Released under the John F. Kennedy
Assassination Records Collection Act of
1992 (44 USC 2107 Note). Case#:NW
88613 Date: 03-18-2025
Date
: 09/30/98
Page
:
1
JFK ASSASSINATION SYSTEM
IDENTIFICATION FORM
AGENCY INFORMATION
AGENCY :
INSCOM/CSF
RECORD NUMBER :
194-10001-10496
RECORDS SERIES : FOREIGN PERSONNEL AND ORGANIZATIONS
AGENCY FILE NUMBER :
AB632604W
-
PAGES
76-79
DOCUMENT INFORMATION
ORIGINATOR :
FROM : EDIFANIO ROMERO-DELGADO
ΤΟ :
TITLE
DATE
: DD FORM 398
:
PAGES :
SUBJECTS
:
01/18/63
4
ROMERODELGADO,
STATEMENT OF PERSONAL HISTORY
EPIFANIO
PAPER, TEXTUAL DOCUMENT
UNCLASSIFIED
DOCUMENT TYPE
:
:
3
CLASSIFICATION
RESTRICTIONS :
CURRENT STATUS :
RELEASED WITH DELETIONS
DATE OF LAST REVIEW : 03/07/95
OPENING CRITERIA :
COMMENTS :
NW 88613 Docld:34528389 Page 1
els
STATEMENT Ohre
CR #53348
FR PERSONA BHIAPAN
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
Edifanio ROMERO-Delgado
3. ALIAS(ES). NICKNAME(S). OR CHANGES IN NAME (Other than by marriage)
Piche
5. DATE OF BIRTH (Day, month, year)
21 Jan 1936
2.
STATUS
MILITARY ON ACTIVE DUTY
☑
CIVILIAN
4. PERMANENT MAILING ADDRESS
1140 SW 9th St. Miami, Fla.
PLACE OF BIRTH (City, County, State, and Country)
PLACE CERTIFICATE RECORDED
Candelario, Pinardel Rio, Cuba
Candelario, Pinar del Rio, Cuba
SCARS, PHYSICAL DEFECTS, DISTINGUISHING MARKS
RACE
Cau
HEIGHT
66"
WEIGHT
165
COLOR OF EYES
COLOR OF HAIR
Brown
Brown
NONE
6. DO YOU HAVE A HISTORY OF MENTAL OR NERVOUS DISORDERS? ☐ YES ✓ NO
NARCOTICS OR BARBITURATES? ☐ YES ☑I NO ARE YOU NOW OR HAVE YOU EVER BEEN A CHRONIC USER TO EXCESS OF ALCOHOLIC BEVERAGES?
ANSWER TO ANY OF THE ABOVE IS "YES." EXPLAIN IN ITEM 20.
ARE YOU NOW OR HAVE YOU EVER BEEN ADDICTED TO THE USE OF HABIT FORMING DRUGS SUCH AS
YES ☐ NO IF THE
7. U. S.
CITIZEN
ALIEN
☑
NATIVE
YES
NO
IF NATURALIZED, CERTIFICATE NO.
IF DERIVED. PARENTS' CERTIFICATE NO(S).
DATE. PLACE, AND COURT
REGISTRATION NO.
NATIVE COUNTRY
DATE AND PORT OF ENTRY
A13 108 636
Cuba
21 Sept 1962
Texas.
DO YOU INTEND TO BECOME
A U. S. CITIZEN?
YES
8.
MILITARY SERVICE
YES ☑ NO IF "YES," COMPLETE THE FOLLOWING:
ORGANIZATION AND STATION
ARE YOU PRESENTLY ON ACTIVE DUTY IN THE U. S. ARMED FORCES DRAWING FULL PAY?
GRADE AND SERVICE NO.
SERVICE AND COMPONENT
DATE CURRENT ACTIVE
SERVICE STARTED
ARE YOU PRESENTLY A MEMBER OF A U. S. RESERVE OR NATIONAL GUARD ORGANIZATION?
GRADE AND SERVICE NO.
SERVICE AND COMPONENT
YES ☑ NO IF "YES," COMPLETE THE FOLLOWING:
ORGANIZATION AND STATION OR UNIT AND LOCATION
9.
NO
HAVE YOU PREVIOUSLY SERVED TOURS OF EXTENDED ACTIVE DUTY, DRAWING FULL PAY, FROM WHICH YOU WERE DISCHARGED OR SEPARATED TO CIVILIAN STATUS? ☐ YES ☑ NO
IF YES." COMPLETE THE FOLLOWING:
COUNTRY
FROM (Date) TO (Date)
SERVICE
COMPONENT
TYPE DISCHARGES OR SEPARATIONS-GRADE AND SERVICE NO.
FROM-
Sep 46
EDUCATION (Account for all civilian schools and military academies. Do not include service schools)
GRADUATE
MONTH AND YEAR
NAME AND LOCATION OF SCHOOL
DEGREE
YES
NO
TO
Jun 49
Escuela Publica San Cristobal
10.
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. It 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.)
