404-10177-10097 . . SECRET ten cetihan a neme meas aemaaamiananietae aman a aa ana enn i . PERSONAL RECERA CUES TIONNAIRE i Part Pi = OPSSALFONAL ENFORMATLON [ersrarcy 90. —— ie vatiol E93 ENGPFUCTIONS Tee CASE OFFICER the Baais af the best svesfabie ia- t.:FAte focw ovat oe Fatbed am by the cose ufficer ur appropriate suthorety on formaftaan Ft 23 at to be shown to tte tabyect. a_i = 2. Aceastiv Restguerters wall be unshie= tq a9sse an approval unless requester furnzsshes onsvers to of) questions 19 Pk, parts Foc Ui. However, it an #rergency provesional eppraval may be obtained by complying with the sp- obacabie provisia-e of FR fo-F1§. paragraphs 68, §. U3 and fad. Thereafter the usual method te document of com- abete the case wes: be fodluwed as sef forth an FR 10-925. . # Yheee ¢ 3} complete! cusses of PR, part? I (anciuding copy in subject+s handwriting, if possible, and two (2) come- eleted copies of this form must be sent ta headquarters 38 soon a3 posstbie, $- Date acquired iater must be sent to headquarters in PRY format in two (2) copsea, §. Fill in aff stews, «¢ tnformatson obdbtasnabie, If item not applicable wrste "NA." 2f additional space cequired for stem, use reverse side of page heyed to appropriate stews numbge. or ~ = 2. PSEUDONTM tisheel M. Ghoaden CONTACT AND DEVELOPMENT, re. EMDICAVE #O8, WHEN, HHERE, WHY. anD GY BOK Sussect WAS FIRST CONTACTED aR “‘pEvELOPED. CRP PON ar, cs) o ® Firet hired as contract arent in Santiago, Clile, and subsequently nis @<, EUY staff o:flecer. ; om | BoP og) “> ak Zz Jo « UNDICATE RHETHER SUSITCT COULO BE T2RSED OVER QUICKLY AND 3% A SECURE MANNER TO AKY RESPONSIBLE CASE OFFICER FOR HANDLING. JF SO. {8GtCATE TO WHO. ‘ . Subject cad be turned over to any fairly senior KUEAMA officer for handling. oy aa * 3. LEST, OTHER CASE OFFICETS WHO HAVE HANDLED SUBJECT OR WHOM HE KNOWS OR HAS KNOWN, GIVE NAMES BY BHICH THEY HAVE SEEN KNOWN. As.a formar staif azont and staff officer Subject kmovs hundreds of XOLCVE ease officerse : pe gt . Pr . BA fe rik . dew. 40. K TePLACES FIRM $4- 958 i : aa a (9+20) PONGY 56 195Qa WHICH war 8€ USED. SECRET aan . Y F ys . aah ae Re a 2
14-00000 ' e . . .- i . . . SECRET AvEY 7 SECHIGH ER | eee oe MOTEVATIGH AND CONTROL . _ ececewte ce umm teenie vee vee ‘ eStimare suesect: $ VoTivaTioN. (a. det wiled, it porreble cata evidence De' not wae ator ch Cytron? such a9 *anteo comeunrst 3 f Subleet’s notlvaticn has been dencnotentald to oe of a high order during his ~ EUR apnloymeate & 2. ins CALE ANAT CONTROL. 1? ANY, EA'STS OVER THE SUBLFCT. (If mo contiol; of af these sa 9 davk of teal cantrol expiaan, 3 Beg. Subject’s contract Lnoludes the veual secrecy cath, violation of which would be puninhable under the tems of tie Espionage Acte : SECTION 148 1. COVER USED Hy. SUBJECK AND CASE OFFICER @M THEIR MEEFINGS...