(104-10219-10446 . % uo ° ~” SECRET Spee acaba PERSONAL RECORD QUESTIORNAIRE PART fi = OPERATIONAL INFORMATION ENSTRUCTIONS TO CASE OFFICER 2. This form-ausl be fsifed in by the cane officer o sppropriate authorety on the besia of the beat available ine formatseo. Ft #6 not fe be shown to the subsect. 2. Neraaiig, headquarters will be unabis fa issues an epproval uniess requestes furnishes saseers to of 8 questionn in P@, gerte § and 33. However, 18 om emergency provistonal epprovwsi may be obtained by compipeng with the “ape eliceabie pgrovisiors of FR 39-3145, paragraphs 68, g. $26 and 27d. Thereaf’+s the asyal method to document of coa- plete the case must be followed as set forth sn FR 86-339. J. Faree (3) completed copsea of PR port F ginedudsag copy in subseetis henderitsang, if postibley asd two (3) com: piloted cagses of thes fore aust be seat fe headquerters ae 800m 88 possible. 4. Date acquired later ust be sent to headquarters sa PRO foreat is ts0 (23 cepees. $. Fill em off jteas, f gaferaation obtasmabie. EF stew aot applicebie write °NA.* BF additaonal apace required foe item, wee severee asde of page keyed to-appropriate iten number. a. CRYP Omen | LXE} SECTION f CONTACT AxD GEVELOPHERT z- PStuSdaver ek ewer Sp we te BO t iNDicarge MOP, BHEN. BHERE, BHY, AND BY WHOM SUBJECT 845 FIRST CONTACTED OA OLVELOP EB, . : Case Officer, Clyde EK. SERYOCK (ps), mo%e contact vith LTZAMIL-1 on 21 Getober | 13959 (see MaxT-5554). Case Officer vent to the business office of Subjeat as @ i | *fptend® of Gustave ABCOS y Bergass, who is presemtly Cuben Aubessedor in Brussels, i Esigim, and forzerly a eontact of Case Officer's while £PC0S was in Hexieo prior to | [the Gouafall of RATISEA. Case Officer meds contest with Subject in oricr to "feol | [nim owt! re his attitede touard the CASEMO regime. . i Station, throwk LIELUAT, was able to evaluate Subject wall before the approach - i / : a> PMDICATE WHETHER SUBJECT COULD BE TUANED OVER QUICHLY AND IM A SECURE MANAER TO ANY RESPONSIBLE CASC OFFICEA FOR HANDLIGG. IF $0, INDICATE TO Boon. - ‘ Subject could be turned over to any Cave Officer with a spasking knowledge of" ar 3. KIST OTHEM CASE OFFICERS BHO HAVE HANDLED SUBJECT OF BHOU HE KNOES OR HAS KNOWN, GIVE NAMES By WHICH THEY HAVE ; BEER ReOeR. : : i Bene. ae ae weit aN tel Foru NO. Sa PEP aces Form stage sar 8 MOV 56 10 WHICH way BE USED. ot ose r scwwane + seutaclanesdigbetusinrve sercBie aA a NEED EERIE. phat ROE ETL ECU RMON Hei FS ETE 10 OI rate te RO Te a 0 ‘A a ey FeO PT oe ! a - “ a taRngpe cyte kd aot seve welt ay a woe wt Begin PTE egomarc” fe Tg MAb Rye efi s t a pet cel ee eeu re GR a he eR te ere TO nL. 2 Tee ete orn Sen et ott . sama TB artage oF 5 ve
ene. nett nct OE DORN PLT Ny Blan SONI AN Brel A eiafarN te ete apeitne Hoten Ren pe SECRET SMCTIOn MOTAVATICR aa. CCBTROL #. ESTeware $+ paecee S$ BOTevATICOn, (Be detailed, sf porssbie cate avadence. Bo not uae stack comment sack as “ant ie foemunset * Suojece, a highiy motiratea Cuban pusineseman in Mexieo, ewmported the 26 of July a Hevemant for idealistie reasons, i.e. rid the country of BATISTA end bring demecracy : || again to Cuba. However, Subject haa bean convinced that the CASTRO regime has been D8 infiltrated by Cammmists and CASTRO, his former friend, has done nothing sbout it. 5. Subjest, therefore, is motivated by. patrictien,.i.e., to rid Cuba of. the Commnist the United States, + ReSped « “Pe. @MGtCATE Brat COWTROL, €F AMY, EKISTS OVER THe SuBsECT. (Ff no control, of af there a9 @ fack of reef control — “dade Officer has Little control or no control ever Subject, it 4s more of a i fo eet Tid OF CARD  enseot fe willing to cooiet PUFEDE in its desire | to get rid of CASTRO, SECTION 286 : Covet §. COVER USED BY SUBJECT AG CASE OFFICER UM THEIR MEETIBGS. Rorting usally ot LERAMEIA1‘s business offles, where Case. Officer could pase as & client. 