14-00000
104-10117-10076
.
2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992
PERSONAL HISTORY STATEMENT
-
(Appendix I)
Listed below are names of organizations identified by the Attorney General, under his responsibility pursuant to
Executive Order 10450, dated 27 April 1953, to list the names of each foreign or domestic organization, association,
movement, group or combination of persons which he designates as Totalitarian, Fascist, Communist, or subversive,
or as having adopted or having shown a policy of advocating or approving the commission: of acts of force or vio-
lence to deny others their rights under the Constitution of the United States, or as seeking to alter the form of
government of the United States by unconstitutional means.
Each applicant or employee and spouse (if any) must review the following list of organizations for certification
purposes, and sign on the last page.
Abraham Lincoln Brigade
Abraham Lincoln School, Chicago, Illinois
Action Committee to Free Spain Now
Alabama. People's Educational. Association (see Communist Politi-
cal Association)
American Association for Reconstruction in Yugoslavia, Inc.
Americam Branch of the Federation of Greek Maritime Unions
American Christian. Nationalist. Party
American: Committee for European. Workers' Relief (see Socialist
Workers Party)
American Committee for Protection of Foreign Born
American Committee. for Spanish Freedom
American Committee. for the Settlement of Jews in Birobidjan, Inc.
American Committee: for Yugoslav: Rellef, Inc:
American Committee to: Burrey Labor Conditions in Europe
American Council: for &. Democratia: Greece, formerly known as the
Greek American Council;: Greek American: Committee for Na-
tional Unity
American Council: on Soviet: Relations
American Croatian Congress
American. Jewish Labor Council
American League Against War and Fascism
American League for Pence and' Democracy
American National Labor Party
American National Socialist Leagus
American National Socialist Party
American Nationalist Party
American Patriots, Inc.
American Peace Crusade
American Peace Mobilization
American. Poles for Peace
American Polish. Labor Council
American Polish. League
American Rescue Ship Mission (a project of the United American
Spanish Aid Committee)
American-Russian Fraternal Society
American Russian. Institute; New York, also known as the Ameri-
can Russian Institute for Cultural Relations with the Boviet
Union
American Russian Institute,. Philadelphia
American Russian Institute of Ban: Francisco
American Russian: Institute of Southern California, Los Angeles
American Blay Congress
American Women for Peace
American Youth Congress
American Youth for Democracy
Armenian Progressive League of America
Associated Klans of America
Association of Georgia Klans
Association of German Nationals (Reichsdeutsche Vereinigung)
Ausland-Organization der NSDAP, Overseas Branch of Nazi Party
Baltimore Forum
Benjamin Davis Freedom Committee
Black Dragon Boalety
Boston. School for Marxist. Studies, Boston, Massachusetts
Bridges-Bobertson-Schmidt. Defense Committee
Bulgarian American: People's. League of the United States of
America
California Emergency Defense Committee
California Labor School, Inc., 311 Divisadero Street, Ban Francisco,
California
Carpatho-Russian: People's Society
Central. Council of American. Women of Croatian Descent, also
known as Central Council of American Croatian Women, Na-
tional: Council of Croatian: Women:
Central Japanese: Association: (Beikoku: Chua: Nipponjin: Kal)
Central Japances. Association of Southern: California.
Central: Organization of the German-American National Alliance
(Deutsche-Amerikanische. Einheitafront)
Cervantes: Ersternal: Society
Chins. Welfare Appeal; Inc.
Chopin Cultural Center
Citizens Committee-for: Harry, Bridges
Citizens Committes of the Upper West Bide (New York City)
Citizens Committee to Free Earl Browder
Citizens: Emergency Defense Conference
Citizens Protective League
Civil Liberties Sponsoring Committee of Pittsburgh
Civil Rights Congress and its amliated organizations. Including:
Civil Rights. Congress. for Texas
Veterans Against. Discrimination. of: Givil Rights Congress of
New York
Civil Rights Congress. for Texas (see Civil Rights Congress)
Columbians
Comite Coordinador Pro: Republica Espanola
Comite Pro Derechos. Civiles
(Bea- Puerto Rican Comite Pro Libertades Civiles)
Committee for a Democratic. Par Eastern Policy
Committee for Constitutional and. Political. Freedom
Committee. for: Nationalist. Action
Committee for Peace and Brotherhood Festival in Philadelphia
Committee for the Defense of the Pittsburgh Bix
Committee for the Negro in the Arts
Committee for the Protection of the Bill of Rights
Committee for. World Youth Friendship and Cultural Exchange
Committee to Abolish Discrimination in Maryland
(Bee. Congress Against. Discrimination; Maryland Congress
Against Discrimination; Provisional Committee to Abolish
Discrimination in the State of Maryland)
Committee to Aid the Fighting Bouth
Committee to Defend Marie Richardson
Committee to Defend the Rights and Freedom of Pittsburgh's
Political Prisoners.
Committee to Uphold the: Bill of Rights
Commonwealth College, Mena, Arkansas
Communist Party; U. 8. A, its subdivisions, subsidiaries, and
amlistos
FORM 444d
USE PREVIOUS EDITIONS
-1-
13-57
1ཡིན 3** ཏཾ ཨཱཝཾསཱཔུཡཱདཱཔརསྶ སྶ
(4)
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Communist Political Association, its subdivisions, subsidiaries,
and amitates, including:
Alabama People's Educational Association
Florida Press and Educational League
Oklahoma League for Political Education
People's Educational and Press Association of Texas
Virginia League for People's Education
Congress Against Discrimination
(Bes Committee to Abolish Discrimination in Maryland)
Congress of American Revolutionary Writers
Congrees of American Women
Congress of the Unemployed
Connecticut Committee to Aid Victims of the Bmith Act
Connecticut State Youth Conference
Council for Jobs, Relief and Housing
Council for Pan-American Democracy
Council of Greek Americans
Council on African Affairs
Croatian Benevolent Fraternity
Dai Nippon Butoku Kal (Military Virtue Society of Japan or Miu-
tary Art Society of Japan)
Daily Worker Press Club
Daniels Defense Committee
Dante Alighieri Society (between 1935 and 1940)
Dennis Defense Committee
Detroit Youth Assembly
East Bay Peace Committee
Elsinore Progressive League
Emergency Conference to Save Spanish Refugees (founding body
of the North American Spanish Aid Committee)
Everybody's Committee to Outlaw War
Families of the Baltimore Bmith Act Victims
Families of the Smith Act Victims
Federation of Italian War Veterans in the U. 8. A., Inc. (Associa
sione Nazionale Combattenti Italiani, Federazione degli Stati
Uniti d'America)
Finnish-American Mutual Aid Society
Florida Press and Educational League (see Communist Political
Association)
Frederick Douglass Educational Center
Freedom Stage, Inc.
