404-10124-10218 . a [ : SUPPLEMENTAL PERSONAL HISTORY STATEMENT rrr perenne er eee 1. NAME (First-middle- fast ) . 2. MARITAL STATUE , ! SInGLE !  OTHEE — James Valton Moore - Mo wareter 3. FF MARRIED- NAME OF SPOUSE (First-middle(maiden)-last ) atricia Anslev Hoore alta heennalt seer etl eaten ate octane Ree ee PLACE OF MARRIAGE _ PDATE OF MARRIAGE __“ashineton, D.C. . _ : 12 Avr ui ; 4. RESIDENCE (Since date of last pys, if overseas residence indicate only city & country) $ [SINCE (Date) NUMBER AND STREET leItTy ANC STATE 7 PRESENT, " [ August 1954 5145 Rexton Lane Dallas, Texas Po DATE TO DATE NUMBER AND STREET jerry AND STATE I - i h Apr 54 to Jul Su 3406 Dartmouth Dallas, Texas ee _ DATE TO DATE NUMBER AND’ STREET ~ 7 {CIETY AND STATE ' FROM , - un 50 to Apr 54 3502 Underwood Houston, Texas 5. RAVE.YOU BEEN ARRESTED, INDICTED, OR CONVICTED FOR ANY VIOLATICN OF Law (Other than for ino: fraffic violetion} SINCE THE DATE OF YOUR LAST PHS ves (Explain' below) ; x. 6. SINCE THE DATE OF YOUR LAST PHS, HAVE THERE BEEN ANY UNFAVORABLE INCIDENTS IN YOUR LIFE | YES (Explain - NO . WHICH’ MIGHT REQUIRE EXPLANATION ibelow) iyo: * 7. NAME OF YOUR PRESENT IMMEDIATE SUPERVISOR EXT RY #,. . _ e toe Ernest A Rische, Houston, Texas 8. ADDITIONAL REMARKS (Use reverse if necessary) a Ee stele a aaa: ete Se SIGNATURE OF EMPLOYEE
14-00000 PERSONAL HISTORY STATEMENT ree Instructions: 1. Answer all questions completely. If question does not apply write “not applic- oo able.” Write “unknown” only if you do not know the answer and cannot obtain the answer from personai records. Use the blank peges at the end of this form for extra details on any question or questions for which you do not have sufi- _cient room. Ls ie -. Type, rint or write carefully; legible or. incompleté forms wil not receive core a oo sidera ion.” Ts. Se “HAVE ‘You READ AND DO YOU UNDERSTAND THE INSTRUCTIONS?. Yes | en : Yes or No Tad “SEC. 1. TansoNAn BACKGROUND | . . ‘Telephone: St. & Nor ‘ PERMANENT cae “245? Tatewia" ‘Stay. » istlai, Texas: St. & No. : ate we r cine St = dtmte WHAT OTHER NAMES HAVE You USED? 7 Nove_ Nowe he wt, By What Authority’ ‘c. DATE OF BIRTH 5 Oot 1919 pace o OF BIRTH Hartwell _Geor ia U.S.A Country D.. PRESENT CITIZENSHIP a BY-BIRTH?. Yess BY MARRIAGE? REY . . ; ot “BY NATURALIZATION CERTIFICATE # —__________ ISSUED AT _ : : vy ON . a : State HAVE You HAD A PREVIOUS NATIONALITY 2. : ¥es or No HELD ) BETWEEN WHAT DATES? ro a ANY OTHER p NATIONALITY? | country HAVE YOU TAKEN STEPS TO CHANGE PRESENT CITIZENSHIP? _ No @rve PARTICULARS: Pee 4 Phe FORM NO, sep 194g 28°!
