(tog t0131-10104 a ~. PRQ KO. PART | ~ BIOGRAPHICAL smFORMATIO“ PUSTRUCTIONS: §. @elte aleetly. 9. Amover off queatiens. ff guestios i@ get applicable, trite *wA . tach blenk pegee, jf additions! sgace ia aeeded. , RECind QUESTIONNAIRE ; : PERSOKAL RECund QUESTION \f- 1a! Py: ® (SecTica 3 Gin€Ra PERSONAL amd PUYSICA BATA c +. AME * (Mee) a. mag ée6at than fTea 9.) 4. ALCASES, NICHMaMES, TELECOOES, LEGAL CHANGE im mame (Stele Flee, TeeseR Ter ahd PIace oF BEE) 24 G@- GATE GF @taTn 6. PLACE GF BIRTH BO Qeroada [4 | Ct HVAHUA, MExice 7. PERSONHE- wast Ts (Liquer, Grudge. ganbltWg, paramours) Nor Knows) TO HAVE ANY -OBsecnommaue PeRzonae HAGizs 8 count aacono (Ceert, date, ercaste, charges, punishaants, sentences, acquitala y ‘Wor Maown Ca e ® 8. BEscaiPTion (Use American standards of messureaents, if possible) COT ee AGE $C. APPARENT AGE | @¢. HEEGHT e@. whiGnT ef. COMPLEXtOM ‘oo: Face (Shape) lots | le | og ; rt | @ | Whi TE OVA oh. CoLoR OF HAIR gi. coor oF EVES a AReu a uA eG. SCARS AMO HARRG OR GQTMER GISTINGUISHINGE FEATURES _sDeetingutmp _.... _PRomideut WOsE omer Oe GENERAL APPEARANCE gO. PROMINENT FEATURES OP: GTMER- 1OENTIFV ING FEATURES a ATTACH SAMPLES OP SIGNATURE AND HANDWRITING: ALSO DATED PHOTOGRAPH AND FINGERPRINTS, IF OBTAINASLE 4 ~ "ge aed Wes ~ Fone 7-8 1650 ete Staveeus teatiens.
a ¢ 4 SECTiOG “bh. CiTt Zen mMP ® a. PRESERT Civizenseie @ AVIQMALETY AT QIATH AND AwyY SueSiGudNT Cifitensuies (If different than Item §.) 3. of sub. ten ene) a FemwANanT agckess (FF different then Itew §.) Oe Bbe/E S$. 16 U.%. NATURALS ZED CIO dda, Give MAME. OATH, CITY AND MUMGER OF CERTIFICATE Grantee U Ty er? Ravel OuTsioE mTAY OF PRESENT RESIDENCE (Countries, dates and parpoesea) 1916 - 1943 - Niveory ARIZONA 1947-1449 -— PANAMA 1943-1965 - WS. ARMY 14 €s- 1447 - Wasutugrod, 0.C. SECTION 864 OCCuPAaTiO“AL AMO FimanctaL Oa . 6 4. PRESEMT SCCuP AT iow a. FITag 3. SALARY (Per snaue) OT Mw @. FimamCiAL SvATUS (Baerainge, bank deposits, securities and property HoT pinews SECcTica i¥ ORGAN | ZATION AL AFFILIATIONS @ i. MEMEERSHIP Fe REL? GIGUS ORGANIZATIONS ~ &- PRESENT ANG PAST MEMBERSHIP im PROFESSIONAL AMD SOCIAL ORGANIZATIONS: POLITICAL AFFILIATIONS Sécvioa ¥ EDUCATIONAL BOATA é i. SCHOOLS : MAME ANO LOCATION GF scHOOL MAME OF COURSE DATES ATTENDED OEGREE rane ve RECEIVED er Haowd 2. LANGUAGES AND DIALECTS LANG AGE Cour E TENCE , aE AD @Rive SPEAR UNDERSTAND (List belaw cach language im which you possess any degree af competence. ) : no ves "0 ves xO yes ao ” oo” rv a o” a