Friends of the New Germany (Freunde des Neuen Deutschlands)
Friends of the Soviet Union
Garibaldi American Fraternal Society
George Washington Carver School, New York City
German-American Bund (Amerikadeutscher Volksbund)
German-American Republican League
German-American Vocational League (Deutsche-Amerikanische
Berufsgemeinschaft)
Guardian Club
Harlem Trade Union Council
Hawall Civil Liberties Committee
Heimusha Kai, also known as Nokubel Heleki Gimusha Kai, Zalbel
Nihonjin, Heiyaku Gimusha Kai, and Zaibel Heimusha Kai (Jap-
anese Residing in America Military Conscripts Association)
Hellenic-American Brotherhood
Hinode Kal (Imperial Japanese Reservists)
Hinomaru Kal (Rising Sun Flag Society - a group of Japanese
War Veterans)
Hokubel Zaigo Bhoke Dan (North American Reserve Officers Asso-
ciation)
Hollywood Writers Mobilization for Defense
Hungarian-American Council for Democracy
Hungarian Brotherhood
Idaho Pension Union
Independent Party (Beattle, Washington)
(See Independent People's Party)
Independent People's Party
(See Independent Party)
Industrial Workers of the World
International Labor Defense
International Workers Order, its subdivisions, subsidiaries and
amlistes
Japanese Association of America
Japanese Overseas Central Society (Kaigal Dobo Chuo Kai)
Japanese Overseas Convention, Tokyo, Japan, 1940
Japanese Protective Association (Recruiting Organization)
Jefferson School of Social Science, New York City
Jewish Culture Bociety
Jewish People's Committee
Jewish People's Fraternal Order
Jikyoku linkal (The Committee for the Crisis)
Johnson-Porest Group
(See Johnsonites)
Johnsonites
(Bee Johnson-Forest Group)
Joint Anti-Pascist Refuges Committee
Joint Council of Progressive Italian-Americans, Inc.
Joseph Wedemeyer School of Social Science, St. Louis, Missouri
Kibel Beinen Kai (Association of U. B. Citizens of Japanese An-
cestry who have returned to America after studying in Japan)
Knights of the White Camellia
Ku Klux Klan
Kythaeuser, also known as Kytthaeuser League (Kythaeuser
Bund), Kyffhauser Fellowship (Kyfthaeuser Kameradschaft)
Kythaeuser War Relief (Kyffhaeuser Kriegshilfswerk)
Labor Council for Negro Rights
Labor Research Association, Inc.
Labor Youth League
League for Common Sense
League of American Writers
Lictor Bociety (Italian Black Shirts)
Macedonian-American People's League
Mario Morgantini Circle
Maritime Labor Committee to Defend Al Lannon
Maryland Congress Against Discrimination
(See Committee to Abolish Discrimination in Maryland)
Massachusetts Committee for the Bill of Rights
Massachusetts Minute Women for Peace (not connected with the
Minute Women of the U. S. A., Inc.)
Maurice Braverman Defense Committee
Michigan Civil Rights Federation
Michigan Council for Peace
Michigan School of Social Science
Nanka Teikoku Gunyudan (Imperial Military Friends Group or
Southern California War Veterans)
National Association of Mexican Americans (also known as Asocia
cion Nacional Mexico-Americana)
National Blue Star Mothers of America (not to be confused with
the Blue Star Mothers of America organized in February 1942)
National Committee for Freedom of the Press
National Committee for the Defense of Political Prisoners
National Committee to Win Amnesty for Bmith Act Victims
National Committee to Win the Peace
National Conference on American Policy in China and the Far East
(a Conference called by the Committee for a Democratic Par
Eastern Policy)
National Council of Americans of Croatian Descent
National Council of American-Soviet Friendship
National Federation for Constitutional Liberties
National Labor Conference for Peace
National Negro Congress
National Negro Labor Council
Nationalist Action League
-2-
.
14-00000
Nationalist Party of Puerto Rico
Nature Friends of America (since 1935)
Negro Labor Victory Committee
New Committee for Publications
Nichibel Kogyo Kaisha (The Great Puji Theatre)
North American Committee to Ald Spanish Democracy
North American Spanish Aid Committee
North Philadelphis Forum
Northwest Japanese Association
Ohio School of Social Sciences
Oklahoma Committee to Defend Political Prisoners
Oklahoma League for Political Education (see Communist Politi-
cal Association)
Original Southern Klans, Incorporated
Pacific Northwest Labor School, Seattle, Washington
Palo Alto Peace Club
Partido del Pueblo of Panama (operating in the Canal Zone)
Peace Information Center
Pesos Movement of Ethiopia
People's Drama, Inc.
People's Educational and Press Association of Texas (see Commui-
nist Political Association)
People's Educational Association (incorporated under name Los
Angeles Educational Association, Inc.), also known as People's
Educational Center, People's University, People's School
People's Institute of Applied Religion
Peoples Programs (Seattle, Washington)
People's Radio Foundation, Inc.
People's Rights Party
Philadelphia Labor Committee for Negro Rights
Philadelphia School of Social Science and Art
Photo League (New York City)
Pittsburgh Arts Club
Political Prisoners' Welfare Committee
Polonia Society of the TWO
Progressive German-Americans, also known as Progressive Cler-
man-Americans of Chicago
Proletarian Party of America
Protestant War Veterans of the United States, Inc.
Provisional Committee of Citizens for Peace, Bouthwest Area
Provisional Committee on Latin American Affairs
Provisional Committee to Abolish Discrimination in the State of
Maryland
(Bee Committee to Abolish Discrimination in Maryland)
Puerto Rican Comite Pro Libertades Civiles (CLC)
(Bee Comite Pro Derechos Civiles)
Puertorriquenos Unidos (Puerto Ricans United)
Quad City Committee for Peace
Queensbridge Tenants League
Revolutionary Workers League
Romanian-American Fraternal Society
Russian American Society, Inc.
Sakura Kal (Patriotic Society, or Cherry Association -
of veterans of Russo-Japanese War)
Bamuel Adams School, Boston, Massachusetts
composed
Banta Barbara Peace Forum
Schappes Defense Committee
Schneiderman-Darcy Defense Committee
School of Jewish Studies, New York City
Beattle Labor School, Beattle, Washington
Berbian-American Praternal Society
Berbian Vidovdan Council
Shinto Temples (limited to State Shinto abolished in 1945)
Silver Shirt Legion of America
Elavic Council of Southern California
Slovak Workers Society
Blovenian-American National Council
Bocialist Workers Party, including American Committee for Euro-
pean Workers' Relief
Bokoku Kal (Fatherland Society)
Southern Negro Youth Congress
Buiko Sha (Reserve Officers Association, Los Angeles)
Byracuse Women for Peace
Tom Paine School of Social Science, Philadelphia, Pennsylvanis
Tom Paine School of Westchester, New York
Trade Union Committee for Peace
(800 Trade Unionists for Peace)
Trade Unionists for Peace
(See Trade Unionists for Peace)
Tri-State Negro Trade Union Council
Ukrainian-American Praternal Union
Union of American Croatians
Union of New York Veterans
United American Spanish Aid Committes
United Committee of Jewish Bocieties and Landsmanschaft Fed-
erations, also known as Coordination Committes of Jewish
Landsmanschaften and Fraternal Organizations
United Committee of South Blavic Americans
United Defense Council of Southern California
United Harlem Tenants and Consumers Organization
United May Day Committee
United Negro and Allied Veterans of America
Veterans Against Discrimination of Civil Rights Congress of New
York (see Civil Rights Congress)
Veterans of the Abraham Lincoln Brigade
Virginia League for People's Education (see Communist Political
Association)
Voice of Freedom Committee
Walt Whitman School of Social Science, Newark, New Jersey
Washington Bookshop Association
Washington Committee for Democratic Action
Washington Committee to Defend the Bill of Rights
Washington Commonwealth Federation
Washington Pension Union
Wisconsin. Conference on Bocial Legislation
Workers Alliance (since April 1936)
Yiddisher Kultur Farband
Young Communist League
Yugoslav-American Cooperative Home, Inc.
Yugoslav Seamen's Club, Inc.
-3-
14-00000
DO NOT USE THIS SPACE
ISSUED BY
PERSONAL HISTORY STATEMENT
INSTRUCTIONS
THIS DATE (Pill in)
September 6, 1961
SfSER JO 05
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 I
1. FULL NAME (Last-First-Middle)
GENERAL PERSONAL AND PHYSICAL DATA
2. AGE
3. SEX
FLORES, Daniel
26
✓ MALE
4. HEIGHT
5. WEIGHT
6. COLOR OF EYES
Brown
7. COLOR OF HAIR
Black
8. TAPE COMPLEXION
Dark
5' 8" 165 pds.