im) . 2 BE. IF BORN OUTSIDE U.S. WHEN DID YOU FIRST ARRIVE IN THIS COUNTRY?, —_——— tye PORT OF ENTRY? ON PASSPORT OF WHAT COUNTRY?. ————————————— “LAST US. VISA a ee Ts, . . Number Place of Issue Date of issue SEC, 2. PHYSICAL DESCRIPTION. OS oO ee - "AGE 50 SEX wre HEIGHT 6' weront 190 Tbe” yes brown HAIR Dorm COMPLEXION —nediun __s SCARS . none ce ‘ ' BUILD average ~ : ” aF YOU HAVE BEEN MARRIED M MORE THAN ONCE — INCLUDE ANWUL- B. WIFE OR. HUSBAND MENTS — USE A SEPARATE SHEET FOR FORMER WIFE OR HUSBAND : . GIVING DATA REQUIRED BELOW FOR Abd PREVIOUS MARRIA' ES.) a Nae OF SPOUSE = Alyce? . ~ Patricia Fu: Ansle; First. oo: Middle . . Maiden mS “Last a PLACE AND DATE OF MARRIAGE - Mashinigtons De Ces April 12, 1941 ~ ee HIS (OR HER) ADDRESS | BEFORE MARRIAGE 8ST Ross Aves, Abilene, Texas St. & No. City _ State. on Country . LIVING OR DECEASED Living DATE OF DECEASE CAUSE PRESENT, oR “LAST, "ADDRESS 2600 Ponbérton Aves, Houston, Texas, U.Sehe St. é Ne. . City me State — DATE OF BIRTH 28 Nove - 2 29fiace o OF BIRTH Fengsoe Texas, USA ° . * : ‘. Es vate, CMty. he _ , State. « CrTIZENSHIP WHEN y ACQUIRED? : Es - city State _ County OCCUPATION __housewife LAST EMPLOYER PBI) EMPLOYER'S OR BUSINESS “ADDRESS —inghington Bete UB _ : . St. & No. ony State . Country ae TO BRAN cH OF SERVICE - MILITARY SERVICE FROM . Date COUNTRY ——____________- DETAILS OF OTHER GOV'T. SERVICE, ‘US. OR p FOREIGN -
14-00000 SEC. 4. CHILDREN OR DEPENDENTS (Include partial dependents) * _~« ee Set 1. NaME Michael Melton Yoore ___ ReLaTionsui Son’ age: 6 _ AGE CITIZENSHIP ‘US ADDRESS “2600 Penber rton Housten, Texas USA SS NO 7 St. & No. City State To, Country _ 2. wame Vargaret Lee Moore ret se loore ______ pgLaTioNSuTP _ Dau hter_ scr 5 cae CITIZENSHIP US _ ‘ADDRESS 2600 Poniber ton, Houston Texas USA. Eo oe Houston, Texas, USA” . Bt. & No. City | : State Country : . 3. NAME _____________petartonsizp # PRESENT, ‘OR, LAST, ADDRESS | = Bt. & No, wile ~ . city rn Btate®. : ew Country DATE OF BIRTH ___1889 | PLACE OF BIRTH urphy County Ne Carolina IF BORN OUTSIDE US. INDICATE DATE AND ‘PLACE OF. ENTRY CITIZEN SHIP _ WHEN | ACQUIRED? =. WHERE? : ey: ae occuraTion isaLopaty LAST noe Baptist Foreign Mission Board : EMPLOYER'S OR OWN | BUSINESS ADDRESS _Louisville, Kontucly Usa , St. & No. City — _ Btate . Country MILITARY SERVICE FROM _t917_ TO 2918 BRANCH OF SERVICE US ar my _, COUNTRY ___ DETAILS ¢ oF * OTHER covr SERVICE, US. OR, FOREIGN. SEC. 6. MOTHER (Give the same information for stepmother on a separate sheet). FULL NAME Minnie ‘Lee * oe Moore First Middle tah LIVING OR DECEASED living DATE OF ‘DECEASE — CAUSE PRESENT, OR’ LAST, ADDRESS Tl South 5th Street Taso, Texas” USA: St. & No. Cee ees ony ne State a Country i DATE OF BIRTH —i892 _ PLACE OF BIRTH cael > “crrizensi Bs WHEN ACQUIRED? . a ce BORN OUTSIDE US. INDICATE DATE AND PLACE OF ENTRY | ror State Country —
j rT & 1 h a 2 . | 4 Reg =a ‘ Fe co a occupation 2ousewife past EMPLOYER _ EMPLOYER'S OR OWN BUSINESS ADDRESS . St. & No. - city Btate Country MILITARY SERVICE FROM TO BRANCH OF SERVICE - ca. i a ae ar ruil NaMeE | 7 _Mertha Jane . : First Middle - PRESENT’ ADDRESS Monna Carroll, Illinois 8t. & No. - _ Oty julie Biriem ©.” ESS - Z Pittsburg, 4 Bt. & No. - “passe 4 ADDRESS ‘7114 Se bth “Street, Waco, Texas Bt. & No., City - __Biate | ; Middle ; State Country Citizenship 2 ee: a AGE “PRESENT ADDRESS —____ ne . St. & No City First Maiaaie. IVING OR pecs SSE DATE OF DECEASE ~ | PRESENT, OR LAST, “ADDRESS oo ‘Dare OF Be 1889 i BORN OUTSIDE US. INDICATE DATE AND PLAGE OF ENTRY r. » oi, CITIZENSHIP WHEN ACQUIRED? WHERE? - = _ =  Secteation of fman a Bleot. Supply Ge rover Ee Hof fen Bleoteical Say pls yee _
