First)
(Middle)
Juanita
(Maiden)
(Last)
RODRIGUEZ
PAULINE
4. STATE ANY OTHER NAMES EVER USED
Ross
INDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH ANY
OF THESE NAMES WERE USED. IF LEGAL CHANGE GIVE PARTICULARS
PAULA (NICKNAME SINCE CHILHOOD) (Where and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 16
5. DATE OF MARRIAGE
JUNE 10.
1948
OF THIS FORM TO RECORD THIS INFORMATION.
6. PLACE OF MARRIAGE (City, State, Country)
New Orleans, LA., U.S.A.
7. HIS (OR HER) ADDRESS BEFORE MARRIAGE (No., Street, City, State, Country)
(300 OAKUM ST. EDENTON, N.C. 4.S.A.
8. LIVING
YES
NO
9. DATE OF DEATH
N.A.
10. CAUSE OF DEATH
N.A.
11. CURRENT ADDRESS (Give laat address, if deceased)
(9361 S.W.
12. DATE OF BIRTH
JAN. 2, 1923
1
178 St. / PERRINE 571, FLA. U.S.A.
13. PLACE OF BIRTH (City, State, Country)
BOGALUSA, LA.
.U.S.A.
SECTION XII CONTINUED TO PAGE 10
-9.
14. CITIZENSHIP
4.S.A.
14-00000
- 10 -
SECTION XII CONTINUED FROM PAGE 9
15. PLACE OF ENTRY
14. IF BORN OUTSIDE U.S.
DATE OF ENTRY
N.A.
16. FORMER CITIZENSHIP(S)
[Counter(ies)]
N.A.
19. OCCUPATION
House Wife
N.A.
17. DATE U.S. CITIZENSHIP 18. WHERE ACQUIRED (City, State, Country)
ACQUIRED
N.A.
N.A.
20. PRESENT EMPLOYER (Also give former employer, or if spouse deceased or
unemployed give last two employers)
21. EMPLOYER'S OR BUSINESS ADDRESS (No., Street, City, State, Country)
N.A.
22. DATES OF MILITARY SERVICE (From and to - By Mo. and Yr.)
23. BRANCH OF SERVICE
N.A.
N.A.
W.A.
24. COUNTRY WITH WHICH MILITARY SERVICE AFFILIATED
N.A.
25. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN
SECTION XIII
N.A.
CHILDREN AND OTHER DEPENDENTS
1. PROVIDE THE FOLLOWING INFORMATION FOR ALL CHILDREN AND DEPENDENTS
RELATIONSHIP
NAME
DATE AND PLACE OF BIRTH
CITIZENSHIP
ADDRESS
EMILIO AMERICO RODRIGUEZ J.R.)
SON
JOSEPH ROSS Rodriguez
SON
PATTI MICHELLE RODRIGUEZ
PAUL MARSHALL RODRIGUEZ
SEPT. 18, 1951, New Orleans, LA.
(MARCH 1, 1953), New Orleans, La.
DAUGTHER OCT. 23, 1954, HAVANA, Cubre
4.S.A.
(9361 SW. 178 ST.
PERRINE ST, FLA).
SON
4.S.A.
4.S.A.
NOV. 1, 1957), HAVANA Cuba U.S.A.
9361 SW. 178ST.)
PERRINEST, FLA:
9361 SW. 178 ST.
PERRINE ST, FLA.
9361 SW. 178 ST.
PERRINE 57, FLA.
2. NUMBER OF CHILDREN (Incuding step-
children and adopted children) WHO ARE
UNMARRIED, UNDER 21 YRS OF AGE,
AND NOT SELF-SUPPORTING.
SECTION XIV
0 4
3. NUMBER OF OTHER DEPENDENTS (Including spouse,
parents, step-parents, sister
, etc.) WHO DEPEND ON
YOU FOR AT LEAST 
50% OF THEIR SUPPORT, OR
CHILDREN OVER 21 
YRS. OF AGE WHO ARE NOT
SELF-SUPPORTING.
FATHER (Give same information, for Stepfather and/or Guardian on a separate sheet)
1. FULL NAME (Last-First-
Mile)
RODRIGUEZ, ARNEST NAPOLEON
5. STATE OTHER NAMES HE HAS USED
NA.
2. LIVING
☑
YES
NO
3. DATE OF DEATH
N.A.
10
4. CAUSE OF DEATH
N.A.
INDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH HE HAS
EVER USED THESE 
NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where
and by what authority). USE EXTRA 
SPACE PROVIDED ON PAGE 16 OF THIS
FORM TO RECORD THIS INFORMATION
.
6. CURRENT ADDRESS - Give it address, if deceased (No., Street, City, State, Country)
The ORICANIAN Apt. wote! ST. CHARLES Ave., New Geleans, LA. US.A.
7. DATE OF BIRTH
10.
•August 1891
8. PLACE OF BIRTH (City, State, Country)
IF BORN OUTSIDE U.S.-DATE OF ENTRY
12. FORMER CITIZENSHIP(S) Country(les)]
Nov. 196
N.A.
15. OCCUPATION
Retired
HAVANA, Cuba.
11. PLACE OF ENTRY
9. CITIZENSHIP
Cuban
New Orleans, LA.
18. DATE U.S. CITIZENSHIP
ACQUIRED
NA
14. WHERE ACQUIRED (City, State, Country)
N.A.
16. PRESENT EMPLOYER (Give last employer, if Father is deceased or unemployed)
SELF EMPLOYED, Century Elect. Co.
17. EMPLOYER'S BUSINESS WIRES OR FATHER'S BUSINESS ADDRESS IF SELF-EMPLOYED
1806 PINE ST., ST. LOUIS. Mo. U.S.A.
18. DATES OF MILITARY SERVES (Rom-and-To) 19. BRANCH OF SERVICE
N.F.
N.A.
20. COUNTRY
N.A.
21. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN INTELLIGECE AGENT FOR 4.5. EMBASSY IN
HAVANA CUBA DURING WORLD WAR I, WORLD WAR II
AND RECENT CASTRO REVOLUTION

14-00000
SECTION XV
MOTHER (Give same information for Stepmother on separate sheet)
1. FULL NAME (Last-First-Middle)
CASANOVA,
Emilia
5. STATE OTHER NAMES SHE HAS USED
2. LIVING
YES
☑
NO
3. DATE OF DEATH
N.A.
4. CAUSE OF DEATH
July 6, 1961 ARTERIOSCLEROSIS
INDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH SHE HAS
EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where
and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS
FORM TO RECORD THIS INFORMATION.
6. CURRENT ADDRESS GIVE LAST ADDRESS, IF DECEASED (No., Street, City, State, Country)
the alterna Apt. Hotel, ST. Charles Ave., New Geleans, LA.
7. DATE OF BIRTH
j
JUNE 5, 1901
8. PLACE OF BIRTH (City, State, Country)
10. IF BORN OUTSIDE U.S.- DATE OF ENTRY
Oct. 1, 1950
12. FORMER CITIZENSHIP(S) [Country(ies)
15. OCCUPATION
IV.A.
HousewifE
HAVANA, Cuba
+
11. PLACE OF ENTRY
U.S.A.
9. CITIZENSHIP
Cuban
New Orleans, LA. U.S.A.
N.A.
13. DATE U.S. CITIZENSHIP
ACQUIRED
N.A.
14. WHERE ACQUIRED (City, State, Country)
16. PRESENT EMPLOYER (Give last employer, if Mother is deceased or unemployed)
N.A.
17. EMPLOYER'S BUSINESS ADDRESS OR MOTHER'S BUSINESS ADDRESS IF SELF EMPLOYED
18. DATES OF MILITARY SERVICE (From-and-To)
N.A.
N.A.
19.
BRANCH OF SERVICE
N.A.
21. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN
US. (Sp. MAIL) CENSOR IN
CENSORSHIP OFFICE DURING WORLD WAR II.
SECTION XVI
1
20. COUNTRY
NA.
NEW ORLEANS
BROTHERS AND SISTERS (Including Half-, Step- and Adopted Brothers and Sisters)
1. FULL NAME (Last-First-Middle)
RODRIGUEZ, ARNESTO
Jose
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
212 MAPLE Rd., METAIRE)
1. FULL NAME (Last-First-Middle)
2. RELATIONSHIP
BROTHER
.LA. U.S.A.
2. RELATIONSHIP
3. CITIZENSHIP (Country)
U.S.
