JFK Assassination System: Date: 10/2/201 Identification Form Agency Information AGENCY: HSCA RECORD NUMBER:  180-10072-10186 RECORD SERIES: NUMBERED FILES. AGENCY FILE NUMBER: 010313 Document Information ORIGINATOR: SOCIAL SECURITY ADMINISTRATION FROM: TO: HESS, JACQUELINE. TITLE: DATE: 07/31/1978 PAGES: 64 SUBJECTS : 4 OSWALD, MARINA; FINANCES, INCOME TAXES. OSWALD, LEE; PRE-RUSSIAN PERIOD, MILITARY SERVICE, COURT-MAR DOCUMENT TYPE: REPORT. CLASSIFICATION: — Unclassified RESTRICTIONS: 3 CURRENT STATUS:  Redact DATE OF LASTREVIEW: 07/10/1996 OPENING CRITERIA : COMMENTS : Includes insurance forms, death certificate, & military documents of Oswald. Box 189. v9.1 1 WW 55923 Doeld:32245128 Page 1
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE SOCIAL SECURITY ADMINISTRATION BALTIMORE, MARYLAND 21235 TOs - 5-1 a JUL 2 8 1978 * O£0313 “Ms. Jackie Hess Select Committee on Assassinations U.S. House of Representatives 3331 House Office Building, Annex 2 Washington, D.C. 20515 Dear Ms. Hess: This is in response to Mr. Blakey's May 15, 1978, request for access to all files and documents concerning or referring to Lee Harvey Oswald and Marina Oswald. The following documents are enclosed: 1. Form 8S- 5, Application for Social Security Account Number, completed by Lee Harvey Oswald. 2. Form Ss-5, Application for Social Security Account Number, completed by Marina Oswald. 3. Numident showing name changes for Marina Oswald. . Form 0A-C5, Application for Survivors Insurance Benefits, completed by Marina Oswald. 5. Certificate of Death issued by the City of Dallas for Lee Harvey Oswald. 6. Marriage certificate (and translation) for Lee Harvey Oswald and Marina Nikolaevna Prusakova. 7. Birth certificate (and translation) for Marina Nikolaevna. 8, Birth certificate (and translation) showing child born to Lee Harvey Oswald and Marina Nikolaevna Oswald. 9. OA-C70h, Certification of Contents of Document(s) or Record(s), , re birth of child to Lee H. Oswald and Marina Nikolaevna Prusakova. MW 55923 Doold:32245128 Page 2
SIRNAL REVENUE SERVICE REQUIRED UNDER THE FEDERAL INSURANCE CONTRIBUTIONS ACT geek B SS Rowene APPLICATION FOR SOCIAL SECURITY ACCOUNT NUMBER 433-54-3937 | ey (Revised 7-46) READ INSTRUCTIONS ON BACK BEFORE FILLING IN FORM DO NOT WRITE IN THE ABOVE SPACE FILL IN EACH ITER. PRINT IN BLACK OR DARK BLUE INK OR USE TYPEWRITER FOR ALL ITEMS EXCEP! ©.“ “TURE, IF THE INFORMATION CALLED FOR IN ANY ITEM IS NOT KNOWN, WRITE “UNKNOWN.” rg . INT NAME YOU GAVE YOUR PRESENT FIRST NAME MIDDLE NAME. CF Yi~' “++ + | MIDDLE NAME OR INITIAL, DRAW A LINE —— PRINT NAME YOU GAVE YOUR PRESENT 1 Ewpcover. OR IF UNEMPLOYED, THE Zz, NAME YOU WILL USE WHEN EMPLOYED 48 OS Ww MAILING ADDRESS SH. AND ST., P.0.BOX,OR RFD) (CITY) (ZONE) (STATE) PRINT FULL NAME GIVEN YOU AT BIRTH 7 Ag LOL DATE OF BIRTH (MONTH) (DAY) (YEAR) PLACE OF BIRTH = (CITY) OCt LB y FATHER'S FULL NAME, REGARDLESS OF WHETHER LIVING OR DEAD GOL, LEE LSWA Wh LTA ° Zp (MARK (X) WHICH) COLOR (MARK (x) WHICH) (IF OBMER, SPECIFY) HAVE YOU EVER BEFORE APPLIER == (MARK (X) WHICH) 9 MALE FEMALE 10 OR WHITE NEGRO OTHER FOR OR HAD A SOCIAL SECURITY OR —— sex: 7 race =P RAILROAD RETIREMENT NUMBER? {NOT WHITE IN THIS SPACE IF ANSWER IS “YES” PRINT THE STATE 2100 STATE IN WHICH YOU FIRST APPLIED AND WHEN _ ALSO PRINT YOUR ACCOUNT . DA Poof pes iu NUMBER IF YOU KNOW IT BUSINESS NAME OF EMPLOYER. IF UNEMPLOYED, WRITE “UNEMPLOYED” i i — Dd; a EMPLOYER'S ADDRESS (No, AND STREET) (city) (ZONE) (STATE) 2 TODAY'S DATE WRITE x AME AS USUALLY WRITTEN (00 NOT PRINT) ie 16—5528-7 NW 35923 Doold:32245128 Page 5 .
