Released under the John F. Kennedy
Assassination Records Collection Act of
1992 (44 USC 2107 Note). Case#:NW
38613 Date: 03-18-2025
JFK ASSASSINATION SYSTEM
IDENTIFICATION FORM
AGENCY INFORMATION
Date : 08/18/98'
1
Page:
AGENCY : INSCOM/CSF
RECORD NUMBER :
194-10005-10140
:
PAGES
RECORDS SERIES : DOD AFFILIATED PERSONNEL AND INCIDENT INVESTIGATIONS
AGENCY FILE NUMBER
1110-1117
DOCUMENT INFORMATION
ORIGINATOR : USA
FROM :
ΤΟ :
TITLE : STATEMENT OF PERSONAL HISTORY
DATE : 10/05/66
PAGES : 8
SUBJECTS:
SCHEER, ROBERT
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:34530159 Page 1
ARMED FORCES SECURITY QUESTIONNAIRE
I.
EXPLANATION
1. The interests of National Security require that all persons
being considered for membership or retention in the Armed
Forces be reliable, trustworthy, of good character, and of com-
plete and unswerving loyalty to the United States. Accordingly.
it is necessary for you to furnish information concerning your
security qualifications. The answers which you give will be used
in determining whether you are eligible for membership in the
Armed Forces, in selection of your duty assignment, and for such
other action as may be appropriate.
2. You are advised that in accordance with the Fifth Amend-
ment of the Constitution of the United States you cannot be
compelled to furnish any statements which you may reasonably
believe may lead to your prosecution for a crime. This is the
only reason for which you may avail yourself of the privilege af-
forded by the Fifth Amendment in refusing to answer questions
under Part IV below. Claiming the Fifth Amendment will not
by itself constitute sufficient grounds to exempt you from mili-
tary service for reasons of security. You are not required to
answer any questions in this questionnaire, the answer to which
might be incriminating. If you do claim the privilege granted by
the Fifth Amendment in refusing to answer any question, you
should make a statement to that effect after the question involved.
II. ORGANIZATIONS OF SECURITY SIGNIFICANCE
1. There is set forth below a list of names of organizations,
groups, and movements, reported by the Attorney General of the
United States as having significance in connection with the
National Security. Please examine the list carefully, and note those
organizations, and organizations of similar names, with which you
are familiar. Then answer the questions set forth in Part IV below.
2. Your statement concerning membership or other association
with one or more of the organizations named may not, of itself,
cause you to be ineligible for acceptance or retention' in the
Organizations designated by the Attorney General, pursuant to Executive Order 10450, are listed below:
Communist Party, U. S. A., its subdivisions, sub-
Armed Forces. Your age at the time of such association, cir-
cumstances prompting it, and the extent and frequency of
involvement, are all highly pertinent, and will be fully weighed.
Set forth all such factors under "Remarks" below, and continue
on separate attached sheets of paper if necessary.
sidiaries and affiliates.
Communist Political Association, its subdivisions,
subsidiaries and affiliates, 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.
Young Communist League.
Abraham Lincoln Brigade.
Abraham Lincoln School, Chicago, Illinois.
Action Committee to Free Spain Now.
American Slav Congress.
American Women for Peace.
American Youth Congress.
3. If there is any doubt in your mind as to whether your name
has been linked with one of the organizations named, or as to
whether a particular association is "worth mentioning," make a
full explanation under "Remarks."
American Youth for Democracy.
Armenian Progressive League of America.
Associated Klans of America.
Association of Georgia Klans.
Committee for a Democratic Far Eastern Policy.
Committee for. Constitutional and Political Freedom.
Committee for the Defense of the Pittsburgh Six.
Committee for Nationalist Action.
Committee for the Negro in the Arts.
Committee for Peace and Brotherhood Festival in
Philadelphia.
Association of German Nationals (Reichsdeutsche Committee for the Protection of the Bill of Rights.
Vereinigung).
Ausland-Organization der NSDAP, Overseas Branch
of Nazi Party.
Baltimore Forum.
Benjamin Davis Freedom Committee.
Black Dragon Society.
American Association for Reconstruction in Yugo- Boston School for Marxist Studies, Boston, Massa-
slavia, Inc.
American Branch of the Federation of Greek Mari-
time Unions.
American Christian Nationalist Party.
