= JFK ASSASSINATION SYSTEM ‘ IDENTIFICATION FORM - . AGENCY INFORMATION Peleased under the John ; Kennedy AGENCY : CIA hssassination Records RECORD NUMBER : 104-10104-10167 ollectian &et of 1992 RECORD SERIES : JFK (44 USC 2107 Note). AGENCY FILE NOMBER : 80T01357A ase#: NW 5353294 Date: DOCUMENT INFORMATION poo is—201" AGENCY ORIGINATOR : CIA FROM : TO : : TITLE : PERSONAL HISTORY STATEMENT DATE : 03/15/1965 PAGES : 17 SUBJECTS : WITHHELD PERSONAL HISTOR DOCUMENT TYPE : PAPER CLASSIFICATION : UNCLASSIFIED RESTRICTIONS : 1A CURRENT STATUS : RELEASED IN PART PUBLIC - RELEASED WITH DELETIONS DATE OF LAST REVIEW : 07/26/93 . COMMENTS : JFK37 : F1l : 1993.07.26.09:42:43:310620 : THIS IS PHS OF AGENCY EMPLOYEE. IT INADVERTENTLY INCLUDED IN JFK MATERIALS. [R] - ITEM IS RESTRICTED 104-10104-10167 aW 53294 Docld:32396016 Page 1
5. a7. ls. SECTION | GENERAL PERSONAL AND PHYSICAL DATA “3 es JS ey dowahe G J & PERSONAL HISTORY STATEMENT : INSTRUCTIONS ~Do NOT attempt to complete this form until you have read the following’ instructions— . Answer all questions completely or check (X) the box which applies. If the question is not applicable, write “NA”. If: you do not know the answer and it cannot be obtained from personal records, write “Unknown”. Use the blank space on pages 15 and 16 for extra details on any question for which you do not have enough space. , : . Type or print carefully; avoid using light color inks. . Leave blank any boxes or columns which are marked ‘FOR OFFICE USE ONLY”. . Consider each of your answers carefully; accurate completion of the form will permit review of your qualifications to the best advantage. Your signature at the end of the form will certify to its correctness. . Page 17 entitled “Personal History Summary” must be completed. It is a brief abstract of information from other parts of the form and will help to speed the processing of your application. W, M. EDWARDS . Full Name (Last-first-middle) . . . ; . 2. Age 3. Sex 4. Social security number .HUBER Herbert Gottlieb _ 34 XQ mote =] Femate| 218 26 5322 -. a Nicknames : . 6. Other names you have used; None a None Indicate circumstances  Gncading length of time} under which you have used the names noted in item 6 above NA | if legal change of name, give particulars (Where and by what outhority) 11. Color of eyes -  .; : . 12. Color of hair : + | 13. Type of complexion 14. Build . Brown. ,'| Brown’ - Med ium _ Medium 18. Current phone number : 19, Long distance 90-A Azalea Drive wd a rn eae - orea code Shaw AFB, South Carolina 29152 nn ~~ 436-6150 20. Permanent address (No., Street, City, Stote & ZIP code—country if not U.S.) , x 1. Permanent phone number 22. Long distance 2. 221 Quaint Acres Drive " : area code Silver Spring, Maryland MA 2-0697 Indicate the lowest annual entrance salary you will accept . . _ | 3. Dates available for employment $e ; Earliest: May l2, 19 . Indicate your willingness to trovel: fx] Occasionally E] Frequently ‘ LJ Constantly prea FORM USE PREVIOUS ; . . ‘ ‘ 444 ““eoTIONS I= : . Indicate your willingness to accept fx] Washington, D.C. . LJ Anywhere’in U.S: _ Outside continental U.S. , assignment in the following focations— check (X) each item spplicoble Ci Certain locations only (specify WW 53294 DoclId:32396016 Page 2
SECTION i _— CITIZENSHIP . . D1. Date of birth” ” a | 2. Place of bith (City, Stote, Country) “~ : : ~ . ~ 3. Present citizenship (Country) January 8, 1931 | Baltimore, Maryland, USA : USA Citizenship [RX] Birth L] Marriage 5. Dote naturalized 6. Naturolization certificate number acquired by: [] Other (Specify): 7. Court issuing naturalization certificate Sos 8. Issued ot (City, State, Country) 9. If alien, give alien registration number swe . ' . |0. Date of arrival in U.S. 11, Have you held previous nationality? os weet a . 12, If yes, give name of country : pa C] ves IX] No - ot . ie : Broo NAL L ft 13. Give particulars concerning previous nationalities MARITAL STATUS 2. State date, place, and reason for all separations, divorces or annulments ' ; ‘ m7 you have been married more than once {including annuiments) use separate sheet for former wife or husband giving data required below for all previous marriages. if marriage contemplated, fill in appropriate information for flance. 3, Name of spouse (First) (Middle) set Bernadette Maril 4, State any other names ever used by spouse Indicate circumstances (including length of time) under which any names noted in Item 4 above were used. If legal change, give particulars (where & . by what authority). Use extra space provided on pages 15 and 16 of this form to record this Information. : 5. Date of birth 6. Place of birth (City, State, Country) 7. Date of marriage December 1 Duluth, Minnesota, USA Februa 8. Place of marriage (City, State, Country) _buluths Minnesota 11. Former citizenship(s) [eountry{ies)] ‘“" None toe 15. Date of arrival in U.S. NA 18. Cause of death ; : : ar a . co . , NA 1 19. Current address (Give last address, if deceased) 90-A Azalea Drive, Shaw AFB, South Carolina 4 20. Occupation . 21. Present employer (Also give former employer, ori if spouse deceased or unemployed, give last two employers} in, | Wife and Mother 23. Dotes of military service + + + | 24, Branch of military service * > (From-—~to~—by month & year) Bey, oe batt de . 'UsS. ‘Air Force Pate tte me TRE: MW 53294 DoclId:32396016 Page 3