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OFFICIAL RECORD FOR SOCIAL SECURITY NUMBER PRINTED ON 071978 O | Oc , FORM 1: APPL/CYCLE 08 64 ENTRY 0 | REF# 65163940518 | © . . | C NAME LINE MARINA NICHOLAEVNA OSWALD | 243 © a . C SIGNATURE . . . CODE S§S © BIRTH DATE 0717941 . SEX 2 RACE 1 C © | MOTHER CLAUDIA V PROOSAKOVA FATHER NIGHOLAI- © UNKNOWN C BIRTHPLACE - ARCHANGEL - UR* oo © C CO > REQ BY BR 032 SEC UNIT _— CLERK 00827 DATE 195 PAGE 10F 3 GC . . \ © OFFICIAL’ RECORD FOR ‘SOCIAL SECURITY NUMBER PRINTED ON 071978 C O DO- IRS FORM 2 APPL/CYCLE 121175 ENTRY 2 REF #) 75165960637. -O © NAME LINE MARINA - NIKGLAEVNA PORTER 636 C 2ND NAME MARINA NIKOLAEVNA OSWALD 243 O | C SIGNATURE fo ‘CODE. $ . BIRTH DATE 0717941 | SEX 2 RACE 0. O | : C MOTHER KLAVDIA .— PROOSAKOVA FATHER - ALEXANDR MEDVEDEV : © BIRTHPLACE © ARCHANGEL UR* . Cc O | C REQ BY BR-032 SEC UNIT ~—‘ CLERK 00827 DATE: 195 PAGE 2 0F 3. Qu soem ee ran € OFFICIAL RECORD FOR SOCIAL SECURITY NUMBER[ srk acto @) | PRINTED ON 071978 © a | - C DO COO FORM 8 APPL/CYCLE 011976 ENTRY 2 REF#. 76010006538 ©Q a C NAME LINE. M N PORTER 636 2ND NAME MARINA NIG OSWALD —— 243 oF : | . | — ¢ . SIGNATURE CODE D ny ©) BIRTH DATE 0717941 , | sex 2 race o. © C © C iy 55935 pBYrBRoVFA BECrage HNIT CLERK 00827 DATE 195 PAGE 3 0F- 3 -
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE SociaL SECURITY ADMINISTRATION DALLES, TEXAS | . Bureau of Old-Age and Survivors Insurance APPLICATION FOR SURVIVORS IN URANGA BRNER AS * Al items on this form requiring an answer must be gnswered or marked “Unknown.” Form roved. <b: 7: , Budget Bureau No. 72-R094.11. wn ee ee ee ene ence (Do not write in this space) “NOTICE. — Whoever (a) makes or causes to ‘be made any} false statemehit, ‘or! a Ns . G material fact for use in determining the right to or the amoynt of any benefit, % individual’s disability, under Title II of the Social Security Act, ont i who; ‘having. ved a pay- 7 ‘ment for the use and benefit of another person, knowingly and wi {fally uses such payment for ‘other than the person for whom it is received, is subject, under the Social Security Act, to a fine of ~ -not more than $1,000 or | year’s imprisonment, or both. . EL CAM 241 Ny. Keech. (Full name of applicant) me under Title II of the Social Security Act, as amended, and to the children listed in item 14 below. \ 1. When was the deceased born? Month ___.........4.@..0000 2 Day ....4.7... woeeees Year 7.97... 2. In what State or foreign country did th: 7eceased have his fixed, permanent home when he died? CA 4 of ee 3. (a) Did the deceased ever serve in » .. .nilitary or naval service of the United States?........ | Of “Yes,” answer (6). (6) Was the deceased in active service after September 7, 1939, and before January 1, 19577... XJ LJ If “Yes,” answer (¢) and (d). a Ce gf eel ey pecs ‘(c) Give dates of service during the period specified in (b) above ofa EG — UM wy ane Ny es (d) Has anyone (including the deceased) received, or does anyone expect to receive, from any ..- 2 25: Federal agency other than the Social Security Administration, a benefit based on the em-— “— ; ployment, military service, disability, or death of the deceased?................6-. 000s ; If “Yes,” name such person(s ) _2..--.