14-00000 ait seamen tinee ote st mo 8 (43) C. HAVE YOU EVER REEN IN, OR PETITIONED FOR, RANKRUPTCY? _. nt \- GIVE PARTICULARS, INCLUDING COURT: ———,. |e weeennaminsnaeann eee senescence anne crtmommmccanannameae sete eee lees eee aes wae eee ont ween seen ene nee noe tee een os Ho ee ae Hehe RET aR Oh D. eve THREE CREDIT REI SRENGES—iIN THE U. S. D. NARMB 2... ~..cccemsnmeren ADDRESS weet Saami rt acetate PTT Land Namber) (Gs) “(Biate 2nawe Nome ADDRESS cc eeetsonuecnniy sarhaeeceraroeneetessenysosee gece Bp ees” , (eg) “(State) &% NAME seecacee ss nn sennecawmenemecammememacetennectn tenes ADDRESS Ki cee en see nemtne cece s antmaninmennteeensss tov womb and Number) (cry) (Stated Sec. 22. RESIDENCES FOR THE PAST 15 YEARS. FROM .ApTil 1952 to Present — (Country) {S%: aod aasaber} «Chey? + State} FROM 1919... ro 1952. 20. fveuD NYC, NY USA sascuecgneesemepeeenanssonpemucuuneuenee . , acing State} . (Country) St. and number FROM .AQuh _ To 2948 20. west f2nd St., NYC, | RY, USA ee Country “(SU and comber} (City) e (Biss) t > a, \: a a CS. ood number) Cig) To Siated (Country) FROM © 22. ee TO eens en meee emma ncee nee ne en cewcmmanmnnces cre cegees sanee enemas ee poe eevenes (St aed sumber} wig eState} “[Grintry) “Gast GS. and cumber} ae St, and numer) aCity) (State) ta sntey) 32 (<0 See & 0 Rn — eS. and Number} “EQity} (States “{country) cree rere rete a Sec. 22 RESIDENCE OR TRAVEL OUTSIDE OF F THE UNITED STATES Country. of birth A. From 1919_- ro 2928 {Purpose} From 19h2. to Sh q ene . Gcoantyh "(Purpore) rrom 1952... ro Eresent... derutlic of Panama OPK icity or section) ¢(Coanury} (Purpose) ww" Gity of section) (Coantevs “THapese) FROM oo... eee DO ei ee re eee en tee cme nnn genes semen feeeees seen enenowscewens Tate oe action) (Country) t Pur pose) Sec. 24. CLUBS, SOCIETIES, AND OTHER ORGANIZATIONS LIST NAMES AND ADDRESSES OF ALL CLUBS, SOCIETIES, PROFESSIONAL SOCIETIES, EM- PLOYEE GROUPS, 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} (St. and Number) ‘ (City) state) Country) DATES OF MEMBERSHEPS o.oo. oocenee meres eneencenmnemarenmnnneeeenns itea tan srewemmmunateuensadeuse 7" Nlaine aad Chapiaey a ad mei Bau” onnter DATES OF MEMBERSHIP: ___.. & 22... ao eeernen ewennenenn ne eneee once pene cegromeneneene snes aneues cuassencersrtneeetnenume see ieteensersmemee tName and Chapter) (St aad Nomber) Sieg State) iCovntry} -DATES OF MEMBERSHIP: ceeemeee crete cre neces cecann sen snnson tan nee ittnsaananessaueneneuen teemenetmannmanerantenesenemen Sa made-$
TODA ei teen eee oO  @ . ° (Name and Chapter) (8. and Numbe. } . (Cary (Stated DATES OF MEMBERSHIPS oon. .cccccesceccsesesesnensnsanc os ccsstassosecsutscvscseesvoyevansstassesumesntseeumuennnstaanenoecnee & & eeeeeme stone seer eten <scuaguneensenmaumas!sovmmnenen as ence cece ancbee een . {Name and Chapter} . (3t. aod Namber} ‘ DATES OF MEMBERSHIP: 0. oo. ncsssccececconcecueccsecsccessecenecuccsscsecsnesevescecesseeeessussussauasusesustenesees (Name and Chapter . (St. and Number) “4 * DATES OF MEMRERSHIP: .......... vocsceeeeeseceneeteanecee aveedeesnneecnecceceseesacestsosecscesueseeecenceeesaseeneees saneeee Sec. 25. MISCELLANEOUS ADO YOU ADVOCATE OR HAVE YOU EVER ADVOCATED: OR ARE YOU NOW QR HAVE You EVER BEEN A MEMBER OF, OR HAVE YOU SUINPORTED, ANY POLITICAL PARTY OR ORGANI- ‘ZATION WHICH ADVOCATES THE OVERTHROW. OF OUR CONSTITUTIONAL FORM OF GOV- ERNMENT IN THE UNITED STATES? IF “YES,” EXPLAIN: .... .......90_ (S00 Pemarn@) B. DO YOU USE, OR HAVE YOU USED; INTOXICANTS? |... 