SECTION V eo. ~~ CHILDREN AND OTHER DEPENDENTS — 1 Provide the following information for all children and dependents: z nee | December 15, 1932. |90-A A,alea Drive Bernadette Marilyn Huber | Wife |Duluth, Minnesota USA |Shaw AFB, S.C. | May 26, 1955 90-A Azalea Drive Michele Gisella Huber Washington, D.C. ace AFB, 3.0. July 16, 1956 | usa [epee Azalea Drive Austin, Texas USA Shaw AFB, S.C. July 10, 1958 usa lepae Azalea Drive Houston, Texas USA {Shaw AFB, 8.0. May 13, 1961 90-A Azalea Drive Wiesbaden Germany USA |Shaw AFB, 8.0. 9 2. No. of children (include stepchildren & adopted children) who are 3. No. of other dependents (e.g., spouse, porents, stepparents, etc.) who i unmarried, under 21 years of age, and are NOT self-supporting. depend on you for ot least 50% of their support or children over 21 fp so NOT self-supporting. . SECTION VI FATHER (Give same information for stepfather and/or guardian on a separate sheet) 1. Fuil name {(lost— First — Middle) Huber Gottlieb © NMI 2. State other names he has used None Indicate circumstances (including length of time) under which any names in ttem 2 above were used. If legal change, give particulars (where & by what authority). Use extra space provided on pages 15 and, 16 of this form to record this information. . 3. Date of birth 4. Place of birth (City, State, Country) ; 5. Living : July 4, 1904 Unterschutzen, Austria TS a Kilve [Jno 6. Date of death “+. 4 1 7, Cause of death . bet, ea ew _ 4 sb EL 8. Citizenship (Country) NA NA ; OS ae ‘USA 9. Former citizenship(s) (country(ies)] poole 11. Where acquired (City, State, Country) Austria a , Baltimore, Maryland: : . 14. Date of arrival in U.S. , April 1925 °:- 221 Quaint Acres Drive, Silver Spring, Maryland |_ —— : 17. Present employer (Give last employer if father deceased or unemployed) Charles H. Thompkins Co. _. 1 M18. Employer's business address or father’s business address if self-employed : Dt 0. Branch of military service. °+!- NA |: "| 22. Details of other government service, U.S. or foreign None 4 SECTION VII - MOTHER (Give some information for stepmother on a separate sheet) . Pe 1. Full name (Los}—First—Middle— Maiden) . . . : : Huber Gisella NMI _ Graf 2. State other names she hos used None Indicate circumstances (including length of time) under which any names noted In item 2 above were used. If legal change, give particulars (where & by whot authority). Use extra space provided on pages 15 and 16 of this form to récord this information. | . : . * 4, Place of birth : Lo ‘ 5. Living : oo Unterschutzen, Austria - | Lo) ves KX No 7. Cause of death a tooG ! : . "Ts 8. Citizenship (Country) Suicide: _ as _USA AW 53294 DoclId:32396016 Page 4
es TS MOTHER (Continued) 7 10, Dote U.S. citizenship acquired 11. Whe. aquired (City, State, Country) , . Austria Sep 9, 1940 Baltimore, Maryland 12. Naturolization certificate number 13. if alien, give alien registration number . 14. Date of arrival in U.S. ; NA Sep 1929 _ Deceased - 615 Lycoming Avenue, Silver Spring, Maryland 9. Former citizenship(s) [country{ies)] 20. Branch of military service NA 4 22. Details of other government service, U.S. or foreign None Vill BROTHERS AND SISTERS (including half-, step-, and adopted brothers and sisters} 1. Full name (last— First— Middle-— Maiden} oS 2. Relationship : 3. Citizenship (Country) Huber Walter Hiward _ . Brother ; USA 1) 4. Date of birth 5. Place of birth (City, Stote, Country) , : a 6. living Jun 23, 1932 Baltimore, Maryland, USA fx]ve [Jno 7. Present employer (Give last employer if deceased or unemployed) 8. Current address (Give last address, if deceased) GSA'=- Civil Service O02 Calvin Lane, Rockville, Maryland ‘ 1. Full Name (Lost— First— Middle — Maiden) 2. Relationship 3. Citizenship (Country) Huber Alfred Graf Brother _ _ USA _ 4. Date of birth 5. Place of birth (City, State, Country) po _ 6. living. a Baltimore, Maryland, USA K] ve .[] no 8. Current oddress (Give fost address, if deceased) DNA ~ Oivil Service 3151 Christine Ave, Beltsville, Maryland 6. Living . Yes C] No ; 3. Citizenship (Country) - , “ | 2. Relationship —. 3. Citizenship (Country) 5. Piace of birth (City, Stote, Country) * 8. Current address (Give fo ) 6. Living [_] ves (no 8. Current address (Give last address, if deceased) . . . Relationship : ‘ zit Falog 2. Relationship *° boy .. 3. Citizenship (Country) . © 5. Place of birth (City, State, Country) 3° 7 3 a ck | 6 biving pte EG Eve: 8. Current address (Give lost address, if deceased) * ? ae HW 53294 DBocld:32396016 Page 5
