C
Released under the John F. Kennedy
Assassination Records Collection Act of
1992 (44 USC 2107 Note). Case#:NW
88613 Date: 03-18-2025
JFK ASSASSINATION SYSTEM
IDENTIFICATION FORM
Date : 01/20/98
Page : 1
AGENCY INFORMATION
AGENCY :
INSCOM/CSF
RECORD NUMBER :
194-10004-10141
RECORDS SERIES : DOD-AFFILIATED PERSONNEL INCIDENT INVESTIGATIONS
AGENCY FILE NUMBER ° PAGES 378-381
DOCUMENT INFORMATION
ORIGINATOR : USA.
FROM: HAYASHIDA, MYRON K.
TO :
TITLE : [ RESTRICTED ]
DATE : 11/26/66
PAGES : 4
SUBJECTS : FROMER, DAVID R.
LEGAL ADVICE
DOCUMENT TYPE : PAPER, TEXTUAL DOCUMENT
CLASSIFICATION
RESTRICTIONS :
CURRENT STATUS :
: UNCLASSIFIED
3
RELEASED WITH DELETIONS
DATE OF LAST REVIEW : 03/07/95
OPENING CRITERIA :
COMMENTS :
NW 88613 Docid:34528582 Page 1
STATEMENT O. ERSONAL HISTORY
INSTRUCTIONS: 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 NAME
MR.
MRS.
MISS
DAVID REED FROMER
3. ALIAS(ES). NICKNAME(S). OR CHANGES IN NAME (Other than by marriage)
None
5. DATE OF BIRTH (Day, month, year)
21 July 1942
RACE
HEIGHT
Cauc
67"
WEIGHT
170
2.
STATUS
CIVILIAN
MILITARY ON ACTIVE DUTY
4. PERMANENT MAILING ADDRESS
13 Rhonda Way, Mill Valley, Calif.
PLACE OF BIRTH (City, County, State, and Country)
Chicago, Cook, Illinois, USA
COLOR OF EYES
Brown
6. DO YOU HAVE A HISTORY OF MENTAL OR NERVOUS DISORDERS?
NARCOTICS OR BARBITURATES? YES ☑✓ NO
COLOR OF HAIR
Brown
YES XX NO
PLACE CERTIFICATE RECORDED
SCARS. PHYSICAL DEFECTS. DISTINGUISHING MARKS
Scar above left eye
ARE YOU NOW OR HAVE YOU EVER BEEN ADDICTED TO THE USE OF HABIT FORMING DRUGS SUCH AS
ARE YOU NOW OR HAVE YOU EVER BEEN A CHRONIC USER TO EXCESS OF ALCOHOLIC BEVERAGES? ☐ YES ☑ NO
ANSWER TO ANY OF THE ABOVE IS "YES. EXPLAIN IN ITEM 20.
IF NATURALIZED, CERTIFICATE NO.
7. U. S.
IF DERIVED. PARENTS' CERTIFICATE NO(S).
DATE. PLACE, AND COURT
IF THE
NATIVE
CITIZEN
☑
☑ YES
NO
ALIEN
| REGISTRATION NO
NATIVE COUNTRY
DATE AND PORT OF ENTRY
DO YOU INTEND TO BECOME
8.
MILITARY SERVICE
ARE 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 COMPONENT
ORGANIZATION AND STATION
A U. S. CITIZEN?
☐ YES NO
DATE CURRENT ACTIVE
SERVICE STARTED
ARE 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 COMPONENT
ORGANIZATION AND STATION OR UNIT AND LOCATION
YES ☑NO
HAVE YOU PREVIOUSLY SERVED TOURS OF EXTENDED ACTIVE DUTY, DRAWING. FULL PAY, FROM WHICH YOU WERE DISCHARGED OR SEPARATED TO CIVILIAN STATUS?
IF YES. COMPLETE THE FOLLOWING:
COUNTRY
FROM (Date) TO (Date)
TYPE DISCHARGES OR SEPARATIONS-GRADE AND SERVICE NO.
SERVICE
COMPONENT
9.
NAME AND LOCATION OF SCHOOL
EDUCATION (Account for all civilian schools and military academies. Do not include service schools)
GRADUATE
DEGREE
MONTH AND YEAR
YES
NO
* X DE
* X DE
FROM-
TO-
1947
1949
1949
1950
1950
1954
1954
1957
1957
1960
10.
