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
о
Date : 01/20/98
Page: 1
AGENCY : INSCOM/CSF
RECORD NUMBER :
RECORDS SERIES :
AGENCY FILE NUMBER
194-10004-10143
DOD-AFFILIATED PERSONNEL INCIDENT INVESTIGATIONS
: PAGES 384-385
DOCUMENT INFORMATION
ORIGINATOR : USA
FROM
: HEADQUARTERS,
USAINTC
TO :
TITLE :
[ RESTRICTED )
DATE : 01/18/67
PAGES : 2
SUBJECTS : FROMER, DAVID R.
LEGAL ADVICE
DOCUMENT TYPE : PAPER, TEXTUAL DOCUMENT
CLASSIFICATION : UNCLASSIFIED
RESTRICTIONS :
3
CURRENT STATUS : RELEASED WITH DELETIONS
DATE OF LAST REVIEW : 03/07/95
OPENING CRITERIA :
COMMENTS :
NW 88613 Docid:34528584 Page 1
2. CONTROL OFFICE:
31-01
糕
US ARMY REQUEST FOR NATIONALASEN
(AR 38130
DOD NAC Center, PO
Fort Holabird. Md. 21219
"
3. LAST NAME FIRST NAME - MIDDLE NAME - ALIAS(ES) - NICKNAMES - CHANGED NAME
FROMER, David Reed
5. DAY, MONTH. YEAR OF BIRTH
21 July 1942
8. RELATIVE'S NAMES
O. FATHER
Irving Fromer
b: MOTHER (maiden name)
Katherine Rhodes
c. SPOUSE (maiden name)
None
6. PLACE OF BIRTH
Chicago, Cook, Illinois
9. DATE AND PLACE OF BIRTH
12 Jul 1913
Cincinnati, Ohio
31 Dec 1909
Estherville, Iowa
10. PRESENT ADDRESS
13 Rhonda Way
Mill Valley, Calif.
13 Rhonda Way
Mill Valley, Calif.
十三
1. DATE OF REQUEST
18 Jan 67
51
4. SOCIAL SECURITY NO.
564-58-8137
7. SERVICE NUMBER
12. RESIDENCES (List all from 16th birthday or during last 15 years, whichever is shorter)
C. NUMBER AND STREET
|1932 Cabrillo St.
d. CITY
11. CITIZENSHIP
U. S.
U. S.
e. STATE
a.
1827 University Ave.
a. FROM
b. TO
1950
1960
1960
1961
2450 Bencroft Way
1961
1962
881 Clayton St.
1962
219 N. Basset
1963
215 Lake Lawn Ave.
1963
1965
a. FROM
b. TO
C. EMPLOYER
Dec 1959
Summer '60
1960
1961
1961
1962
San Francisco
Calif.
Berkeley
Calif.
San Francisco
Calif.
Madison
Wisconsin
Madison
Madison
Wisconsin
Wisconsin
Franci
1966 EMPLOYM435/W North Westhday or during last 15 years, white casotee
Dec 1959 Paul Dler Bookstore
Summer 1962 & 1963
Fall 1962
FROM
1966
YES
X
NO
16. REMARKS
X
☑
Illinois
d. PLACE
San Francisco, Calif.
San Francisco Council Camp Fire Girls San Francisco, Calif.
Fairmont Hotel
Foster's Restaurant
Madison Board of Education Rec.
Clark Service Station
b. TO
C. NAME
Present
a.
14. LAST
COPY
CIVILIAN NATION
University of Wisconsin
15. ITEM ("Yes" answers are
San Francisco, Calif.
San Francisco, Calif.
Madison, Wisconsin
Madison Wisconâin
1. PLACE
Madison, Wisconsin
IS THE SUBJECT AN ALIEN OR A NATURALIZED CITIZEN OF THE UNITED STATEST
OF ANY
expanded TA TO DATE
b. ANY FOREIGN CONNECTIONS, INTERESTS, EMPLOYMENT OR MILITARY SERVICE?
c.
ANY FOREIGN TRAVEL OTHER THAN FOR THE UNITED STATES GOVERNMENT?
DOD NAC CENTER
d. EMPLOYMENT BY A FIRM HAVING A CLASSIFIED US GOVERNMENT CONT
e. FORMER US GOVERNMENT EMPLOYMENT OR MILITARY SERVICE?
Holabird, Md
f. ANY QUALIFICATION OF DD FORM 398 OR DD FORM 987
g. ANY ARREST OR COURT RECORD?
(If additional space is needed, continue on plain paper)
NEME Cheek
ONLY
Item 12. 1966 to Present 13 Rhonda Way, Mill Valley, California
Item 13.
1966 to Present
Oct 65 50 June 66
140 Langdon Street, Madison, Wisconsin
Cooks Cupboard, 1718 Walls St., Chicago, Illinois
Employer: Bob Geroge Reason: Return to S. F.
Item 15. Registrant refused to execute DD Form 98 and explained in the remarks section.
Also refused to answer Item 17 and answered affirmatively Item 19 and
explained in the remarks section. Refused to be fingerprinted also. (NCC)
17. CONTROL OFFICE USE
nac completed
FOR THE DIRECTOR, & Kell FEB 18 1967
18. FROM:
ATTN:
HEADQUARTERS, USAINTC
ICOP-III -31
Fort Holabird, Md.
384
21219
W
REPLACES DA FORM 340. 1 DEC 58 WHICH IS DESIve marking
620AR25 1987
from automatic termination
(6.353-6004)
DA FORM
1 AUG 65
3027
FINGERPRINT CARD FD 258 MUST BE ATTACHED
NW 88613 Docid:34528584 Page 2
52
R
(6353-6004) 18 Jan 67
FROMER, David Reed
DPOB: 21 Jul 42; Chicago, Illinois
Con't Item 16 (Remarks)
-
-
-
Item 15
SUBJECT explained in the "Remarks" section as follows: "(I have not
done anything that I am not proud of) I have been advised by my attorneys that
I cannot sign this form without placting myself in jeapardy: Peter Franck
personal attorney, Vincent Hallinan family attorney."
-
-
FBI reports, San Francisco, California, titled: David Reed FROMER, with
Bureau File #: 100-433071, dating from 3 May 1960 to the latest dated 23
November 1966, are in the possession of this office. Request any additional
and/or subsequent information.
NW 88613 Docid:34528584 Page 3
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