FEMALE
9. TYPE BUILD
Medium
10. SCARS (Type and Location) Right cheek, one-half inch scar; left upper lip, one-
quarter inch scar; both received playing football
11. OTHER DISTINGUSHING PHYSICAL FEATURES
..
.
None
12. CURRENT ADDRESS (No., Street, City, Zone. State and Country)
(2828 Connecticut Avenue, N. W., #203)
Washington 8, D. C.
14. CURRENT PHONE NO.
(265-8322) 08
17. NICKNAMES
Dan
&
15. OFFICE PHONE NO. & EXT.
None
13. PERMANENT ADDRESS (No., Street, City, Zone, State and
Country) AND PHONE NO. :
Stage
1)
2828 Connecticut Avenue, N. W.
#203
-
Washington 8, D.C.
16. LEGAL RESIDENCE (State, Territory or Country)
Washington, District of Columbia
18. OTHER NAMES YOU HAVE USED
None
19. INDICATE CIRCUMSTANCES (Including Length of Time) UNDER WHICH YOU HAVE EVER USED THESE NAMES.
-
Personal acquaintances twelve years
20. IF LEGAL CHANGE, GIVE PARTICULARS (Where and by What Authority).
SECTION IE
NA
POSITION DATA
1. INDICATE THE TYPE OF WORK OR POSITION FOR WHICH YOU ARE APPLYING
work.
Any phase of communications; administration; or personnel
2. INDICATE THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL 3. DATE AVAILABLE FOR EMPLOYMENT
ACCEPT (You will not be considered for 
any position with a lower
entrance salary).
OCCASIONALLY
$ 4,250.00
✗FRI
FREQUENTLY
Immediately
4. INDICATE YOUR WILLINGNESS TO TRAVEL
CONSTANTLY
OTHER:
5. INDICATE YOUR WILLINGNESS TO ACCEPT ASSIGNMENT IN THE FOLLOWING LOCATIONS (Check (X) each item applicable)
CERTAIN LOCATIONS ONLY (Specify):
☑ WASHINGTON, D.C. ANYWHERE IN U.S.
☑ OUTSIDE CONTINENTAL U.S.
6. INDICATE WHAT RESERVATIONS YOU WOULD PLACE ON ASSIGNMENTS OUTSIDE THE WASHINGTON, D.C. AREA.
I would be willing to travel within the United States provided
said travel would not involve a permanent move whereby my legal
residence would be changed. However, it is my wish to live overseas
on a permanent basis.
>
FORM 444 USE PREVIOUS EDITION.
11-58
3/10
.JOY COONEY
.1. 49
(4)
14-00000
SECTION III
CITIZENSHIP
1. DATE OF BIRTH
2. PLACE OF BIRTH (City, State, Country)
August 4) 1985 10 (San Marcos_:) Texas
☑ BIRTH
4. CITIZENSHIP ACQUIRED BY
MARRIAGE
OTHER (Specify):
7. COURT ISSUING NATURALIZATION CERTIFICATE
5. DATE NATURAL-
IZED
•
NA
3. PRESENT CITIZENSHIP (Country)
United States of America
6. NATURALIZATION CERTIFICATE NO.
NA
NA
B. ISSUED AT (City, State, Country)
ΝΑ
9. HAVE YOU HELD PREVIOUS NATIONALITY 10. IF YES, GIVE NAME OF COUNTRY
YES
NO
11. GIVE PARTICULARS CONCERNING PREVIOUS NATIONALITY.
NA
NA
12. HAVE YOU TAKEN STEPS TO CHANGE
PRESENT CITIZENSHIP
YES
NO
13. GIVE PARTICULARS
NA
14. IF YOU HAVE APPLIED FOR U.S. CITIZENSHIP, WHAT IS PRESENT STATUS OF YOUR APPLICATION (First Papers, Etc.)?
NA
15. DATE OF ARRIVAL IN U.S.
NA
16. PORT OF ENTRY
NA
18. LAST U.S. VISA (No., Type, Place of Issue)
SECTION IV
NA
17. ON PASSPORT OF WHAT COUNTRY
NA
19. DATE VISA ISSUED
NA
EDUCATION
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
1. NAME OF ELEMENTARY SCHOOL'
08
San Marcos) Elementary School'
3. DATES ATTENDED (From-and-TO)
Sept., 1942 May, 1951
-
1. NAME OF HIGH SCHOOL
San Marcos High School
3. DATES ATTENDED (From-and-TO)
Sept., 1951 May,
-
1. NAME OF HIGH SCHOOL
NA
3. DATES ATTENDED (From-and-To)
1955
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)
San Marcos, Texas, U.S.A.
☑ YES
3. HIGH SCHOOL
4. GRADUATE
NO
2. ADDRESS (City, State, Country)
(San Marcos, Texas, U.S.A.
☑ YES
10
4. GRADUATE
NO
2. ADDRESS (City, State, Country)
YES
4. GRADUATE
NO
১
4. COLLEGE OR UNIVERSITY STUDY
NAME AND LOCATION OF COLLEGE OR UNIVERSITY
SUBJECT
MAJOR
MINOR
DATES ATTENDED
FROM
DEGREE
REC'D
DATE
REC'D
SEM/QTR
HOURS
TO
(Specify)
6170
SECTION IV CONTINUED TO PAGE 3
:
14-00000
.
SECTION IV CONTINUED FROM PAGE 2
5. IF 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.
NA
NAME AND ADDRESS OF SCHOOL
6. TRADE, COMMERCIAL AND SPECIALIZED SCHOOLS
STUDY OR SPECIALIZATION
FROM
TO
MONTHS
NA
7. MILITARY TRAINING (FULL TIME DUTY IN SPECIALIZED SCHOOLS SUCH AS ORDNANCE, INTELLIGENCE, COMMUNICATIONS, ETC.)
NAME AND ADDRESS OF SCHOOL
Marine Security Guard
School
-
Henderson Hall
Hq. Marine Corps,
Washington 25, D.C.
STUDY OR SPECIALIZATION
Security Guard
Training
FROM
TO
MONTHS
19/28/58 10/31/58 (5 wks)
8. OTHER EDUCATIONAL TRAINING NOT INDICATED ABOVE.
Weapons Training in Marine Corps.
Acted as partisan during cold weather training at Bridgeport,
California (Pickle Meadows
-
USMC).
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
FOREIGN LANGUAGE ABILITIES
COMPETENCE - IN ORDER LISTED
R-Road, W-Write, S-Speak
HOW ACQUIRED
EQUIV-
ALENT
TO
NATIVE
FLUENCY
FLUENT
BUT
OBVIOUSLY
FOREIGN
ADEQUATE ADEQUATE
FOR
FOR
RESEARCH TRAVEL
LIMITED
KNOW-
LEDGE
NATIVE
OF
COUNTRY
PRO-
LONGED
RES-
IDENCE
CONTACT ACADEMIC
STUDY
(with
(all
parents,
etc.)
levels)
RWSRWSRWSRWSRWS
X X X☑
2. IF YOU HAVE CHECKED "ACADEMIC STUDY” UNDER "HOW ACQUIRED", INDICATE LENGTH AND INTENSIVENESS OF STUDY.
ΝΑ
3. IF YOU HAVE INDICATED FLUENCY FOR A LANGUAGE HAVING SIGNIFICANT DIFFERENCES IN SPOKEN AND WRITTEN FORM, EX-
PLAIN YOUR COMPETENCE THEREIN.