Nettelhorst Elem. School, Chicago, Illinois
La Casita Elem. School, Clovis, New Mexico
Argonne Elem. School, S.F., Calif.
Presidio Of High, S.F., Celff.
Geo. Washington High School, S.F., Calif.
X
✗
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. If 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
FATHER
IRVING FROMER
MOTHER (Maiden name)
Katherine Rhodes
SPOUSE (Maiden name)
None
OTHER (Specify)
Brother
Jon Fromer
Ann Spake
Sister
DATE AND PLACE OF BIRTH
12 July 1913
Cincinnati, Ohio
31 Dec 1909
Estherville, Iowa
11 May 1946
Chicago, Illinois
15 Aug 1939
San Francisco, Calif.
PRESENT ADDRESS, IF LIVING
13 Rhonda Way
U. S. CITIZEN
YES
NO
Mill Valley, Calif.
13 Rhôda Way
Mill Valley, Calif.
✗
881 Clayton St.
San Francisco, Calif.
881 Clayton St.
San Francisco, Calif.
378
FORM
NW 88613 Docid:3452858 Page 2
PREVIOUS EDITIONS ARE OBSOLETE.
"EL OFFICIAL USE ONLY" Approved by Bureau of the Budget June 1960
Exception to Standard Form 86
H
12.
11.
OTHER RELATIVES AND ALIEN FRIENDS LIVING IN FOREIGN COUNTRIES (List grandparents, first cousins, aunts, uncles.
brothers- and sisters-in-law, and other persons with whom 
a close relationship existed or exists)
RELATIONSHIP AND NAME
None
FROM-
DATES
TO-
AGE
OCCUPATION
ADDRESS
FOREIGN TRAVEL (Other than as a direct result of United States military duties)
COUNTRY VISITED
PURPOSE OF TRAVEL
None
CITIZENSHIP
13.
FROM-
EMPLOYMENT (Show every employment you have had and all periods of unemployment)
MONTH AND YEAR
TO-
NAME AND ADDRESS OF EMPLOYER
Paul Elder Bookstore
Dec 59
Dec 59
Summer 60
Sutter & Stockton Sts.,S.F.,Cal.
San Francisco Council Camp Fire
Girls, S.F., Calif.
Fairmont Hotel
NAME OF IMMEDIATE
SUPERVISOR
REASON FOR LEAVING
End of holiday
season
End of summer
Camp
Part-time
Paul Elder
Unknown
1960
1961
Summer
1961
San Francisco, Calif.
Foster's Restaurant
1962
San Francisco, Calif.
S. F. Boys' Chorus
Unknown
job
Unknown
1961 & 1962
1962 &
Fall 1962
1963
San Francisco, Calif.
Madison Board of Education Rec.
Madison, Wisconsin
Clark Service Station
Atwood Ave., Madison, Wisconsin
Madi Bacon
Unknown
Ed Cutter
Part-time job
End of summer
camp
end of school
year
Conflict with
studies
Self-employed
-
musicians in
folk trio
Cooks Cupboard
Oct 65 Jun 66
1718 Wells St.,Chicago, Illinois
Bob George
Return to
S.F.
14.
CHARACTER
CREDIT
SOCIAL SECURITY NO.
☐ YES ☑ NO DO YOU HAVE
DID ANY OF THE ABOVE EMPLOYMENTS REQUIRE A SECURITY CLEARANCE?
ANY FOREIGN PROPERTY OR BUSINESS CONNECTIONS, OR HAVE YOU EVER BEEN EMPLOYED BY A FOREIGN
HAVE YOU EVER BEEN REFUSED BOND
? 
☐ YES
GOVERNMENT, FIRM, OR AGENCY? ☐ YES XX NO
☑NO IF THE ANSWER TO ANY OF THE ABOVE IS "YES," EXPLAIN IN ITEM 20.
564-58-8137
CREDIT AND CHARACTER REFERENCES (Do not include relatives, former employers, or persons living outside the
United States or its Territories.
NAME
(List 3 credit and 5 character)
YEARS
KNOWN
STREET AND NUMBER
(Business address preferred)
CITY
None
STATE OR
TERRITORY
Malvina Reynolds
Stephan Negoesco
Madi Bacon
Richard Correll
Archie Brown
=
10
2027 Parker Street
Berkeley
Calif.
10
Sonora Way
4
1120 Kaith Avenue
Corte Madera
Berkeley
Calif.
