SEC, 4. MOTHER (Give the ES. i mation for step-mather on a BQ. @. seot) FULL NAME LIVING OR DECEASED 17 Us vy DATE OF DECEASK CAUSE ~ ~—— \ \ PRESENT, O LAST ADDKESS 64F Flet her etue Méust h eyvnow, HU. Y.. 4 uf SAL. \ :9 Btate test. DATE OF RIKTI ACE UF snura{ torn) Turtle valley ! Wisconsin 1d U.S. A. . . . Cuz ate Wee tl oe crrizensinfi neti CA WHEN ACQUIRED? Lure th | owrgee, ~ .. . . city Plate Com iae d \ - oceuration AOUL Wife | taspemploveR &*EAOWA 4 2 “EMPLOYER'S OR OWN BUSINESS ADDHESS | CHA MOM we ‘ : . . Be & Ne chy State _ fennery DETAILS OF GOV'T SERVICE, UB, Ot FOREIGN | UN New bee be bebe cece eceeevseeereet es eee ‘SEC. 5. BROTHERS AND SISTERS (Including half-, step-, and ad«ptect teuthers and sisters) ‘a FULL NAME. a i i ; i present aponess 6 F/¢hher Ave. , floanl 2 ‘Er NON , We’ USA. ‘ ! Bhim Bhd LE, f csty Pie tou wy : FULL NAME | al eee eee boven nee PREBENT ADDRESS aa Fletcher Ave. Meant Vernen , 4. Gf a. 4. i yo OA fin. Bhar soutuy & FULL NAME 0.00.00 we Cees re, a er, Firat BM? Lanes PRESENT ADDRESS .0 uo, Lo ee eee meer Gt. d& Ru ante State fonuniry SEC. 6. MARITAL. STATUS : A. SINGLE XxX .. MARRIED 77 . pIvoRcRD A” WIDOWED a i STATE DAT. rLACR AND REABON FOR SEPANATION OR DIVORCE nah App hic.able . i . . ee ce tee teen e en teas 1 en ' W. WIFE OR NURNAND SIP YOU HAVE AEEN MARRIED MORE THAS ONCE URK A ARPABATE SHEET roy Foe WIPE Oi HUSHAND AND OTE REQUIKEO DATA FURL Ald, sie Vi- THA MAMIIAGI Eat Ps LACE & , NAME hot Aypji ¢ Able LATE GY MANRTAQR Pied SPteAar orf BePR Fe atdemt Remet . PARSE Coad Deda AGstib BRP RAS ACH os & we aceg rots - OL ee ' LNG an PRORARED oe. DATE CY BECHAGT La ate bry fuseerty Fs hee LaAey afuImesss ta en a hp fhereg aKa te
74- “EC. G. MARITAL, STATUS (Contd) _ AOF Applicable . : ‘ DATE OF BIRTH . PLACE OF MATH ween a 3 t . City Atate tnntey 3 4 CITIZENSHIP WHEN ACQUIKED? - WHERE? 20 0 Lee ae, . , : i City fate Country ; , i OECUPATION PAST EMPLOYER - Z : i wens oe i EMPLOYER'S OR OWN BUSINESS ADDREBS TT Hy agg ee : } St & Ro chy filate Country MILITARY SERVICE FROM. ong BRANCH OF SERVICER oe ~ Date Dat COUNTRY. DETAILS OF OTHER Govt SERVICE, US. OR FOREION.. petition tinnuuininne SEC. 7, PATHER-IN-LAW i Not Applicable : FULL NAME 00 wea eee ‘ Fira Mtvatys Lpeq : LIVING OR DECRASED oe DATE OF DECREASE || | 77 re f” PRESENT, OR Last, iene ee too, ! St. & No city Steta Country ff BIRTH coven —_ “CITIZENS, ene I Date . Chtp Deantry - WHEN ACQUIREDS Lome, WHERE? . an Loe | . Oitty Seoen Countey : | Ss a oe ee ante as are onamet OSES RSS SS RS eee, . i ! SEC. 8, MOTHER-IN-Law : : i fet Appl.'¢ Able ; FULL NAME oo, to, dha ee. . Pires Bladen Laat j . i LIVING OR DECEASND ~~" DATE OF Decrasr eT, fe if PREBENT. OR LAST, aMDWRRG © date eevee oa BL & Ke cuy State County ; i ; : . wee ~ : [: binTi etna tole CITIZENSHIP re ee i Date City Country Mt . 7 TO a eg _. i WHEN ACQUIRED? a a = K Clee Gtate Tountey BEC. 0. CHILDREN OR DEPENDENTS Cincinde partial dependents) i NAME hot APF Me Able RELATIONSHIP “oo AQE. i CITIENAHAp ADDR ESA i Ay MB, UHlg Gilate trang NAME —~ RELATIONSHIP ~e AOR CITARNMOp TT ADDRESS ‘ 6 ® Ra bly Slate Quuatey . NAME a HELA rtoNahip AGEL, pipe eerie ADM ica cay oe & ho eee ; ere & S ; Ma Th we J Meare Remtie | a ba meb rt” .- _ oo —_e ae : a we _ *
