4 ; } at 3 : +3 , i - 4 3 3 : £ Ez ? z 2 . : “2 t bey « . : a a § : . . ‘ . w . ’ : ‘ 4 . é 7 4 + eMabes sesecs Sesto tudes we
APYFll & May LY0Y , OGC St. ,ect: NOSENKO, ri ’ rT \ 6 9 , ' ‘ " t. : . ' -t L, my : i : py hey , . iW oo : : APPLICATION FOR SOCIAL SECURITY NUMBER . au (Or Replacement of Lost Card) — : 4 information Furnished On This Form Is CONFIDENTIAL . DO NOT WRITE IN THE ABOVE SPACE : : See instructions on Back. Print in Black or Dark Bive ink or Use Typewriter. . H uo 4 Print FULL NAME * ae (Middle Name or initial—If none, draw line—)} Pu i YOU WILL USE IN WORK <9 . : OR BUSINESS M. 107. | i : Print FULL ae NATH your (Month) (Day) (Year) : NAME GIVEN : A DATE OF . | CS | YOU AT. BIRTH \ 07 jad em = =64¢ 0661S 28 4] : i i . f bed a YOUR COLOR OR RACE a ; Tt NEGRO OTHER : aa: Ug} FOR OR HAD A SOCIAL SECURITY, : tN RAILROAD, OR TAX ACCOUNT NUMBER? 4 ff ManING : i CH ADDRESS . : 1 TODAY'S DATE _ : ; W422 April 1969 | : TREASURY, DEPARTMENT Internal Revenue Service Re . : DMINISTRATION DISTRICT OFFICE ; : Form $$-5 (12=64)} HAVE YOU COMPLETED ALL 13 ITEMS? : : Nc at rtm api wareeneans enantio ferns ene ae ant vara ayspenenine querer ee ye 1 t ! ‘ ‘ . t : : . cane aed ' LF ry aan ‘ . “ ’ ’ 1. bh a : + . ‘ i \ t o : . ' n : aot
at yt DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE SOCIAL SECURITY ADMINISTRATION (Gy SECURE Dy og) NUMBERZ 4 { 4 : y 2 atatraaacant ta 1 ~ 2 Haste saocarndinuteds TY -cBetsa ASH Patan Ba Lacie camel Bi dtl occa Sa tieiiataiataad su y | FILE —— | e SIGN YOUR NAME on both cards. . . ; THIS STUB | e REMOVE THE TOP CARD ond carry it in your X wi IN A SAFE [he ai wallet or purse, or keep it where it will be handy. N \- e LEAVE THE BOTTOM STUB ottached fo this PLACE AS holder and keep it with your other important papers . _A RECORD such as birth certificate, insurance policies, etc. ~ OF YOUR (SIGNATURE, enemas @ FOR IMPORTANT INFORMATION, SEE OVER \ ‘N FOR SCCLAL SECURITY AND TAX PUPPESES— het Fu ENURCATION NUMBER —_ ” + 4 “a Ww a capi dpeta ss PH,
—_ : ov ; REFERENCES — Robort T. Foley Company ASSIGNED TO CHECKED BY “cceceeceseeseunasseesumacinacicassuaes Builders/Developers/Managers ADDRESS oceans eeeecreeemeree ne ey a 1100 Connecticut Avenue, N.W. DATE cecccenccsensnseersnsssuesomessssanesvenenssseresscessaanecesoee Washington, B.C. 20036 RENTAL occcssessssessneessecereenmnet ene eetenenmnetrae Telephone (202) 293-1133 ‘ MGS, APPL nnnesnmnmnneneatmnntnrntnem - ERE. DATE cocccsecen cence ence, i APPLICATION FOR RENTAL OF APARTMENT AGO cwacsasercenee 6! * Wite’s or Other Occupant’s Name cscs TLOME.cscecesetsssseescnereeseennntnseccecnenentesvsnasonnensnnenagenenss tet te ee Present Address Apt. 1C North, 1025 Fifth Ave., New York, N.Y. 10026  cceeenearesaese Phone econstcsaeseeseaetoere * Present Rental Agent Michael Swift... LEigh 5-3459 sneteceeseecasseees « ccepuesuestuacaeessesceeseeneeaes Present Rental Amt.....9400.00........ ; Have you a lease now? ......4.2.5...... When dogs It expire? .......... April, 30,1969  cecceeesvucesvacsuecanavensucsnnversestisessecesnaserasscaccaneeqnareneveraumnenmaaaes 7 Previous Address ....... ELAM Funct GOLMADY. a cemeemnnenennenneninnmannitnts inte etn _ _ ~. No. of Childran ROUGE... AG@S on. ees esse eeeeeneeseneeseeee No. of Cara .... none... Other Vehicles . ceseasees NONE... Pats ...... mane... "Names of any occupants other than immediate family: 1..........---.-.--- TOME, cocccccecsssssscesassanansnnesessessusenvsenssssonsneeeesussensentvat “ecceueresansessavecsenneceesuneese _ os cccccssssatiestuinutentseesertneetnngenesunepnecesensnesnnaunsnnenunneinanctareenat © B cccececesnssssesensinasanentnaytnnssneasnnntnnenisnesunesneneuanenaeseceennte — Approximate Income of Applicant .......... $15 4000 POT VEAL ccsssasssscceseecesessssesesseesen Income of Wife ............... TIQTAG.....nccacnccasensorsessses a Applicant's Place of Employment “Linguistics. Services..0ffice,.HQs,..Repariment..of.Arny sccsuesscssusnssesssucessaeceenateneees : : Washington, Dec ccssseeemnseccenmessseemensntset Phone OXford. 