Calif.
Street
18 782708011 št.
379
Jui
San Francisco
San Francisco
Colif
Calif.
NW 88613 Docid:34528582 Page 3
U.S. GOVERNMENT PRINTING OFFICE: 1960 0-573450
15.
16.
MONTH AND YEAR
T
LIST ALL RESIDENCES FROM 1 JANUARY 1937
STREET AND NUMBER
FROM-
TO-
1942.
1949
2817 Pine Grove Street
1949
1950
Edwards Street
1950
1960
1932 Cabrille Street
1960
1961
2850 Bzncroft Way
1961
1962
881 Clayton Street
1962
1963
1963
1964
1964
1965
1965
1966
1966
1966
140 Langdon Street
NAME AND ADDRESS
219 N. Basset
215 Lake Lawn Avenue
1427 University Avenue
881 Clayton Street
435 W. North Avenue
13 Rhonda Way
CITY
Chicago
Clovis
STATE OR COUNTRY
Illinois
New Mexico
San Francisco California
Berkeley
California
San Francisco
California
Madison
Wisconsin
Madison
Wisconsin
Madison
San Francisco
Chicago
Mill Valley
Madison
PAST AND/OR PRESENT MEMBERSHIP IN ORGANIZATIONS
TYPE
(Social, fraternal, professional, etc.)
Wisconsin
California
Illinois
California
Wisconsin
MEMBERSHIP
OFFICE HELD
FROM
TO-
17.
YES
NO
ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF THE COMMUNIST PARTY U. S. A.. OR ANY COMMUNIST ORGANIZATIONS ANYWHERE?
ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF A FASCIST ORGANIZATION?
ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF ANY ORGANIZATION, ASSOCIATION, MOVEMENT. GROUP OR COMBINATION OF PERSONS WHICH ADVOCATES THE
OVERTHROW OF OUR CONSTITUTIONAL FORM OF 
GOVERNMENT, OR-WHICH HAS ADOPTED THE POLICY OF ADVOCATING OR APPROVING THE COMMISSION OF ACTS OF FORCE
OR VIOLENCE TO DENY OTHER PERSONS THEIR RIGHTS 
UNDER THE CONSTITUTION OF THE UNITED STATES, OR WHICH SEEKS TO ALTER THE FORM OF GOVERNMENT OF
THE UNITED STATES BY UNCONSTITUTIONAL MEANS?
•
ARE YOU NOW OR HAVE YOU EVER BEEN AFFILIATED OR ASSOCIATED WITH ANY ORGANIZATION OF THE TYPE DESCRIBED ABOVE AS AN AGENT. OFFICIAL, OR EMPLOYEE?
ARE YOU NOW ASSOCIATING WITH, OR HAVE YOU ASSOCIATED WITH ANY INDIVIDUALS, INCLUDING RELATIVES, WHO YOU KNOW OR HAVE REASON TO BELIEVE, ARE OR
HAVE BEEN MEMBERS OF ANY OF THE ORGANIZATIONS IDENTIFIED ABOVE?
HAVE YOU EVER ENGAGED IN ANY OF THE FOLLOWING ACTIVITIES OF ANY ORGANIZATION OF THE TYPE DESCRIBED ABOVE: CONTRIBUTION(S) TO. ATTENDANCE AT OR
PARTICIPATION IN ANY ORGANIZATIONAL. SOCIAL. OR 
OTHER ACTIVITIES OF SAID ORGANIZATIONS OR OF ANY PROJECTS SPONSORED BY THEM: THE SALE, GIFT, OR DIS-
TRIBUTION OF ANY WRITTEN, PRINTED, OR OTHER 
MATTER, PREPARED, REPRODUCED, OR PUBLISHED, BY THEM OR ANY OF THEIR AGENTS OR INSTRUMENTALITIES?
IF "YES." DESCRIBE THE CIRCUMSTANCES. ATTACH ADDITIONAL SHEETS FOR A FULL DETAILED STATEMENT. IF ASSOCIATED WITH ANY OF THE ABOVE ORGANIZATIONS. SPECIFY NATURE
AND EXTENT OF ASSOCIATION WITH EACH, INCLUDING OFFICE 
OR POSITION HELD. ALSO INCLUDE DATES. PLACES, AND CREDENTIALS NOW OR FORMERLY HELD. IF ASSOCIATIONS HAVE
BEEN WITH INDIVIDUALS WHO ARE MEMBERS OF THE ABOVE 
ORGANIZATIONS, THEN LIST THE INDIVIDUALS AND THE ORGANIZATIONS WITH WHICH THEY WERE OR ARE AFFILIATED.