14-00000 ee mer verte ee nt oy ome es wee pe erearnd natn amen arene: arene amarmpeame rcs ag Sa a , Ss a RSH SEC. 10. RELATIVES BY BLO uD, © vance OR ALZIPTION, Whe LIPh ARHOAD, AHE UNDER THE JURISDICTION OF A FOREIGN POWEK, ARE NOT CITIZRNS OF TH2Z UNITED STATES, OR ARE MARRIED TO NON-CLITIZENS; : Unknown . NAME 0. o.., . RELATIONSHIP 0 wo... Lo. . AGE CUPZENSUIP 200.0 0.0. . .. ADLTZEG rn Lee - . bt dé Ho city Peta Ciaantry REASON FOR LISTING UNDER THIB QUESTION NAME... 6 oe. c eee : RELATIONHHIP . 0 000.00. Cenc OT TE a ae AGE... CETIZENSIUP. 00.002... rm we ADUEESB 2... : Bt. & Ko. REASON FOR LISTING UNDER THIS QUESTION - NAME .... |; STITT Stbece eens RELATIONBIIP CITIZENSHIP... 20.00, ee, ADDIFBB 00... UTD Le. it. de Na. REASON FOR LISTING UNDEH THIS QUESTION (00 TTD eee. SEC. 11. RELATIVES BY BLOOD OR MAMMIAGE, 1h MILITARY, NAVAL OR OTHER GOV'T SERVICE — U.S. OR FOREIGN ; cee nneine ‘ UnK NOW 9 - wane _. peLationsuie, AUWE . ow. = AGK VPTZENSINP A VC py 3705) Fy aie Aelita ton, V, , USA. CITIZENSINP AM@r/7 CAR... © ADLERE IWS td Se, St toy A. 5 . . & He. Oley tete anery TYPE AND LOCA TION OF BERVICE UF KNown, C7670... Servs cc , Washi Aq fon PL, ‘NAME 00 0 0 occ eee eeecee eee) RELATIONSHIP 0 00. AGE CITIZENSIIP ADDHESA 0 TT, oe, Laces £t & Ha, . City tale Country TYPE AND LOCATION OF SERVICE (IF KNOWN) msm HAME ..... TTT, Co. RELATIONBHIP 0000 . AGE CITIZENBIUP TDD lo) ADURERB leeee es nee nee ‘ ; ; 60. & Ma. onsy Grate ; TYPE AND LOCATION OF BERVICE UF KNOW? 0.0... Tec enc ce tee eceactesetetevreeuresee van Se area ca aman oe re a NENT eae Rb : SEC. 12. GIVE FIVE CHARACTER REFERENCES — IN THE US. --- (Give business address:s where pesaible} MAME: aporens 29/4 Userver sity Aye. , Des Alwnwes , Izwa et a fa CUES tate NAME: avons 7d & > fd th ST. , lnc C; ty g Mu Jerse Bt B.. ety NAME é aposiens (5/9 - 4 ad SAL Les Maines , Lowa NAUIE ADDIS (JaxO * IV th Sf, 08 lost es, Lew . ; NAME pong, O# a - 63 4 Sf Bes lilernes Kava oa & i oad Le pee ee eYesv
14-00000 a han ess 9 3 Se ne cea meine eae so, io sth meetup ant mS teeth Ante eee oe ees} : _WHO KNOW YOU SOCIALLY IN THE UNITED STATES. NOT ilu Suess addresses where possible) Ure h SCL TS. NAMES OF 5 PERSON: ENCES ¢ i. NAMA | ADUNESH 2EI 3 Moind St, Philade hha, PA, y Suk M, yey feat 2! NAME  Abonesia: FOF ~ 16 th Ave, Tuscaloosa , Ala. a. NAME ADDIS 1009 - rem § ot, Des Moines ae reas 4. NAME  aprnmess: 2 Schoo! Sf, MANOR, " Wt. ff. | \ su any tate ’ NAME . AbunEsg: 72 < 57 Mh, St POMEL EEA, ISEC. 14. GIVE THREE NEIQHBOKS AT YOUR LAST NORMAL RESIDENCE IN THE UB. I NAME} cee anpress /e 1G = $6 He ot, es Mes LINE 5, Tous | | NAME: Loo ADDIEBR 1214- H te st, Des Ke ne. 5, houly ‘ et. & J : L NAME: oo.) ADDRERE AT ALR - nicer sity hue. ‘pes Movers, ] \ BOO Ne ehy State fui, + eit nme sti nec oer oer ee a EI pe EE —aee "SEC. 18. EDUCATION __ see Separate sheet “SCHOOL: Loe ee ee.) ADDRESS - . cones ‘ . - Mit State CUUBey DATES ATYENDED: 200000000 00... . DEGREE BCHOOL cece ne eee ADDRESS - . ality Biate Carlee DATES ATTENDED: 0000000... Lee DEGREE ; coutece: Cartntoath College. _ ADDRESH Hanover wv. H., Dd. “SA. cuy btste SPI paves arrennea:F/1/ 44 fe present time pranex COLLEGE: 2. ww. wee. ta. . ADDRESS . City Slate tyranny DEGREE DATES ATTENDED: SS OLR a ee aS EE oe SEC. 16. MILITARY, NAVAL OR OTHER GOVT SERVIC K—-US OR FORRIGN “ ag “as A, aay AS, pees Mi] 4e, Paaniey Beg vic act Saf Pics: WA.CEO Ua t the 2 +f f- 7/7 Rencrd ole Capt DE Cersansings ester Pee Type af Ais Rae le rere Fe are Hach Platts, Al 2erd(ce wi scheotl. REMARK: ‘s, hee . , r) e
ne SOE ren om REESE p+ wa Sane By teat rt rrpeoeetsenmme i { i i i + Teme ae Nonree Seboal TVSL = Land Mloo I Ape l- Jute m nk ace ate ¥ As {ore cej onl (erece) eas) Highland Junior Mich Scho ‘be rere, Tuscaloor ~ 104 f -lgaad = Lal Tf, Rooreveldt Live) -« 1964 Hiskh Sehaol Mnsor @ttsr, lows, Leuicgilte,- Ky. Tureainaiusg, Aln., Pegs Moatscea, Jove, ev Uerere U.S.A. eden ene