104-10218-10180 we onem vege a - Seta erecta ate Se woe sep mt ee ereerencimte ametees weterige 4 ate ame wrt fe ye ng enen eee van PERSONAL RECORD QUESTIONNAIRE PART iil = OPERATIONAL INFORMATION INSTRUCTIONS TO CASE “-FFICER Thes fora must be falied in by the cage officer of appropesats authority on the beara of the best available ia formation, F¥@ §9 age to be shoen to the subsect, 2. Moreally, hesdquarters will be unable to issue an spproval uniess requester furnishes srasercs to all questions sn PRO parts §— and £7. However, sm an emergency provisional approval may be obfeaned by conplpyang with the age plicable provisions of FR 19-31%. paragraphs ¢8, §, #276 and 42d. Thereafter the waval sethod to document of cow plete the case aust be foifosed as set forth sn FR f0-345. 3. Three ¢3) completed copies of PRO part F Cinctuding copy in subsect’s handersting, if posssbley and two (2) coe- pleted copies of this form must be sent ta headquarters as soun as possablie. 4. Bate acquired later aust be sent to headquarters in PRG format in two (2) copies. S. Fill en atl atees, if anformetson obtainable. Ef ctem not applicable wrate "“NA.* EF addetional space required for ifea, wae reverse sade of page keyed to appropriate etem number. CAYF TONY iM PSEuUDONYR 2. SECTION 1 CONTACT AND DEVELOPMENT #- INDICATE HOW, @WEN, @HERE, WHY, AND GY WHOM SUBJECT WAS FIRST CONTACTED OR DEVELOPED. ne nonee Fat ewppereemenenanen ene + 2. GNOTCATE BAETHER SUBJECT COULD BE TURNED OVER QUICKLY AND FN A SECURE MANNER TO &%f RESPONSE BLE CASE OFFICER £38 HANDLING. FF SO. ERBICATE FO BH On. Se ne A SO oe sensi oh, itadita theo « Hd Arent esti Be LIST OTHER CASE OFFICERS WHO HAVE HANDLED SUBJECT OR WHOM HE KNOBS OR HAS FNGBN, GIVE NAMES BY BHICH THiY wave BEEN KRORN- 2, de RAS ae, r . | ; USE FRETEGUS EOE TIOwsS, att a Premera ne covert hed Wa mteatnneees nk on! AAT niente tet nema to Ko ennenitinnckinnt et? hae
14-00000 sop Maree mne encyetonrtenemerserea Ae Fe nwd + et are woereragereerren aunmarenteneene cnc it yn enn (mimes Mepnenen men meee sae eu REAC ROE eRe Hee Meee emuOHR SA Abr R PRIME TNe Nene SmeNEEAt SR ima und memnnmn Ee “nine peter a mat nam meee emcee sini alacant ‘meRareiycretnan © tan rene PRUETT © FE oy ew. em — (see ke remit tee went “ - ed - ry 4 ag ; ane eo yet : wan oe nam van H t. ESTIMATE SUBJECTS MOTIVATION, (Be detailed, af pousshie cite evidence. Do not use Stock comment such as “antge . Communsee. “y ‘ é H » 4 ‘3 2- INDICATE meAT CONTROL, FF AMY, EXISTS OVER THE SUBJECT. (Ef no controd, of if these in @ fach of real control explain. SECTION Li! f. COVER USED By SUBJECY AND CASE OFFICER IN THEIR MEETINGS. ’ ' COVER USED Be SUBJECT Im OSTAINENG HIS INFORMATION AND t% CONTACTING HIS INFORWANTS. q SECTION EV INTELLIGENCE CONNECTIONS