NA
4. DESCRIBE YOUR ABILITY TO DO SPECIALIZED LANGUAGE WORK INVOLVING VOCABULARIES AND TERMINOLOGY IN THE SCIEN-
TIFIC, ENGINEERING, TELECOMMUNICATIONS, MILITARY, AND OTHER SPECIALIZED FIELDS.
Could act as literal interpreter at almost any level.
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. 51
14-00000
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.
KNOWLEDGE ACQUIRED BY
NAME OF
REGION OR COUNTRY
TYPE OF
SPECIALIZED KNOWLEDGE
DATES OF
RESIDENCE
OR TRAVEL
DATES AND
PLACE OF STUDY
RESI-
DENCE
TRAVEL STUDY
WORK
ASSIGN
MENT
Bolivia
Peru
Chile
Argentina
Uruguay
11/13/58 to
General knowledge 1/14/60
General knowledge 11/20/60
✗
1/14/60 to
X
X
6/16/59 to
6/21/59
16/21/59 to ☑
6/30/59 to
7/2/59
2. INDICATE THE PURPOSE OF VISIT, RESIDENCE, OR TRAVEL IN EACH OF THE REGIONS OR COUNTRIES LISTED ABOVE.
Marine Security Guard
Vacation
-
-
American Embassy
-
Bolivia and Peru
Chile; Argentina; Uruguay; Panama
3. UNITED STATES PASSPORT NUMBER AND EXPIRATION DATE, IF ISSUED.
No. (1748500 SP-85575) Passport has been cancelled.
SECTION VII
1. TYPING (wpm) 2. SHORTHAND(wpm)
45 wpm
None
TYPING AND STENOGRAPHIC SKILLS
GREGG
3. SHORTHAND SYSTEM USED - CHECK (X) APPROPRIATE ITEM
STENOTYPE
SPEEDWRITING
OTHER (Specify):
2. INDICATE OTHER BUSINESS MACHINES WITH WHICH YOU HAVE HAD OPERATING EXPERIENCE OR TRAINING (Comptometer,
Mimeograph, Card Punch, Etc.).
Thermofax, mimeograph, switchboard
SECTION VIII
SPECIAL QUALIFICATIONS
1. LIST ALL HOBBIES AND SPORTS IN WHICH YOU ARE ACTIVE OR HAVE ACTIVELY PARTICIPATED. INDICATE YOUR PROFICIENCY
IN EACH.
Foot ball
Basketball
Swimming
good
fair
.- .good
:-
Reading
Contract Bridge
-
average
very good
2. INDICATE ANY SPECIAL QUALIFICATIONS RESULTING FROM EXPERIENCE OR TRAINING WHICH MIGHT FIT YOU FOR A
PARTICULAR POSITION OR TYPE OF WORK.
None to my knowledge
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.
Upd
None
SECTION VIII CONTINUED TO PAGE 5
52
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).
NA
6. FIRST LICENSE OR CERTIFICATE (Year of Issue)
NA
7. LATEST LICENSE OR CERTIFICATE (Year of Issue)
NA
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.). i.
None
9. INDICATE ANY DEVICES WHICH YOU HAVE INVENTED AND STATE WHETHER OR NOT THEY ARE PATENTED.
None
10. LIST PUBLIC SPEAKING AND PUBLIC RELATIONS EXPERIENCE.
Have spoken in my father's church and other churches approximately
150 times. Met and assisted public in Embassies during my tour of
duty with the Marine Security Guard.
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.
None
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.)
From 1949 to 1953
3. ADDRESS (No., Street, City, State, Country)
10 (San Marcos, Texas
4. KIND OF BUSINESS
Drug Store
6. TITLE OF JOB
Fountain attendant
9. DESCRIPTION OF DUTIES
Employee at soda counter
2. NAME OF EMPLOYING FIRM OR AGENCY
Hillburn's Drug Store
об
5. NAME OF SUPERVISOR
06
Mr. William (Hillburn)
7. SALARY OR EARNINGS
$100.00 PER month
B. CLASS. GRADE (If Federal Service)
3/10
10. REASONS FOR LEAVING
To participate in school events (football).
SECTION IX CONTINUED TO PAGE 6
. 5. 53
14-00000
2
3
4
5
SECTION IX CONTINUED FROM PAGE 5
1. INCLUSIVE DATES (From and To By Mo. and Yr.)
July 1954-June 1955
3. ADDRESS (No., Street, City, State, Country)
об
2. NAME OF EMPLOYING FIRM OR AGENCY
Diamond) Grocery Store
(South Guadalupe St. San Marcos, ) Texas
4. KIND OF BUSINESS
Grocery Store
6. TITLE OF JOB
Butcher
9. DESCRIPTION OF DUTIES
08
5. NAME OF SUPERVISOR
Mr. (Ignacio Gonzales) 06
7. SALARY OR EARNINGS
PER Week
$30.00
Slaughtering and preparing meat for sale as well as
10. REASONS FOR LEAVING
To attend college
?
1. INCLUSIVE DATES (From and To By Mo. and Yr.)
May, 1955
-
September, 1956
3. ADDRESS (No., Street, City, State, Country)
(San Marcos) 10 Texas
4. KIND OF BUSINESS
Private School
6. TITLE OF JOB
Painter's Assistant
9. DESCRIPTION OF DUTIES
Painted dormitories in the Academy
10. REASONS FOR LEAVING
To attend school
8. CLASS. GRADE (If Federal Service)
actual selling.
2. NAME OF EMPLOYING FIRM OR AGENCY
(San Marcos) Baptist Academy
୦୪
5. NAME OF SUPERVISOR
Mr. (John Sparkman)06
7. SALARY OR EARNINGS
$ 35.00
PER Week
8. CLASS. GRADE (II Federal Service)
1. INCLUSIVE DATES (From and To By Mo. and Yr.)
-
September, 1956 July, 1957
3. ADDRESS (No., Street, City, State, Country)
(San Marcos, 10 Texas
4. KIND OF BUSINESS
Clothing Store
6. TITLE OF JOB
Sales Clerk
9. DESCRIPTION OF DUTIES
2. NAME OF EMPLOYING FIRM OR AGENCY
::::conomy): Department Stores
00
5. NAME OF SUPERVISOR
ов
Mr. Max Mendlovitz
7. SALARY OR EARNINGS 8. CLASS. GRADE (If Federal Service)
$ 30.00 PER week
Assisted customers in selecting and buying goods.
01721
10. REASONS FOR LEAVING
To join the Marine Corps.
1. INCLUSIVE DATES (From and To By Mo. and Yr.)
July 26, 1957 - July 25, 1961
3. ADDRESS (No., Street, City, State, Country)
2. NAME OF EMPLOYING FIRM OR AGENCY
United States Marine Corps
Marine Corps Schools, Quantico, Virginia
4. KIND OF BUSINESS
Military
6. TITLE OF JOB
Marine Corps Museum Attendant
5. NAME OF SUPERVISOR
Col. John Magruder
7. SALARY OR EARNINGS B. CLASS. GRADE (If Federal Service)
$ 180.00 PER Month Cpl. (E-4)
SECTION IX CONTINUED TO PAGE 7
54
1
14-00000
5
6
9. DESCRIPTION OF DUTIES
SECTION IX CONTINUED FROM PAGE 6
Acted as guide to all visitors entering Museum, explaining
Marine Corps history, etc. Also on several occasions acted as
interpreter for visiting military personnel from Latin America.
