14-00000 RESIDENCE E AND DEPENDENCY REPORT... otros INSTRUCT 1 On B: Sabah En triplicate: mises OFSOEed Nersess ad wherever designited place of resisenxe of marital or trad eee 8 GOVE te. tA Conn] mes allowable i¢ in dopondens yg status Chagriges IMPGHIAan? in detorsini- Tent expense, fatura to tenidunceypur-sapseation, A TOF Tweeter of tion with Bhignent of pressing Of omgin ge nate OF FMPLOTEE le : f q - ALC) . ry Lee RESIDENCE CATA eae nae S493 FQATE OF WEL tDEMCL tm COMFimiwtan yi3. cee af fciateg sagoage PLact up SEDSOTMLE ete aPrormttyD 0 sEMeILE x a mal ba ta. = PLACE Ie COMTIBEMTAL Y.4, CEIIGHATID PRuesetar og RCGAl Besa nrace , wit, © g: MARITAL STATUS : ‘comune BETA PLATE OF waneiane OATE OF manRiace 1 | =e TOE LALs A, Le Ma W438 1 $8 . PLACE OF OLy¥GecE GE Cate Oath O8 otvoecr Dine ta ‘ C=} otvosceo . ! “ Semmes ee { ; OATE SPOUSE D4ED i PLACE SPOUSE DELO RADU Las a rire er sees one eer ae A ee Be pee my tenet eee ist SLATER CATION OF wimerns ¢ OF tet orate Famite RELATIONS Smae So ads Auth LIE Com nn 2 Ce Auguet 22, 1981 [YT care —_ STERTT TTT —— POR 80. 4) may 1989 37-70
14-00000 ™A, Be os --GENTRAL-INTELLIGENCE AGENCY , 2430 & STREET NW. WASHINGTON 25, D.C, . Date 22. August—Lgysi--- - —-- - ‘ + Dear Mr. PeCord: 1. This fa to notiry you that the United States Government aa ropre- sented by the Contral Intolligonco Agoncy, has ascopted your employment offoctive. Poaition: GS-11 | Base Salary: 351,00 eer annum 2. You will ba: _ a. Entitlod to annual and sick leave in accordance with Civil Service Commission rulog and regulations, or such other provisions of law or rogulationa ae may be outablished in lieu thereof; . : b. Reimbursed for travel expenses in accordance ‘with CIA Regu- lations or Standardized Government Travel Regulations, ay umonded, c. If setationod outaide continental United States, granted such monetary allowances as are prescribed by CIA Rogulations, 3. Employment {8 conditioned upon satisfactory completion of the training courues preacribed by CIA and satisfactory performance of duty for a total purtod of siz months from date of employment, In the event either training or performance of duty {9 deemed unsatiefactory by CIA, ° you will bo offored other types of employment if available, or your eme ployment will be terminated, &, Your appointment to for ouch time as your services may be re- quired and fundu are available for the work of CIA. Notice of terminntion will be given you by procedure gimilar to that provided by Civil Service rulea and regulations, ‘ , authorized tc ale’ ottera of 7 oo ee ne - G&ppointsernt  - = ee - “re a I accept the above agreomant oa & condi- tion of my employmont by CIA, i LOYGe y ; Dato if Form to. 1-105 June 1948 ?