FATHER
RELATION AND NAME
Felipe Romero
MOTHER (Maiden name)
Sagunda Delgado
SPOUSE (Maiden name)
Ilda Martinez
OTHER (Specify)
Arturo Romero
Son
Balerio Romero B
DATE AND PLACE OF BIRTH
date unknown
Conzolaciondel Sur, Cuba
date unknown
It
It
1 Feb 1936 Candelaria
Pinardel Rio, Cuba
9 May 1962 San Cristobal
Pinar del Rio,
Cuba
Finca Sabana La MarSan
PRESENT ADDRESS, IF LIVING
DECEASED
Finca Sabana La Mar
San Cristobal Pinardel Rio, Cuba
"
"1
11
It
"}
Cristobal Finardel Rio Cuba "
"
11
11
11
"
U. S. CITIZEN
YES
NO
✗
☑
✗
Jose Manuel Romero B
11
11
"
11
11
76
Aniceto Romero
B
11
"
"
"
tt
"1
11
Santiago Romero
B
11
11
11
11
"
"
NW[88613 Doad:3452889 PageEOUS EDITIONS ARE OBSOLETE.
☑
☑
☑
Exception to Standard Form 86
✗
Approved by Bureau of the Budget June 1960
CHARACTER
CREDIT
14.
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)
ADDRESS
RELATIONSHIP AND NAME
AGE
OCCUPATION
Juan Delgado
U
36
farmer
Pedro Delgado
U
38
tt
Francisco Delgado
U
40
11
Niebe Delgado
A
39 housewife
A
39
"
Consolasiondel Sur, Cuba
Candelaria Pinardel Rio, Cuba
Santa GrusPinardel Rio, Cuba
11
"
Maria Delgado
12.
"I
11
"
FOREIGN TRAVEL (Other than as a direct result of United States military duties)
DATES
COUNTRY VISITED
FROM-
TO-
29 Aug62
21 Sep62
Mexico
in transit to USA
PURPOSE OF TRAVEL
CITIZENSHIP
Cuban
11
11
II
"
13.
FROM-
Feb59
EMPLOYMENT (Show every employment you have had and all periods of unemployment)
MONTH AND YEAR
TO-
Jan 60
NAME AND ADDRESS OF EMPLOYER
Equipos Quesada
Pinar del Rio, Cuba
NAME OF IMMEDIATE
SUPERVISOR
Nestor Prieto
REASON FOR LEAVING
Politicalreasons
DID ANY OF THE ABOVE EMPLOYMENTS REQUIRE A SECURITY CLEARANCE? ☐ YES ☑ NO DO YOU HAVE
ANY FOREIGN PROPERTY OR BUSINESS CONNECTIONS, OR HAVE YOU EVER BEEN EMPLOYED BY A FOREIGN
GOVERNMENT, FIRM, OR AGENCY? ☐ YES ☑ NO HAVE YOU EVER BEEN REFUSED BOND? ☐ YES
SOCIAL SECURITY NO.
463-74-2051
☑ NO
IF THE ANSWER TO ANY OF THE ABOVE IS "YES," EXPLAIN IN ITEM 20.
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)
NONE
YEARS
KNOWN
STREET AND NUMBER
(Business address preferred)
CITY
STATE OR
TERRITORY
Juan Noriega
Gustado Acosta
REMARKS.
10
10mo
1040 15th St.Apt#15
1140SW 9th St.
Miami Beach
Miami
Fla.
11
17
NW 88613 Docld:34528389 Page 3
U.S. GOVERNMENT PRINTING OFFICE 1960 0-573450
16.
15.
MONTH AND YEAR
LIST ALL RESIDENCES FROM 1 JANUARY 1937
STREET AND NUMBER
FROM-
TO-
Jan37
Aug62
Aug62
Dec62
FincaSabanalamar
1140 SW 9th St.
NAME AND ADDRESS
MRC CUBA
MDC CUBA
INIDAD REVOLUCIONARIA, CUBA
BOde Now, CUB A
17.
YES
NO
✗
x
×
CITY
STATE OR COUNTRY
Pinardelio
Miami
Cuba
Fla.
PAST AND/OR PRESENT MEMBERSHIP IN ORGANIZATIONS
TYPE
MEMBERSHIP
OFFICE HELD
(Social, fraternal, professional, etc.)
FROM
TO-
Subject claims he assisted any and all organizations
against Castro. These were all in Cuba
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.
Has been in Jail without trial in the
22 April 1961 for political reasons.
G-2 of Pinar del Rio, Cuba about 18 days from
79
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
NW 88613 Docid:34528389 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
20. REMARKS
ITEM #10
Fernando Romero B
San Cirtobal Pinardel Rio
Finca Santa Amalia Sabana LaMar
Sabina Romero S
Augustina Romero S
11
It
San Cristobal Pinardel Tio, Cuba
I
"
"
11
11
11
"
"}
11
1 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
18 Jan 63
21.
SIGNATURE OF PERSON COMPLETING FORM
Belami Flower Delgado
AME AND ADDRESS OF WITNESS
TYPED NAME
LUIS A. ZAYAS, MSGT, AFES&IS, CORALGABLES, FLA.
SIGNATURE OF WITNESS
Ce
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
79
RECORD OF PRIOR CLEARANCES
DATE OF CLEARANCE
TYPE OF CLEARANCE
AGENCY THAT COMPLETED INVESTIGATION
REMARKS.
NW 88613 Docid:34528389 Page 5
U.S. GOVERNMENT PRINTING OFFICE 1960 0-573450