10. REASONS FOR LEAVING
Dis charged
1. INCLUSIVE DATES (From and To By Mo. and Yr.)
July 28, 1961 August 30, 1961
-
3. ADDRESS (No., Street. City, State, Country)
(S. Capitol and I Streets, S. W.,
Y KIND OF BUSINESS
Construction
6. TITLE OF JOB
Laborer
9. DESCRIPTION OF DUTIES
Handyman for Company
08
2. NAME OF EMPLOYING FIRM OR AGENCY
08 Ohio Valley Engineering Company
Washington, D.
5. NAME OF SUPERVISOR
Mr. (L. G.
C.
Bruce
06
18. CLASS. GRADE (If Federal
Service)
hour
7. SALARY OR EARNINGS
$ 2.17
PER
7
10. REASONS FOR LEAVING
Temporary work while seeking permanent employment.
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
6. TITLE OF JOB
9. DESCRIPTION OF DUTIES
10. REASONS FOR LEAVING
5. NAME OF SUPERVISOR
7. SALARY OR EARNINGS
8. CLASS. GRADE (If Federal
Service)
$
PER
8. 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.
7 1/2 years
YES
☐ NO
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
Honorably discharged from United States Marine Corps.
.7.
55
3/12

14-00000
'
SECTION X*
MILITARY SERVICE
1. CURRENT DRAFT STATUS
1. ARE YOU REGISTERED FOR THE DRAFT UNDER ✗ YES 2. SELECTIVE SERVICE CLASSIFI 3. SELECTIVE SERVICE NO.
THE UNIVERSAL MILITARY TRAINING AND
SERVICE ACT OF 1948 (As amended)
4. IF DEFERRED, GIVE REASON
NA
NO
CATION
IV-A
41-65-35-18708
5. LOCAL DRAFT BOARD NO. OR DESIGNATION AND ADDRESS
|#65 101 1/2 E. San Antonio St.,208
2. MILITARY SERVICE RECORD 10 (Lockhart :)) Texas
1. CURRENT AND/OR PAST ORGANIZATIONAL MEMBERSHIP
CHECK (X) AS
APPROPRIATE
ARMY
NAVY
HAVE SERVED
MARINE
CORPS
X
AIR
FORCE
GUARD
GUARD
COAST MERCHANT NATIONAL AIR NAT'L FOREIGN ORGAN. OR MIL.
MARINE
SERVICE (Specify):
GUARD
NOW SERVING -
None
2. BRANCH OR CORPS OF ABOVE CHECKED ORGANIZATION(S)
Personnel Administration
3. DATE SEPARATED FROM EXTENDED ACTIVE DUTY (Past service 4. TOTAL LENGTH OF EXTENDED ACTIVE DUTY IN U.S. ARMED
25 July, 1961
5. DATE ENTERED PAST SERVICE
FORCES (Past and current service)
4 years
6. TOTAL LENGTH OF ACTIVE DUTY IN FOREIGN MILITARY OR-
GANIZATION
CURRENT SERVICE
ACTIVE DUTY -
26 July, 1957
7. RANK, GRADE OR
RATE
-
PAST SERVICE
CURRENT SERVICE
B. SERVICE, SERIAL OR FILE NUMBER (If now serving, provide cur
rent number)
Cpl. (E-4)
9. PRIMARY MILITARY OCCUPATIONAL
SPECIALTY (Mos or Designator) AND TITLE
10. SECONDARY MIL. OCCUPATIONAL
SPECIALTY (Moe or Designator) AND
TITLE
PAST SERVICE
0141 - Chief Clerk
PAST SERVICE
None
CURRENT SERVICE
CURRENT SERVICE
11. BRIEF DESCRIPTION OF MILITARY DUTIES (Indicate whether applicable to past or current service)
Past Service:
Clerk
-
Maintained personnel service records.
2 years as Security Guard in the American Embassies
La Paz, Bolivia and Lima, Peru.
in
☑ 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
RETIREMENT FOR PHYSICAL DISABILITY
UNDUE HARDSHIPS
OTHER:
OTHER (Including AUS)
13. CHECK (X) COMPONENT IN WHICH YOU SERVED
RESERVE (Including the National and Air National Guard)
3. MILITARY RESERVE, NATIONAL GUARD AND ROTC STATUS
2. ARE YOU NOW A MEMBER OF THE
NAT'L. GRD. OR AIR NATAL.
GRD.?
☑ REGULAR
1. DO YOU NOW HAVE ✗ YES
RESERVE STATUST
NO
YES
X NO
3. ARE YOU NOW A MEMBER OF
THE ROTC?
4. IF YOU HAVE ANSWERED "YES" TO ITEMS 1, 2 OR 3 ABOVE, CHECK COMPONENT MEMBERSHIP BELOW
ARMY X MARINE CORPS
NAVY
AIR FORCE
5. CURRENT RANK, GRADE OR
RATE
NATIONAL GUARD
AIR NAT'L. GUARD
COAST GUARD
ARMY ROTC
May, 1959
6. DATE OF APPOINTMENT IN CURRENT
RANK
8. CHECK (X) CURRENT RESERVE CATEGORY
Cpl. (E-4)
0141
READY RESERVE
9. PRIMARY MILITARY OCCUPATIONAL SPECIALTY (Mas or Desig-
nator) AND TITLE
11. BRIEF DESCRIPTION OF MILITARY RESERVE DUTIES
NAVY ROTC
AIR FORCE ROTC
TION
YES
X NO
INDICATE ROTC CATEGORY NUM-
BER
7. EXPIRATION DATE OF CURRENT RESERVE OBLIGA-
January 20, 1962
STANDBY(Active) X STANDBY (Inactive)
RETIRED
10. SECONDARY MILITARY OCCUPATIONAL SPECIALTY (Mos or Dea-
Ignator) AND TITLE ·
None
None
12. ARE YOU CURRENTLY ASSIGNED OR ATTACHED
TO A RESERVE, NAT'L. GUARD OR ROTC TRAIN-
ING UNIT
YES
>
✗ NO
14. HAVE YOU A MILITARY MOBILIZATION ASSIGN-
MENT?
YES
16. INDICATE TOTAL MILITARY SERVICE YEARS
FOR LONGEVITY PURPOSES INCLUD
ING ACTIVE AND INACTIVE DUTY
X NO
MONTHS
7
7
56
3/P/
13. IF YOU HAVE ANSWERED "YES" TO ITEM 12, GIVE UNIT OR AGENCY
AND ADDRESS
15. IF YOU HAVE ANSWERED "YES" TO ITEM 14, GIVE UNIT OR AGENCY
AND ADDRESS
17. WHERE ARE YOUR SERVICE RECORDS KEPTI
Headquarters Marine Corps, Washington
25, D.C.
14-00000
15
5
SECTION XI
- FINANCIAL STATUS
1. ARE YOU ENTIRELY DEPENDENT ON YOUR SALARY?
2. IF YOUR ANSWER IS "NO" TO THE ABOVE, STATE SOURCES OF OTHER INCOME
Wife's income
YES
☑ NO
3. BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS
NAME OF INSTITUTION
The Bank of California, N.A.
Union Trust Company
ADDRESS (City, State, Country)
330 S.W. 6th Avenue,
Portland, Oregon
15 and H Streets, N.W. ,
Washington, D.C.
4. HAVE YOU EVER BEEN IN, OR PETITIONED FOR, BANKRUPTCY.
YES
☑ NO
5. IF YOUR ANSWER IS "YES" TO THE ABOVE, GIVE PARTICULARS, INCLUDING COURT AND DATE(S)
6. GIVE THREE CREDIT REFERENCES IN THE UNITED STATES
NAME
ADDRESS (No., Street, City, State)
1310 S.W. Yamhill Street,
Portland 5, Oregon
General Motors Acceptance Corp.