14-00000 i a oe . . a I . ; "gc. 9, MOTHER-IN-LAW | ; NAME _____ Margaret. - ge : First Middle . Last at LIVING OR DECEASED —tiving _ DATE OF DECEASE ____- cause Seiiii acereah ice tetera oe PRESENT, ‘OR LAST, ADDRESS 857 Ro a St & No. ey Dare OF BIRTH SS peace’ OF F BIRTH — Sen Antonio, Texas IF BORN OUTSIDE Us. INDICATE DATE AND PLACE OF ENTRY. Teenager aE 7 CITIZENSHIP a WHEN ACQUIRED? be, “OCCUPATION housewife: |=" LAST EMPLOYER | SEC. 10. RELATIVES BY BLOOD, MARRIAGE OR ADOPTION, WHO EITHER ‘LIVE ABROAD ( OR +. WHO ARE NOT CITIZENS ( OF THE UNITED STATES: nN * i RELATION SHIP «fee ee ,  _ Bt. & No. ne a _, State | Country | SEC. 11. "RELATIVES BY ‘BLOOD OR MARRIAGE IN THE MILITARY OR CIVIL SERVICE ‘OF THE U.S. OR OF A FOREIGN GOVERNMENT. Hot applicable . RELATIONSHIP - eae ao CO . CITIZENSHIP po ADDRESS | Bt. &Wo Cty ; State TYPE AND LOCATION OF SERVICE UF KNOWN) _ 3. NAME J RELATIONSHIP ’_ AR CITIZENSHIP ____________ ADDRESS " ‘TYPE AND LOCATION OF SERVICE (1F KNOWN) °. E Py Z :
SEC 12. EDUCATION Cnine Inlend | issior ELEMENTARY SCHOOL 722126 ~2260+ ADDRESS Cuuroe, Sherntant, Be Shins nas qees Cry State Country DATES ATTENDED 27S 7 2o"" GRADUATE? 1es HIGH SCHOOL 22355 -"iene | senacr ADDRESS _Treles, Shantumc, |. Sins Cus Srate Country SSct Tess ron DATES ATTENDED _. 2580 ~ 180 GRADUATE? res COLLEGE Haréiz Simmons University . appress Abilene, “7s Wes Tens none City _ State Country Tees sass DEGREE Ze, DATES ATTENDED COLLEGE S292: DATES ATTENDED 1946 - 3194] DEGREE “> a SEC. 13. MILITARY, NAVAL OR OTHER GOV'T SERVICE — U.S. OR FOREIGN Us Levy Resiem ven €, 45 to dune 46 Country Service Rank Dates of Service he Ching 445 a TAG Honorsbdle ean eae Last Station Serial No. Type of Discharge REMARKS: WR A SELECTIVE SERVICE BOARD NUMBER ADDRESS _ IF DEFERRED GIVE REASON INDICATE MEMBERSHIP IN MILITARY RESERVE ORGANIZATIONS SEC. 14 CHRONOLOGICAL HISTORY OF EMPLOYMENT FOR PAST 15 YEARS. ACCOUNT FOR ALL.PERIODS. INCLUDE CASUAL EMPLOYMENT. INCLUDE ALSO PERIODS OF UNEMPLOYMENT. GIVE ADDRESSES AND STATE WHAT YOU DID DURING PERIODS OF UNEMPLOYMENT. LIST LAST POSITION FIRST.. 1. FROM June 1946 TO _-resent EMPLOYING FIRM OR AGENCY SS a ee te A Re St. & No. City Btate Country ct KIND OF BUSINESS NAME OF SUPERVISOR TITLE OF JOB SALARY $_8800+ _ per Sum YOUR DUTIES ___._ REASONS FOR LEAVING my Fa ° we
14-00000 sa agen FROM _C&z+ FROM Appt pg ehinnta ans ‘a a DRESS ESI Clog sf Ve vel 2 AD 4 rr EG tn een tere nt we we ae &:. & No. eur Siate Coustry KIND OF BUSINESS NAME OF SUPERVISOR TITLE OF JOB SALARY £__ COPPER REASONS FOR LEAVING _ Ao we .eoeer Leite TO Gare 2d EMPLOYING FIRM OR AGENCY Sr ADDRESS whe invren. =. of. 148 St & No. City ; State Countrs ° KIND OF BUSINESS _.._ i‘ COUNAME OF SUPERVISOR TITLE OF JOB. SALARY UE 1) PER YOUR DUTIES Special scont REASONS FOR LEAVING 1 1sé0 TO oar. 1942 ADDRESS Bt. & No. cis State Country KIND OF BUSINESS U0 WNAME OF SUPERVISOR TITLE OF JOB CU SALARY S Chee PER a YOUR DUTIES speci al Strefecler Searener REASONS FOR LEAVING __ FROM ______.__ TO EMPLOYING FIRM OR AGENCY __ ADDRESS .00 Ee St. & No. city State Country KIND OF BUSINESS __ ee NAME OF SUPERVISOR TITLE OF JOB We T:CSALLARY S_CCCC:*:éCiP@R YOUR DUTIES ~ 2S REASONS FOR LUAVING
a Fr HAVE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN FROM ANY FOSITICN? HAVE YOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH YOU DESIRE TO EXPLAIN? GIVE DETAILS: N ts YY a es so SS Sn SEC. 16. GIVE FIVE CHARACTER REFERENCES —IN THE U.S.— WHO KNOW YOU INTI- ; MATELY — (GIVE RESIDENCE AND BUSINESS ADDRESSES WHERE POSSIBLE.) treet and Number City State i In, Sovtert Richerdser. ¢ ESUADIT. __#tiisns, Temes 9 _Froie Stenhensen BUS. ADD. Férdin Simons Univ. Abilene, Texas RES. ADD. 3 ‘.dhece “Fenian 4 ford Silis Trad ihn ams > wee ad i 5 FPrea mhoLarGa BUS. ADD. 22: eshin ctor i. fe RES. ADD. WW SEC. 17. NAMES OF FIVE PERSONS WHO KNOW YOU SOCIALLY IN THE UNITED STATES — NOT REFERENCES, SUPERVISORS OR EMPLOYERS — (Give residence and business ad- dresses where possible.) -— . on Street and Number city ” ‘Btate 1. : BUS. ADD. C 3 washington D. CG. op RES. ADD. : RES. ADD. —_— 3. Pe Je Gavin BUS. ADD. RES. ADD. __U:512 Lecrel, Yovston, Texas 4, denes Forr _ pus. app. _20é Sterling Side., Houston, Texas RES. ADD, ___ : 5 nek Ae) elcher BUS. ADD. ola, Houston, Texas RES. ADD.