American Committee for European Workers' Relief.
American Committee for Protection of Foreign Born.
American Committee for the Settlement of Jews in
Birobidjan, Inc.
American Committee for Spanish Freedom.
American Committee for Yugoslav Relief, Inc.
American Committee to Survey Labor Conditions in
Europe.
American Council for a Democratic Greece, formerly
known as the Greek American Council; Greek
American Committee for National Unity.
American Council on Soviet Relations.
American Croatian Congress.
American Jewish Labor Council.
American League Against War and Fascism.
American League for Peace and Democracy.
American National Labor Party.
American National Socialist League.
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 American Russian- Institute for Cultural Re
lations with the Soviet Union).
American Russian Institute, Philadelphia.
American Russian Institute of San Francisco.
American Russian Institute of Southern California,
Los Angeles.
DD FORM 98
chusetts.
Bridges-Robertson-Schmidt Defense Committee.
Bulgarian American People's League of the United
States of America.
Committee for World Youth Friendship and Cul-
tural Exchange.
Committee to Defend Marie Richardson.
Committee to Uphold the Bill of Rights.
Congress Against Discrimination.
Congress of the Unemployed.
Commonwealth College, Mena, Arkansas.
Connecticut Committee to Aid Victims of the Smith
Connecticut State Youth Conference.
Congress of American Revolutionary Writers.
Congress of American Women.
Act.
Council on African Affairs.
California Emergency Defense Committee.
California Labor School, Inc., 321 Divisadero Street, Council of Greek Americans.
San Francisco, California.
Carpatho-Russian People's Society.
Central Council of American Women of Croatian
Descent (also known as Central Council of Amer-
ican Croatian Women, National Council of Croa-
tian Women)
Central Japanese Association (Beikoku Chuo Nippon-
jin Kai).
•
Central Japanese Association of Southern California.
Central Organization of the German-American Na-
tional Alliance (Deutsche-Amerikanische Einbeits-
front).
Cervantes Fraternal Society.
China Welfare Appeal, Inc.
Chopin Cultural Center.
Citizens Committee to Free Earl Browder.
Citizens Committee for Harry Bridges.
Council for Jobs, Relief, and Housing.
Council for Pan-American Democracy.
Croatian Benevolent Fraternity.
Dai Nippon Butoku Kai (Military Virtue Society of
Japan or Military Art Society of Japan).
Daniels Defense Committee.
Daily Worker Press Club.
Dante Alighieri Society of 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.
Citizens Committee of the Upper West Side (New Families of the Baltimore Smith Act Victims.
York City).
Citizens Emergency Defense Conference.
Citizens Protective League.
Civil Liberties Sponsoring Committee of Pittsburgh.
Civil Rights Congress and its affiliated organiza-
tions, including Civil Rights Congress for Texas.
Veterans Against Discrimination of Civil Rights
Congress of New York.
Columbians.
Comite Coordinador Pro Republica Espanola.
Comite Pro Derechos Civiles.
Committee to Abolish Discrimination in Maryland.
Committee to Aid the Fighting South.
Families of the Smith Act Victims.
Federation of Italian. War Veterans in the U. S. A..
Inc. (Associazione Nazionale Combattenti Italiani,
Federazione degli Stati Uniti d' America).
Finnish-American Mutual Aid Society.
Florida Press and Educational League.
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.
Committee to Defend the Rights and Freedom of German. American Bund (Amerikadeutscher Volks.
George Washington Carver School, New York City.
Pittsburgh's Political Prisoners.
PREVIOUS EDITIONS OF THIS
RE OBSOLETE (for Army use).
NW 88613 Bocid:34530159 Page 2
t
Page 1
"FOLD”HERE *.
German American Republican League.
German American Vocational League (Deutsche
Amerikanische Berufsgemeinschaft)
Guardian Club.
Harlem Trade Union Council.
Hawan Civil Liberties Committee.
Heimuska Kai, also known as Nokubei Heieki.
Gimusha Kai, Zaibel Nihonjin. Heiyaku Gimu.
sha Kai and Zaibei Heimusha Kai Japanese Re-
siding in America Military Conscripts Association).
Hellenic American Brotherhood.
