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
AGENCY INFORMATION
AGENCY : INSCOM/CSF
RECORD NUMBER :
RECORDS SERIES :
194-10003-10336
INTELLIGENCE/COUNTERINTELLIGENCE SOURCES
AGENCY FILE NUMBER : PAGES 4-5
DOCUMENT INFORMATION
ORIGINATOR : USA
FROM
TO:
:
TITLE :
59TH ORD GP
USA ADVANCED WEAPONS SUPPORT COMD
( RESTRICTED ]
DATE : 11/17/71
PAGES :
SUBJECTS
: KACZMARCYYK, GEORGE
RESULTS OF NATIONAL AGENCY CHECK
DOCUMENT TYPE
CLASSIFICATION
RESTRICTIONS
CURRENT STATUS :
: UNCLASSIFIED
:
PAPER, TEXTUAL DOCUMENT
:
3
RELEASED WITH DELETIONS
DATE OF LAST REVIEW : 03/09/95
OPENING CRITERIA
:
COMMENTS
:
NW 88613 Docid:34529119 Page 1
Date : 01/14/98
Page: 1
NACC Use Only
266-1407
ал
STAPLE HERE
DEPARTMENT OF DEFENSE
NATIONAL AGENCY CHECK REQUEST ·
1. LAST NAME - FIRST NAME - MIDDLE NAME
KACZMARCZYK, Edward NMN
107
NR 10/150 84.
5284
REQUEST DATE
16 Sep 71
☐ 2 SEX
E5
Male
5. MONTH, DAY, YEAR OF BIRTH
Aug 06, 47
3. ALIAS(ES) AND ALL FORMER NAME(S)
NONE
6. PLACE OF BIRTH
Bomblitz, West Germany
RETURN
RESULTS
TO:
(Include ZIP
Code)
9. :
a. FATHER
पर
Commanding. Officer
OCT
"
GE
4. SOCIAL SECURITY NUMBER
143 40 1685
7. SERVICE NUMBER
1272 4692
&& SECURITY PROGRAM
☑✓ MILITARY
☐
CIVILIAN
EM
INDUSTRIAL
US Army Advanced Weapons Support Command
ATTN: Intelligence Branch
MPO NY 09189
RELATIVES
KACZMARCZYK, Josef
b. MOTHER (Full Maiden Name)
IWANOWA, Dorota
¤ SPOUSE (Full Maiden Name)
EASON, Patricia Ann
A
10.
1G
DATE AND PLACE OF BIRTH
12 Nov 12
Frampol, Poland
19 Mar 06,
Alexandrolsk, Ukraine,
୮
ACCT# 6124
b.
☑
LOCAL FILES CHECKED
WITH FAVORABLE RESULTS
C. INITIATOR OF REQUEST
Commanding Officer
HHC, 59th Ord Gp
PRESENT ADDRESS
300 Stone St
381130
Newport News, VacEthan DAI
30 Am 18
13. RESIDENCES (List all from 18th birthday or during past
a. FROM
b. To
Dec 64
Jun 65
Jul 65
Feb 67
Mar 67
Jan 68
Jan 68
Mar 69
Apr 69
Aug 70
Mar 70
Aug 71
INGENC
C. NUMBER AND STI
OPR
OPR
°
St
othan, Ala.
Coverdale Rd #2715
Riverdale, Mat
12. CITIZENSHIP
Bolish
Polish
US
ver is shorter. (If under 18, list present and most recent addresses.) –
ARMY
ENTNAC under pro
completed with 
res
4313 I Rose Terrace.
NETH E. THIERER
d. CITY
Ft Dix
AFB
e. STATE
NJ
Chief, PSI Division auville AFB France
Ft Sill
Hue
Ft Knox
Fla.
Okla
RVN
Ky
14. EMPLOYMENT (List all from 18th birthday or during past 15 years, whichever is shorter. If under 18, list present and most recent employment)
a. FROM
Mar 70
Jun 70
b. TO
Jun 70
Aug 70
15.
a. FROM
Nov.60
b. TO
c. EMPLOYER
Unemployed
Briggs Co
LAST CIVILIAN SCHO
d. PLACE
Landover,
Md
are necessary for positive check
Check of FBI investigative files based o
FBI Identification Division. 
Fingerprints
to 
be considered as 
a clearance. To 
check
information 
pertinent to your inquiry 
Not
upon 
data 
submitted located no 
identifiable
arrest records request 
must be 
submitted 
to
DN
YES NO 16
☑
a.
✗
Jun 64
C. NAME
Wilson Jr HS #12
("Yes" answers must be explained in Item 18, below.)
Is the subject an alien or naturalized citizen?
b. Has the subject any foreign connections, employment or military service?
c. Has the subject travelled or resided abroad other than for the US. Government?
☑ d. Has the subject had employment requiring a security clearance or investigation?
e. Is the subject now or has he ever been in the Federal Civil Service or Armed Forces?
✗ . Has the subject qualified DD Form 398, 98, 48-1, or similar security form?
✗ε Has the subject ever been addicted to drugs?
18. REMARKS (If additional space is needed, continue on plain paper.)
ITEM #13. Sep 71 - present, OPR, Pirmasens,
ITEM #8a. & 8b.
0
4
ermany
DASA
☑ODCA
REQUEST DATA
DESIGNATOR
b.
REASON
BASIC TRAINEE
PRE-COMMISSION
NUCLEAR
BI.
✗ SECRET
☑ CLEARANCE
Josef Kaczmarczyk, DPOE: 2 Nov 60, NYC, NY, Alien reg. #A7904415
Dorota Iwanowa Kaczmarczyk, DPOE: 2 Nov 60, NYC, NY, Alien reg # A7904416
continued
DDD 1584
REPLACES DA FORM 3027, 1 AUG 65, WHICH IS OBSOLETE
✰ GPO: 1967 0 279-094
NW 88613 Docid:34529119 Page 2
DD FORM 1584
-
continu
KACZMARCEYK, Edward NMN, DP: ☐ Aug 06, 47, Bomblitz,
West Germany, SSAN: 143 40 1685
ITEM #15a. Subject was naturalized on 24 Oct 69 in US District Court, Honolulu,
Hawaii. Naturalization No: 9271178
ITEM 15b.
Uncle,
Aunt,
Aunt,
Stanley Kaczmarczyk, age 66, Sluchowo, Poland
Ann Artabolowska
Kshania Hitriowa
Stepbrother, Wladimir Iwanow
ITEM 15c.
, age 67, Charkow, USSR
, age unk, Charkow, USSR
, age unk, Charkov, USSR
Subject immigrated to United States with parents on 25 Nov 50. From 19 Dec 55
until 2 Nov 60 traveled through USSR and Poland visiting family. Detained
in USSR for 9 months before exit was permitted. Subject left Poland with family
on 16 Apr 57 to return to United States. Family (including subject) was held
over in Hamburg, West Germany, awaiting sponsorship to return to United States.
While in Germany, subject visited Luton, Bedfordshire, England, from 17 Dec 58
until 12 Mar 59.
Subject re-entered the United States on 2 Nov 60, NYC, NY, for purpose of
legal residence.
Subject also visited Canada from 6 Aug 63 12 Aug 63.
ITEM 15e.
-
Active duty, US Army, E5, Dec 64 Mar 70, Aug 70 to present.
NW 88613 Docid:34529119 Page 3
266-140
>
are necessary for positive check.
FBI Identification Division. 
Fingerprints
arrest records request must 
be submitted 
to
to 
be considered as a 
clearance. 
To check
information pertinent to your inquiry. Not
upon data submitted located no identifiable
Check of FBI investigative files based
5