14-00000 SEC) 18. GIVE THREE NEIGHBORS AT YOUR LAST NORMAL RESIDENCE IN THE US — (Give residence and business addresses where possible.) Street ang Number Citr Biste do ewe HONEA SG eke BUS. ADD. RES. ADD. uns Urcsswait veers ee Teves BUS. ADD. rAL a 7 ~ RES. ADD. 3500 Vadervocd, Ecucion, Tenge BUS. ADD RES. ADD. ESO) Dngervood, ~euston, Terre tn ty Q roy © FINANCIAL BACKGROUND 4. ARE YOU ENTIRELY DEPENDENT ON YOUR SALARY? __Lés If NOT, STATE SOURCES OF OTHER INCOME B. NAMES AND ADDRESSES OF BANKS WITH WHICH YOU HAVE ACCOUNTS Reoryne ree a ergre rts ve tio foe et Deni C. HAVE YOU EVER BEEN IN, OR PETITIONED FOR, BANKRUPTCY? ride GIVE PARTICULARS, INCLUDING COURT: tr enna eeEEEe D. GIVE THREE CREDIT REFERENCES —IN THE U.S. 1. NAME ADDRESS : St. & No. City State 2. NAME ADDRESS a 8t. a No. city Brate 3. NAME ADDRESS St. & No. City Btate SEC. 20. RESIDENCES FOR THE PAST 15 YEARS St. No. City Brate Country FROM 1940 TO 1242 Neshinctom, D, 2c, 54 ~ St. No. ° City State Country FROM _=° 45 TO 1645 sen Franeiseo, Gelifernis TSA Bt, No, City Biate Country FROM 1945 TO 1247 Korth Ching 8t. No. City Strate Country FROM _1947 TO fpr 1948 Tsinstoo North Chins Bt. No. City State Country FROM _/Pr_1948&6 Sevt. 1949 Celoutts India 8t. No. City State Country — ee TO FROM St. No. City Btate Country FROM _______._ TO SEC. 21. RESIDENCE OR TRAVEL OUTSIDE OF THE UNITED STATES A. FROM 19290 . vo 1236 Cheroo Merth Gnines with parents , " ~~ City or Section . ~ Country ae FROM 1945 TO 194% Shinn enc Indic _ City or Section Country Purpose FROM www. TO LU City or Section Country Purpose
14-00000 10 City or Section Country _ Purpose i FROM . oa City or Section Country . ; Purpose 3 3 City or Section ” HOW MANY OTHER U.S. PASSPORTS HAVE YOU HAD? “DATES: = PASSES | OF fiveil NATIONS: : “List “NAMES ‘AND ADDRESSES OF “ALL CLUBS, SOCIETIES, PROFESSIONAL * ROCIETIES, - _ EMPLOYEE GROUPS, ORGANIZATIONS OF ANY KIND (INCLUDE MEMBERSHIP IN, OR SUP-...., PORT OF, ANY ORGANIZATION HAVING HEADQUARTERS OR BRANCH WA FOREIGN COUN- Mel 6 SAR Name and Chapter... . . Bt. & No, — Ly “City —_ Btate _ Gountry DATES OF MEMBERSHIP: — o . ® - . 4 : ; Name and Chapter Be. & No. « . City - State . Country. . ‘DATES OF MEMBERSHIP: a a Name and Chapter oO ae St. & No. a ‘DATES OF MEMBERSHIP: “Name and Chapter . St. & No. DATES OF MEMBERSHIP: eT - Name and Chapter St. & Ne. city Btate Country _—- DATES OF MEMBERSHIP: Name and Chapter : DATES OF MEMBERSHIP:
cy » GENERAL QUALIFICATIONS A. FOREIGN LANGUAGES (STATE DEGREE OR PROFICIZNCY AS “SLIGHT” “FAIR” OR “FLUENT") LANGUAGE __Chinesre SPEAK _: £37 READ ___7" WRITE 77 Peenes Sekt Siickst iekt LANGUAGE _ 7" & PCs SPEAK _~*2Eo* READ __7~""=""“_ WRITE SAEERS LANGUAGE _____«C SPEAK READ uw :«CWWRITE LIST ALL SPORTS AND HOBBIES WHICH INTEREST YOU: INDICATE DEGREF OF PROFI- CIENCY IN EACH: HAVE YOU ANY QUALIFICATIONS, AS A RESULT OF TRAINING OR EXPERIENCE, WHICH MIGHT FIT YOU FOR A PARTICULAR POSITION? LIST BELOW THE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO WHICH YOU HAVE APPLIED FOR EMPLOYMENT SINCE 1939: eee rr ermrmenrr cS ereeAAhhe PSC ngppper pr eernecereer reer ee ete Department of Justice CTL IF, TO YOUR KNOWLEDGE, ANY OF THE ABOVE HAS CONDUCTED AN INVESTIGATION OF YOU, INDICATE BELOW THE NAME OF THAT AGENCY AND THE APPROXIMATE DATE OF THE INVESTIGATION: ll
SEC. 24. .MISCELLANEOUS A. DO YOU ADVOCATE OR HAVE YOU EVER ADVOCATED; OR ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OR, OR HAVE YOU SUPPORTED ANY POLITICAL PARTY OR ORGANI- ZATION WHICH ADVOCATES THE OVERTHROW OF OUR CONSTITUTIONAL FORM OF GOV- ERNMENT IN THE UNITED STATES? If “YES", EXPLAIN: —_- a eve B. DO YOU USE, OR HAVE YOU USED, INTOXICANTS? ian IF SO, TO WHAT C. HAVE YOU EVER BEEN ARRESTED, INDICTED OR CONVICTED FOR ANY VIOLATION OF LAW OTHER THAN A MINOR TRAFFIC VIOLATION? IF SO, STATE NAME OF COURT, CITY, STATE, COUNTRY, NATURE OF OFFENSE AND DISPOSITION OF CASE: D. HAVE YOU EVER BEEN COURT-MARTIALED WHILE A MEMBER OF THE ARMED FORCES? IF ANSWER IS “YES,” GIVE DETAILS BELOW: i re Ho tt RR te ae SEC. 25. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY: re. Zacricia A. Loore Wife NAME 72? 7 RELATIONSHIP — OLA Techertor Street Se mt pee. Teme wet Boole rE oe rvol wees i eg sess ewes BCUTEZ, vse ADDRESS ee EE EE eee OO _ St. & No. City State Country SEC. 26. YOU ARE INFORMED THAT THE CORRECTNESS OF ALL STATEMENTS MADE HERE- IN WILL BE INVESTIGATED. ARE THERE ANY UNFAVORABLE INCIDENTS IN YOUR LIFE NOT MENTIONED ABOVE WHICH MAY BE DISCOVERED IN SUBSEQUENT INVESTIGATION, WHETHER YOU WERE DIRECTLY INVOLVED OR NOT, WHICH MIGHT REQUIRE EXPLANATION? IF SO, DESCRIBE. IF NOT, AN- SWER “NO.”
