14-00000 SECRET beh Pablo tae SECTION ¥ CORTIMUED FROM FAGE TTP TSE IOAS @e te mune asee NES aan ant AERO Rr eer See e. Pata, voce, State, Cunntey } wae Fes Cag 4 h say. al €§ pa ae Set! oc. Aes; Saus Gr Cys rr trics ve Fred sea! ICES TARE cue QMAWE VOL eee BEae TN, PLUETICNED Fie, MANA Re Pre AL UP Yel ae ANSRE REO TPES Ta ves we {he NUCSUTUM 2 @8OWE ited PARTICULARS, ENC LUO NY CQumt Qs Garin ts 2) @U SECTION WE _ CartzteSHiP - @ tT. COUN ERY OF CURRENT CHa sins a. Crease wceee® AC GUERG OO Bros Cuan fRR ONES U S. : (4 Te oe eee cq wouee GSpensty pe 3. HAVE YOU PaseN STEPS Po creanGr YOUR 4 Giwe Pa Pca ans PRESENT COLEZE NSH Ee? Toye Cit: A ay ae | STATUS OF YOUR APPLICARD Aut Be EF YOu wave amore FoR ug. ChTige Pee ENDTCATO FALSEMT = t . Ay wt, » SESECTION Vil ECUCATION . 8 = a ne . be CHECK PND bese rivet Of EOC aAtIcN Alta Nap tess Han HEGH Qemco weanwnth - Peta fee te eae aT vetted + 8 Breed - 7 Abo TOMER See a th Peane, BUSERESS, Ce GuwBer es Pat AOMOOL eavuate fer FaRAN Cok ated ae dbase ee somes - 2) CLR GP OF UN EVER ULDY Stuns . Dates. DS ATTENDED Ub here ‘ites gtk MAG ° NAME AMD LOCATION OF COLLEGE OR UNEVERSETY ‘ . Cd? ETE . are i . =e fece fapecaly} . era meee ey te ereiannysaannuraangssnnge— me one == . 3. FRADE COMMERC AL AMO SPEC TAL ESI D SodoE Ss - . . : PAILS atbtnurg tata MAWE OF SCHOOL "Fue Ge sPReCEAL IT 2aTION - - : 4a. MICTasy VHarNing CFudl tase duty in apecialised avhoula auch as Ordnance, Lotedlagence, Coaaunigatians, etc.j : : ORTLS AF heen sO" tata NAME OF SCHOOL STUDY OF SPCCLAL IZATION wLtn: ERG S. OTR FOUL ATION AL TRAININE NOT GNDITCATED anave 3. . . *
TNSECATE PTL Pum era res Gare. ANT fects, maveta, shorf efuriee, ete.) B. INtrcate ANY HEVICES mites Pe OREST AMY PUDL EC SPE arth de MBER RECAP Gey Pec e Rr wee OH WO. Last any PROVERTION aL, 8h at Pe ORTEY ANY GEONTAPC ANP Pint i Sat ATE RIAL qT ON MAY UMVES AEE Bet) i WiMArH, LEST ACADEMIC HORUS Wo HAVE (Prune and Tur) tM UStvE, GAPE Serr 14s 7? NO. OF LMPLOYEES UNOFE eSyh HTREET SUPERV ESE OM “ : CUSCREIP TION OF PuUrEes . ! i - LC beru es vem r - errs Raia BRE BEES tb} } is 9%, ° ty t FEE Pte o Feey ence = SERCE LAST COMPLETION OF & PERSUPALL GQUALIFICAT cee ate ne mem en ee De mp ee ee ; oCURET ey tahoe Feb bat fae ese remyeare f | SECTION & COMPINUEU Fe fact a copaee us G6 miereas ete ADL feck Age paket yER oF amitinng (None fretast. actenftitee wor licdieu, gereral interes? tele re RP ATINTED wert lath SRN at @EREL fOrmwioie & PaTPOMUA OR SOCTE TEES fo. mi ffod eva ABN SO OR Ring eto. ONS QUEST iGwps ee ee ep dt ft. OFPlensoive PONT BRANCH OF BEST GNMINT ad. ne ye et & ATRL OCLAL PUSETIGH TITLE rr FL /O ATES &LOUA