Hinode Kai Imperial Japanese Reservists)
Hinomaru Kai Rising Sun Flag Society-a group
of Japanese War Veterans)
Hokuber Zaigo Shoke Dan (North American Reserve
Officers Assolation)
Hollywood Writers Mobilization for Defense.
Hungarian-American Council for Democracy.
Hungarian Brotherhood.
Idaho Pension Union.
Independent Party (Seattle, Washington).
Independent People's Party.
Industrial Workers of the World.
International Labor Defense.
International Workers Order, its subdivisions, sub-
sidiaries and affiliates.
Japanese Association of America.
Japanese Overseas Central Society (Kaigal Dohn
Chuo Kut)
Japanese Overseas Convention, Tokyo, Japan. 1940.
Japanese Protective Association Recruiting Organ.
ization)
Jefferson School of Social Science. New York City.
Jewish Culture Society.
Jewish People's Committee.
Jewish People's Fraternal Order.
Jikyoku Lin Kai (The Committee for the Crisis).
Johnson Forest Group.
Johnsonites.
Joint Anti-Fascist Refugee Committee.
Joint Council of Progressive Italian-Americans, Inc.
Joseph Weydemeyer School of Social Science, St.
Louis, Missouri.
Kibei Seinen Kai Association of U. S. citizens of
Japanese ancestry who have returned to America after
studying in Jap.in)
Knights of the White Camelia.
Ku Klux Klan.
Kyfthaeuser. also known as Kyffhaeuser League
(Kyffhaeuser Bund). Kyffhaeuser Fellowship (Kyff.
haeuser Kameradschaft)
Kyffhaeuser War Relief (Kyffhauser Kriegshilfswerk).
Labor Council for Negro Rights.
Labor Research Association, Inc.
Labor Youth League.
League for Common Sense.
League of American Writers.
Lictor Society (Italian Black Shirts).
Macedonian-American People's League.
Mario Morgantini Circle.
Maritime Labor Committee to Defend Al Lannon.
Maryland Congress Against Discrimination.
Massachusetts Committee for the Bill of Rights.
Massachusetts Minute Women for Peace (not con-
nected 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 Asociacion 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 the Defense of Political
Prisoners.
National Committee for Freedom of the Press.
National Committee to Win Amnesty for Smith
Act Victims.
National Committee to Win the Peace.
National Conference on American Policy in China
and the Far East (a Conference called by the Com-
mittee for a Democratic Far 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.
Nationalist Party of Puerto Rico.
Nature Friends of America (Since 1935)
Negro Labor Victory Committee.
New Committee for Publications.
Nichibei Kogyo Kaisha The Great Fuji Theatre).
North American Committee to Aid Spanish Democracy
North American Spanish Aid Committee.
North Philadelphia Forum.
Northwest Japanese Association.
Ohio School of Social Sciences.
Oklahoma Committee to Defend Political Prisoners.
Oklahoma League for Political Education.
Original Southern Klans, Incorporated.
Pacific Northwest Labor School. Seattle, Washing-
ton.
Palo Alto Peace Club.
Partido del Pueblo of Panama (operating in the
Canal Zone).
Peace Information Center.
Peace Movement of Ethiopia.
People's Drama, Inc.
People's Educational and Press Association of Texas.
People's Educational Association (Incorporated under
name Los Angeles Educational Association. Inc ),
also known as People's Educational Center. Peo-
ple'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 IWO.
Progressive German-Americans, also known as Pro-
gressive German-Americans of Chicago.
Proletarian Party of America.
Protestant War Veterans of the United States, Inc.
Provisional Committee of Citizens for Peace, South-
west Area.
Provisional Committee on Latin American Affairs.
Provisional Committee to Abolish Discrimination
in the State of Maryland.
Puerto Rican Comite Pro Libertades Civiles (CLC).
torriquenos Unidos (Puerto Ricans United).
Quad City Committee for Peace.
Queensbridge Tenants League.
Revolutionary Workers League.
Romanian-American Fraternal Society.
Russian American Society, Inc.
Sakura Kai (Patriotic Society, or Cherry Association.
composed of veterans of Russo-Japanese War).
Samuel Adams School, Boston, Mass.
Santa Barbara Peace Forum.
Schappes Defense Committee.
Schneiderman-Darcy Defense Committee.
School of Jewish Studies, New York City.
Seattle Labor School, Seattle, Washington.
Serbian-American Fraternal Society.