14-00000 So. ii, I'CERTIFY THAT THE FOREGOING ANSWERS ARE TRUE AND CORPECT To THF BEST OF MY KNOWLEDGE AND BELIEF, AND I AGREE THAT ANY} T ANY MISSTATEMENT OR OMISSION AS TO A MATERIAL FACT WILL CONSTITUTE GROUNDS FOR Tah MEDIATE DISMISSAL OR REJECTION OF MY APPLIC: TION. weet mas Ore o Tacte se a ett eg LERES SIGNED AT ‘sf Posr City and Grate To we Oren 1 Witness USE THE FOLLOWING PAGES FOR EXTRA DETAILS. NUMBER ACCORDING TO THE NUMBER OF THE QUESTION TO WHICH THEY RELATE. SIGN YOUR NAME AT THE END OF THE ADDED MATERIAL. IF ADDITIONAL SPACE IS REQUIRED USE EXTRA PAGES THE SAME SIZE AS THESE AND SIGN EACH SUCH PAGE. 13 U.S. GOVERNMENT PRISTING OFFICE :195G 0 - £87823
a * Listed below are names of organizations identified by the Attorney General, under his responsibility pursuant to Executive Order 10450, dated 27 April 1953, to list the names of each foreign or domestic organization, association, movement, group or combination of persons which he designates as Totalitarian, Fascist, Communist, or subversive, or as having adopted or having shown a policy of advocating or approving the commission of acts of force or vio- lence to deny others their rights under the Constitution of the United States, or as seeking to alter the form of PERSONAL HISTORY STATEMENT — (Appendix ID government of the United States by unconstitutional means. Each applicant or employee and spouse (if an purposes, and sign on the last page.’. - Meet gt oar ee Abraham Lincoln Brigade . inols Abraham Lincoln School, Chicago, 1 Action Committee to Free Spain Now : . Alabama People’s Educational Association (see Communist Politi- cal Association) American Assoctation for Reconstruction in Yugoslavia, Inc. American Branch of the Federation of Greek Maritime Unions American Christian Nationalist Party American Committee for European Workers’ Relief (see Socialist Workers Party) American Committee for Protection of Foreign Born American Committee for Spanish Freedom - 4 American Committee for. the Settlement of Jews in. Birobidjan, Inc. | |. American Committee for Yugoslav Relief, Inc. . . . American Committee to Survey Labor Conditions in Europe American Council for a Democratic Greece, formerly known as the Greek American Council; Greek American Committee for Na- tional Unity American Council on Soviet Relations American Croatian Congress American Jewish Labor Council American League Against War and Fasciam American League for Peace and Democracy American National Labor Party American National Socialist League American National Socialist Party American Nationalist Party American Patriots, Inc. American Peace Crusade American Peace Mobilization American Poles for Peace American Polish Labor Council American Polish League American Rescue Ship Mission (a project of the United American Spanish Aid Committee) American-Russian Fraternal Society American Russian Institute, New York, also known as the Amert- can Russian Institute for Cultural Relations with the Soviet Union . American Russian Institute, Philadelphia American Russian Institute of San Francisco American Russian Institute of Southern California, Los Angeles American Slay Congress American Women for Peace American Youth Congress American Youth for Democracy Armenian Progressive League of America Associated Elana of America Association of Georgia Klans Association of German Nationala (Reichsdeutseche Vereinigung} Auslend-Organization der NSDAP, Overseas Branch of Nazi Party Baltimore Forum Benjamin Davis Freedom Committee Bleck Dragon Soclety PORM uss 444d vse PREVIOUS EDITIONS ) must review the following list of organizations for certification Boston School for Marzist Btudies, Boston, Massachusetts Bridges-Robertson-Schmidt Defense Committee Bulgarian American People's League of the United Btates of America, California Emergency Defense Cornmittee Calfornia Labor School, Inc., 321 Divisadero Street, San Francisco California : Carpatho-Russian People's Society Central Council of American Women of Croatian Descent, also known as Central Council of American Croatian Women, Na- tional Council of Croatian Women Central Japanese Association (Belkoku Chuo Nipponjin Kal) Central Japantse Association of Southern California Central Organization of the German-American National Alliance (Deutsche-Amerikanische Einhettsfront) Cervantes Fraternal Society China Welfare Appeal, Inc. Chopin Cultural Center Citizens Committee for Harry Bridges Citizens Committee of the Upper West Side (New York City) Citizens Committee to Free Earl Browder Citizens Emergency Defense Conference Citizens Protective League Civil Liberties Gponsoring Committee of Pittsburgh Civil Rights Congress and its affiliated organizations. including: Civll Righta Congress for Texas Veterans Against Discrimination of Civil Rights Congress of New York Civil Rights Congress for Texas (see Civil Rights Congress) Columbians Comite Coordinador Pro Republica Espanola Comite Pro Derechos Civiles (See Puerto Rican Comite Pro Libertades Civiles) Committee for a Democratic Far Eastern Policy Committee for Constitutional and Political Freedom Committee for Nationalist Action Committee for Peace and Brotherhood Festival in Philadelphia Committee for the Defense of the Pittsburgh Six Committee for the Negro in the Arts Committee for the Protection of the Bill of Rights Committees for World Youth Friendship and Cultural Exchange Committee to Abolish Discrimination in Maryland (See Congress Against Discrimination; Maryland Congress Against Discrimination; Provisional Committee to Abolish Discrimination in the State of Maryland) Committee to Aid the Fighting South Committee to Defend Marie Richardson Committee to Defend the Rights and Freedom of Pittsburgh’s Political Prisoners Committee to Uphold the Bill of Rights Commonwealth College, Mena, Arkansas Communist Party, U. S. A., its subdivisions, subsidiaries, and affiliates 8 (4)
Communist Political Association, ite subdivisions, subsidiaries, aiid affiliates, including: Alabama People’s Educational Associatién Florida Press and Educational League Oklahoma League for Political Education People’s Educational and Press Assoctation of Texas Virginia League for People’s Education Congress Against Discrimination (See Committee to Abolish Discrimination in Maryland) Congreas of American Revolutionary Writers Congress of American Women Congress of the Unemployed Connecticut Committee to Aid Victims of the Smith Act ' Connecticut State Youth Conference Councll for Jobs, Relief and Housing Councl for Pan-American Democracy Council of Greek Americans Council on African Affairs Croatian Benevolent Fraternity Dai Nippon Buteku Kali (Military Virtue Boclety of Japan or Mili- tary Art Society of Japan) Dally Worker Press Club Daniels Defense Committee Dante Alighiert Society (between 1935 and 1940) Dennis Defense Committee Detroit Youth Assembly East Bay Peace Committee Elsinore Progressive League Emergency Conference to Save Spanish Refugees (founding body of the North American Spanish Ald Committee) Everybody's Committee to Outlaw War Families of the Baltimore Smith Act Victims Families of the Smith Act Victims Federation of Italian War Veterans in the U. &. A., Inc. (Associe- gione Nazionale Combattent! Italiani, Federagione degli Stati -Uniti d'America) Finnish-American Mutual Aid Society Florida Press and Educational League (ses Communist Politica? Association) Frederick Dougiass Educational Center Freedom Stage, Inc. Friends of the New Germany (Freunde des Neuen Deutschlands) Friends of the Soviet Union Geribald! American Fraternal Society George Washington Carver School, New York City - German-American Bund (Amerikadeutscher Volksbund) German-American Republican League German-American Vocational League (Deutsche-Amerikanische Berufsgemeinschaft) Guardian Club Harlem Trade Union Council Hawaii Civil Liberties Committee Heimusha Kai, also Known as Nokubei Heleki Gimusha Kai, Zaibe) Nibonjin, Helyaku Gimushe Eal, and Zaibel Heimusha Kei (Jap- . anese Residing in America Military Conscripts Association) Hellenic-American Brotherhood Hinode Eai (Imperial Japanese Reservists) Hinomaru Kail (Rising Sun Flag Society —a group of Japanese War Veterans) Hokubel Zaigo Shoke Dan (North American Reserve Officers Asso- elation) Hollywood Writers Mobilization for Defense Bungsrian-American Council for Democracy Hungarian Brotherhood Idaho Pension Union Independent Party (Seattle, Washington) (See Independent People’s Party) Independent People’s Party (Bee Independent Party) Industrial Workers of the World International Labor Defense International Workers Order, ita subdivisions, subsidiaries and affiliates Japanese Association of America Japanese Overseas Central Society (Kaigai Dobo Chuo