288. IF SO, TO WHAT EXTENT? BORE WEE ROORS e ncaee cence ceccenneten ceeeetce erereeweveeseseeesene vesecceeneume GHAVE YOU EVER BEEN ARRESTED, INDICTED OR CONVICTED FOR ANY VIOLATION OF LAW OTHER THAN A MINOR TRAFFIC VIOLATION? If SO, STATE NAME OF COURT, CITY, STATE, COUNTRY, NATURE OF OFFENSE AND DISPOSITION OF CASE; D.HAVE YOU EVER BEEN COURT-MARTIALED WHILE A MEMBER OF THE ARMED FORCES? IF ANSWER IS “YES,” GIVE DETAILS BELOW: rence nee neers erneee ED ecenensaneessmnenenseeceenenttnatennssnteseeneecmmnes aunts ctsmeeney “mun cuwee E.LIST BELOW THE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO WHICH YOU HAVE APPLIED FOR EMPLOYMENT SINCE 1940; .  Prpgent Organieation er cccentnceee ener aemnnnaes
- qua} F. AF, TO YOUR KNOWLEDGE, ANY OF TUR ABOVE HAS CONDUCTED AN INVESTIGATION OF you, INMICATE RELOW THE Nak ar THAT AGENCY AND THE APPROXIMATE DATE OF THE INVESTIGATION: Sederal Sureag of. savestigation o- rent ssrseteennsneemsatats iment caremmume eae eee pete ome en ee ERE eee ene ee RE keen Renee Eee EEL He nen nes WiDTeneen ne cenn@enenme Sec, 26 PERSON TO BE NOTIFIED IN CASE OF EMERGENCY: 900 © => NAME - annde- Louise Pa RELATIONSHIP ene: nn ADDRESS 7 Same Sone 9 evpligeatin i aaaanannaninnT <7 anaes SEC. . Mi. YOU ARE INFORMED THAT THE CORRECTNESS OF ALL STATEMENTS MADE > HEREIN WILL BE INVESTIGATED, ARE THERE ANY UNFAVORARLE INCIDENTS IN YOUR LIFE NOT MENTIONED AROVE WHICH MAY RE DISCOVERED IN SURSEQUENT INVESTIGATION, WHETHER YOU WERKE DIRECTLY INVOLVED OR NOT, WHICH MIGHT REQUIKE EXPLANATION! IF SO, DESCRIBE, IF NOT, ANSWER °NO,” 4 eRe eee eee hae cee ne erete es wees Sec, 28. PF CERTIFY THAT THE FOREGOING ANSWERS ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND LAGREE THAT ANY MISSTATEMENT OR OMISSION AS TO A MATERIAL FACT WILL CONSTITUTE GROUNDS FOR IM- REDIATE DISMISSAL OR REJECTION OF MY APPLICATION. SIGNED AT _.Pty dmator, Conal fone... DATE Me WT G8 ity and State} iia al Niet Jtouny & &, eth aG ~o Signature af Apphoene 2 (Witne 3) — USE THE FOLLOWING PAGES FOR EXTRA DETAILS, NUMBER ACCORDING TO THE NUM. BER OF THE QUESTION TO WHICH THEY RELATE, SIGN YOUR NAME AT THE END OF THE ADDED MATERIAL. IF ADDITIONAL SPACE 18 REQUIRED USE EXTRA PAGES THE SAME SIZE AS THXSE AND SIGN EACH SUCH PAGE. & & eovesemget Fetetreg Grete | §Y --eRASR- | : ; 4 cea)
14-00000 Demon te cee? as wes PLL SHED Bape paces be CO _ Ss Section 14 «‘knil> an undercover avent for the ¢cderal Rureau af. investigations . from.19l6 to 1949 1 used the nore uf bernard Harri’ to rembers of - the Communist Party of the United Stites. This in‘ormation is already on file in this organizations - Section 1D »- I became an Amorican citizen at birth throuzt the citizenship of ny father, This informtion is already on file in this organizations Section 3B ky wife is’ employed by this organization. | ST . ae Section 10 .— I have many relatives in opain ‘and Cuba but do net correspond with: , them and so-do not know names, aldresses or present status, - Section 18 - 411 persons ‘mentioned in this section are employees ef this organization. Sections FT) and 20 = Not having lived in the ULA for over five years ¥ have lost all contact with old friends, neighbors, etc, Ido not know their addresses, | status, etc., at tnia time, Section 25 = My.past connections with any suiversive groups and the reasons for such connections 19 already on file in the files of this organization.
14-00000 RECORD OF PREVIOUS GOVERNMENT _ SERVICE RETURNED TO FEDERAL RECORDS CENTER IN ST. LOUIS, MO.