----0n0qeeeeeee eene ence Moone ence ee eee eee ee ence ences * - aenceee me - List all SUCH AQENCLES -- 20.0 -ceeee-nn nn cennnee nen ene ne cence nen enna nce nnec nantes necenenraeresccencsnenacac noses , 4. Did the deceased work in the railroad industry at any time on or after January 1, 1937?...... UW ad es 5. Give the names and addresses of the deceased’s employers during the 12 months before his death; if the deceased worked in agricultural employment, give this information for the year of death and the year before. (If self-employed, write ‘“Self-employed.’’) ‘ . Work ENDED Month Year 1 Neggets Ob haw. taal 62a ecter, Mallee |" 04... de 2d ww | oe. BEB. wait. Cr olert ibe 2apiap ct Sheer bihe eseseee bande pork: 6. If the was self-employed last“yéar or the year before, give? voces veloc te , Kind.gf Trade or Business oF Amount of Net Earnings pendnenoee ce eemeecee cence .- : ; coe ceceeneeinnpeseeeeeesters.-A_]Less than $400 .$400 or moreL] [Less than $400 $400 or moreL] Zz ) 3 _< = Z pa E 7-4 B k om Zz e) Qa w a2) < a al a NAME AND ADDRESS OF EMPLOYER - 7. About how much did the deceased earn from employment and self-employment during Z ; the year in which he died?............. One vee seeteeeeeeeerees re $2220.98 0 8. Give the following information about each marriage of the deceased, including his marriage to you. MarriaGE ENDED Date Place LA 4 yatfes LithHee cts DATE AND PLace OF MARRIAGE(S) Month, Day, Year 10. When and where were you born... 9b. Th ES Leet "ARAMARK ) Reta (Moth, day, and year) (State or foreign country) : . * This may also be considered an application for survivors benefits under Section 5 of the Railroad Retirement Act and for Veterans Administration payments under Title 38 USC., Veterans Benefits, Chapter 13 (which is, as such, an application for other types of death benefits under Title 38). partner deereseen ering He setae or wena ts vam Fog Form OA-C$ NW 55923 Doold:32245128 Page 8
_HW 55923 Doold: 32245128 Page 3 11. Indicate by ()/) whether your marriage to the deceased was performed by: - --- cee ' Clergyman or authorized public official x or Other Oo -12, Were you married before your marriage to the deceased? . weenie eee leeeeeee tee et LI 13. (a) Were you and the deceased living together at the same address when the deceased died?. Ke C} es No (6) If either you or the deceased was away from home. (whether or not temporarily) when the deceased — “died, give thé following: which of you was away; date last home; reason absence began; reason you - d nature of confinemen an a. Me were apart at time of death; if hospitalized, name of hospital a 14. Was the deceased survi fed by any unmarried children (including ste af : widren, ad6pted, and illegitimate ede, (a) who were > under 18 years of age when he died: or (6) who were 18 ff your answer is “No,” leave out the next questions and continve with question 21. _ Lf your answer to question 14 is “Yes,” give the following information about each such child. (If uncertain as to name, date of birth, or whereabouts of any of these children, explain under “Remarks” on last page.) Show relationship to you and the deceased by placing (/) in the proper column. «DaTE OF BIRTH RELATIONSHIP TO DECEASED RELATIONSHIP TO YOu Lewmtd.| 21 eel xT sen ee - a _ Fur. NAME OF CHILD (If you are not filing this application ‘on behalf of any ‘child listed above, give 1 under “Remarks” on last page the name of each such child and the reason(s) for not filing. If a child of the deceased is born after this application is filed, notify your office of the Social tt Security Administration promptly, as such child may receive benefits.) es No Df “No,”’ and the deceased was the FATHER or ADOPTING FATHER who died before September 1960, answer (b). (8) ‘Which of the children listed in item 14 were living with their STEPFATHER when the deceased died? .____.. 17." “Are all the children listed in item 14 now living with you?.... liveceeeeeues . Lea eee pd CJ a Yes “No “Uf "No, ”” give the following information about each child not living with you now. Person WitH WHoM CHILp Now Lives Furi Name or Cuitp Not Livinc Wrrx You eee : : Name and Address Relationship to Child NIDUVW NI aLIUM LON Od ISVaTd 4