PUA the h Pan pe bad tos wl. Wwe a : ¢ foes tra bans 2 femtere ea ee anne te we NOL OF euPLOvies UngPR couM omer: i SUPL A yi SLUM : : S. BESCRIPELOM OF CUTIES Pe oe Chey few os plem no, f os a OFFICE /OIWE STON. BRANT GE BUSEG 2-0 AG | 5. OFPACH AL PO FiOM TE Tek PF 4. INCLUSIVE DATES (Prae- and Tas yj Pa. NO, OF EMPLOVEES UNGE@ £52 BERLET | SUPERVISION eo 6. DLSCHIP TION OF Hurit s t INCLuSive UATES (Prams and fas y : i ] t— 78. 80. OF EMPLOYERS UNDER FOO BIHEC? : SUP RAVIS 1 OR Bi te rn re at ee I DESCRIPTION OF DUTIES 7 | ab anne vane Pr. Imclusive vate (Flom aid fa~ ) (a P4o NO, OF EMPLOYEES UNOLe Voue OLA? | 2. GRADY Is. orrd 2pm eee ent ate cation fe SUPERVISION | DIT PCRS DEWESTENS RANT OF SE TE ONMENT EAU VE SIONS Sag l OF q z a Tetra Gerel pal POTION 2. GRAGE | 3. OFF ECRFDE WISE lowe BR ENC OF BSS) GMENT — bone eae oe S$. OFFICE AL POSTTidkm Tite Lo een meee eee ema ah eee enn no mene x “I ig. BLACREP TION OF DUTIES H Une adds pares if re SECRET 5
SECRET , f Phen Pifdet dn) . : . @e i Stcrion Ait CHILURES: AB GIHEY DEPLADLAT ere Le Omit Tpmeluding apone Tuding apo haddee cece Rohe STE OER Stas parenge, stepperertin, epanre, ePe.y / | wey EOE Fy VOI Fan at Pease ane OF : THEE SUPPORT, Mb» Coda mye ETE fio vi ang Yok AGL BG ARR OL SOR he PEE LN lee 1. eUMBPe GF CurLogen (iae and edegted childcen) peg age UNWARK ETO, H tMDER 2h ¢£ANG OF Act, AND AMF NOT SEL E> i SUPPORT ity, . i 9. PADwIDE Tee POLL BING TNF OAMwATION FOR Ath erates tare hte annie pee rahe Ped het ee bey GEV ERUEN TA a pn nr tree tne nat CETUS See PEb% YP REO TOF CF * BUDRE SS Crrrs MEL ATE Ore Soe 0h . erence tie ee faint mene mame te Cparsrerder & WiEKEA ee oe aan I ne an U Sof ee amen nL DEE TED AEEB Sahr TSS SET ER AE Sh ee el Weel te ot ety eta eee recat ee er aot as bie eh PALCH hing 1th Raven anes arent [CTE TES aE GE ADDETIONAL COMBENT ANO,/OR CONTENT EON ae DATE Co“PLLT£S . SIGRATURE GF a om ee wept th fon ' q oye be “97s 2 ‘ : Ms 4 Aol ny . e Set 4
H i oe a SECRET 7! “nies Filled fn he er reenact oe eet ae i iQ ws - sede) é a fo. a THIS OATE 16 May 1957. . PERIODIC ana PERSOMAL MASTOKY § ene 3 - ae, ee al = : _SASTRUCTIONS anh ett tte it ents oom ae Thie face gpravedee the moane shereaby your 4 aaa | perennnel peceede will he kept eusrent, Even thengh ef duplicates [. sufaraation gun have furnighed prasiunuely, whtl be aeceasary for yuu to complete Sertigng | theangs Xi cm theee entarety, You need complete geettuua mada thenugh AEE unty if there has been a change e:nce you entered am duly ata tha arhanivetion ae if pou beflove t the a? diem ¢4quicon mare complete coverage than you have previonsly copocted OL cECTiC® 4 __ GENERAL ‘ ; & TIL Chae LT PT RTT ES Hy Leo _Nobarh_._._. aGUHE aS (Mu. , Ateeat, Clty, 15 Hote Stront, Fotrfax, Virginta Zune, dtate) 3. PLHMAMIN: ADORELSS (Now, Street, City, sone, State) 15 Hode Street, Watrfax, Virginta Ci Len oe ratuid BE S. OFATE, FERRTPORY, POSSESSION GF COUNTRY ir miciCre YOu Sow CLAIM RE STORNUE Virginia SiCtiia 4 ~ PERSON TO BE ROTIFIED IR CASE OF ENERGEACY _ 1, yeep. (LasteRiratetiddlay PREFERABLY 7 REDIUING IK Ura, z HELATIONSHIO A1347d, Zllen Made nnn Wife Be wyut 54885, ffie., Biveet, City, done, State, Country). Acie Streot, Yuirfax, Virginia. 4. Sitieess anumesy (Nu, Gteael, City, fume, State, Country je INDI CANE MAME OF FERM OF PMPLOVER, TF GPR CABLE . 50 | ¢3; - aera net aeeanc on ts inne nn taeAOATE@ee o $- et TAL Ae asoe BUM OE 6 HUAINESS TELPPHONE NUMULI Pe PUTEME DT TEER PRONE ERTENS EON i ala Lhesco os 950 hone ona. — fe iy o5E UT UME L CY, UTHER CLONK WOLATiges (pause, Muthor, Patent} MAY ALSO BE MOTIF IED, FF Suen NOTIFICATION $3947 VETIPOGLE OKCAUSE OF HEAL IN 08 OTHLG HEASOND, PLEASE 30 STATE, not desiraole SECTION O68 MARITAL STATUS Uchange) 8 t. fate fed Qees I [armen & x [usuario [winoms.o 6 > | Ean [orvoncro] ANAULLEO a. Tubatin Vase, PLACE Ano REAM FO ALL SEP ANATIONS, OLVORCES Of ANNULMENTS Ra a ae S108 68 wHUHAND: 14 you have heen mareied mara than onca, Jacluding annulmonts, wea a separate sheet fat former ei fe! ot huskhend giving deta hefow for ot! previous marriagaa, Ef macrings ia contamplated, provida sano data for fiance Be wane (Piraty . (aiddia) (Malden) (Least; Alice Ellen | Rader - ” *WIGHEN & DATE AF GAC RIAGE % “PLACE GF WMARBI ALE cChty, State, Country) 27 sept 1952 Washington, D.C. _ . “4 6. mit (oF ery sgnness atvrauy mantiacr (No,, Street, City, State, Cauntry) rc Hoo 29th Hoad parts Arlington, Virginia tiHal na OR @. CAUSE OF DEATH, Living pale OF DEATH a Err Co na 19. CURSEn? agoeesg (Give fast addreee, df deceased) pee oe . e . ep . 15 Ue Strent, Fairfax, Virginia Leas ee ee ee meme rere ene mse Do cd ed $i. DATE Ce HIRT 12. PLACt OF BIRTH (City, Stato, Country) 53 13 Avupust 192 | Roanoke, Virginia Qile #3. 4 S0;%m OY FSIOE ,3.°DATE OF ENTRY fia, PLACE OF ENTRY BA na : 1%. Crlezeamie (Country) DATE ACQUIRED 17. wuERE Acquirto (City, State, Country) U.S 1 na mit - tara nee 1a. Ofc. RTIOW PRESENT CMPLUYER (Alav dive farmer emplayer, ar if spouse is deveased of Beaplayed, fuat eo employ houseeifa SOREN Arlington County Sc hol Board ___ 20. KwPLGr EES OR BUSINESS ADORESS (No., Afroet, City, State, Country) Arlington Virginia oe - SECTION J1t CONTINUED TO PAGE 2 1 SEP 56 peitw @¢ oBsouRre, FORMU mG, quubrerenees Foam 278 : SECRET ; tah 4 .