AND TRAINING ¥. EXPLAIN SGG@TETT'S KeOOW PAST GR PALCSENT CONNECTION WETH ANY OTHER INTELL EGERCE SEMVICE. INDICATE THE EXTENT SuCH CONNEC TIS% &€3S RNGU OVERTLY. B. ERPLAEH ANY TRAIMING SUBJECT HAS HAD tm CLANDESTINE OPERATIONS. wees SECTION ¥ COLLABORATION POTENTE AL i. ENDICATE OT-€& FOREIGN PORER SUBJECT OULD SE MOST LIKELY TO COLLABORATE BETM BECAUSE OF HES 1BDEOL > ° OW FAST ASSOCEATIONS. ERPLAEM. va tk ath aint, 5 Pood “Poa? ws weet aw Daw adi, Ws stein x aes elas ry
Ae De ee eee oe ee fee cower ee a rey ae aes wees se ° ~~. TL). - SECRET oy Section Vi be 9F SUBJECT HAS GEES USED ware ME CAT Tube. SHEO- OPERATIOmaL USE ~ CONTACT O@ CONTACTED @trony, 8MOICATE ACTIVITY 1% @HICH ME AS ENGAGED Amt Toe TvPE OF ERFOR Re tanta bt donde B. ERDECATE GHAY R&S BEEN FOLD SUBJECT AS TO THE DISPOSE TRON OF INFORMATION HE FURNE SHES. at Ye eetarert eee DETAIL SUBJECT*S PADPSSED Fs ae OR C8 TYPE USE OF DUTEES. + ead os nee EEE EE HT Bete Le ees de eng cers rte mere $- DETAIL SUBJECT*S PRSPOSED PP-PM TYPE USE OR OUTIES. eee gene a atte Tet tatneleedaite © ee eee ee ene eens vameaiy mann stmt sam tm saint at SR Na peti meter fr eAe ewire ens tn magennnnnR meant ene mewerecemt peg emmamtens tuinananngers Sg E i SECTION ¥i5 PROPOSED LIAISCN OR OPERATIONAL ACTEVETY F : #. BDETARL SUSYsECT'S PASPISES LiS'SOm TYPE CONPacY GR QPESATIONAL USE. ! &. WHERE SYUBIECT &€S a8 OFFICIAL MEMBER GF A FOREIGN GOVERNMENT: ‘ . ! 4 vt . 3 2 ‘ : @. BHERE SUSSECT £S Am GFFICIAL MEMBER OF AN ODYOKE AGENCY. H : SECTION VEIT AGENCY RELATIONSHIP WITH SUBJECT a. EXPLAIN NATURE OF AGENCY MELATIONSHIP WITH SUBJECT: 1.8. TRAINEE, OPPOSITE NUMBER: REMUNERATION, OF Any: agtney’ f*' PERSONNEL KNOWN FTO SUSsECT. *. wee ahee fe te temis 3 4 enetesit’ oghdad Sisecrer furs ba eee Agee He RR EN EEO RE OH Np Mt nee eh ees +f cine feat je Semin tee
wary ® } f gp en erent cn cam mtn RI EY Rak me NEN wow Sc yg es mags tun me mene em fe me ar ern, Gamren =~ emammanani, oo 2m rome mane wean a ’ Pome A te oe . . ms, F SECTION 1K _QUALEFICATEONS FOR GTHER OPERATIONS t. EMDICATE SPECHAL ABECETIRS, TALENTS. wae QUAL - OCA To cm. POLSE SSE BY SUBJECT Snit4t wSULD LONCEI Vast Y BE OF VALUES FOR OTHER OPERATIONS. SECTION X COMMITMENTS : 1. OF FY 19 PROPOSED 10 Pay SUBSECT & BEGILAR SALARY, BMOECATE THE @LEKLY AMOUNT. BF PAYMENT TO BF WADE a EXCHAN ‘ COwMGDITILES, SUBSIDY OR OTHER mETHOO, SPECIFY AND GEYE DETAILS. 