18. HAVE YOU EVER BEEN DETAINED, HELD, ARRESTED. INDICTED OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING, OR CONVICTED, FINED, OR IMPRISONED OR
PLACED ON PROBATION, OR HAVE YOU EVER BEEN ORDERED TO DEPOSIT 
BAIL OR COLLATERAL FOR THE VIOLATION OF ANY LAW, POLICE REGULATION OR ORDINANCE (excluding
minor traffic violations for which a fine or forfeiture of $25, or less was 
imposed)? INCLUDE ALL COURT MARTIALS WHILE IN MILITARY SERVICE. ☐ YES ☑ NO
IF "YES.** LIST THE DATE, THE NATURE OF THE OFFENSE OR VIOLATION. THE 
NAME AND LOCATION OF THE COURT OR PLACE OF HEARING, AND THE PENALTY IMPOSED OR OTHER
DISPOSITION OF EACH CASE.
380
19. ARE THERE ANY INCIDENTS IN YOUR LIFE NOT MENTIONED HEREIN WHICH MAY REFLECT UPON YOUR LOYALTY TO THE UNITED STATES OR UPON YOUR SUITABILITY TO PERFORM
NW 88613 Docid:54528582 Page°4′
19. ARE THERE ANY INCIDENTS IN YOUR LIFE NOT MENTIONED HEREIN WHICH MAY REFLECT UPON YOUR LOYALTY TO THE UNITED STATES OR UPON YOUR SUITABILITY TO PERFORM
THE DUTIES WHICH YOU MAY BE CALLED UPON TO TAKE OR WHICH MIGHT REQUIRE FURTHER EXPLANATION? ☑ YES ☐ NO * IF YES." GIVE DETAILS
Iam a conscientious objector. My case is in the courts at the present time.
20. REMARKS
I have been advised by my lawyers that I cannot sign #16 or #17 without
putting myself in jeapardy. Private attorney - Peter Franck
Family attorney Viocabt Hallinan
-
David Reed Fromer, born 21 July 1942, in Chicago, Illinois,
a registrant under the Univeral Military Training Act, was
this date given an opportunity to execute DD Form 398 and
in my presence he refused to do so, in its entirety.
:
BYRON K. HAYASHIDA
1/LT, AGC
ITEM #9 EDUCATION (Continued)
DEGREE
1960
1961
1962
1964
1965
1966
-
-
1961
1962
University of California, Berkeley, California
No
-
1964
City College of San Francisco, San Francisco, Calif.
University of Wisconsin, Madison, Wisconsin
Yes
No
-
-
1965
1966
San Francisco State College, San Francisco, Calif. (Ext.)
Roosevelt University, Chicago, Illinois
No
No
-
No
Present University of Wisconsin, Medison, Wisconsin
I CERTIFY THAT THE ENTRIES MADE BY ME ABOVE ARE TRUE, COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND ARE MADE IN
GOOD FAITH. I UNDERSTAND THAT A KNOWING AND WILLFUL FALSE STATEMENT ON THIS FORM CAN BE PUNISHED BY FINE OR IMPRISONMENT OR BOTH
(See U. S. Code, title 18, section 1001)
DATE
21.
SIGNATURE OF PERSON COMPLETING FORM
David Reed Fromen
21 Nov. 1966
TYPED NAME AND ADDRESS OF WITNESS
1/LT, AGC
1515 Clay St., Oakland, Calif.
SIGNATURE OF WITNESS
THIS SECTION TO BE COMPLETED BY AUTHORITY REQUESTING INVESTIGATION
BRIEF DESCRIPTION OF DUTY ASSIGNMENT AND DEGREE OF CLASSIFIED MATTER (top secret, secret, etc.) TO WHICH APPLICANT WILL REQUIRE ACCESS
7
RECORD OF PRIOR CLEARANCES
DATE OF CLEARANCE
TYPE OF CLEARANCE
AGENCY THAT COMPLETED INVESTIGATION
REMARKS.
381
NW 88613 Docid:34528582 Page 5
U.S. GOVERNMENT PRINTING OFFICE 1960 0-573450