5. LIVING
.6. AGE
YES
NO
38
3. CITIZENSHIP (Country)
2
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
5. LIVING
YES
6. AGE
NO
1. FULL NAME (Last-First-Middle)
2. RELATIONSHIP
3. CITIZENSHIP (Country)
3
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
5. LIVING
☐ YES ☐ NO
6. AGE
1. FULL NAME (Last-First-Middle)
2. RELATIONSHIP
3. CITIZENSHIP (Country)
4
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
5. LIVING
6. AGE
YES
NO
1. FULL NAME (Last-First-Middle)
2. RELATIONSHIP
3. CITIZENSHIP (Country)
5
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
1. FULL NAME (Last-First-Middle)
2. RELATIONSHIP
5. LIVING
☐ YES ☐ NO
3. CITIZENSHIP (Country)
6. AGE
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
5. LIVING
☐ YES ☐ 'NO
6. AGE
1. FULL NAME (Last-First-Middle)
2. RELATIONSHIP
3. CITIZENSHIP (Country)
7
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
5. LIVING
6. AGE
YES
NO
1. FULL NAME (Last-First-Middle)
2. RELATIONSHIP
3. CITIZENSHIP (Country)
8
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
5. LIVING
6. AGE
YES
NO
- 11.
14-00000
SECTION XVII
1. FULL NAME (Last-First-Middle)
Ross
SAMUEL SANFORD_)
5. STATE OTHER NAMES HE HAS USED
SAM (NIKNAME SINCE CHILDHOOD)
- 12 -
FATHER-IN-LAW
2. LIVING
YES
3. DATE OF DEATH
4. CAUSE OF DEATH
NO
JUNE 30, 1958 HEART ATTACK.
INDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH HE HAS
EVER USED THESE NAMES. IF LEGAL 
CHANGE, GIVE PARTICULARS (Where
and by what authority). USE EXTRA 
SPACE PROVIDED ON PAGE 16 OF THIS
FORM TO RECORD THIS 
INFORMATION.
6. CURRENT OR LAST ADDRESS (No., Street, City, State, Country)
(Route 2
7. DATE OF BIRTH
JULY 2,
EDENTON, N.C.)
+
8. PLACE OF BIRTH (City, State, Country)'
Box
500
1890
10. IF BORN OUTSIDE U.S.-DATE OF ENTRY
4.S.A.
MOBILE, ALABAMA, U.S.A.
11. PLACE OF ENTRY
9. CITIZENSHIP
4.5.A.
N.A.
N.A.
12. FORMER CITIZENSHIP(S) [Country(ies)]
15. OCCUPATION
SAWYER
SECTION XVIII
N. A
1. FULL NAME (Last-First-Middle)
13. DATE U.S. CITIZENSHIP
ACQUIRED N.A.
14. WHERE ACQUIRED (City, State, Country)
N.A.
16. PRESENT EMPLOYER (Give last employer, if Father-in-Law is deceased or unemployed)
R.P. BAER AND Co.
EDENTON), N.C.
U.SA.
MOTHER-IN-LAW
2. LIVING
3. DATE OF DEATH
YES
NO
N.A.
4. CAUSE OF DEATH
N.A.
BONTA
1
PATTI JUANITA
5. STATE OTHER NAMES SHE HAS USED
N.A.
INDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH SHE HAS
EVER USED THESE NAMES. IF LEGAL 
CHANGE, GIVE PARTICULARS (Where
and by what authority). USE 
EXTRA SPACE PROVIDED ON PAGE 16 OF THIS
FORM TO RECORD THIS INFORMATION
.
6. CURRENT OR LAST ADDRESS (No., Street, City, State, Country)
f
Route 2,
7. DATE OF BIRTH
Box 500 EDENTON, N.C.
4.SA.
8. PLACE OF BIRTH (City, State, Country)
LAUREL), Miss.
4.S.A.
10. IF BORN OUTSIDE U.S. DATE OF ENTRY
11. PLACE OF ENTRY
N.A.
N.A.
Dec. 21, 1899"
9. CITIZENSHIP
4.S.A.
12. FORMER CITIZENSHIP(S)) [Country(ies)] 13. DATE U.S. CITIZENSHIP
N.A.
ACQUIRED N.A.
15. OCCUPATION
HOUSEWIFE
SECTION XIX
2
14. WHERE ACQUIRED (City, State, Country)
N.A.
16. PRESENT EMPLOYER (Give last employer, if Mother-in-Law is deceased or unemployed)
N. 
A.
RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (1) LIVE ABROAD,
(2) ARE NOT U.S. CITIZENS OR (3) WORK FOR 
A FOREIGN GOVERNMENT
1. FULL NAME (Last-First-Middle)
LOPEZ
ELENA
4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
212 MAPLE Rd., METAIRE, LA. U.S.A.
6. CITIZENSHIP (Country)
MEXICAN
1. FULL NAME (Last-First-Middle)
2. RELATIONSHIP
SISTER IN LAW
5. EMPLOYED BY
3. AGE
33
BERLITZ SCHOOL OF LANGUAGEZ
7. FREQUENCY OF CONTACT
18. DATE OF LAST CONTACT
ONCE YEARLY (4)
JUNE 1961
2. RELATIONSHIP
3. AGE
4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
3
5. EMPLOYED BY
7. FREQUENCY OF CONTACT
8. DATE OF LAST CONTACT
6. CITIZENSHIP (Country).
1. FULL NAME (Last-First-Middle)
2. RELATIONSHIP
4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
5. EMPLOYED BY
4
6. CITIZENSHIP (Country)
7. FREQUENCY OF CONTACT
B. DATE OF LAST CONTACT
1. FULL NAME (Last-First-Middle)
2. RELATIONSHIP
4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
5. EMPLOYED BY
5
6. CITIZENSHIP (Country)
7. FREQUENCY OF CONTACT
8. DATE OF LAST CONTACT
SECTION XIX CONTINUED TO PAGE 13
3. AGE
3. AGE
14-00000
SECTION XIX CONTINUED FROM PAGE 12
6. SPECIAL REMARKS, IF ANY, CONCERNING RELATIVES NOTED IN SECTION XIX ABOVE
Above Relative has been a continuous resident in the U.S.A. Since 1945 in New
Qeleans, LA.
SECTION XX
1. NAME (Last-First-Middle)
RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO ARE IN THE MILITARY OR CIVIL
SERVICE OF THE UNITED STATES
2. RELATIONSHIP
BROTHER IN LAW
3. AGE
4. CITIZENSHIP
५०
U.S.A.
Ross
Joseph
ALBERT)
1
5. ADDRESS (No., Street, City, State, Country)
Route 2, Box 595H, Pensacola, FLA, USA.
1. NAME (Last-First-Middle)
6. TYPE AND LOCATION OF SERVICE (If known)
MARINE PILOT AND PHOTOGRAPHER INSTRUCTOR
PENSACOLA NAVAL AIR STATION
2. RELATIONSHIP
3. AGE
4. CITIZENSHIP
2
5. ADDRESS (No., Street, City, State, Country)
1. NAME (Last-First-Middle)
S. ADDRESS (No., Street, City, State, Country)
6. TYPE AND LOCATION OF SERVICE (If known)
2. RELATIONSHIP
3. AGE
4. CITIZENSHIP
6. TYPE AND LOCATION OF SERVICE (If known)
SECTION XXI
REFERENCES, ACQUAINTANCES, AND NEIGHBORS
1. LIST FIVE CHARACTER REFERENCES, NOT RELATIVES, IN THE U.S., WHO KNOW YOU INTIMATELY
NAME
(Last-First-Middle)
1
A.C. White
3 J.S. MENEELY
P.M. ARTHUR
DOROTHY MANESS JONES.
C. A. ZEHNDER,
BUSINESS ADDRESS
(No., Street, City and State)
N.S. A.
WASHINGTON, D.C.
U. S. N.
RESIDENCE ADDRESS
(No., Street, City and State)
10125 MARKHAM ST.
SILVER SPRING, Md.
1601 ARDEN WAY
USS SARATOGA FPO N.Y. NY. (CVA-60) JACKSONVILLE, FLA.
INTELLIGENCE
UNK.
HouseWife
UNK.
EBASCO SERVICES N.Y.
UNK.
DRAWER K
FT. AMADORI CANAL ZONE
210 W. PRESident, Apt. 4
GREENWOOD, MISS.'"
´P.O. Box 285
PINE BLUFF, ARKANSAS
2. LIST FIVE PERSONS, IN THE U.S. WHO KNOW YOU SOCIALLY NOT RELATIVES, SUPERVISORS OR EMPLOYERS
NAME
(Last-First-Middle)
J. W. BARNES
L.T. WOLF
J. BRUNO
DOROTHY BOETTCHER)
A. TAWATER
BUSINESS ADDRESS
(No., Street, City and State)
MANUFACTURER REPRESENTATIVE
UNK.
.