- Subjeet and ease o:.ficer have known each other soalally fer several years, and their meetings are under social gover. 2. COVER USEO BY SUBJECT IN OGTAIMENG HES INFORMATION and 1M CONTACTING HES INFORMANTS. . Subject has a public relations Ilm which provides 1 hin with cover to cbhiain iaforta tlotie 3. INDICATE SERVICE FOR WHICH SUBJECT THINKS HE (Wall work) (19 working). . Subjeet tmovs he ie woreing for KUBAEK, . ‘SECTIOR EV INTELLIGENCE COHNECTIONS AND TRAINING 1. EXPLAIN SUBJECTS S KNOWN PAST Of PRESENT COeNECTION Wht wiih ANY OTRER INTELLIGENCE SERVICE. INDICATE THE EXTENT SUCH CONNECTION FS KNOWN OVFRILY. Subject has no past or present connection with any otner intelligence services 2. LIST OTHER INDIVIDUALS (Agents, relataves, friends) WHO KNOW OF SUBJECT*’S PRESENT INTELLIGENCE SCTIVITIES. ANULLA and ANULLA I are aware tint Subjest bas a connection with KVEAIK. are 3. EXPLAIR ANY TRAINING SUBJECT HAS HAD IN CLANDESTINE OPERATIONS, ° + .. Subjest’s training recort is on file at headquarters. , a, . SECTION ¥ : COLLASORATION POTENTIAL INDICATE OTHER FOREIGN POWER SUBJECT WOULD BE MOST LIKELY TO COLLABORATE WITH BECAUSE OF HIS FDEGLOGY OR PAST ASSOCIATIONS, EXPLAIN. None 2 secrer TY aA aggponagneye semiprime nee py tte segs as cane
SR ERATION AL USE - CONTACT SUOsELT BBS SPER CRED GR CDM FEL TED Ba Oke MATION HE AAS 6 Arka me ne ne ae tener ene eee ane peMee 7h alTt we Tr tH Pe WE WAS ENGAGE ANY Tok Thee oe Subject wea a ALGAAS eteff apent in Hsbana in 1956, thr IRs cs SECRET wuss ‘4 SECTION Vi 1.008 \ \ \ 2. INORCALE Md AND FP ROw BHOM SLBIFECT CBLAINS sHFOAMATICN, Subject hes sany contscts in tho newspaper and advertising fLelda. 3. INDICATE OHAT MAS BEEN TOLG SUBJECT AS YO THE DISPOSITION OF INFORWAT TON Na FURNISHES. Subjeat ia familiar with intalli,ence processing procedures. w 4 OEPAIL SUBJECT*S PROPOSED FE OR CE TYPE USE OR DUTIES.: , Subject will provide infomation which he obtains in the course of his normal business activities. t 5. { DETALL SUBJECT’ S PRGPCSTO PPP TYPE uSE OF SuTIEtS. It is anticipated that Subject will develop and orerate Q projoss which will provide a newsefeature television pro,:ran to Latin Aserican television atatlongs. SECTION Vil PROPOSED LIAISON OR OPERATIONAL ACTIVITY f. GETAIL SUBJECT'S PROPOSEO LEALSON TYPE CONTACT OR OPERATIONAL USE: a. WHERE SUBJECT 15 An GCEFRCIAL MEMBER OF A FOREIGN GOVE ANMENT: WA B. WHERE SUBJECT IS AN OFFICIAL MEMBER OF AN ODVOME AGENCY: SECTION Vaid & AGENCY RELATIONSHIP wiTH SUBJECT ay ’ - ‘ 7 5 - ' * . . be ExPLAIH MATUPE OF AGENCY AELATIONSHEP WET SUBJECT: #£.£. TRAIMEE, OPPOSITE MUMBER., REMUNERATION.” TF axy: AGENCY vo. PERSONNEL KNOWN TO SUBJECT. . , , Contract A:en$ 7 a “se ‘ SECRET, ” pte te ae keds romerdey es f. . \ in ew far ae wean TRE PORTS