N ~ FATHER-IK__ «W'(If marriage contemplated, fill in information for futs . Full name, flast-first-middle) . Early Bernard Joseph 2. State other names he has used . None SECTION IX peony ther-in-law) ‘ .. Indicate circumstances. (Including length of time) under which any names noted In item 2 above were used. If legal change, give porticulars (where & by what authority). Use extra space provided on pages 15 and 16 of this form to record this information. 3. Date of birth 4. Place of birth : . / 5. living Jul 6, 1900 (7) | Duluth, Minnesota - — | Eve LX No 4, Date of death . 7. Cause of deoth” 9. Citizenship (Country) * H | Dec 26, 1934, Tuberculosis bo, USA rer a 9. Former citizenship(s) (country(ies)} Co, 10. Date U.S. citizenship acquired =| 11. Where acquired (City, State, Country) : r we . : { NA i) ; ee a 13. if alien, give alien registration number : | NA _ 415. Occupation 16. Present employer (Give last employer if father-in-law deceased or unemployed) Unknown “417. Current address (Give last oddress, if deceased) : “| Deceased - 307 9th Ave. West, Duluth, Minnesota SECTION X . MOTHER-IN-LAW {if marriage. contemplated, fill in information for future mother-in-law) : 1. Full name (Lost -—First —Middle— Maiden) ; a ; Early Mae Virginia Beach 8. Citizenship (Country) - . : . USA 10. Date U.S. citizenship acquired 11. Where acquired (City, State, Country) NA hes ‘| NA: 13. If alien, give alien registration number 14, Date of arrival in U.S. -NA ‘ NA . 15. Occupation Ls a 16. Present employer (Give last employer if mother-in-law deceased or unemployed) Officeworker . ‘| Plaunt Plumbing Oo, Duluth, Minnesota 7 17. Current address (Give last address, if deceased) . . 810 N 8th Ave. East, Duluth, Minnesota SECTION XI . " RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (1) LIVE ABROAD, (2) ARE NOT U.S. CITIZENS OR (3) WORK FOR A FOREIGN GOVERNMENT 7. Name (Lost—First— Middle) “| 2. Relationship * 3. Date of birth 5. Citizenship (Country} . 6. Address or country in which relative resides . meta | #1 Unterschutzen; Austria 7. Employed by ° : oa 8. Frequency of contact | ~ : 9. Date of last contact seit (Farmer) 1, Name (Last— First— Middle} . 2. Relationship 3. Date of birth 4. Place of birth (City, State, Country} Huber .Edward NMI & family — nterschutzen, Aus 5. Citizenship (Country) 6. Address or country in which relative resides : 2) austria #70 Unterschutzen, Austria . ; ‘ ; 8. Frequency of contact. it : 9. Date of last contact 3. Date of birth 4. Place of ‘birth (City, State, Country) |! tak ntesschateen, Aus #46 Unterschutzen, Austria’ his” rs . 8. Frequency of contact : 3 ‘. . Seldom - 3 4, Place of birth (City, Stote, Country) nterschutzen, Aus 7 Li rr 7. Employed by Self. (farmer). 1. Name (Last— First-— Middle) Kurtz, Hermina NMI Seldom 2. Relationship & family --| Aunt .|.- 6. Address or country in which relative resides 5. Citizenship (Country) 3} Austria -- 7. Employed by. : Self (farmer 9. Date of last contact Iv. Deo.d 964 3 HW 53294 DoclId:32396016 Page 6
en REL..../VES WITH FOREIGN CONNECTIONS (C  ‘nued) ; 1. Name (Lost—First— Middle) 2. Relationship 3. Dais-of birth | 4. Place of birth (City, Stote, Country) Graf Leopold NMI & famil Uncle Unk Unterschutzen, Aus 6. Address or country in which relative resides Austria 8. Frequency of contact . . 9. Date of last contoct : Seldom Dec 1964 2. Relationship 3. Date of birth 4, Place of birth (City, State, Country) Cousin Unk nterschutzen, Aus 5. Citizenship (Country) Austria Kammer Gerti NMI (Hube 5. Citizenship (Country) 6. Address or country in which relative resides Austria #22 Unterschutzen, Austria 7. Employed by 5 8. Frequency of contact 9. Date of last contact Unknown Seldom Dec 1964 RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO ARE IN THE MILITARY OR CIVIL SECTION Xil SERVICE OF THE UNITED STATES | iH 3. Date of birth 4. Place of birth (City, State, Country) un 23, 52 Balto Md USA: .... 6. Address (Number, Street, City, State, Country) wl 7. Type and location of service (If known) 502 Calvin Lane =| —. «SO¥. *y,, | GSA — Civil Service Rockville, Maryland « | > | Washington, D.0. 1.. Name (Last— First— Middle} ; a . 3 2. Relationship ' 3. Date of birth 4. Place of birth (City, State, Country) 6. Address (Number, Street, City, Stote, Country) . a 7. Type and tocation of service {if known) 3131 Ohristine Avenue DNA.- Civil Service ' -| Beltsville, Maryland *-> | Washington, D.C. . 1. Nome (tast—First— Middle) 2. Relationship |, - 3. Date of birth 4. Place of birth (City, State, Country) 3) §. Citizenship (Country) 6, Address (Number, Street, City, State, Country): 7, Type ond locotion of service (If known) 6615 48th Street NW USAF - Military USA ; Tacoma, Washington 98467 McChord AFB, Wash State SECTION XI, ot EDUCATION ; HA ELEMENTARY SCHOOL 2. Address (City, State, Country) 1. Name (Lost—First-—— Middle) 2. Relationship Huber Walter Edward Brother 5. Citizenship (Country) 3. Years attended (From — to —)| 4. Graduate , MK Yes»: . Name of elementary school Baltimore, Maryland » | Feb 37-Feb 43 Alex Hamilton #65 4, Graduate xx Yes O No 1 3. Years attended (From — to—) 11, Name of high school . 