14-00000
104-10117-10075
2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992
SECTION 1.
SUPPLEMENTAL PERSONAL HISTORY STATEMENT
INSTRUCTIONS
Submit in duplicate. Answer all questions completely. If question does not apply, write "NA." Write "UNKNOWN" only if you do not
know the answer and it cannot be obtained from personal records. If 
additional space is required use extra pages the same size as this
page and sign each such page. Reference each continued item by "section and item 
number to which it relates.
1. FULL NAME (last-first-middle)
12. DATE OF BIRTH 3. PLACE OF BIRTH (City, State, Country) 4. SOC SEC NO.
Flores, Daniel
09 4 Aug 1935 (San Marcos) Texas
460-48-6230
5.
6. STATE DATE. PLACE. AND REASON FOR ALL DIVORCES OR ANNULMENTS
PRESENT STATUS (Single, widowed, divorced, or annulled) SPECIFY: Married,o
30
"NA"
SECTION 11.
". NAME OF SPOUSE (last-first-middle-maiden)
Flores, (Dorothy Arnett) 06
4.
DATE AND PLACE OF MARRIAGE
6.
18 November 1960
(Lima, Peru) 10
SPOUSE
09
2. DATE OF BIRTH
3.
31 Jan 1935
PLACE OF BIRTH (spouse)
Portland, Oregon
5. CITIZENSHIP OF SPOUSE (If naturalized, indicate date & place
naturalization & certificate no.)
USA
STATE DATE. PLACE. AND REASON FOR ALL SEPARATIONS. DIVORCES OR ANNULMENTS
"NA"
7. OCCUPATION
Legal Secretary
8. PRESENT EMPLOYER
(Arnold and Porter) 08
Country if not U.S.)
9. EMPLOYER'S OR BUSINESS ADDRESS (No., Street, City, State & Zip Code -
08
(1229 19th) Street NW, Washington, D.C.
SECTION 11I. RESIDENCE (Since date of last PHS, if overseas residence indicate only city and country)
ADDRESS LAST RESIDENCE FIRST (number, street, city, state, country) Incl. Apt. #
(Guayaquil, Ecuador)
(Lima, Peru) to
об
☛ Vienna, Va (8151 Larkin La.
INCLUSIVE DATES (month & year)
FROM.
TO-
May 1969 May 1971
Sept. 1971 Feb. 1974
Feb. 1974
CHILDREN AND OTHER DEPENDENTS (Provide information for all children and dependents)
SECTION IV.
NAME
ob Kendra) Flores
ов
06 (Zola Marie) Flores
RELATIONSHIP DATE & PLACE OF BIRTH
Daughter 3 March 1971
CITIZENSHIP
USA
Washington, D.c.
Daughter 15 March 1974
|Washington, D.c
USA
08 ADDRESS
8151 Larking La)
Vienna, Va.
"
FORM
12-70
444e
OBSOLETE PREVIOUS
EDITIONS
(4)
14-00000
SECTION V
'
RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (1) LIVE ABROAD,
(2) ARE NOT U.S. CITIZENS OR (3) WORK FOR A FOREIGN GOVERNMENT
'J. NAME (Last-First-Middle)
5.
[0
GUERRERO, Richard
CITIZENSHIP (Country)
USA
7. EMPLOYED BY
U.S. Army
1. NAME (Last-First-Middle)
6.
Ansbach,
2. RELATIONSHIP
Nephew
3. DATE OF BIRTH 4. PLACE OF BIRTH (City, State, Country)
New Orleans,
"UK
La
ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
Germany
8.
FREQUENCY OF CONTACT
Periodic
9
March 1974ONTACT
....-
5.
CITIZENSHIP (Country)
(2)
7. EMPLOYED BY
6 2 RELATIONSHIP 3. DATE OF BIRTH 4. PLACE OF BIRTH (City, State, Country)
6. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
8. FREQUENCY OF CONTACT
9. DATE OF LAST CONTACT
1.
NAME (Last-First-Middle)
2. RELATIONSHIP 3. DATE OF BIRTH 4. PLACE OF BIRTH (City, State, Country)
5.
CITIZENSHIP (Country)
6. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
(3)
7. EMPLOYED BY
8. FREQUENCY OF CONTACT
9. DATE OF LAST CONTACT
SECTION VI.
PERSONAL DECLARATIONS
1. HAVE YOU BEEN ARRESTED. INDICTED OR CONVICTED FOR ANY VIOLATION OF LAW (Other than for
minor traffic violation) SINCE THE DATE OF YOUR LAST PHS
2. SINCE THE DATE OF YOUR LAST PHS. HAVE THERE BEEN ANY UNFAVORABLE INCIDENTS IN YOUR LIFE
WHICH MIGHT REQUIRE EXPLANATION.