70 no Eet, essanenecereae vecucocucetesesrasuensuensuaceeuacaaconsaccerssessonevsnsesnernesonessesnsassssacersavasaanessaressgeasenesnenese ens seneeseeeeeeee ee ene es eee eee CCGG GS A Pererrerresrie. Oe eC ar ne sassnieecsibeeenesencssDenassenanncacuovebosnencnmanaesauaasnceneanaanenensetneeeeeeettt ete e eee IGS ~... Wife's Place of Employment .....---s.e--se-sssssee TOTS a scscsssesssuseceasnessensecenseserscnsesensnasecsenaseectaeesstenesestae essustsnseceneeeeeeceseestesemanannananenercerascsuutamtan wee Personals cece eB eacecceessesnesnereneeesenenessnsnees AGGTOSS atch anccsresen stein testcase erie diol oo SESS , Business: ........ Supervisor decsescesscssssesenssarsestussacsesseanerseues ACCr@SS ....--eccescceoceceeenceseserentterenscneeeesens desecessenees PHONG ......-.-----esseneee - : A deposit in the sum of $.......... cesaeeenvesseseseense is made herewith as a security deposit to be held by Robert T. Foley Company with thes clear understanding that this application is subject to approval and acceptance by Robert T. Foley Company; and If approved and accepted * then the applicant agrees to execute a written agreement or lease before possession Is given and to pay the first month's rent within five (5) * days‘aiter being notified of acceptance, or the deposit will be forfelted as liquidated damages. If this application Is not approved and accepted, by the‘owner, the deposit will be refunded with the exception of $5.00 which will be retained for the cost of the credit report. The undersigned. + makes’ the foregoing representations knowing that Robert T. Foley Company will rely on the accuracy thereof in acting on this application © . . . . : cd . HOW DID YOU LEARN OF THIS. APARTMENT? oo . ‘ Notes ; “ff: Evening Star - () OrivingBy pot BO,  BIGMOM o.caceccsoeneeee wicessanuaseseeees essussseuassevenscseesss sssnuseeaneesen secateseseuvesseoese wnssenea tt °C) Wash. Post... CJ Other ............ seomeeteeeseenes _ ; ms --, - Appiteant ee BQ Felon’) + cesssccsrssnnessessece sensenceeee seoeee ce, SIgn@d ....crcsccsscneseosereasenss secceueesseuzececausecessessseuenessaveqreaeueaqauecsersnsssesesseovennnateg§i eee ee a re "Applicant, care re : oF a area " + ee a ee EE FTOOLE SFE NGO OYE poe ee reyes oper opt me RTE be odds eee ae dy en ee ae GT Te ie
DATE OF BIRTH: 15 April 1928 PLACE OF BIRTH: Karlovy Vary Czechoslovakia CITIZENSHIP: Czechoslovakian Entered U.S. at J.F.K International Airport via Pan American Airlines Flight No. 1 on 17 March 1965 destined to Al Palocsik, Fidelity Detective Bureau, 661 Madison Avenue, New York, New York. Residence 53 Wilton Street, New Hyde Park, New York. Visa issued at Frankfurt, Germany on 2 March 1965. Czech passport #G-01684/1710-63. MARITAL STATUS: Single SOCIAL SECURITY NUMBER: 224-24-5866 RESIDENCES: Birth to 1963: Czechoslovakia and Russia 1963 to March 1965: Various addresses in Frankfurt, Germany March 1965 - 1 April 1965: Friends and hotels in New York City 1 April 1965 - 30 April 1969: Apartment 1 C North, 1025 Fifth Avenue, New York, New York 10028. Resident Superintendent is Mr, Michael Swift,” Telephone 212-LEigh 5-3459. (This is a very: large fashionable and expensive apartment building on Fifth Avenue). (BK
. ae > ° . . . , “6 . . . io 2 ? { A a . '
4-90000 3 £ DES ee MYM ONE SER RES peste mAb a gershepeen 1s Mire «6 ~~ i i ee 2 LAL AR CHUA ACR UM VteeaeMON ery Pon is eto nc et Wey ASU ENR EI ae a LPR RAN oR BA BSNS = ROR chad aty Maat ih” Peg SN At tetera drain : “- we