"19. Do you understand that all payments made to you on behalf of a child must be spent or saved | for his use and benefit, and do you agree to so apply the benefits?......................... . es No 20. Do you agree to notify the Social Security Administration promptly when you no longer have responsibility for the welfare and care of any child for whom you are filing this application?. *K] Yes 21. Have you or any children listed in item 14 married since the death of the deceased?......... ia hd - oe : . Yes ° Uf “Yes,” give name of person who married and date Of Marriage... eee ee we ceeeeeeneneeceee, 22. Have you or any children listed in item 14 ever had a social security account number?....... CJ kK) Yes No Sociat Security Account NUMBER eeaee poecsensce snes ec os estates ee eee ee ee eee enor 23. Have you or any children listed in item 14 ever filed an application for social security benefits before? eee. Leen ee eee eee e ee teen e eee eeenas oo Yes No < . If “Yes,” give the name and account number of the person on whose earnings record such previous claim was based. - Zz sinentescenen cnn cag pone eees ce cenne anne neg aeee eee etatececncceeeeeeeeneceeneees ceeceeeescecogeegepeeecegerstcaseeneeesecteseteesenceees o (Name of wage-earner or self-employed person) (Social security account number) & Answer questions 24 and 25 only if you are within 3 months of age 62 or older. = . Z 24. Were you in -the active military or naval service of the United States after September 7, 1939, - - and before January 1, 19577... 0.00 c ene n eee vette bebe eceee eee eee, O° oO . z Yes No B ©25. Did you work in the railroad industry at any time on or after January 1, 1937?......... we. OO C Yes No : 5 Deductions are made from the benefits (other than disability benefits) of any person under age 72 who earns more than Z $100 a month in employment or renders substantial services in self-employment, and has earnings in excess of $1,200 for the 4 taxable year.* This applies to all employment and self-employment, whether or not covered by the Social Security Act. | % 26. (a) Are you or any of the children for whom you are filing now earning more than $100a a - month in employment or rendering substantial services in self-employment?.............. 2 Yes No If “Yes,” give the name of each such person .......2..022-.2----- ect e eee eee n ene eee ee nee eee enn enn eee eee ee eee: & (6) Do you expect your total earnings or the total earnings of any child for whom you are filing to exceed $1,200 this year (count all earnings beginning with the first month of this year)?........ Dee eee eee eee Meee ee deeees “eee eee eee If “Yes,” give the name of each such person and the amount of his expected earnings. If “‘No,’’ con Yes No tinue with question 27. , : ; PERSON ExpecreD EARNINGS Yes No If “No,” give the name of each person and the months of this year in which the person did not earn more than $100 a month in employment and did not render substantial services in self-employment. If any such person was self- employed, show: the number of hours he devoted to self-employment opposite each month listed—tf none, show “None.” MOonTHS SFA IT SEE PAE ENT L IET T  E TN TEET T