Kal) Japanese Overseas Convention, Tokyo, Japan, 1940 Japanese Protective Association (Recrufting Organization) Jefferson School of Social Science, New York City Jewish Culture Society Jewish People’s Committee Jewish People's Fraternal Order Jikyoku Tinkai (The Committee for the Crisis) Johnson-Forest Group (8ee Johnsonites) Johnsonites (See Johnson-Forest Group) Joint Anti-Pascist Refugee Committee Joint Council of Progressive Italan-Americans, Inc. Joseph Wedemeyer School of Social Bcience, Bt. Louls, Missouri Eibel Seinen Kai (Association of U. 8. Citizens of Japanese An- cestry who have returned to America after studying in Japan) Knights of the White Camellia Ku Klux Klan Kyfihaeuser, also known as Kyffhaeuser League (EKyfhaeuser Bund), Eyfheeuser Fellowship (Kyfhaeuser EBameradschaft} Kyffhacuser War Relief (Kyffhaeuser Eriegshilfswerk) Labor Council for Negro Rights Labor Research Association, Inc. Labor Youth League League for Common Sense League of American Writers Lictor Society (Italian Black Shirts) Macedonian-American People's League Mario Morgantini Circle Maritime Labor Committee to Defend Al Lannon Maryland Congress Against Discrimination (See Committee to Abolish Discrimination in Maryland) Massachusetts Committee for the Bill of Rights Massachusetts Minute Women for Peace (not connected with the Minute Women of the U. 8. A., Inc.) Maurice Braverman Defense Committee Michigan Civl) Rights Federation Michigan Council for Peace Michigan School of Social Science Nanka Telkoku Gunyudan (Imperial Military Priends Group or Southern California War Veterans) National Association of Mexican Americans (also known as Asocia- cion Nacional Mexico-Americansa) National Blue Star Mothers of America (not to be confused with the Blue.Star Mothers of America. organized in February 1942) National Committee for Freedom of the Press National Committee for the Defense of Politica] Prisoners National Committee to Win Amnesty for Smith Act Victims National Committee to Win the Peace National Conference on American Policy in China and the Far East (a Conference called by the Committee for a Democratic Par Eastern Policy) . National Council of Americans of Croatian Descent National Council of American-Soviet Friendship National Federation for Constitutional Liberties National Labor Conference for Peace National Negro Congress National Negro Labor Council Nationalist Action League ~2-
Nationalist Party of Puerto Rico Nature Friends of America (since 1935) Negro Labor, Victory Committee New Committee for Publications Nichibei Kogyo Kaisha (The Great Pujll Theatre) North American Committee to Ald Spanish Democracy North American Spanish Aid Committee North Philadelphia Forum Northwest Japanese Association Ohio School of Social Sciences Oklahoma Committee to Defend Political Prisoners Oklahoma League for Political Education (see Communist Politi- cal Association) Original Southern Klans, Incorporated Pacific Northwest Labor School, Seattle, Washington Palo Alto Peace Club Partido del Puebio of Panama (operating in the Canal Zone) Peace Information Center Peace Movement of Ethiopia People’s Drama, Inc. ° People’s Educational and Press Association of Texas (see Commu- nist Political Association) People’s Educational Association (incorporated under name Los Angeles Educational Association, Inc.), also known ae People’s Educational Center, People’s University, People’s School People's Institute of Applied Religion Peoples Programs (Seattle, Washington) People’s Radio Foundation, Inc. People’s Righta Party Philadelphia Labor Committee for Negro Rights Philadelphia School of Social Science and Art Photo League (New York City) Pittsburgh Arts Club Political Prisoners’ Welfare Committee Polonia Society of the TWO Progressive German-Americans, also knowm as Progressive Gere man-Americans of Chicago Proletarian Party of America Protestant War Veterans of the United States, Inc. Provisional Committee of Citizens for Peace, Southwest Area Previsional Committee on Latin American Affairs Provisional Committee to Abolish Discrimination im the State of Maryland (See Committee to Abolish Discrimination In Maryland) Puerto Rican Comite Pro Libertades Civlles (CLC} (See Comite Pro Derechos Civiles) Puertorriquencs Unidos (Puerto Ricans United) Quad City Committee for Peace Queensbridge Tenants League Revolutionary Workers League Romantan-American Fraternal Goclety Russian American Society, Inc. Sekura Esai (Patriotic