Serbian Vidovdan Council.
Shinto Temples (Limited to State Shinto abolished
in 1945).
Silver Shirt Legion of America.
Slavic Council of Southern California.
Slovak Workers Society..
Slovenian-American National Council
Socialist Workers Party, including American Com-
mittee for European Workers Relief.
Sokoku Kai (Fatherland Society)
Southern Negro Youth Congress.
Suiko Sha (Reserve Officers Association, Los Angeles).
Syracuse Women for Peace.
Tom Paine School of Social Science, Philadelphia,
Pennsylvania.
Tom Paine School of Westchester, New York.
Trade Union Committee for Peace.
Trade Unionists for Peace.
Tri-State Negro Trade Union Council.
Ukranian-American Fraternal Union.
Union of American Croatians.
Union of New York Veterans.
United American Spanish Aid Committee.
United Committee of Jewish Societies and Lands-
manschaft Federations, also known as Coordina
tion Committee of Jewish Landsmanschaften and
Fraternal Organizations.
United Committee of South Slavic Americans.
United Defense Council of Southern California
United Harlem Tenants and Consumers Organiza-
tion.
United May Day Committee
United Negro and Allied Veterans of America.
Veterans Against Discrimination of Civil Rights
Congress of New York.
Veterans of the Abraham Lincoln Brigade.
Virginia League for People's Education.
Voice of Freedom Committee
Walt Whitman School of Social Science, Newark
New Jersey
Washington Bookshop Association.
Washington Committee to Defend the Bill of Rights
Washington Committee for Democratic Action.
Washington Commonwealth Federation.
Washington Pension Union
Wisconsin Conference on Social Legislation.
Workers Alliance since April 1936)
Yiddisher Kultur Farband.
Yugoslav American Cooperative Home. Inc.
Yugoslav Seamen's Club, Inc..
III.
INSTRUCTIONS
1. Set forth an explanation for each answer checked "Yes"
under question 2 below under "Remarks."
Attach as many
extra sheets as necessary for a full explanation, signing or initial-
ing each extra sheet.
a ma-
2. Title 18, U. S. Code, Section 1001, provides, in pertinent
part: "Whoever
falsifies, conceals or covers up.
terial fact, or makes any false
statements
or makes
or uses any false writing
shall be fined not more than
$10,000 or imprisoned not more than 5 years, or both." Any
false, fraudulent or fictitious response to the questions under Part
IV below may give rise to criminal liability under Title 18,
U. S. C., Section 1001. You are advised, however, that you
will not incur such liability unless you supply inaccurate state-
ments with knowledge of their untruthfulness. You are there-
fore advised that before you sign this form and turn it in to
Selective Service or military authorities, you should be sure that
it is truthful; that detailed explanations are given for each "Yes"
answer under question 2 of Part IV below, and that details given
are as full and complete as you can make them.
3. In stating details, it is permissible, if your memory is hazy
on particular points, to use such expressions as, "I think," "in
my opinion," "I believe," or "to the best of my recollection."
.3
Page 2
NW 88613 Dociá:345/30159 Page 3
US GOVERNMENT PRINTING OFFICE 1961 O-607912
For Official Use Only
Page 4
IV. QUESTIONS
(For each answer checked 'Yes'
under question 2, set forth a full explanation under "Remarks" below)
YES NO
1. Have you ever contributed money to any of the organizations,
groups, or movements listed?
YES
NO
YES
k Have you ever contributed services to any of the organizations,
groups, or movements listed?
1. I have read the list of names of organizations, groups, and move-
ments set forth under Part II of this form and the explanation which
precedes it.
2. Concerning the list of organizations, groups and movements set forth
under Part I above:
a. Are you now a member of any of the organizations, groups, or
movements listed?
b. Have you ever been a member of any of the organizations, groups,
or movements listed?
c. Are you now employed by any of the organizations, groups, or
movements listed?
d Have you ever been employed by any of the organizations,
groups, or movements listed?
e.
Have you ever attended any meeting of any of the organizations,
groups, or movements listed?
f. Have you ever attended any social gathering of any of the organ.
izations, groups, or movements listed?
g. Have you ever attended any gathering of any kind sponsored by
any of the organizations, groups, or movements listed?
h. Have you prepared material for publication by any of the organ-
izations, groups, or movements listed?
i. Have you ever corresponded with any of the organizations, groups,
or movements listed or with any publication thereof?
