* -p CONFIDENTIAL ther Faltet pre RESIDENCE AND CEPENDENCY REPORT A% OFT maeL OF THES FOU MIAL AY FEC UTED Rv Fares EMPL ere at Pee VEE OF FG APP OEM TES oe met A Coa! OCCURS it Sar f% arace § wy price. ETEMS OF ChAT ES tay HE BTRL OTIC ie THE GPRRCH RATE HLTA SIP eeseeh ComrPre Tams fag Prater e & OF Tee FGOw CECE T tore PMPLOVER'S SIC meTUOE Fit ATE wr PPE CUTENG 8 TEM @ ALSO Comm Le wr tre muh PO6 7, . PUP stentL TMPOLENCY an LocaTaa mec oans, Pur Jobe BILE AE COMPLETED ONT HY BEADOUART TES PERS ENSEL ann RF Gee? TO Ter Fitat. FOSM watt AL FELTO th Teh FMP, OVE E'S PPI tat PERL ONmEL FOUR BE, GEMERAL AME OF Eee E OTT {heapy — “TFieet) ee reytdloy Flores ' Daniel I. ” MARITAL STATUS (Check ome On pte geen a H pyrene [XT wase resi “] l Sth ahATED ] OEYOECED #ENOeS r AWAUL LED 1¢ wabOseC, PLACE CF waRatatg . ‘ort “on wacmi ace Lima, Peru Te Nov 1960 fe we ee ne Pete et emer emer aoe ee — ene ees cena neice ee tN pee anna nee eaten ome ae $6 Owoacs Ss, PLace OF Givaece HECRET Gate oF Drcmer , 2. , MEMBERS OF FAMILY . RaMe £2 8 0US6 nn SSt*~*~*é‘i ON MO Steet Cote State. dip Code) [rrpernowe wo. | Vienna, Va. 57-0797 __ Bin B tS Lorne See anne kenttroan Ed Rt Sent ——es jaoonest ~ i 92186 °°- —— a TE Tae OF BERT i (Same as above) F | a | | = fe | Seramtaneteeecaptthetadbeaaeteee ieeseeaeene rededandaamnmenenndanemaenk terketaeenedtilianmadabemniebedeetanamenemntammmtmaaemmmnsenmsmmetenmrieeemmemenanmmatn Erarereaane fave OF FaTmEe (oe esis guards an} paooarss PTELEP HORT BO. wane eo fosais guardians Lar ross WO. Brat wowhesi Gs OF SOUR SAWILY IF BMY, WAS Belt FOLD GF VOww BEPELT APIO BITH THE OFFsRigatiow $6 Contact ts a2: GUiIsTS fm am AMPAGLALY, ur. | | - Brother-in-law OTH(e & AE LATHVES WHO ARE OC PEROENT UPON ME FOR at Last ‘Bit oF THE aR SUPPORT And MEET OTMER REQUIRE MEGTS 1B TRAVEL REGULATIONS (ue ae han Srrcafe HAMES and RELATIONSHIPS. , att o@ Siete fevcatiousure i t i ‘ i i nee en gn ttt ns nnn ena eninenrnan ae pa rere ceed PERSCM REDIDIBG 14 U5. TO BE MOTEOLEG tm CASE OF Cul kGi acy Reet 2g. “ee P2882. ~ Boot Peer weatieas Opals mse ese Mr. : Brother-ine law tae GNP HEAT 14m tesdee Cote 2b 0ls Pep pote. ger was #8 tee. geeh 1s ohh ver ages herd CREO OR! Mek Soguin, Tea, 7HES5 Hi2-375- 1087 SS MERE aoe Re ee 2 Be Reseed ese Beore Fea Cees, ates Mem FO FE ok BOER hey HS Eee Teer eat A Falters & : Seguia Schou} District System A ee ee ee se eT ew BLT. ge Fe cen preheat porra chia tat @ PP “he Bbee wane aot etteaee af 3 ; Se gee hoe pes FS RHE OH me Bart Fey f§ f see > * . nn 4 . 4 . eh othe Re fee Oe Be ee ted Oe eed Vee be HO Cw 8 F Sa Bee fe Fee ae Bt Of. 46 bm af etn et pee TR e* b46e pred gr EET EE OF Pre eee ee mee Fhe pet Habe ane t Bee ietaed ge vont sf owbrgpaarg 4¢ mie > . | Spouse - x rr re re ee Oe ee ee i 2 ee eC ee eo Ci Cae oi ee ee ce. 2 ce ee oe 4 A 5 : ber tpen wie Cm vee § Ppa pet awd ve demd (9 Ftp § ot b BRerd aap bbe Be eh. 8 HF im o hed oF Hmd- ereD so wow we Pies etire 19 Bee ve BOs PR tee oF THR OS ob conte Chames Fi best H Bt e?r se stew ore fat GevEEre bere ct feat re te tI REA A SPA DLE St I hn Ry OREN LRH IE 1AT SS OEE EON EIEIO OLE TEE CBO TTT TELE COOLIO NE EEE NTE AERO ORLA TE) iia daLeiaaeenain aaaencee aoe) tye Cwer ice eliar . For. ee 2 ee ‘
CONFIDENTIAL ' patow Fabfot Pro VOLUNTARY LRTRIES wperience ia the “handling of employee energencies han shoe that the absence of certain personal data often de = Vays ard complicetes the settlarent of estate and financial eattors, Tre information cecuested in thia section mey Oreve very useful to your family or attorney in the event of your disability of death and will be disclased only when circumstances warrant, wot ate BABE AMO ADRESS OF ANY panninn AMET EVE T ICM BETH weet te NOU Mase ACCURNTS An Pet NAMES FN wert Tee ace COUNTS ARE CARB IED, ARE YOu & WEVHTA OF Ht HORT at ST rrotmat cure union? f "| ves ~Y “J RO teed AF HS, CO POU MAYE A JOIWE ACCOUNT? | ves I } ao HAWE YOU CUWPLETED A LAST WELL AMD TEaSTAWEATE CJ ves { ‘| BO, C20 “Yea* ehere aa de-ument focated>) Mavi YOu PRUPLANKED an ARRANOED GUARD ARWHEP oF our CHELORE im CASE YF COMWON DISASTER TO BOTH PART NTE? . [_] {| NO. (47 "Vee" give name(s) and atdcoaa) 1 ON or ams mmemmit tem heme R ne i A EG er ee mt ame Meee oman nee wee WAVE VOU ERRCUTED A PORER OF ATTORNEYE cy vas Cc NO. C4? “Yoa*. who poasesa the Power of setorneve) 6. RODITIONAL DATA AND/OR CONTINUATION OF PRECEDING LTENS __ _ ?. RESUOENCE OATA = TO BE COMPLETED OWLY BY EMPLOYEES ENTERING OM OUTY . (ks Approval Bequiseds : RESIDANCE OMEN EWFLAVEO (Pull Badpoes) ~~ ”—””—*d By muans nt? PLacd Ov #t8s00NCE Aa DEFIAGO A nm Pde 3 6 ° (Full Addevos} ie CHANGE IM PERMAMEAT PLACE OF MESIOEMCE wace we pa ts 8. (fo Be Conptered by Fopleree Perering Such CAaage B85 le Anatgoat f« Soedgaaetore} Tee ae padss ° ~ f cepues yet. toe oe ctpiene , |e stp Be } 2 5 H i é me ~ ° votes ane 4 j tr@trtte of re grangy fates spels vate is f yohte gee RB Fo- 2b ‘ ‘& i : eitaat af pre7see . 4 ary - Lif, . re 3 , ivy st he Sn GORE LOE BTIAL E é 3
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