Society, or Cherry Association — composed of veterans of Russo-Japanese War) Samuel Adams School, Boston, Massachusetts Santa Barbara Peace Forum Schappes Defense Committee Schnelderman-Darcy Defense Committee School of Jewish Studies, New York City Seattle Labor School, Seattle, Washington Serbian-American Fraternal Soctety Serbian Vidovdan Council Shinto Temples (imited to State Shinto abolished in 1945) Silver Shirt Legion of America Slavic Council of Southern California Slovak Workers Society Slovenian-American National Council Boclalist Workers Party, including American Committee for Euro- pean Workers’ Rellef Sokoku Eal (Patherland Society) Southern Negro Youth Congress Sultko Sha (Reserve Officers Association, Los Angeles) Syracuse Women for Peace Tom Paine School of Social Science, Philadelphia, Pennsylvania _Tom Paine School of Westchester, New York Trade Union Committee for Peace (See Trade Unionists for Peace) Trade Unionists for Peace (See Trade Unionists for Peace) Tri-State Negro Trade Union Council Ukrainian-American Fraternal Union Union of American Croatians Union of New York Veterans United American Spanish Aid Committee United Committee of Jewish Societies and Lamdamanschaft Fed- erations, also known as Coordination Committee of Jewish Landsmanschaften and Fraternal Organizations United Committee of South Slavic Americans United Defense Council of Southern California United Harlem Tenants and Consumers Organization United May Day Committee | United Negro and Allied Veterans of America Veterans Against Discrimination of Civil Rights Congress of New York (see Civil Rights Congress) Veterans of the Abraham Lincoln Brigade Virginia. League for People's Education (see Communist Political Association) Yoice of Freedom Committee Walt Whitman School of Social Science, Newark, New Jersey Washington Bookshop Association Washington Committees for Democratic Action Washington Committee to Defend the Bul of Rights Washington Commonwealth Federation Washington Pension Union Wisconsin Conference on Social Legislation Workers Alllance (since April 1936) Yiddisher Kultur Farband Young Communist League Yugoslav-American Cooperative Home, Ine. Yugoslav Seamen's Ciub, Inc.
' . CERTIFICATION I certify that I have read the names of the above listed organizations. To the best of my knowledge and belief, I am not, nor have I been a member of, contributed to, recelved liter- ature from, signed petitions of or in behalf of, or attended meetings of any organization Usted above, or any organization outside the United States espousing Communist, Fascist, Totalitarian or Nazi causes, except as noted below. To the best of my knowledge and belief, none of my close relatives are, nor have ever been members of, con- tributed to, recelved literature from, signed petitions of or in behalf of, or attended meetings of any such organiza- tions, except as noted below. j»ven<—- INSTRUCTIONS For the purpose of this certification, if an applicant or employee is completing this Jorm, the term “close rela- tive” will include spouse, children, parents, brothers, sisters, uncles, and aunts. “Close relatives” of the spouse, for this purpose, will include children, parents, brothers, sisters, uncles, and aunts. if there are exceptions to this certification, set forth below under Remarks all pertinent information concern- ing the nature and extent of your activities or those of your close relatives in such organizations, including the names of the organizations, dates of membership, meetings attended, titles of positions held, amounts and dates of contributions, nature of petitions signed falling within the meaning of the above certification and circumstances thereof, titles and authors of literature received, and dates on which received. In exceptions concerning relatives, include only such information presently known to you or available from your own records. I] necessary, use additional sheets and sign each sheet. Write none if there are no exceptions. tt hn REMARKS: To be completed by Spouse | REMARKS: To be completed by Applicant or Employee + we Date Date Signature of Spouse Signature of Applicant or Employee 7 } i. Lo, ; 7 a . . a u “pot Pf 4, fi lice to! Ci. A) preonk _ Lee Vai [Livery Address — City_and State Addréss — City,and State ~ TLS Lodien Ka ame Lab , wer, Los Lady Kant, —ubiact A few mee. Witness, Oe ee Ck eer Lenehan aaa Bet Lon Sot ok, Address — City and State . Address — ‘Clty and State ~4-