2. Address (City, State, Country) e Feb 43-Feb 46 3. Years attended (From— to—) Baltimore, Maryland : 2. Address (City, State, Country) 4] Gwynne Falls Jr High #91 11. Name of high school : . : . 4. Graduate 4X Yes ) No | Baltimore City College Baltimore, Maryland. Feb 46-Feb 49 COLLEGE OR UNIVERSITY STUDY Grade or Number of i’ ¥ Degree Year : Name ond location of college or university [Subiect cars attended ore reo Paint Sem./ Qtr, A : : 7 , BY upper! level University of Maryland 7 "| Sep 49 -: June | Bus Adm|: ‘| Mar 63 1963 | ‘College Park, Md & Germany... Sep 57 - Nov 57 Mississippi Southern at, ' Biloxi, Missiesippi University of ‘Texas ol Austin, Texas , " 4. Ifo graduate degree has been noted above which required submission of o HW 53294 DBocld:32396016 Page 7 Loe
TRADE, COMMERCIAL AND SPECIALIZED SCHOOLS 4 Study or specialization lsUniversity of “Ben jamin Franklin Washing ae AB 30330. Keesler AFB» Mieeiseippi - 1XX. Sig ee eae Ground Electronic - Countermeasures | Ade Force Suppl FR=700 Ampex Video Tape Recorder Operation: and + ‘Maintenance Other education or training not indicated above On-duty Manufacturer's representative conducted training in Operation and Maintenance of Electronic Data Analysis Equipment ‘ yor List below the foreign language or languages on which? °°% you possess any degree of competence. Indicate your:; - proficiency. in each of the five skill factors shown (read- ing comprehension, writing ability, etc.) by noting the . number most indicative of your level of skill under-the ¢ factor being considered. ‘ if your proficiency relates to'a particular dialect of ao major language, identify this dialect by noting it in’ * parentheses after the language on the same line. - If you have no proficiency in any foreign _ language, check (X) box at right and Jeave———> other, items blank. ; . None ability in any position for which you might be selected? WW 53294 DoclId: 32396016 Page 6 . If you have noted a proficiency in language, would you be willing t to use this ; FOREIGN LANGUAGE ABILITIES “" tevel of Skill 3 5 ety O=No proficiency ina specific skill factor HOW ACQUIRED [Check (X) Box(es) which apply} Om Pree Ely
“SECTION XV GEOu _APHIC AREA KNOWLEDGE AND FOREIG? ~RAVEL List below any foreign regions or countries in which you have travelled or gained knowledge as result of residence, study o or work assignment. ladicate type of knowledge such as terrain, harbors, industries, utilities, railroads, political parties, etc. Knowledge acquired by—Check (X) Work Resi- Travel Study Assign- dence ment x Dates & Place of Study Dates of Travel or Residence Type of Specialized Knowledge Name of Region or Country ———a Jun 59-65 _|_—__— ic 2. Indicate the purpose of visit, residence or travel in each of the regions of countries listed above Eng & Scotland ~ Military Assignment Austria - Visit Relatives Germany: =; :. - Military Assignment ee Holland — - Visit as tourist 3. Indicate shorthand system used— check (X) appropriate item: Other— Cc Gregg CI Speedwriting | Stenotype | Specify: _ SPECIAL QUALIFICATIONS _ . List oll hobbies and sports in which you are active or have actively participated.’ Indicate your proficiency i in each. JT gE ae . . : soe \ : . ~ Swimming, Bowling, Fishing, Dancing - Amateur, but "hold m 2. Indicate any special qualifications resulting from experience or training which might fit you for a particular position or type of work.. Education,..training and work experience in techniques and procedures of Elect tronic Data Readout, Analysis and Evaluation, Maintenance and Operation of associated | Equipment. X13. Excluding business equipment or machines which you may have listed in item 4, section XVI, list any special skills you possess relating to other equipment ands machines such | “4 as operation of radio transmitters (indicate CW speed, sending & receiving), offset press, turret lathe, scientific & professional devices. : sore Maintenance and Operation of Electronic Data.Analysis and Readout equi 4. Are you now or have you ever been a licensed or certified member of any trode or profession such as pilot, electrician, radio operator, teacher, lawyer > CPA, medical technician, psychologist, physician, etc.? : 5 . If you have answered ‘‘Yes"’ to item 4 above, indicate kind of license or certification and the. issuing State, municipality, ete. __ {Provide license registry number, if known) NA . List any significant published materials of which you ore the author (do NOT submit copies unless requested): fiction or scientific articles, general interest subjects, novels, short stories, ete, y rn re ~ t _ Indicate the title, publicatign date, and type of writing (non- : ‘ ne aan : .. Indicate any devices which. you have invented and state whether or not they are Patented 4 10. List public speaking and public relations experience. None). other than college requirenente and military trainin : Nain este tS ais aeRO RE AIS REN OE OT HW 53294 DBocld:32396016 Page 9