EBASCO SERVICES N.Y.
UNK.
CIVIL SERVICE
UNK.
HousewiFE
UNK.
UNK.
RESIDENCE ADDRESS
(No., Street, City and State)
6938 Colbeat.St.
New Orleans, LA.
420 Park Ave.
SWARTHMORE, PA.
3310 CASTIGLIONE
New Orleans, LA.
839 PALERMO Ave.
CORAL Gables, Miami, FL
1211 W. ARKANSAS LANE
Rt. 2, Box 16, ARLINGTON, TRAS
3. LIST THREE NEIGHBORS AT YOUR MOST RECENT NORMAL RESIDENCE IN THE U.S.
NAME
(Last-First-Middle)
DR. E. Peebles
D. White
C. MACE
BUSINESS ADDRESS
(No., Street, City and State)
TULANE MEDICAL SCHOOL
New Orleans, LA.
RETIRED
CIVIL SERUCE
Tulane UNIVERSITY
SPANISH DEPARMENT
- 13.
RESIDENCE ADDRESS
(No., Street, City and State)
2207 BROAWAY Ave.)
New Galeaus 18, 4.
512 WALNat St.
New Orleans, LA.
unk.
14-00000
SECTION XXII
- 14 -
CLUBS, SOCIETIES, AND OTHER ORGANIZATIONS
NOTE: List names and addresses of all clubs, societies, professional societies, employee groups or organizations of any kind
(Include membership in, or support of, any organization having headquarters or branch in a foreign country) to which you
belong or have belonged.
NAME AND CHAPTER
Phi Sigma Iota
American Ass. of Tauchers of Spanish & Portuguese
ADDRESS
(Number, Street, City, State, Country)
TULANE, UNIVERSITY
unk.
DE PAUW UNIVERSITY
unk.
DATES OF MEMBERSHIP
FROM
TO
1951
renk.
1952.
Present.
Present
SECTION XXIII
RESIDENCES FOR THE PAST 15 YEARS
ADDRESS LAST RESIDENCE FIRST
(Number, Street, City, State, Country)
INCLUSIVE DATES
FROM
TO
FOCSA BLDG. APT. 284, 17+ M St., Vedado, HAVANA, Cuba
Oct. 1956
June1961
FINCA Emilita +
2D Newcomb Campus, New Orleans, LA, U.S.A.
510 Walnut St., New Orleans, LA., U.S.A.
23051/2 Almonaster Ave., new Orleans, LA., U.S.A.
#510 Walnut St., New Orleans, LA., U.S.A.
, Klm 12 Central Highway, SAN FRANCESC a de Paula, Hespen Cuba. April 185Y - Oct.1956
Augh. 1951 April 1954
Jan. 1950 Aug. 1951
Oct. 1949
Jan. 1850
110v. 1942 Oct.1949
14-00000
SECTION XXIV
55°
ADDITIONAL INFORMATION
1. DO YOU ADVOCATE OR HAVE YOU EVER ADVOCATED; OR ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF;
OR HAVE YOU EVER SUPPORTED OR BEEN ASSOCIATED WITH ANY POLITICAL PARTY. INDIVIDUAL OR ORGAN -
IZATION WHICH ADVOCATES OR TEACHES THE OVERTHROW OF THE GOVERNMENT OF THE UNITED STATES BY
FORCE, VIOLENCE OR OTHER UNCONSTITUTIONAL MEANS, OR SEEKS BY FORCE OR VIOLENCE TO DENY PERSONS
THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES?
2. IF YOU HAVE ANSWERED "YES" TO THE ABOVE QUESTION, EXPLAIN
N.A.
YES
NO
3. DO YOU USE OR HAVE YOU
EVER USED INTOXICANTS?
5. DO YOU USE OR HAVE YOU
EVER USED NARCOTICS?
YES
4. IF SO, TO WHAT EXTENT?
☑
NO
YES
6. IF SO, TO WHAT EXTENT?
NO
N-A
N-A.
7. HAVE YOU EVER BEEN A MEMBER OF, OR SUPPORTED, OR HAD ANY CONNECTIONS WITH A FOREIGN INTELLIGENCE ORGAN-
IZATION OR ITS ACTIVITIES?
☐ YES.
☑ NO IF ANSWER IS "YES", GIVE COMPLETE DETAILS.
N.A.
B. LIST BELOW THE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO WHICH YOU HAVE APPLIED FOR EM-
PLOYMENT SINCE 1940
USIA.