oe . . KRY ui. SECT OX QUAL TFC ATECRS oR OTHER OPERATIONS *. TMEPCATE SP Eo: AL ABLE PIES, TALPMIS, Ua Tyat SSN ONS KO GE Soe BY SUB PECT Bete ¢ GH QtmEw DPEGATIONS, Sublect hes bon a lecturer on latin Anextea, and hss had experlense in radio projraniine. . DP tow lee hOly RE FF wae £ Section & COMMITMENTS #. ¢F 97 1S PROPOSED TO Pay SUBSECT & APEC AR Savaee  ENGEC ATE TMh WEEKLY AMIUNT. TF PAYMENT FO BE WADE IM EACH ANGE COMmMGGITIES. SUBSIDY 98 OTHER WETKUD, SPECIFY 489 Give DETAILS. Subject is belng paid §C00 per nonthe 2- EXPLAIN ANY PROMISES, OTHERWISE NOT COVERED HEREIN, “WADE TO SuBsECT, (Etarple: Comnsteent's regarding evacuation of subject and family.) All commitments are detailed in Subjest’s contract. SECTION XG , AND SECURITY : : +. INDICATE THE FELD AGENCIES AND FIELD FILES Whe WHICH SUBJECT'S NAME HAS SEEN CRECKED AND THE RESULTS. Ae a staff officer, Subject had a econplete field and Hasdqvarters inves tign tlone 2. IMOECATE GTHER INVESTIGATIVE MEASURES TAKEN TO VERIFY BECGRAPHICAL INFORMATION FURNISHED’ BY SUBUECT. . Hone © §NOICATE OH CTHER GR NOT PROVISIONAL OPERATIONAL APPROVAL OM OPKHATTONAL AP 4. Bare APPROVAL OBEAINED PROVAL FOR SUAIECT’S YSE HAS BEEN PREVIOUSLY OBTAIyEeo. - Full clearance as staff officer. __ jAvallatle at Headquarters Ss. FVALUATE SUBJECT*S CHARACTER, HELPABILITY AND SECUREIY, CHTING EVIDENCE HHERE POSSIALE. Evidence of Subject’s character, rellabllity, and security is contained 4a : Bubseet’s personnel file at Headquarters 6. EXPLAIN ANY SITUATION GR IMDISCRETEON tN WHECH SUBJLOT WAY HAVE BEEN INVOLVED WHICH “UST @f EVALUATED FROM A tye pe. CEAOPERATIONAL SECURITY VIERPOINT. - oo? None SECTION Xit SUBJECT'S PERSONAL HABITS Jf te USE OF LIQUOR, DRUGS: GAUBLING, PARAWOURS. : o Hoderate use of liquer. SECRET gyre : . . . : : ' j CRs eee
14-00000 SECTION X04 _. ce eet eee A ki VW SECRET ; Lies AVOCATION AL bATERESTS FOAM LAD & BAR LTS HOBBIES CH Late Bese Subject is interested in awimoing ano sidandivines w% SPORTS wee fi . vere eee eee wee ee GE Ve ENDICATE WHETHER SUBJECTS LAWGUACE ABILITIES AND OTHER CRARACTERISTICS, (ARE SUCH AS HE COULD FASS AS A NATIVE OF A COUNTRY GR REGION OTHER Tey MES Con, ERPLATR. ° Gould mot ;asa as 4 native ef any other country than the United Stated. SECTICH RW INDICATE WHETHER INFORMATION 1% PARQ PARTS + AND 11 WAS QBTAINED BY REST ARCH, CLANOLS TINE ASSESSMENT, FILES, ae CORME SB HE A ays GStsined Yréa Babjeot and fre fLles. 3. IF OTMER FRAN ROUTINE ACTION 15 ACQUIRED. (Ff AND WHEN TERMENATION OF SUBJECT as EFFECTED, PLEASE EXPLAIN, (Also gee part. 3b, supeay Tersinstion comiitions are incluced in Subjects contrndé. SECTION XY EMERGENCY CONDITIONS RECONTACT ARRANGEMENTS f- GIVE #uab DETAILS 2.E. RECOGNITION SIGNALS, S/Wi WHERE COULC CONTACT BE WAGES WHAT RCNA FIOES COULD INOFVioUAL MAK ENG ‘Gntag OSE? . Céntact aould be mace by any of tha many KULATK persona he knowge . . : : SECTION X¥E ; = MISCELLANEOUS OPERATIONAL CATA AND REMARKS 2 nen eT ray yard Ot SECRET JO f-- IS fos