I SECTION XVII. . . “TO MILITARY SERVICE : - ae CURRENT DRAFT STATUS . Are you registered for the Draft under the Uni- - > 2. Selective Service classification versal Military Training & Service Act of 1948 . 1-C, 5-A at discharge (as omended)? 4. Local Selective Service Board Number and Address $53 , Jesoup-Blair House, Silver Spring, Maryland 209 MILITARY SERVICE RECORD . ‘ Complete the following items for current and/or pest active duty military service with the Army, Navy, Air Force, Marine Corps, Coast Guard, Merchant Marine, National Guard, Alr National Guard, or foreign (non-U.S.) military organization. For foreign military organization, specify both nationality and organization in Item t below. ‘ 1. Militory organization (Army, Novy, ete. — specify) 2. Branch or Corps 3. Dates of service (extended active duty) ey 11, 1965 Jan 8, 1951 Present 7. Type of separation from.: ,: + active duty (insert number for ? type which applies —see |. - list below) , 4 From = - Air Force NA 4. Status: (Regular, Reserve, efc.— | 5. Rank, grade or rate (at separation | 6. Serial, service or file number ~ . specify) . ; if past service) ; . : Regular MSgt (P-1) E-7: AF13371224 8. Brief description of military duties (record the duties and skills which best describe your work or function in the militory service) PO ~ Electronic: Warfare Technician, with duty. in Maintenance and Operation OF - :;Electronic Data Analysis equipment, Technical Advisor and Instructor: ne ph _ equipment maintenance and operation and analysis, mission. and equipment “and technical requirements, problems and procedures. Oh 73 - AF Supply Supervisor, responsiile for management, eupervieton and | operation of various organizational supply activities. ee Oo 1. Military organization (Army, Navy, etc. — specify) . 3. Dates of service (extended active duty) 2. Branch or Corps : NA 7. Type of separation from, - active duty {insert number for _ type which applies — see , . . list below) | 4 > ">. Dobe. * From— 4. Status (regular, reserve, etc. — ‘ 5. Rank, grade or rate {at separa | * “ specify) ae , . _ tion if past service). . Types of separation from * 1 —Honorable discharge : + 4—Retirement for service 7—Undve hardships active duty —record . . . ae —Other— specify in applicable number in 2—Releose to inactive duty 5 —Retirement for combat disability item 7 in lieu of item(s) 7 above 3—Retirement for age 6—Retirement for physical disability number Complete the following Itoms if (1) you now have reserve status, (2} you are a a momber of the Notional Guard or Air Netlonal Gvard, or (3) you dro a member of the ROTC. . : Check (X) Reserve, Guard or f | Amy : National Guard * ROTC organization to which Liver nas Air Nat'l Guard — rorc: Air Force ROTC ; : 4, ROTC a number oo you belong 3. Expiration date of current . fesetve obligation * 1. Current rank, grade or rate If you ore currently assigned to a Reserve, National Guard, or ROTC Training | Unit, identify the unit and its address 7. 8. if you have a military mobilization assignment, identify the unit and its oddress HW 53294 DBocld:32396016 Page 10
SECTION XIX -_ EMPLOYMENT HISTORY NOTE: LIST LAST POSITION FIRST. Indicate chronological history of empio~ment for past 15- -years, | ate | with current or most recent position. Account for all periods including casual employment and all periods of unemployment. Give address and. 4@ what you did during periods uf unemployment. List all civilian employment by a foreign government, regardless of dates. in completing item 10, ‘description of duties", consider your experience carefully and provide meaningful, objective statements. 1. Inclusive dates’ (From— to— by month & year) . 2. Name of employing firm or agency Jun 64 to Present —. Electronic Warfare Center 3. Address (Number, Street, City, State, Country) 4. Indicate specific area or place of emptoyment if other than address noted in item 3 363 Tac Recon Wg Shaw AFB, South Carolina NA 5. Kind of business 6. Name of supervisor Electronic Intelligence Edward Baumann, Og rh =} 7. Title of ib Non-Commissioned Officer In Cha rge 8. Salary or earnings : 9. Class; grade if Federal Service and Chief, Maintenance and Suppl s212+50___pemon # allo MSgt (P-1 10. Description of duties responsible for overall operation of Oenter, personnel duty assignments and performance, coordination with related activities. Management and supervision of procurement, installation, modification and maintenance of equipment. Accountable for all Government propert Instructor to technicians