3 i : : i } 3 2. EMPLAIN ANY PROMISES. OTHERWISE WOT COVERED HEREIN, MADE TO SuBsECT. (Example: Commitments regarding evacuation ‘ . of subsect and famaly ») i i ase. es Pot Subse ea tot . i : wo CORUM VALS. ' i : : : SECTIOW Kt CE AND SECURITY i t F a. ENDECATE PHE FIELD AGENCIES ANO FEELS FILES WITH omICH SUBJECTS AML WAS BEEN CHECKED AND THE RESLLIS. . i j iB ¢ 4 t 3 = 4 3 ti | ‘ 3 } } "3 3 : § OTHER ENVESTIGATiIVE MEASURES TAKEN TO VERIFY BIOGRAPHICAL INDICATE 2. TNF ORMATION FURSISHED BY SUBJECT. ia. Headquarters (see Heo wguarters’ His). a Cee nn nn Enea ntnaastmaneeememncaanieemamattamataastatmmntante aetemeaael 3e GNDICATE #HETHER OR MOY PROVISSONAL CPERATIGNAL APPROVAL OR OPERATIONAL APs PROVAL FOR SUQsECT’S USE HAS GLEN FRE eiVUSLY OBTAINED. Dare APPROVAL Sethingys oe ny otha preppy; eevemeeremees EVALUATE SUBJECT*S CHARACTER, RELFABILETY AND SccuRi TY. CITING EviOENCE WHERE PSSsigie. voaen has boen . Then @enoti T + by eee Dow! Leubyeet hos aorced i nstiobl a 2a Se we + epeprceryereginre ine erereesey ee ental Uinuiatads, $- EXPLAIN ANY SITUATION OR INDISCRETIOn EM BHEICH SUBJECT MAY HAVE BEEN CE/GPERATIONAL SECURITY WIEWPOINT. Subject ¢ close relationship with LINLUCK, Subjuct = overt Ose peat 2 artich 2) atacain ing { tha Castro reek INVOLVED aff woSt BE EVALUATES Row A $. USE OF LEQUOR, DRUGS: GAMBLING, PARAWGURS. nuject is kuown to drink sociall iy. (see Headquarters’ fuisz 2 ASOT 8 Onin ateR ena ae EO inne ome openieinene bad 8 pebaremenene mate
14-00000 i x secret ae crete mromatmene at i uae verturtanmpene “teemeame ran Mineman ennai trettnene Sete Free ene Brienne epee mare seem eRe Bet ammemrany memes ETE Tm SR tee ant et Fg mam ata mney ga i eo fee a . : nr meen © errs ninemsn, * EE CRET ee AVOCATIOHAL GNTERESTS INDICATE SyBsECT°S MOBHITS CO INTEREST EN SPORTS, MUSIC. ETC. Sabjeet ts intercated Inthe arty in general, SECTION KI¥ GEIERAL f+ TRDICATE BHEIHER SUBJECT"S LAayGUAGE ABILITIES AMD OTMEM CHARACTERISTICS, OF A COUNTRY OR PEGION OYnNEx THAN HES GOON. EXPLAIN, CORRESPONDENCE OR OTHER MEARS. matien contained t wee para. 3b, supra) see NRE TIER en enee mee nay SAN OF nLfH MIONEENE Scent ween 6 renee Henry nt Satie ema Sat MO poe ete e Be eer eee enmtt e crete cnet ere ee ee ne ne $ nee Een te eee ae ry tm ae ee net mabe mem 3+ 4F GYHER THAN ROUTINE ACTiScw §S REQUIRED, $F AND WHEN TERMINATION OF SUBJECT ES EFFECTED, PLEASE EXPLAIN, ARE SUCH AS HE COULD PASS AS A NATIVE 2+ SRDICATE WHETHER INFORMATICW F% PRO PARTS F amD Lf WAS OBTAINED BY RESEARCH, CLANOLS TINE ASSESSMENT. FILES, (alto ~ ¥- GIVE FULL DETAILS 9F.€. RECOGNITION SIGNALS, S/8: WHERE COULD CONTACT GE MADE? BHAT BORA FIOES COULD INDI VEOUAL MAKING CONTACT uSE?- ehrk 7k patet tga With ode Coal SECTION KVi MISCELLAREOUS OPERATICHAL DATA AND REMARKS Ss ye ort tenettaeemettmetts nts Sen sabia ot pa onan aaah erinhlelel oe cettinermertneth Mish He brite elimi si SnAniee Atti eit steerer’ Nabi 6 dS tblne sites 4 i Ra mpilenialdsiungerieniinenmenss Sone min meni! betcinete < the ie remanent yoo Te ete at St aaah reetie malic ey Ean ae een ans tartenaess tie adteifievenb Ser. sae emer anager ape = i tet Brace eres eesrec ak