C.I.A., STATE DEPARTMENT, PAN AMERICAN UNION, CIVIL SERVICE,
9. IF TO YOUR KNOWLEDGE, ANY OF THE ABOVE HAVE CONDUCTED AN INVESTIGATION OF YOU, INDICATE THE NAME OF THE
AGENCY AND THE APPROXIMATE DATE OF THE INVESTIGATION.
UNK.
NOTE SPECIAL If your answer is "YES" to the following Questions 10, 11 or 12, provide the information requested for each
INSTRUCTIONS question on a separate, signed sheet and attach the sheet to this form in a sealed envelope.
10. HAVE YOU, OR TO YOUR KNOWLEDGE HAS YOUR SPOUSE, EVER BEEN DETAINED, ARRESTED, INDICTED OR CON-
VICTED FOR ANY VIOLATION OF THE LAW OTHER THAN A MINOR TRAFFIC VIOLATION IN THE UNITED STATES OR
ABROADT
IF SO, STATE NAME OF COURT, CITY, STATE, COUNTRY, DATE, NATURE OF OFFENSE AND DISPOSITION OF CASE
IN ACCORDANCE WITH THE SPECIAL INSTRUCTION ABOVE.
YES
NO
11. HAVE YOU EVER BEEN ARRESTED, COURT-MARTIALED OR OTHERWISE PUNISHED UNDER MILITARY LAW OR REG-
ULATION? IF SO, DESCRIBE INCIDENT(S) AND PROVIDE DATE(S) OF OCCURRENCE ON SEPARATE SHEET IN AC-
CORDANCE WITH SPECIAL INSTRUCTIONS ABOVE.
YES
NO
12. ARE THERE ANY UNFAVORABLE INCIDENTS IN YOUR LIFE, NOT MENTIONED ABOVE, WHICH MAY BE DISCOVERED
IN SUBSEQUENT INVESTIGATION, WHETHER YOU WERE DIRECTLY INVOLVED OR NOT, WHICH MIGHT REQUIRE EX-
PLANATION? IF SO, DESCRIBE INCIDENT(S) AND PROVIDE DATE(S) OF OCCURRENCE ON SEPARATE SHEET IN AC-
CORDANCE WITH SPECIAL INSTRUCTIONS ABOVE.
SECTION XXV
1. NAME (First-Middle-Last)
PAULINE
JUANITA
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
RODRIGUEZ)
2. RELATIONSHIP
Wife
YES
NO
3. HOME ADDRESS (No., Street, City, Zone, State, Country)
9361 SW. 178 St. PERRINE ST, FLA.
14. HOME PHONE NO.
(CEDAR-S-8341
5. BUSINESS ADDRESS (No., Street, City, Zone, State, Country) - INDICATE NAME OF FIRM OR 6. BUSINESS PHONE NO. & EXT.
EMPLOYER, IF APPLICABLE
N.A.
N-A.
7. IN CASE OF EMERGENCY, OTHER CLOSE RELATIVES (Spouse, Mother, Father) MAY ALSO BE NOTIFIED. IF SUCH NOTIFICATION
IS NOT DESIRABLE, BECAUSE OF HEALTH OR OTHER REASONS, PLEASE SO STATE.
NA-
- 15 -
14-00000
1
SECTION XXVI
- 16.
CERTIFICATION
YOU ARE INFORMED THAT THE CORRECTNESS OF ANY STATEMENT MADE IN THIS APPLICATION
WILL 
BE INVESTIGATED.
ST
I have read and understand the instructions. I Certify that the foregoing answers are true and correct to the best of my
knowledge and belief. I agree that any misstatement or 
omission as to material fact will constitute grounds for immediate
dismissal or rejection of my application
. I also understand that any false statement made herein may be punishable by
law (U.S. Code, Title 18, Section 1001).
1. DATE OF SIGNATURES
Sept. 5, 1961
3. SIGNED AT (City and State)
MIAMI, FLA.
2. SIGNATURE OF APPLICANT
Erilis
N
4. SIGNATURE OF WITNESS
Paul R. Rodrigue
NOTE: Use the following space for extra details. Reference each continued item by section and item number to which it relates,
sign your name at the end of 
the added material. If additional space is required use extra pages the same size as this
page and sign each such 
page.
U. S. GOVERNMENT PRINTING OFFICE: 1959 O-492175