and analysts. Technical Advig 11. Reasons for leaving Obtain civilian position 1. Inclusive dates (From-— to— by month & year) Jun 63 to Jun 64 3. Address (Number, Street, City, State, Country} 363 Tac Recon Wg Shaw AFB, South Carolina NA 5. Kind of business 6. Nome of supervisor . c Electronic Intelligence Frank M Hayes, 1/Lt Chief Maint & Suppl if 2) 7. Title of job Non-Gommissioned Officer In Charge 8. Salary or earnings 9. Closs; grade if Federal Service 4 | Maintenance and Supply Se ction TSet (P-1 “10,-Dascriptien of duties Responsible for supervision and scheduling “of ‘installation, medifie eation, and maintenance of equipment and suppliess procurement of supplies and equipment. Instructor to technicians and analysts on equipment operation and maintenances Technical Advisor on ana ie V1. Reasons for leaving 4. indicate specific area or place of employment if other than address noted in item 3 Received promotion 1. Inclusive dates (From— to— by month & year) Jun 61 to Jun 63 “3. Address (Number, Street, City, Stete, Country) 4. Indicate specific area or place of employment if other than address noted in item 3 NA APO 633, New York, NY 5. Kind of business +6. Name of supervisor Electronic Intelligence -Leonard R Kyer OWO Chief Maint &. Supply ; (3) 7. Title of iob)}on—Commisgs ioned Officer In| Charge 8. Salary or earnings oo: 9. Class, grade if Federal Service : Maintenance Section +00 ,.mon / allow TSgt (P-1) 10. Description of duties responsible for supervision and scheiat ing of installation, modification, and maintenance of equipment. Instructor to technicians and analysts on equipment. = ~ operation and maintenance. Technical Advisor on analysis and maintenance ‘problems ~ and procedures. Execution of Special Projects. . Reasons for leaving Overseas tour completed . Inclusive dates (From— to-—- by month & yeor) Jun 59 to Jun 61 . Address (Number Street, City, Stote, Country) — . bas ho ast a A. Indicate specific area or place of employment if other than address given in item 3 “APO 633, New Yorky NY PT A . Kind of business eo td gas tt. 4 6... Name of supervisor Electronic Intelligence “ a Jo Harold W Crum MSgt NCOIO Maintenance 7. Title of job . 8. Solary or earnings 9. Class, grade if Federal Service Assistant NCOIC, Maintenance Technician’ “Ts § 270-00 permon # allow SSet (P-1) AW 53294 Docld:32396016 Page 11
o | @ | _ | ~ EMPLOYMENT HISTORY (Continue 10. bacipion of dieAsaietant to NCOIO in supervision and scheduling of Maintenance Section activities. Ae Maintenance Technician - install, layout, modify, inspect, perform preventative and corrective maintenance on operational equipment as directed by the NCOIC. Instruct technicians and analysts in equip operation and maintenance procedures | ‘ i 11. Reasons for leaving , | Received promotion 1 é \. inclusive dates (From— To— by month & year} 2. Name of employing firm or agency . ', poss Mar 58 to Jun 59 Det #+, 10 RAdar Bomb Scoring Squadron 3. Address (Number, Street, City, State, Country) 4, Indicate specific area or place of employment if other than address noted in item la Detachment has since moved. Squadron McCarty Drive (Highway 90) Headquarters at Oarswell AFB, Texas Houston, Texas . _| 5. Nome of business 6. Name of supervisor : USAF (SAC) Radar Bomb Scoring and. ECM Huey P Porsche, SSgt, NCOIO ECM Section | a (5 } ‘7. Title of job 8. Salary or earnings 9. Class; grade if Federal Service ! Orew Chief, ECM Section $220.00.» wmon_¢-allou | 10. Description of dues Supervisor Of ECM Operations and Maintenance Crew. See isios ofoperation; | and emergency maintenance during "on-watch" time, preventative and corrective maint. | daily on ground intercept and transmission equipment. -Instructor for on-the- Job and cross training. Assistant to Detachment 00 on Supply difficulties. | 11, Reasons for leaving 3 Reassigned (volunteer) overseas . Inclusive dates (From— To— by month & year) . Let. 2. Name of employing firm or agency Jul 57 to Feb 58 so | 5411 Student Squadron! :: 3. Address (Number, Street, City, State, Country} . , "+ | 4, Indicate specific area or place of employment if other than address noted in item 3 ; Keesler AFB, Mississippi - 0 | NA 5. Kind of business ‘ . 6. Name of supervisor : USAF Technical School a NA UT (6) 7. Title of job - aoa Stud ent pe 10. Description of duties YS, Air Force Course Noe AB 30930 » Ground “Electronic Countermeasures . Specialist. Bo 11. Reasons for leaving. School completed 1. Inclusive dates (From— To— by month & year) , ue . : 2. Name of employing firm or agency Jan 51 to Jul 57 ne Various _AF uni: 3. Address (Number, Street, City, State, Country) 3. Kind of business . . 6. Name of supervisor USAF ~ Organizational Supply | NA: ee {7) 7. Title of job : 8. Salary or earnings _ Supply Supervisor or Specialist s.210-00>.,mon # allow 10. Description of duties Supervise or work in various Air Force organizational supply activities. Majority of assignments were in a supervisory. capacity. ees NOTE: Detailed listing of assignments on continuation sheet 11. Reasons for leaving 3] If prior service with the Federal Government is noted above, indicate the number of years creditable toward U.S. Civil Service Retirement, if known , i HW 53294 DBocld:32396016 Page 12