3. NAME OF YOUR PRESENT IMMEDIATE SUPERVISOR (include Room Number and Extension) Mr.
X-7451
'
YES (explain
below)
☑ NO
☑ NO
YES (explain
below)
Nestor Sanchez
RM 3D30
SECTION VII.
1.
NAME (Last-First-Middle)
PERSONS TO BE NOTIFIED IN CASE OF EMERGENCY
Same as previous PHS.
2.
RELATIONSHIP
3.
HOME ADDRESS (Number, Street, City, State, ZIP Code)
4.
HOME TELEPHONE NUMBER
5.
BUSINESS ADDRESS (Number, Street, City, State, ZIP Code)- INDICATE NAME OF
OR EMPLOYER. IF APPLICABLE
FIRM
6. BUSINESS TELEPHONE NUMBER & EXT.
7.
> MAY ALSO BE NOTIFIED.
IF SUCH NOTIFICATION
IN CASE OF EMERGENCY. OTHER CLOSE RELATIVES (spouse, mother, father
IS NOT DESIRABLE BECAUSE OF HEALTH OR OTHER REASONS. PLEASE IDENTIFY THE PERSONS NOT TO BE NOTIFIED AND THE REASON.
SECTION VIII.
'
ADDITIONAL REMARKS
DATE
SIGNATURE OF EMPLOYEE
14-00000
1. NAME (First-middle-last)
Daniel (mmm) Flores
SUPPLEMENTAL PERSONAL HISTORY STATEMENT
2. MARITAL STATUS
SINGLE
MARRIED
OTHER
3. F. MARRIED:
06
NAME OF SPOUSE (First-middle(maiden)-last.)
Dorothy A. Moran Flores
PLACE OF MARRIAGE
(Lima, Peru
110
DATE OF MARRIAGE
18 November 1960"
4. RESIDENCE (Since date of last PHS. if overseas residence indicate only city & country)
SINCE (Date)
PRESENT August 1961
NUMBER AND STREET
2828 Connecticut Ave., N.W.
08
NUMBER AND STREET
CITY AND STATE
Washington, D.C. 20008
CITY AND STATE
DATE TO DATE
FROM
DATE TO DATE
FROM
NUMBER AND STREET
CITY AND STATE
5. HAVE YOU BEEN ARRESTED. INDICTED. SOR CONVICTED FOR ANY VIOLATION OF LAW (Other than for
minor traffic violation) SINCE THE DATE OF YOUR LAST PHS
6. SINCE THE DATE OF YOUR LAST. PHS. HAVE THERE BEEN ANY UNFAVORABLE INCIDENTS IN YOUR LIFE
WHICH MIGHT REQUIRE EXPLANATION
7. NAME OF YOUR PRESENT IMMEDIATE SUPERVISOR
8.
Harry R
Mahoney
ADDITIONAL REMARKS (Use reverse if necessary)
YES (Explain ☑ NO
below)
YES (Explain
below)
EXT7176
RM. 3054
☑ NO
DATE
29 March 1967
FORM
4-51
444e
SIGNATURE OF EMPLOYEE
Tamil.
(4)
14-00000
SUPPLEMENTAL PERSONAL HISTORY STATEMENT
1. NAME (First-middle-last)
Daniel (nm) Flores
3. IF MARRIED
NAME OF SPOUSE (First-middle(maiden)-last)
06 Dorothy A. Moran Flores
PLACE OF MARRIAGE
Lima, Peru) 10
2. MARITAL STATUS
SINGLE
✓ HARRIED
OTHER
4. RESIDENCE (Since date of last PHS, if overseas residence indicate only
SINCE (Date)
NUMBER AND STREET.
PRESENT August 1961
.08
2828 Connecticut Ave., N.W
+
DATE OF MARRIAGE
18 November 1960
city & country)
CITY AND STATE
Washington, DC 20008
NUMBER AND STREET
CITY AND STATE-
DATE TO DATE
FROM
DATE TO DATE
NUMBER AND STREET
CITY AND STATE)
FROM
5.
HAVE YOU BEEN ARRESTED, INDICTED OR CONVICTED FOR ANY VIOLATION OF LAW (Other than for a
minor traffic violation) SINCE THE DATE OF YOUR LAST PHS
6.
SINCE THE DATE OF YOUR LAST PHS. HAVE THERE BEEN ANY UNFAVORABLE INCIDENTS IN YOUR LIFE
WHICH MIGHT REQUIRE EXPLANATION
PR
YES (Explain
below)
YES (Explain
below
7. NAME OF YOUR PRESENT IMMEDIATE SUPERVISOR
Harry T. Mahoney
8.
ADDITIONAL REMARKS (Use reverse if necessary)
EXT 7176 RM.#3054
ETURN PHS AND ATTACHMENTS
TO HEADQUARTERS
10
3
DATE
29 March 1967
FORM
4-61
444e
SIGNATURI OF EMPLOYEE
i
3/P1
sty
☑ No
NO
(4)