2. COVER USED BY SUBJECT 1% GATAIBING HIS INF OOMATION AUD 1m CONTACTING WIS INFORMANTS. Subject, & long tise friend of officials of the Cuban Bxbassy, werely Listens to is friends relate their problems and activities. 3. INDICATE SERVICE FOR WHIcH SUBJECT THinns wk (Madl vorky C7» working). - Subject knows he 4g cooperating witha PHPRIME intelligence egenay. _f SECTIOM 4¥ GWVELLIGEMCE COMMECTIONS ANO TRAIH ING a pte ERPUREM SUBJECT*S BNOWR PAST OR PRESENT COnMECTION SIT aug OTHER INTELL EGENCE SERVECE. INDICATE THE CRTENT “ Syte CONNECTION £5 auOOM CYEa@TLY. ‘ete ee ee ae nee wetted for. any intelligence 758 ee however, 2. | ecxvice of duly Movement during period 1957= has equipeed + | him wal for intelligence work. os : .@ LEST OER INDiViNUALS (agente, sedatives, fesenday BHO aude OF SUBIECT'S PREGENT ENTERLEIGENCE- ACTAWETIES, itriiie? kuows Ghat Subject is cooperating with FarEing. 2: GSPR Ale Amv TRAIM ING SUBJECT HAS NAD IN CLAMBDESTENE OPERATIONS. : Bene. Tovever, fibject ves involved in several clantastine novemaute while [ Srevemror of the 26 of Judy Movenaat during 1957-98. COLLABORATION POTD: TIAL ‘t. INDICATE OTHER COREL GS POSER SUBJECT BOULD BE MOST LIKELY TO COLLABORATE with BECAUSE OF NIS IDEOLOGY Of ASSOCTATIONS. EXPLATH. gue one a z B og pap reser ONE ELIA Bil oh sees ame RA Beha el ed eee napa eel Peay oe et rican dire Uapemtte cage He RARER ag Tee egg ashe 2 ager teydertepargs’ EAE “peste
14-00000 . ; ° ’ - vy . , » . ts . , : at % . - - a : . . . nee : sta of SECRET i . SECTi€M vi - CPERATIONAL USE - ComTACT . oe . : 1. OF SUBJECT HAS SEES USED Of COMTECTED Sie Gas, Pedi Cate ACTiwsty im eich wk PAS ENGAGED BOL "HE TYPE GF fer ake . “1 é MAT IO HE HAS € SUE SHEE, + . 3 ; During 1958 Subject was avare of Gustavo ARCOS' contact with the Case Officer i @nd on ore oseasion called the Case Officer to say that ARCOS would not be able to Bo i ake @ meeting. . . yo in : fo - : 2. ADICATE HOW AUD FROW EHOW SUBJECT OBTAINS FeeGRMATION. | Subject obteins his infomation from officials in the Cuban Eabasey.es a friend. - |: 7 3. G@ORCATE BHAY mG BEER TOLD SUBsSECT AS TO Td SISFOSITION OF EBFGAMATION HE FURHISHES. os Subject is evare that the infomation he provides ia sent te Yealhgton. . . ree 2 ae eeees 4. GETAIL SUBUECT*S PROPOSED Fi OR Ci TVPE USE GR DUTIES. ‘Gubjeot will assist in coordinating anti-CASTRO activities in Mexico as part of : * S- DETAIL SUBIECT’S PROPOSED PR-Pe TYPE USE OM SUTTES. an se “ PROPOSED LEAISOM OR OPERATIO@AL ACTIVITY. fF FAME ABER a Bk Sree DS FE NONE GAOT tL stn a eat aD EF ORME IaH aE ee A Seem RIO ERMA (t MO mE oe 1 | a 9. GHERE SUBJECT €5 am OFFICIAL MEMBER GF A. GCTORE AGENCY: i i { i “TSECTiog Wilt AGENCY RELATIONSHIP WiTs SUBJECT f- EXPLASH RATYRE OF AGERCY RELATIONSHIP WITH SuBsecT. §.€. TRAIMEE, OPPOSITE NUWBER: AEMUNERATIOW. §F Amys. AGENCY PEQSIANEL KNOWN TO SUBIECT. pene Rees Subject is an umpaid field agent of KUPARK, . wea 5 ay papas peeie tan Mees 1 ' see na “ "SECRET a eA ION OR I Lem SRC TIMOR ERNE Rm NEON 6 Th ETE Reitman aptentaen tin ate a swim ated Ae 3 , . a co wt : . : . - ' ~3 . . ” Loo TG Nee De as 7 * . oo . us o t ¢ . 4 bd . a 3 f i 22a ' tne ey ~ ey 2 cu st . ate, . SERRE ATE Seat Ge Beaten Yee Panetes PAT 2 ones ot Ass teheerhl wide suet Ber BEN oy Bag tigre De pies,