Answer item 27 only if the deceased died before this year. , ‘ 27. Did you or any child for whom you are filing earn more than $1,200 last year?.............. O x Yes No Lf “Yes,”’ give the name of each such person, show hrs total earnings, and list the months of last year in which the person did not earn $100 a month in employment and did not render substantial services in self-employment. If any such person - was self-employed, show the number of hours he devoted to self-employment oppostte each month listed—tf none, show ~ “None.” (Do not lest any month before the month the deceased died. ) PERSON ‘ Earnincs MONTHS Ao annual report of earnings must be filed with the Social Security Administration within 3 months and 15 days after the end of any year in which you, while under age 72 at least one full month of that year, or any child for whom you are filing, earned more than $1,200. Also, your benefit is not payable for any month you do not have in your care a child of the deceased entitled to a child’s benefit unless you are receiving. benefits because you are a widow age 62 of over. FAILURE TO REPORT THESE EVENTS MAY RESULT IN THE LOSS OF ADDITIONAL MONTHLY BENEFITS. = “gO A widow’s entitlement to benefits ends- with the month before the month in which: (a) she remarries, with certain excep- tions (however, all marriages must be reported); or (b) she is under age 62 and no child of the deceased is entitled to child’s insurance benefits. A child's entitlement to benefits ends with the month before the month in which the child: (a) attains age 18 (unless the child has a physical or mental impairment which began before age 18, is expected to be long-lasting, and prevents any sub- stantial gainful activity); (6) dies; (¢) marries, with certain exceptions where the child is disabled (however, all marriages must be reported); or (d) is legally adopted (unless the adoption is by the child’s stepparent, grandparent, aunt, or uncle after the death of the parent on whose record the child’s claim is based). If che child is age 18 or over and is receiving benefits as a disabled child, his entitlement to benefits also ends with the second month after the month in which his disability ceases. 30. Do you agree to notify the Social Security Administration promptly if any of these events occur and to return promptly any check for benefits received by you if you or any of the children are ww C] not entitled to it? ne eee c eee e ene nenes Yes No REMARKS: (This space may be used for explaining any answers to the questions. If you need more space, attach a Separate sheet.) Le baa Ahedmet but ‘Alspoced egy cee Ki Elan, Aictine Dewi 0! elt 5m thle? nIDUvN NL FLIYM LON Od aSVaTd Knowing that anyone making a false statement or representation of a material fact for use in determining the right to or the amount of Federal old-age, survivors, or disability insurance benefits or in determining an individual's disability, com- mits a crime punishable under Federal law, I certify chat the above statements are crue. If this appl ication has been signed by mark (X), two wit- Signature of applicant (Write tn tnk): nesses who know the applicant must sign below, giving their Sign > > . a Here aes VY. full addresses. (First name) (Middle initial) (Last name) (treet and ¢ number) Sine Kamien (State) Telephone number at which I can. be reached: (City) (Zone number) (State) (Zone number) (State) (Month) (Day) (Year) . GOVERNMENT PRINTING OFFICE : 196! OF —S8assa uu w NW 33923 Doocld:32245128 Page ii