I Have you ever subscribed to any publication of any of the organ-
izations, groups, or movements listed?
m.
n
°.
Have you ever been employed by a foreign government or any
agency thereof?
Are you now a member of the Communist Party of any foreign
country?
Have you ever been a meniber of the Communist Party of any
foreign country?
p. Have you ever been the subject of a loyalty or security hearing?
q. Are you now or have you ever been a member of any organiza-
tion, association, movement, group or combination of persons
not on the Attorney General's list 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?
r. Have you ever been known by any other last name than that used
in signing this questionnaire?
REMARKS
I refuse to answer
because the
these
questions
vickte my rights
Greated
to me harder the First, Fifth, and
Fourteenth Amendments to the U.S.
Constitution.
REMARKS (Continued)
NW 88613 Docld:34530159 Page 4
.10
Page 3
REMARKS (Continued)
Robert Scheer, born 4 April 1936 in Bronx, New York,
a registrant under the Universal Military Training
Act, was this date given an opportunity to execute
DD Form 98 and in my presence he refused to do so.
HYRON K. HAYASHIDA
1/LT, AGC
CERTIFICATION
In regard to any part of this questionnaire concerning which I have had any question as to the meaning, I have requested
and have obtained a complete explanation. I certify that the statements made by me under Part IV above and on any supple-
mental pages hereto attached, are full, true, and correct.
TYPED FULL NAME OF PERSON MAKING CERTIFICATION
SERVICE NUMBER (if any)
SIGNATURE OF PERSON MAKING CERTIFICATION
TYPED NAME OF WITNESS
DATE
SIGNATURE OF WITNESS
113
NW 88813 Docid:34530159 Page 5
US GOVERNMENT PRINTING OFFICE 1961 0-607912
For Official Use Only:
Page 4
STATEMENT
JONAL HISTORY-
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
ROBERT (NMN) SCHEER
3. ALIAS(ES). NICKNAME(S). OR CHANGES IN NAME (Other than by marriage)
None
:
D
2.
STATUS
CIVILIAN
MILITARY ON ACTIVE DUTY
4. PERMANENT MAILING ADDRESS
2828 Milvia St., Berkeley, California
PLACE CERTIFICATE RECORDED
Bronx, New York
5. DATE OF BIRTH (Day, month, year)
4 April 1936
RACE
HEIGHT
Cauc
70"
WEIGHT
180
PLACE OF BIRTH (City, County, State, and Country)
Bronx, New York, New York, USA
COLOR OF EYES
Brown
6. DO YOU HAVE A HISTORY OF MENTAL OR NERVOUS DISORDERS?
COLOR OF HAIR
Brown
SCARS. PHYSICAL DEFECTS, DISTINGUISHING MARKS
None
YES XX NO ARE YOU NOW OR HAVE YOU EVER BEEN ADDICTED TO THE USE OF HABIT FORMING DRUGS SUCH AS
NARCOTICS OR BARBITURATES? ☐ YES ☑ NO ARE YOU NOW OR HAVE YOU EVER BEEN A CHRONIC USER TO EXCESS OF ALCOHOLIC BEVERAGES?
IF THE
ANSWER TO ANY OF THE ABOVE IS "YES." EXPLAIN IN ITEM 20.
YES ☑ NO
7. U. S.
CITIZEN
☑
NATIVE
YES
IF NATURALIZED, CERTIFICATE NO.
IF DERIVED, PARENTS' CERTIFICATE NO(S).
DATE. PLACE, AND COURT
J
NO
ALIEN
REGISTRATION NO
NATIVE COUNTRY
DATE AND PORT OF ENTRY
☐ Bef
8.
MILITARY SERVICE
ARE YOU PRESENTLY ON ACTIVE DUTY IN THE U. S. ARMED FORCES DRAWING FULL PAY? ☐ YES ☑ NO IF "YES." COMPLETE THE FOLLOWING:
GRADE AND SERVICE NO.
SERVICE AND COMPONENT
ORGANIZATION AND STATION
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
DO YOU INTEND TO BECOME
A U. S. CITIZEN?