Se ae ESS a SECTION XX CLUL SOCIETIES, AND OTHER ORGANIZATIONS. NOTE: List names and addresses of all clubs, socleties, professional societies, employee groups ts. —_-ganixations of any kind to which you belong or havo belonged (include membership tn, or support of, any organization having hoadquartors ‘or branch in a foreign country). Name and chapter fume BO ead, Address (Number, Street, City, State, Country) Date of membership (From) (To) i SECTION XXL ~_FINANGIAL STATUS 1. Are you entirely dependent on your salary? Yes. Tj No 2. If your answer is "‘NO"! to the above, state sources of other income NA re re ee ; ee 3. Credit references (banking institutions, charge accounts, etc.) : a ‘aI Name of institution Baltimore, Maryland a ‘Sumter, South Carolina - Prudential Life Insurance Co es Deen Silver Sp olitan Life Insurance Co : ‘Silver Sp 6. Do you receive an annuity from the United States or District of Columbia Government under ‘any retirement act, pension, or compensation for military or naval service? 7. If you answer is YES" to the above question, give complete details NA vere 8. Do you have ony financial interest in, or official connections with, non-U.S. ‘corporitioné or businesses or in or with U.S. corporations or businesses having substantial foreign : ° interests? a Yos \ No (If answer is 'YES"', furnish details in space, below — Continue on separate sheet, if necessary) & WW 53294 Docld:32396016 Page 13
SECTION XXill. - RESIDENCES FOR THE PAST 15 YEARS (including Reside. maintained while in Military Service) at Address — last residence first (number, street, city, state, country) Inclusive dates (month & year) [s0-4 saaten Drive, shaw Ara, South Garolina 29152 | oot 65 | "Provan [42-0 Orchid Drive, Shaw APD, south carotinn 52 | 65 | ose os | | | Mar 58. Apr 58 221 Quaint Acres Drive, Silver Spring, Maryland - ~ 1 Dec 55 ie] 2024 Naylor Road SE, Washington, D.O. Jul 55 SECTION XXIV REFERENCES . iene ‘1. List five character references (not relatives) in the U.S. who know you intimately Name (lasf-first-middle) Business Address : Residence Address 2 Slyder, Richard L, Captain |Mather AFB, California Unknown braska —-__|Unknown Borden,: Thomas W, Major Washington, D.0O« Vienna, Virginia Z Biebusch, Viola »- _|Unkmom _. _|Silver Spring, Maryland Buchholtz, Carl Unknown Baltimore, Maryland _ McClure, Frank B, Major 2. List five persons in the U.S. who know you socially (not relatives, supervisors or employers) 149 University Terrace Columbia, South Carolina Buchholtz, Herbert __ Unknown Pasadena, Texas 14 Washington Court Mt. Pleasant, Michigan 124 Cherokee Trail -_ gia ___|St- Louis, Missouri SECTION XXV PERSONAL DECLARATIONS _ ; . 1 Do you advocate or have you ever advocated, or are you now or have you ever been a member of, or have you ever supported or been associated ., nee with any political party, individual or organization which advocates or teaches the overthrow of the government of the United States by force, violence, Xx] ' or other unconstitutional means, or seeks by force or violence to deny persons their rights under the Constitution of the United States? : nn C] Yes No 3215 Bennington Avé Chavez, Paul Earp, George ' ld 2 Wf you have answered ‘‘YES"’ to the question above, explain; \ AW 53294 Docld:32396016 Page 14
—-PERSONAL DECLARATIONS (Continued) 3. Do you use or have you | ; " >» e:4 Yes 4. If so, to whot extent? ever used intoxicants? . Limited 5. Do you use or have you . lf s0, to what extent? ever used narcotics? 7. Have you ever been a member of, or supported, or had any connections with o foreign intelligence organization or its activities? . tf answer is ‘‘Yes"’, give complete details: 8. List the names of Government departments, agencies or offices to which you hove applied for employment since 1945 NSA - 1965 DIA - 1965: USAF- 1951, 1954, 1959 9. If to your knowledge, any of the above have conducted an investigation of you, indicote the name of the agency and the approximate date of the investigation * USAF-Top Secret-BI 27 Feb 60 OSI Dist 70 USAFE Filed OSI Dist 4 Bolling AFB Wash DO Secret-NAC 26 Jul 56 OSI Dist 4 bolling AFB Washington DC Note’ Special If your answer Is “Yes” to the following questions 10, 11 or 12, provide the information requested for each question ona separate, Instructio ns signed sheet and attach the sheet to this form in a sealed envelope. id 410. Have you, or to your knowledge has your spouse, ever been detained, arrested, indicted, or convicted for any violation of the law other than a minor traffic violation (in which the fine