STATE OF TEXAS CERTIFICATE OF DEATH STATE FILE NO. a ay 7 1, PLACE OF DEATH . 2. USUAL RESIDENCE (Whore deceased lived. If institution: residence before admission) f) ». COUNTY - Dallas estate TEXAS b.couy Dallas 2 b. CITY OR TOWN [If outside city limits, give Precinct 0.) c. LENGTH OF STAY! 7. - ¢. CITY OR TOWN [If outside city limits, give precinct no.) : wo : Dallas ",” 13 Mo. - + Dallas C) d. NAME OF (fnot in hospital, give street address} . d. STREET ADDRESS (If rural, give location) HOSPITAL OR ° : ; wsmut0N- Parkland Hospital . 1026 N. Beckley 3 @.S PLACE OF DEATH INSIDE CITY LIMITS? . @. IS RESIDENCE INSIDE CITY LIMITS? £,1S RESIDENCE ON A FARM? & ; SO . YEScX Noo eo] *  vesBy noo YES) NoRd <3. NAME OF (o) First {bj Middle fe) Lost 4, DATE OF DEATH DECEASED : : Z| {Type o print Lee - - Harvey -' .+ “Oswald Novemb er 24, 19 6 3 > (5. SEX . COLOR OR RACE a wedPQ Never Moniod ] C2 DATE er BIRTH AGE {in year IF re ORE (YEAR YEAR WNDER 24 HES, fe) . al bit jarri lever Marrie: October 1 1 tthdey) | Mont! Doys jours Minutes IS Male White Widowed] Died 91939) yr 3 | 0a, USUAL OCCUPATION (Give Kind of week done] (Ob. KIND "OF BUSINESS OR INDUSTEO® & E11. BIRTHPLACE [Stote or foreign country) Tia. CITIZEN OF WHAT COUNTRY? > uring most of ar” life, even if retired) . . “| Laborer Printing,Book,Metal New Orleans,La USA = | 13. FATHER’S NAME 14. MOTHER'S MAIDEN NAME z Robert Edward Lee Oswald Margeruite Claverie a 15. WAS DECEASED EveR IN_U.S. ARMED FORCES? 16. SOCIAL SECURITY NO. NEQRMANT = {Yes e" ge" Tee HOSS selgyd 765 y f) yl . 5 - -1959| 433-54-3937 ~ Z atl eer 1 ae eg = 18. oa Sen ae cee en per line for (a). (b), and {c).] oo \ Cette orate wed va oo # IMMEDIATE (24. Jet. A rasan te 0 : ubry ” ae Conditions, if any, hat are tha hex > INVER wi which gave rise to AMAA UNA u D a above cause (. DUE TO i & < ht stating the under- 45 lying cause lest. = bur 10.44 ¢] - z PART Il, OTHER SIGNIFICANT CONDITIONS CONTREUTING TO DEATH BUT NOT RELATED TO THE TERMINAL DISEASE CONDITION GIVEN IN PART Meh 19. WAS ALFOPSY PER- ° 5 veer & 20a. ACCIDENT SUICIDE HOMIC! 20b. ie HOW INJURY ald A f injury in Part | or Port Il of Item 18.) . é OAS oh obras je £ 2 Ate On G| 20c. TIME ny a Month > Oy Yeor Wy i = , INJUR * A A 2 AS! — “4 ay L3 - Juyrr hn hime fur 6 20d. INJURY OC RRED ; PLACE OF INJURY {e.9.. rene ii ik fi Sry, 2 ra TOWN, OR LOGATION COUNTY street, office building, atc] ia mie [' wou hPa l lekkonr Dr Tat se thereby certify that | ottancded the decen sod fram, fo Howe othe com AN A \~ ¢ de ee * > Koes é Es — 7 ™ + . Desthloceurred aia on the date steted above, ond to the jhe best of my knowledge, (SEE ne tated 22a. SIGNATURE | 2) 4 ene 22b. ADDRESS 22c. DATE SIGNED \ AMAL 4 ak pat 240 Crk orn (2-S- (5 23a. BURIAL, CREMATION, REMOVAL (Specify} 23b. DATE |23c. NAME OF CEMETERY OR CREMATORY (Pigas 43) 2. oo” XSHEREK REMOVAL November 25,1963 Rose Hill Burial Ps 23d. LOCATION (City, town, or county) ‘[State) 24. FUNERAL DIRECTOR'S SIGNATUR @ Css OE Fort Worth Texas Miller Funeral Hom © Worgh, Oy 25a. REGISTRAR'S FILE NO. 25b. DATE REC'D BY LOCAL REGISTRAR \g 6712 DEC 1868 4 TD Mh - Sonealee Set? DALLAS, TEXAS Jan, 2, 1964 # T HEREBY CERTIFY THAT THIS IS A TRUE COPY OF DEATH _onRe TIFICATE OF ONE. Lee Harvey Oswald oe . a vas 1s RECORDED IN THIS OFFICE IN-THE CITY OF DALIAS, oe county oF DAL iS, SR_OF TEXAS. 2g ; ear Stan DALLAS, TEXAS. tote ee ee ee ee ante ee. =. MW 55923 Doold: 32245128 Page i2 _