YES
NO
DATE CURRENT ACTIVE
SERVICE STARTED
:
HAVE YOU PREVIOUSLY SERVED TOURS OF EXTENDED ACTIVE DUTY, DRAWING FULL PAY, FROM WHICH YOU WERE DISCHARGED OR SEPARATED TO CIVILIAN STATUS? ☐ YES
IF "YES." COMPLETE THE FOLLOWING:
COUNTRY
TYPE DISCHARGES OR SEPARATIONS-GRADE AND SERVICE NO.
SERVICE
COMPONENT
T I FROM (Date)
BAKUM K'
TO (Date)
WHI
NO
9.
10.
FROM-
EDUCATION (Account for all civilian schools and military academies.
MONTH AND YEAR
NAME AND LOCATION OF SCHOOL
GUTOCLATCe nacy po counters DD FOLW 286 TV
Jun 53 Christopher Columbus High School, Bronx, NY
Queens College, Queens, New York
Sep 49
Sep 53
Jun 55
Sep 55
Jun 58
Sep 58 Coun 59
DEGREE
Do not include service schools)
GRADUATE
YES NO
✗
Academic
✗
✗
B.A.
✗
The City College of New York, New York, N.Y.
Syracuse University,Syracuse, New York
Sep 59 perh: Jun 6ura (University of Calif., Berkeley, CHELOR SUS NUIced Pea
and place), children, brothers and sisters, even though deceased. Include any others you resided with of with whom a close relationship
FAMILY (List in onder givent parents spouse, guardians stepparents foster parents, parents in law former spouse(s) (if divorced give date
existed or exists. If 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.)
RELATION AND NAME
PRESENT ADDRESS, IF LIVING
U. S. CITIZEN
YES
NO
FATHER
Fred Scheer
MOTHER (Maiden name)
DATE AND PLACE OF BIRTH
25 May 1898
co list. TanGermanyrerusu
24. Apr 1900
Feb 1942
Eureka, Calif.
Ida-Kuran LUGTER WIREL
SPOUSE (Maiden name)
Anne Weills
OTHER (Specify)
None
concre Debensedia sug ŋsbsu
2860 Bronx Park East
Bronx, New York
2828 Milvia Street
Berkeley, Calif.
2114
FORM
Page
OBSOLETE.
NW 8861 Docid:38453013 Bayle 6 DREVIOUS EDITIONS ARE OPERATE (nightl
A
-
PETRO
✗
✗
Exception to Standard Form 86
f the Budget June 1960
12.
brothers and sisters
RELATIONSHIP AND NAME
None
ENDS LIVING IN FOREIGN COUNTRIES (List grandparents, first cousins, eur
aw
, and other persons with 
whom a close relationship existed or exi:
AGE
OCCUPATION
ADDRESS
FOREIGN TRAVEL (Other than as a direct result of United States military duties)
COUNTRY VISITED
50
PURPOSE OF TRAVEL
DATES
FROM-
TO-
Aug 1960
Jan 63
Sep 1960 Cuba
e
To learn to write
Write
-
uncles,
CITIZENSHIP
Feb 1965
13.
Mar 1963 England, France, Poland,
Hungary,Soviet Union
& Czechoslavkia
Mar 1965 Vietnam, Cambodia, Indonesia
Japan La09 & Thailand
Write
EMPLOYMENT Show every employment you have had and all periods of unemployment)
MONTH AND YEAR
TO-
NAME OF IMMEDIATE
SUPERVISOR
REASON FOR LEAVING
NAME AND ADDRESS OF EMPLOYER
FROM-
Soring
S. Kleins
1952
Jan 1953
14th St., New York, New York
U. S. Post Office
Unknown
Christmas over
1956
1957
New York City, New York
Unknown
School
Syracuse University
Sep 58
Jun 59
Syracuse, New York
Unknown
Sep 60
Jun 61
Sep 61
Dec 63
Jun 65
Present
University of Calif.
Berkeley, Calif.
City Lights Bookstore
261 Columbus, S.F., Calif.
Rampert's Magazine
301 Broadway, S.F., Calif.
Unknown
Mr.L.Ferlinghetti
W. Hinckle
14.
DID ANY OF THE ABOVE EMPLOYMENTS REQUIRE A SECURITY CLEARANCE?