Gulf Oil Corporation
Ninde Furniture Company
P.O. Box 7245,
Atlanta 9, Georgia
917 Caroline Steet,
Fredericksburg Virginia
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?
YES
☑ NO
8. IF YOUR ANSWER IS "YES" TO THE ABOVE QUESTION, GIVE COMPLETE DETAILS
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 INTERESTS?
YES
☑ NO
SECTION XII
(If answer "YES", fumish details on separate sheet.)
MARITAL STATUS
1. PRESENT STATUS (Single, Married, Widowed, Separated, Divorced, or Annulled) SPECIFY: Married
2. STATE DATE, PLACE, AND REASON FOR ALL SEPARATIONS, DIVORCES OR ANNULMENTS
NA
WIFE, HUSBAND
OR FIANCE:
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.
3. NAME
(First)
Dorothy
06
4. STATE ANY OTHER NAMES EVER USED
(Dorothy A. Moran
5. DATE OF MARRIAGE
(Middle)
Anne
(Maiden)
06
Arnett ]
_ (Last)
Flores
•
INDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH ANY
OF THESE NAMES WERE USED. IF LEGAL CHANGE GIVE PARTICULARS
(Where and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 16
OF THIS FORM TO RECORD THIS INFORMATION.
✓ PLACE OF MARRIAGE (City, State, Country)
November 14, 1960 Lima, Peru JÃO
7. HIS (OR HER) ADDRESS BEFORE MARRIAGE (No., Street, City, State, Country)
American Embassy, (La Paz, Bolivia) 10
9. DATE OF DEATH
10. CAUSE OF DEATH
8. LIVING
X YES
NO
.
11. CURRENT ADDRESS (Give last address, if deceased)
08
(2828 Connecticut Ave., N.W., #3203) Washington 8. D.C.
12. DATE OF BIRTH
13. PLACE OF BIRTH (City, State, Country)
January 31, 1935
Portland, Oregon
SECTION XII CONTINUED TO PAGE 10
14. CITIZENSHIP
United States of An.
57
14-00000
- 10 -
SECTION XII CONTINUED FROM PAGE 9
14. IF BORN OUTSIDE U.S. DATE OF ENTRY
NA
16. FORMER CITIZENSHIP(S)
NA
19. OCCUPATION
Legal Secretary:
[Country(ies)
15. PLACE OF ENTRY
NA
17. DATE U.S. CITIZENSHIP 18. WHERE ACQUIRED (City, State, Country)
ACQUIRED
NA
NA
20. PRESENT EMPLOYER (Also give former employer, or if spouse deceased or
memployed give last two employers)
(Boykin and De Francis) 308
Former: Department of State
21. EMPLOYER'S OR BUSINESS ADDRESS (No., Street, City, State, Country)
1000 16th St., N.W.08 Suite 603.) Washington 6, D.C.
22. DATES OF MILITARY SERVICE (From and to By Mo. and Yr.)
None
23. BRANCH OF SERVICE
24. COUNTRY WITH WHICH MILITARY SERVICE AFFILIATED
25. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN Foreign Service
1960; Civil Service April 1961 June 1961
SECTION XIII
-
-
CHILDREN AND OTHER DEPENDENTS
1. PROVIDE THE FOLLOWING INFORMATION FOR ALL CHILDREN AND DEPENDENTS
DATE AND PLACE OF BIRTH
NAME
RELATIONSHIP
-
Jan., 1958 Oct.
-
CITIZENSHIP
ADDRESS
None
2. NUMBER OF CHILDREN (Including step-
children and adopted children) WHO ARE
UNMARRIED, UNDER 21 YRS. OF AGE,
AND NOT SELF-SUPPORTING.
SECTION XIV
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-Middle)
(Jose S.) Flores
TE OTHE
5. STATE OTHER NAMES HE HAS USED
None
2. LIVING
☑ YES
NO
3. DATE OF DEATH
D
4. CAUSE OF DEATH
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 last address, if deceased (No., Street, City, State, Country)
08
501 S. Guadalupe Street, San Marcos) Texas
7. DATE OF BIRTH
December 20, 1898
8. PLACE OF BIRTH (City, State, Country)
9. CITIZENSHIP
USA
Mier y Noriega, Nuevo Leon, Mexico
10. IF BORN OUTSIDE U.S. DATE OF ENTRY
May 24, 1918
12. FORMER CITIZENSHIP(S) [Country(ica)]
Mexican
15. OCCUPATION
Baptist Minister
11. PLACE OF ENTRY
Unknown
13. DATE U.S. CITIZENSHIP
ACQUIRED
1957
14. WHERE ACQUIRED (City, State, Country)
· Austin, Texas
16. PRESENT EMPLOYER (Give last employer, if Father is deceased or unemployed)
Mexican Baptist Church
17. EMPLOYER'S BUSINESS ADDRESS OR FATHER'S BUSINESS ADDRESS IF SELF-EMPLOYED
(501 S. Guadalupe Street, 'San Marcos) Texas
14. DATES OF MILITARY SERVICE (From-and-Tox 19. BRANCH OF SERVICE
To my knowledge never
served in any military
21; DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN
20. COUNTRY
5/2/
58
:
14-00000
,
SECTION XV
MOTHER (Give same information for Stepmother on separate sheet)
1. FULL NAME (Last-First-Middle)
Flores, Agustina 706
5. STATE OTHER NAMES SHE HAS USED
None to my knowledge
2. IVING
3. DATE OF DEATH
June 1939
4. CAUSE OF DEATH
Unknown
YES ☑ NO
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)
S. Austin and Lee Streets, San Marcos) Texas
7. DATE OF BIRTH
8. PLACE OF BIRTH (City, State, Country)
September 20, 1903 Mier y Noriega, Nuevo Leon, Mexico
10. IF BORN OUTSIDE U.S.- DATE OF ENTRY
Unknown
12. FORMER CITIZENSHIP(S)
NA
15. OCCUPATION
Housewife
[Country(ies)
11. PLACE OF ENTRY
Unknown
9.