A. REQUEST FOR ASSISTANCE (Complete only if document is sent to another office for translation.) TRANSLATION —— 7 NAME. OF INSURED INDIVIDU AL SOCIAL SECURITY ACCOUNT NUMBER 2 __ 433-5 ¢-3937 TRANSLATING OFFICE 3 Social Security Administration 4 B. TRANSLATION (To be filled out by official translator) DATE: | Va3/ey . LANGUAGE OF DOCUMENT: Ky 5s,an) . PERSON(S) FOR WHOM PROOF SUBMITTED: (If married woman give maiden name) » FACT(s) TO 3E PROVED: » ALLEGED DATE EVENT IN ITEM Aaa OCCURRED: t. TYPE OF DOCUMENT: QUIN 2. |? Bow EV NT LG / 3. eee COCUMENT |? Soe A BO Wh / BO0f 6 / Centuks 4 TITLE OF OFFICER E ECUTING here Vw.wee) MWaue clued) | 6. Does this document appear tebe genuine and Ban OF amen Ree Waa t , CM hus Beat EI Ga Hb ce ; 7 diered, cad to ansieee be (ne 7. Is Foreign Service post verification stamp shown on document 8. Describe and explain any irregularities in document: Ce 9. The document, which is in the vi OSs New ORLeEAUS language, contains the following pertinent information: o 3 [e oll (nt. ho, 332z¥! SIGNATURE OF AUTHORIZED TRANSLATOR A212 Mi erVuUsed on © / hq Mo, HIS RECUES™ ING OF FICE: > | Social Security Administration | NW SO eC eo TSSee—— Page _ VY Va Fiergry Vi DATE PO tf, / /23 CY TrhWT
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TRANSLATION NAME. OF INSURED INDIVIDU AL SOCIAL SECURITY ACCOUNT NUMBER 433 -5V-39 37 TRANSLATING OFFICE Social Security Administration B. TRANSL ATION » TYPE . FACTI(S) TO 3E PROVED: i mi . REQUEST FOR ASSISTANCE (Complete only if document is sent to another office for translation.) - DATE: V23/¢6 . LANGUAGE OF DOCUMENT: KussAaal : PERSON(S) FOR WHOM PROOF SUBMITTED: (If married woman give maiden name) . ALLEGED DATE EVENT IN ITEM As4 OCCURRED: (To be filled out by official translator) 2. DATE EVENT REGORDED,IF 3. DATE DOCUMENT ¢/ EL Bathe Cost cafe 4. TITLE OF OFFICER EXECUTI show Bl uy ) | ISSUED: Wh fr made at the time purported? 2... es 3. NAME Mee, f AGENCY: t _ Does this document appear to be genuine and unaltered, and to have Seen Clves (no [_] ves [_] no 7. Is Foreign Service post verification stamp shown on document... . 0. ee ee ee ee ee 8. Describe and explain any irregularities in document: Q. The document, which is in the___ Pe i language, contains the following pertinent information: PLLA GX Moe, gf ahecos Elsi coheet Social Security Administration Res Bo, LASS RECU TING comcclt nd VoCume ed, ZACS Dun A _| HW 559203eu Os G8350%45128— Page 16 ya Melee, “Waa nimice Wukelotyncg., luna Roche) IGNATURE OF AUTHORIZED TRANSLATOR O. AD (s (ore C0 oth ~ WADA TITUS DATE GPO : 1962 © - 648770
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| A. REQUEST FOR ASSISTANCE (Complete only if document is sent to another office for translation.) JL36Y . LANGUAGE OF DOCUMENT: Kussianu . PERSON(S) FOR WHOM PROOF SUBMITTED: (If married woman give maiden name) TRANSLATION NAME. OF INSURED INDIVIDU AL SOCIAL SECURITY ACCOUNT NUMBER 483 -54-3939 TRANSLATING OFFICE Social Security Administration . FACTIS) TO 3BE PROVED: DP TS S. ALLEGED DATE EVENT IN ITEM As4 OCCURRED: B. TRA‘ SL ATION (To be ited out by official translator) 2. DATE EVENT RECORDEDSIF - DATE DOCUMENT . SHOWN: ISSUEL 4. TITLE OF OFFICER EX UTING ee ( 5. NAME OF ISSUING AGENCY: 6. Does this document appear - 2 CCl unaltered, an ral ST ’ ae yes [_]no hie 7. Ts Foreign Service post verification stamp shown on document... 0... ee ee ee eee eee eee ee eee eee {] ves [_] no 8. Describe and explain any irregularities in document: 9. The document, which is in the... Sd omguage, contains the following pertinent information: Faumnly Name | OsusAacd [-ATher 5 MAME ' a 4 LEE PARYVE SS Tide Nome : D_ me My au niche Soe: “Hebrwang 1 16 1962 “netens gf Mtience Matas ves ee of Birth: Munk, uM, He Raspae rep! SIGNATURE OF AUTHORIZED REQUESTING OFFICE: TRANSLATOR | Social Security Administration | |e IG, Kel esfafon age = Jy 23/04 TIT Nw 55925 °"BOMGSEb IMI o8 Page 18 GPO : 1962 © - 648770