14-00000 3 SECRET QUALIFICATIONS FOR GTHER OPEFATS ONS TALENTS, OF GUAL ITEC ATIO~S POSSESSED BY SL BJECT HICH CindS CONCEI VAG © Bf OF VARLE SNDICATE SPECHAL ABEL ATIES, FOP NteTs “PT AasTic .8. Subject |and therefore could if necessary provide printed material clenideatinely. if GY 83 PROPOSES TO PAY SUBSECT A PEG LER SALARY, FMAICAYE THE WEERCY AMOUNT. COMMODITIES. SUBSIDY O8 OTHER METHOD, SFECERY ANDO Gi¥E OETAILS. Subject will te given gifte at appropriate times during the year. if PaewssyY TO SE .waAdE-~ te EC Asse : EXPLAIN AY PROMISES, QYHERBISE BOT COVERES wHEREin, wase To suBsEcH. (Leanpie: Comméteents cogardiag evacuation of subject and famsiy.} AHOBCATE OVWER BAVESTIGAT?i vE MEASURES Yadie TO VERIFY BIOGPAPHICAL tRSSAWATION FURNES“EE By EYESECT. A @inensiad check by Dan ang Bredstreet was also run on Subjest. + ENDICATE GHETHER OR KOT PROVISIONAL OPLGATIONAL APPROVAL OR OPERATIONAL AP- PROVAL FOR SUQJECT'S USE HAS BEEN PREVIGESLEY OBTAINED. 4. BAIT APPROVAL OBTAINED EVALUATE sumsters. CuamacTER, “pELiagivi ty AnD SECURITY, CEVENG RYIDERCE were posstat. ig.@ liberal .Cuban businessman who -dodieated tins and money to the — Cries 06 ef Inly Movesant in Meaieo during 1957-56. He is of strong character end eee eee oot ca Prrchad, exeeegt  e nny in Haxhabe Be is an independent thinker emi cannot be “paghedi exound.® $- CXPLAGR ANY SETUATION OR INDIGCRETIOn- Fr Sei SUBJECT WAY HAVE BEEN IMVOLSED Bute tS GE EVALYATED FROe A o/ re Case s Oftiser kes met LIZAMTL-1 on several cecasions @aring the past year at hie beshess office. While at tke office, Ricardo VIDAL Dominguels, Cuban Chargeas bas been Case Offiesr at the office anfd-on two oceasions talked with Case Officer. LITAMIL-1 believes that VIDAL will not talk about these contests te.Ceben officials. SUBJECT'S PERSONAL HABITS PAR aMOURS. SECvION Ril 8. USE OF LiguoR, DRUGS: . Subject not mow to have exy obvions vices. Co ete teh ta GasBh tee, SECRET. Pearriteren Sone wos tat wt tag cone .. . Feu pan de gabe tgedvanae d On ataciet ithe mi Lanett
’ ee eres « . x $- $@DICATE SuBsECT’S HOBBIES CH IMTEREST I SPORTS, muStC, ETC- Bexing enthusiast SECTION XIV GERERAL INDICATE BHE THER SUBJECT’S LamGUAGE ABILETIES AND OTHMLA CHARACTERISTICS, OF & COUNTAY OR REGION OTHER Taam #15 ObN. CHPLAIN, megs ee neat ta Nemec te ae ERAN meee Pare ay Sabjest could -pass-aa a native of any latin American country.” ~ fROTCATE GrETHER PNFORMATICN 0% #RO PARTS § AbD Of GAS OBTAINED CORRESPONDENCE OR OTHER WEAN. Information obtainsé throvgh LIFBAT, neme checks Station files, Mexican Govermzent files, Dun end breéstrest, and Headquarters. BY RESTARCH, CLANDESTINE ASSESSMENT, THAN BOUTIME ACTION £% RLOUIREB, 435, aupeay t® OTHER ae para, - GivE FULL OL TAILS 8.6, WARING CONTACT USET RECOGRETHON SIGNALS, S/s an€RE COLD CONTACT BE ware: WHAT SONA FIDES COULD ne MISCELLANEOUS OPERATIONAL GATA AND REMARES aM, Ane ton - ween ue ate toy te heee ages . 48E SUCH AS ME COULE PASS AS & ATIVE IF AMO WHEW TERMINATION OF SUBJECT 6S EFFECTEO. PLEASE €xPL ain. spe att bes 4 2 AEA tae Files, (also rt 4. INDE WE CVAL t eae B? ee ote nT an Cae