AITIZENSAT
Mexican
13. DATE U.S. CITIZENSHIP 14. WHERE ACQUIRED (City, State, Courier)
ACQUIRED
NA
NA
16. PRESENT EMPLOYER (Give last employer, if Mother is deceased or unemployed)
NA
17. EMPLOYER'S BUSINESS ADDRESS OR MOTHER'S BUSINESS ADDRESS IF SELF EMPLOYED
NA
18. DATES OF MILITARY SERVICE (From-and-To)
NA
19. BRANCH OF SERVICE
NA
21. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN
20. COUNTRY
NA
NA
>
SECTION XVI
1. FULL NAME (Last-First-Middle)
1
2
3
4
5
6
7
8
BROTHERS AND SISTERS (Including Half-, Step- and Adopted Brothers and Sisters)
(Patlan, Frances 206
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
Street
(631 S. River St. 08 Seguin, Texas
1. FULL NAME (Last-First-Middle)
✓ Renteria, Rachel) 06
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
08
(311 Lambert St., San Antonio, Texas
1. FULL NAME (Last-First-Middle)
Black, Rebecca Mary (26
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
2. RELATIONSHIP
Sister
2. RELATIONSHIP
Sister
2. RELATIONSHIP
Sister
(501 S. Guadalupe St. San Marcos,) Texas
1. FULL NAME (Last-First-Middle)
Flores, Samuel 06
Street City
•
4. CURRENT ADDRESS (No.. Strook Els State, Country)
(Rosemary and Chapman, Seguin, Texas
1. FULL NAME (Last-First-Middle)
Flores, (Joe) 06
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
Route 2, Box 320, San Marcos.) Texas
Y. FULL NAME (Last-First-Middle)
NAME
(Bruce, Esther)
4. CURRENT ADDRESS (No.,
Sheet, City, Zone, State, Country)
2. RELATIONSHIP
Brother
2. RELATIONSHIP
Brother
2. RELATIONSHIP
Sister
(7252 Exmore St., Springfield.) Virginia
Y. FULL NAME (Last-First-Middle)
Flores, (Eleazar) 06
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
Deceased
1. FULL NAME (Last-First-Middle)
Flores, Juan) 06
4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
Deceased
2. RELATIONSHIP
Brother
2. RELATIONSHIP
Brother
3. CITIZENSHIP (Country)
U.S. of America
5. LIVING
☑ YES
6. AGE
NO 41
3. CITIZENSHIP (Country)
U.S. of America
5. LIVING
☑ YES
6. AGE
NO 39
3. CITIZENSHIP (Country)
U.S. of America
5. LIVING
✗ YES
$6. AGE
NO 34
3. CITIZENSHIP (Country)
U.S. of America
5. LIVING
☑ YES
6. AGE
NO 32
3. CITIZENSHIP (Country)
U.S. of America
5. LIVING
☑ YES
6. AGE
NO 29
3. CITIZENSHIP (Country)
U.S. of America
5. LIVING
✗
YES
6. AGE
NO 27
3. CITIZENSHIP (Country)
U.S. of America
5. LIVING
6. AGE
YES Χ NO 7
3. CITIZENSHIP (Country)
U.S. of America
5. LIVING
YES ✗ NO
6. AGE
NA
16/11
·
11.59
:
14-00000
SECTION XVII
FULL NAME (Last-First-Middle)
Arnett, Carl Raymond]
5. STATE OTHER NAMES HE HAS USED
FATHER-IN-LAW
2. LIVING
3. DATE OF DEATH
4. CAUSE OF DEATH
06
☑ YES
NO
Ray
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)
(4505
ENT OR LAST ADDRESS (No., Street, City, State, Country 50 Oregon
DATE OF BIRTH
January 2, 1909
•
8. PLACE OF BIRTH (City, State, Country)
Minot, North Dakota
10. IF BORN OUTSIDE U.S. DATE OF ENTRY
NA
12. FORMER CITIZENSHIP(S) [Country(ies)]
NA
:
11. PLACE OF ENTRY
NA
13. DATE U.S. CITIZENSHIP
ACQUIRED
NA
9. CITIZENSHIP
U.S. of
America
14. WHERE ACQUIRED (City, State, Country)
NA
16. PRESENT EMPLOYER (Give last employer, if Father-in-Law is deceased or unemployed)
(Rudy Wilhelm Inc., Portland, Oregon
15. OCCUPATION
☐ Warehouse Foreman
I SECTION XVIII
1. FULL NAME (Last-First-Middle)
Tompkins, Alma Dean) 06
5. STATE OTHER NAMES SHE HAS USED
ов
1 Alma Dean Arnett)
..
ळ MOTHER-IN-LAW
:
2. LIVING
YES
3. DATE OF DEATH
4. CAUSE OF DEATH
NO
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.
CURRENT OR LAST ADDRESS (No., Street, City, State, Country)
(13920 S.E. Portland View Place, Portland 36) Oregon
7. DATE OF BIRTH
May 4,
10.
1910
8. PLACE OF BIRTH (City, State, Country)
Portland, Oregon
IF BORN OUTSIDE U.S. DATE OF ENTRY
NA
12. FORMER CITIZENSHIP(S) [Country(ies)]
NA
11. PLACE OF ENTRY
ENTAN
NA
13. DATE U.S. CITIZENSHIP
ACQUIRED
NA
9. CITIZENSHIP
U.S. of America
14. WHERE ACQUIRED (City, State, Country)
NA
16. PRESENT EMPLOYER (Give last employer, if Mother-in-Law is deceased or unemployed)
15. OCCUPATION
Homemaker-
SECTION XIX
RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (1) LIVE ABROAD,
(2) ARE NOT U.S. CITIZENS OR (3) WORK FOR A FOREIGN GOVERNMENT
2. RELATIONSHIP
3. AGE
1 FULL NAME (Last-First-Middle)
None to my knowledge
4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
5. EMPLOYED BY
2
6. CITIZENSHIP (Country)
7. FREQUENCY OF CONTACT
1. FULL NAME (Last-First-Middle)
4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
3
6. CITIZENSHIP (Country)
7. FREQUENCY OF CONTACT
1. FULL NAME (Last-First-Middle)
4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
4
6. CITIZENSHIP (Country)
7. FREQUENCY OF CONTACT
1. FULL NAME (Last-First-Middle)
5
8. DATE OF LAST CONTACT
2. RELATIONSHIP
5. EMPLOYED BY
8. DATE OF LAST CONTACT
2. RELATIONSHIP
5. EMPLOYED BY
8. DATE OF LAST CONTACT
2. RELATIONSHIP
8. DATE OF LAST CONTACT
4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
>
6. CITIZENSHIP (Country)
7. FREQUENCY OF CONTACT
5. EMPLOYED BY
SECTION XIX CONTINUED TO PAGE 13
60
3. AGE
3. AGE
3. AGE
14-00000
SECTION XIX CONTINUED FROM PAGE 12
6. SPECIAL REMARKS, IF ANY, CONCERNING RELATIVES NOTED IN SECTION XIX ABOVE
NA
SECTION XX
1
2
1. NAME (Last-First-Middle)
RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO ARE IN THE MILITARY OR CIVIL
SERVICE OF THE UNITED STATES
Arnett, Raymond Wesley 306
5. ADDRESS (No., Street, City, State, Country)
U.S. Army Depot, Pueblo, Colorado
1. NAME (Last-First-Middle)
(Miller, Claude 106
5. ADDRESS (No., Street, City, State, Country)
Air Station, Quantico, Virginia
1. NAME (Last-First-Middle)
[2. RELATIONSHIP
Bro-in-law
3. AGE
4. CITIZENSHIP
24
U.S. of America
6. TYPE AND LOCATION OF SERVICE (If known)
:
2. RELATIONSHIP
2nd Cousin
3. AGE
14. CITIZENSHIP
Unk U.S. of America
6. TYPE AND LOCATION OF SERVICE (If known)
Aviation
-
1st Sgt., USMC
4. CITIZENSHIP
2. RELATIONSHIP
3. AGE
3
5. ADDRESS (No., Street, City, State, Country)
SECTION XXI
6. TYPE AND LOCATION OF SERVICE (If known)
REFERENCES, ACQUAINTANCES, AND NEIGHBORS
1. LIST FIVE CHARACTER REFERENCES, NOT RELATIVES, IN THE U.S., WHO KNOW YOU INTIMATELY
NAME
(Last-First-Middle)
06
Mr. and Mrs. (Jose Espinosa)
06
Rev. (Carlos Paredes)
Mr. (Thaxter L. Goodell)
Mr. (Alfred Beat((x)
ов
06
Cpl. Michael Hennessy)
BUSINESS ADDRESS
(No., Street, City and State)
аб
S. Guadalupe St.,
San Marcos, Texas
First Baptist Church
Austin, Texas
②2430 E. St., N.W.108
Washington, D.C..
Dept. of Agriculture
The American Embassy,
Lima, Peru
RESIDENCE ADDRESS
(No., Street, City and State)
об
25 (San Marcos.) Texas
08
2,508
Austin, Texas
3742 Jason Avenue
Alexandria, Virginia
1711 Massachutes Ave. 2) 08
Washington, D.C.