was less thon $25.00) in the U.S. or abroad? If so, state name of court, city, State, country, date, nature of offense and disposition of cose in accordance with special instructions above. : . . . ‘ . . Have you ever been arrested, court-martialed or otherwise punished under military law or regulation? If so, describe incidents and provide date(s} of oc- currence on a separate sheet in accordance with instructions above. ; . . ne OE . Are there any incidents in your life (unfavorable) not mentioned above which may be discovered in subsequent investigation, whether you were directly involved or not, which may require explanation? If so, describe incident(s} and provide date(s} of occurrence on separate sheet in accordance with special . « instructions above. . : : : Have you ever been dismissed or asked to resign from any position? [| Yes kit No Have you left a position under circumstances which you desire to explain? Cc] Yes No . If your answer to either or both questions in Item 13 above is ''Yes,"’ give details . Name (Last— First--Middle) . ’ : . Relationship Huber Gottlieb a Father 3. Home address (Number, Street, City, State, ZIP Code} , . : . Home telephone number ~ 221 Quaint Acres Drive, Silver 81 MA 2-069 5., Business address (Number, Street, City, Stote, ZIP Code)—indicate nome of fim or employer, if applicable Charles He. Thompkins Co. 16th Street, NW, Washington, DC 7. in cose of emergency, other close relatives (spouse, mother, father . . .) may also be notified. identify. the persons not to be notified and the reason. ‘ | SECTION XXVIil oo CERTIFICATION 7 : aba You ARE INFORMED THAT THE ACCURACY OF ANY STATEMENT MADE IN THIS APPLICATION , WILL BE INVESTIGATED t have read and understand the Instructions. | certify that the foregoing answers are true and correct to the best of my knowledge ond belief. | agree that any misstatement or omission as to moterial fact will constitute grounds for immediate dismissal or rejection of my applicotion. _ | also understand that any false statement made herein may be punishable by law (U.S. Code, Title 18, Section 1001). 1. Date of signotures ' , : ‘ i 2 , Signature of applicant HW 53294 DBocld:32396016 Page 15
Use the following space for extra details. Reference each continued item by the section and item number to which it relates and sign your name at the end of the material. If additional space is required beyond page 16, use extra pages the same size as this page and sign each such page. SECTION VID STEPMOTHER 1. Huber Elise B (Unk) Widow - Polzin Maiden - Unk 2. None 3, Oct 14, 1901 — 4, Stuttgart, Germany 5. living 6.NA 7. NA 8, USA 9. Germany 10. Nov 1h, 1950 11. Baltimore, Maryland 12. 6094163 13. NA 1k. May 1925 i. 221 Quaint Acres Drive, Silver Spring, Maryland 16 thru 22. NA SECTION XI RELATIVES ABROAD (6) 1. Levinsky Louise (Graf) & family 2. Aunt 3. Unk 4. Unterschutzen, Austria’ oo 5. Austria 6. Bezirk 2 Bocklingerstrasse 96 Vienna, Austria Te Self (Bakery) 8. Seldom 9. Dec 196), ae a, (7) Details of. Step-mother's family in Germany unknown. | One contact only - July 1929, after driving vacationing: ‘parents from Rhein-Main airport to Stuttgart, Germany. SECTION XIX © | EMPLOYMENT HISTORY (7)a. Jun 56 to Jul 57 | 523 Strategic Fighter Squadron, Bergstrom AFB, Texas . .b. Jan 56 to Jun 56 Det #h, 1110th Air Support Group, APO 21h, New York Oct 54 to Dec 54 ~— see (8) , Ce Aug 53 to Oct 54 3508 Periodic Maintenance Squadron, Greenville AFB, Mississippi, _ de Feb 53 to Aug 53 3506 Maintenance Squadron, Greenville AFB, Mississippi | | e. Aug 51 to Feb 53 . 3405 Food Service Squadron, Goodfellow AFB, Texas £. Jun 51 to Jul 51 3405 Air Base Group, Goodfellow AFB, Texas hha: go Mar 51 to May 51 AB 641XX AF Supply Technical School, Lowry AFB, Colorado {.\' h. Jan 51 to Mar 51 Basic Training, Lackland AFB, Texas (8) Oct Sh to Dec 54. Student - University of Benjamin Franklin, Washington, D. Cee Part-time Produce Clerk, Giant Food Stores ine, Wash, D. Ce ih -Re-enlist USAF a . cs (9) Sep 50 to Dec 50 Student - University of Benjantn Franklin, Washington, D. Ce | ‘Enlist USAF My ge (10) . Jun 50 to Sep 50 "Summer Job - - Laborer, Charles Hi Thompkins Co, Washington, D. Ce (11) Sep 49 to Jun 50 Student, University of Maryland, College Fark, Maryland Seas } SECTION XXIIL — _ RESIDENCES 2315, Naylor Road SE, Washington, D.C. Oy 9823 Dallas Avenue, Silver Spring, Maryland 615 Lycoming Street, Silver Spring, Maryland . 1007. Dukeland Avenue, Baltimore, Maryland | * i AN Feb 55 to Jul 55 |. May 51 to Feb 55. Jun 8 to May 51 |: Jan 31 to Jun 48 ; _ (Signature) —* Space for extra details continued or peg 16 ne AW 53294 Docld:32396016 Page 16
a SECRET CLEARENCES OSI Dist 70 USAFE ‘TOP SECRET ~ Mar 9, 1960, BI - Februa o~, ; . : - = teal g os A. . . n~ a > a. : a peers - Boo ‘ i ' OSI Diet eT ENE. ee ry 27, 190, tories Say, a t ‘ pane Filed OSI District 232396016 Page 1? DoclIda HW 535294