y4-qo000 ~ é ‘@ (Sécrios Vi, "SPECIAL aL QUALIFICATIONS AnD INTERESTS @ i. $9O1CATG amv ems Time. Gtve OETAtLs (mCiudtes TEPLES OF BOOKS on amricues. ALso AMES oF PusLisHnas. aaO Fuses. ac fide @aras. Nor Kaows w -. _~— a a. SPECIAL Gm itas, a@eeetegs, wOaBIES Such A$ MADIO, PHOTOGRAPHY. EFC. Ae ttine 6 Nar iCmown, @ | SECTION Vil MILITARY SERVICE 7 je GATES ‘Si Pye |. *(OCMTIFVING COuMmTHY. IMDICATE guERE SERVICE PERFORMED. DECORATIONS. wHEN AND env "D1 SCHARGED. Give O° 9 1% eae PRISGHER. premotAtice DiscHAkac agent: . ui? av 3d ai oe ee ne . , id a wold EMPLOYMENT _ HISTORY @ INOICAYE CHBQROLOGICAL HISTORY OF EMPLOYMENT LISTING LAST POSITION FIRST. INCLUO& ANY GOVERNWENT BWPLOYWENT. 1947-144 Reale Cor oh gus, 4. fv?@ @F wae ABY OR TARMINGS S- @8 850m FOR LEAVING Twp cegnes | REASOM FOR LEaving ae Od t. INCLUSIVE GaTES (Prom-To 2: €MPLOYER + AGORESS : 4. TYPE OF foeK "g. SALARY GOR EanminGS | [@. REASON FOR LEAVING ' $ i. (mChuSive oateg ¢ Prea- Fo 2- EMPLOYER . (3. ABORESS 4. VvPE OF BORE S- SALARY OR EARNINGS G+ REASON FOR Lavine :§ he a f. (MCLUSIVE Dares (Proa-Tofz., EuPLOVER 3. apoRE ss a. TYPE oF eoag $- SALARY O8 EARNINGS @- REASON FOR LEAVING Cn Ce 5)
WRI S + &)SCETtOM La t mace | seat { creer, trie SFE OF MuSBaNO. 3. MAME OF SPOUSE 4. OaTE OF MARRIAGE cote peers [ [ettoe PLACE AMO REASON FOR ary SEP aR ats Jeg MARITAL STATUS ° etc Bi vIBL ES OR arererd wE RTS N. A. (F VOyU Wave GEER MARRIED wore GivInG OATA REQUIRED BELOG £99 ALL PREVISU VaARAL AGES. | [seravarto / Tore Fea meres cot tn cae RR se ee A tt Enter C3 SHEET FOR FOautR wie 98 MUSsgaAuS FAN QNEE. INTL UOING AMMULMENTS, 7. PLACE OF BERTH cstensehaeadhemeataiienanmmmmmmaceenemnemenramemeeenmee 6. Bare OF Bia TH ie) AYOCA Ss G MATIGNALOTY af giarn G- SUBSEQUENT TETIZER GH IPS 10. PRESEMT Réesipence (Lael reardence. iF deceasedy 7 7 ttt ~ = % 36 @ |SEcTion Xx _ CHILORER ® See YE ap . « — te - Eutt Name ST] OF erate: PLach OF BIoTM | NATIONALITY AT 818 oH i of { : -_ : | . 1940 Tucson, Akron | \ . nat RILEY, KANSAS | + 4 . . ae : : 4@ PAuAmA lt | | te i a ANY CHILO (Identify child and give hd 8. of hes, present addresay ad : . a @ | SECTION 1 FATHER @ Baten lB SLS Dn fit Ail. fay a. vEaR OF BIRT - PLACE OF Bra re DEMS 4 “WATIGMALE TY aT B1atn Let | aeceunens. G a @. OCCUPATION sree RESIOCENCE @ SECTION Kil MOTHER ® YEAR OF GI@tTm | 3. CLACE OF BIRTH MOA ME ig. [a NATIONALE TY aT 618TH €4 §%. SUSSEQUENT CITI ZENSHIPS 6. OCCUPATION 7. PRESENT RESIDENCE (@ral 9. ee Y BS -_ e ty € . .