172 Bartolome Herrera 083
✓ Miraflores, Lima, Peru
2. LIST FIVE PERSONS, IN THE U.S. WHO KNOW YOU SOCIALLY - NOT RELATIVES, SUPERVISORS OR EMPLOYERS
NAME
(Last-First-Middle)
06
Mr. (Howard Wickland Jr.)
Mr. (Max Pine)
Miss Mary Ann Newman
06
Miss (Ruth F. Stewart.)
06
Mrs. (Bea Lux)
BUSINESS ADDRESS
(No., Street, City and State)
Department of State,
Washington 25, D.C.
Department of State,
Washington 25, D.C.
RESIDENCE ADDRESS
(No., Street, City and State)
Hilltop House, об
Euclid St., Wash., D.C.
|(3571 Section Road,
Cincinnati 36, Ohio
Allen Lee Hotel, 23rd & 08
F Sts., N.W., Wash., D.C.
(601 Cascade, 08
Boulder, Colorado
173 Bartolome Herrera, 08
Miraflores, Lima, Peru
3. LIST THREE NEIGHBORS AT YOUR MOST RECENT NORMAL RESIDENCE IN THE U.S.
NAME
(Last-First-Middle)
Miss (C: Cancy Payne) 06
Lt. and
06
Faulman)
Mrs. (William Faulmar
BUSINESS ADDRESS
(No., Street, City and State)
RESIDENCE ADDRESS
(No., Street, City and State)
402 Hanover St.
50
Fredericksburg, Virginia
c/o Lee Pelts,
108
Route 1, Kennett, Mo.
i
35/N
- 13.
61
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
Spanish Club
ADDRESS
(Number, Street, City, State, Country)
(San Marcos High School,
10 San Marcos. Texas
08 San Marcos: High School,
Distributive Education Club San Marcos O Texas
Baptist Youth Organization
:::::::::::::: Mexican Baptist) 00
Church, San Marcos, Tex.
10
DATES OF MEMBERSHIP
FROM
TO
May
Sept.,1954 1955
Sept.,. May
1954
1955
Jan.,
1957
May
1957
. -
SECTION XXIII
08
RESIDENCES FOR THE PAST 15 YEARS
ADDRESS - LAST RESIDENCE FIRST
(Number, Street, City, State, Country)
(4736 Kenmore Ave., #201) Alexandria, Virginja
об
(402 Hanover St.) Fredericksburg, Virginia
672 Bartolome Harrera, Miraflores) Lima, Peru
Calle Potosi,
USIS Building, 3rd & 4th Floors, La Paz, Bolivia
"F" Company, Headquarters Marine Corps, Henderson
Hall, Washington 25, D.C.
Cold Weather Training Battalion, Pickle Meadows,
Bridgeport, California
Marine Corps Base, 29 Palms, California
INCLUSIVE DATES
FROM
TO
March, 1961 Aug., 1961
Dec., 1960 Mar., 1961
Jan.,1960 Nov., 1960
Nov.,1958 Jan., 1960
Sept., 1958 Nov.,1998
Jan., 1958 Aug.,1958
Dec.; 1957 Jan., 1958
Marine Corps Recruit Depot, San Diego, California
July., 1957 Nov., 1957
Nov., 1957 Dec., 1957
Marine Corps Base, Camp Pendleton, California
об
501 S. Guadalupe St., San Marcos) Texas
Howard Payne College, Brownwood, Texas
(501 S. Guadalupe St., San Marcos > Texas
об
May 1956 July, 1957
Sept., 1955 May, 1956
Sept., 1955
1946
14-00000
SECTION XXIV
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
YES
☑ NO
4. IF SO, TO WHAT EXTENT?
YES
3. DO YOU USE OR HAVE YOU
EVER USED INTOXICANTS?
5. DO YOU USE OR HAVE YOU
EVER USED NARCOTICS?
☑ NO
6. IF SO, TO WHAT EXTENT?
YES
☑
NO
7. HAVE YOU EVER BEEN A MEMBER
IZATION OR ITS ACTIVITIES?
OF, OR SUPPORTED, OR HAD ANY CONNECTIONS WITH A FOREIGN INTELLIGENCE ORGAN-
☐ YES
☑ NO IF ANSWER IS "YES", GIVE COMPLETE DETAILS.
8. LIST BELOW THE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO WHICH YOU HAVE APPLIED FOR EM-
PLOYMENT SINCE 1940
I served 4 years in the United States Marine Corps.
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.
An investigation ( I do not know by whom) was conducted prior
to my departure for Bolivia where I was attached to the American
Embassy.
This investigation took place during August and September
of 1958.
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
ABROAD?
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.
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)
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
Mrs. Daniel Flores
YES
☑NO
YES
☑ NO
3. HOME ADDRESS (No., Street, City, Zone, State, Country)
(2828 Conn. Ave #203, Washington 8. D.C.
02
2. RELATIONSHIP
Wife
4. HOME PHONE NO.
265-8322 J
08
5. BUSINESS ADDRESS (No., Street, City, Zone, State, Country) - INDICATE NAME OF FIRM OR 6. BUSINESS PHONE NO. & EXT.
EMPLOYER, IF APPLICABLE
Boykin and De Francis
об
1000 16th St., Suite 603, Washington 6, D.C.
(DI 7-5444)
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. 06
In all cases wife: Relative, DMC:Rrs.
( Seguin Texas
Vicente Patlan) (631 S. River St.) 08
Telephone Fr 9-1087) 08
Simi
- 15 -
43
14-00000
SECTION XXVI
CERTIFICATION
YOU ARE INFORMED THAT THE CORRECTNESS OF ANY STATEMENT MADE IN THIS APPLICATION
WILL BE INVESTIGATED.
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
8, 1961
3. SIGNED AT (City and State)
Washington, District of Columbia
APPLICANT
2. SIGNATURE OF AP
10
4. SIGNATURE OF WITNESS
C
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.
06
MARITAL STATUS: Item #4, Section XII
September 1, 1956 to October 6, 1956. Married to (Lt. Col. Joseph G.
Moran) in Portland, Oregon, by Circuit Court Judge. Used name of (Moran)
until November 14, 1960, when changed to Flores.
FATHER-IN-LAW: Item #5, Section XVII
Short name for Raymond
GEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL: Item #1, Section VI
Argentina
Panama
2 July 1959 to 3 July 1959
Travel
10 November 1958 to 13 November 1958 Travel
06
2/FU
SEE ATTACHED SHEET FOR PERTINENT INFORMATION RELATIVE TO STEP-MOTHER.
Signed at Washington, D. C., this
8th day of September,
1961.
Harl
Двам
Daniel Flores
14-00000
3171
ATTACHMENT TO FORM NO. 444
PERSONAL HISTORY STATEMENT
Section XV STEPMOTHER
-
06
Full name: Concepcion: CRC:_:.:) Flores
Living: Yes
Other Names She Has Used:
None to my knowledge
Current Address: 501 S. Guadalupe Street, San Marcos,) Texas
Date of Birth: December 8, 1914
Place of Birth: Mexico
Citizenship: Mexican
об
If Born Outside U.S. - Date of Entry: December 8, 1922
Place of Entry: Unknown
Former Citizenships: None
Occupation: Homemaker and Missionary
08
Present Employer: (Mexican Baptist Church, SanMarcos,) Texas
Never served in Military or other Government service to my knowledge.
This paper is attached to and hereby made a part of Form No. 444.
La
2
Daniel Flores
65