ANY FOREIGN 
PROPERTY OR BUSINESS CONNECTIONS, OR HAVE YOU EVER BEEN EMPLOYED BY A FOREIGN
☐ YES ☑X NO DO YOU HAVE
GOVERNMENT, FIRM, OR AGENCY? ☐ YES ☑✓ NO 
HAVE YOU EVER BEEN REFUSED BOND?
☑ 
NO
IF THE ANSWER TO ANY OF THE ABOVE IS "YES," 
EXPLAIN IN ITEM 20.
☐ YES
SOCIAL SECURITY NO.
112-28-1134
CREDIT AND CHARACTER REFERENCES (Do not include relatives, former employers, or persons living outside the
United States or its Territories.
NAME
37 YEARS
J(List 3 credit and 5 character KNOWN
None
J27
STREET AND NUMBER
(Business address preferred)
ثاني
BU
CITY
STATE OR
TERRITORY
10
กะ:
CREDIT
CHARACTER
Sad
27680085
33
Robert Avakian
· David Welsh
Sol Stern
Robert Trushaft
Malcolm Bernstein
NW 88613 Docid:34530159 Page 7
0013
,
of
Unknown
301 Broadway
10
301 Broadway
:
A
5
Berkeley
Calff.
A San Francisco
Calif.
San Francisco
Calif.
Oakland
Calif.
Calif.
3
Trushaft & Walker
Trushaft 
& Walker
For Official Use Only
Oakland
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
VOUC
20. REMARKS
See Remarks
CTY
ITEM #12, FOREIGN TRAVEL (Continued)
CITA
TTA ONE
12 ADDN
Feb 1966 to Mar 1966 Vietnam, Combodia, Thailand and Japan
15
- Write
X
I refuse to answer questions 16, 17,
constitutional rights under the 1st,
Constitution.lu ma
gch 20
200 40
QU 20
200 22
0261 26
and 19 on the grounds that they violate my
5th & 14th amendments to the United States
PAGE
6 NOW KOLK'
nce
ON AURK
Robert Scheer,adregistäent under the Military Training a
and Service Act, refused to complete DD Form 398 in its
entirety.
MYRON K. HAYASHIDA
1/LT, AGC
23
I 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
SIGNATURE OF PERSON COMPLETING FORM
5 Oct 1966
TYPER NAME AND ADDRESS OF WITNESS
"MYAÛN "K". HAYASHIDA, 1/LT, AGC
1515 Clay St., Oakland, California
21.
SIGNATURE OF WITNESS
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
X
30
1.J
XX
Eenu
BOTH
RECORD OF PRIOR CLEARANCES -
4
"
DATE OF CLEARANCE
TYPE OF CLEARANCE
AGENCY THAT COMPLETED INVESTIGATION
REMARKS.
NW 88613 Docld:34530159 Page 8
117
U.S. GOVERNMENT PRINTING OFFICE 1960 0-573450
XN
15.
16.
T
MONTH AND YEAR
FROM j
1949
$1958
653 Brittoh Street, 'Bronx'
1958
1959
1959
1961
Francisco Street
LIST ÁLL RESIDENCES FROM 1 JANUARY 1937
STREET AND NUMBER DEMON
CITY
New York
Sprecuse N.Y. Married Student Housing Syracuse
Berkeley
1961
1963
2157 Mason Street
San Francisco
STATE OR COUNTRY
New York
New York
California
California
1963
1963
444 Columbus Street
San Francisco
California
1964
1965
1965
Present
332 Castro St. & 2870 Geary
2828 Milvia Street
San Francisco
Berkeley
California
California
NAME AND ADDRESS
See Remarks
3RD OF
+OSOL
17.
204
PAST AND/OR PRESENT MEMBERSHIP IN ORGANIZATIONS
TYPE
(Social, fraternal, professional, etc.)
MEMBERSHIP
OFFICE HELD
FROM-
TO-
YES:
No
20 CO
་་་
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?
TWE
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? a
12.007
A
RUBK
TCES
ARE YOU NOW OR HAVE YOU EVER BEEN AFFILIATED OR ASSOCIATED WITH ANY ORGANIZATION OF THE TYPEDESCRIBED ABOVE AS AN AGENT. OFFICIAL, OR EMPLOYEE? .
POLYUO 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.
10 T85L
See Remarks
'
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.
_THER RELATI.
.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
See Remarks
NW 88613 Docld:34530159 Page 9