14-00000 STanmann ORES Gf etesca caF 1s _ ae _ Poms: Fe 2 BS Adeik JAP. 8 LAM BG See 7 ~ 7 ~ APPOIHTMENT AFFIDAVITS . ; IMPOR TANT.— Before awearing to theses Agzcuntment affidavits, you should road and .understand-_the i. . . : - ° “attached infcraiation for appointes _ Central Intelligence heency oe . cone Onwe, a rensg: inpment) Uecrei soe 118 Bad try DH | J mes Waiter MeCords Ire see nseseeece seccnceetvusvesennelones Go wetinly pwear (or affirrn) that-— A. OATH OF OFFICE — Iwill support and defend the Constitsti-n of the United States zzainst ali enemies, forcign and domestic; that I vil! bear true faith and é.egiance to the same; thet i tone this obligation freely without any ments! reservation or PUrpece é of evasion; that Dail wel and feithfully discharge the duties of the office on which Lam about ts eter, £9 HELP ME GOD. ——=B. AFFIDAVIT AS TO SUBYERSIVE ACTIVITY Bho AFFILIATION lam not a Communist or Fascist. 1 id ant advocate nor zm fa member of any organization that advocates the overthrow of the Goverccnent of the United States j by force or violence or other unconstitutional means or seeking by force o: vivlence to deny other persons their rights under the Constitution of the United States. FT de forvosr swear (or afSrrn) 1 will not 8» advocate, nor will I become a member of euch organization dzrs-g the period that lem an employce of the Federal Government. C. AFFIDAVIT AS TO STRIKING AGAINST THE FEDERAL GOVERNYENT Tam not engaged ii any strike against the Gov ernment ¢ of the United States and that I will not 60 engage white an employee of the Gove at of the United States: that I ern not a member of an organization of Government employess t asserts the right to strike ayainst the Government of the United States, and that I will net, Wee | a “Go vernment enplovee, become a member of such an organization,. _ D. AFFIDAVIT AS TO PUPCHASE AND SALE OF SFFICE ther thing of value to any person, Thave not pusc “a. ta offered or promizet to pay, any money er othe: firm or corporation fer the use of influence te procurc My appointment £. AFFIDAVIT AS TO DECLARATION OF APT OINTEE The answers given‘in the Declaration <f Appointee on the rev ese of this form are true and correct. _ 22 August 952 og oe. bin, MT Beg FA. cccecsteesiscessese Wrere of eraroges om oe - i : engestore esas - Subscribed and eworn before me this etc cneceeere ne § “Say af cote ee ece neds weet ee centers ALD. IG, ; ae Crreamesetsecnesceasesceensscse a seeecees ce eecns oo cees + tans pe fee ee eee eee (See) tee e een een eee eer acee ewan ee ee : [spaL} Pa Sheer of ‘eters i : ame wee ieee eee wae ote cemes 2 eh Hrratsan ef diss commission should Ad -Retew-B ween eee nee weeds Uf the oath ss ishen before a Netary Pubic the dale of es de afiow sn NOTE. "TERRE eatt
-____. DECLARATION CF APPOINTEES This form is to W aseipleted before entrance on duty. Answee sll questions, Any false statement in-this declaration wil he gre Hr CanecHation of application or disnussa! after Appaintinent. dinpersonation is a minal offense and will 6 pecsecuted accordingly, . ESS _(ntreed e.cd save Sey ie ard. Sate}. — eee £, . enki ha Soha Be <a mee i qe) PLACE CF DIET (ciey wr town ond Steta at counter) Ta ot tte arene ET B27 CITY AND STATE CO) TOE psa RO. . é itatlease! [TO] e SOU OM AA RBIACE) ITH WHORG YOu USE OF Stir earco witha asta Noth Wire | & OOS The extra crairs ¢. SSUCA OAT BVASE IN A CILIAM Capac PME PUSS 2a UTES my sta FNS ff mo, for each wih cataeine fol ve thee BE Dacescary, om : tech such retariee aol ee ete _Pmcessary. oni Te ne nay ee = . i TR beat Ban. noe ; ay FRE ACRES my em ge age . | RELATION. | sancae +7 RANE i (Gue ssseed number Tf any) J ercerantwent SR FEESCE ON WHC Lark RID ; A t [Chev ’ one SPACE FOR DETAILED ANSWERS TO OTHER QUESTIONS AcNO” ANSWER BY PLACING iW FaUPTR GOLEM | eee ee TERE enaneeeerctos | eCEEGEAeD & eRe CU ACITIENOF OR BOW Oa) a nae TO THE UsUT ES Srareg?. | “ ee ATES & AE vows aN OFFICIAL GR EMR OTE OF ay Brat TESRITOAL. COUN? FLOR RORCIPALIT TP i. aces eee ee meee Mea 8 eee ene ore ay dent neem mes > ae] + ff your answer ia Yea", See Beads i Ireai 10. Ives! no bee ——H2$ | jum |_SRIE ME LOFT COLUMA BiMarRS CH TEMS TO WHICH OFTAREO ANSWERS UPPLY SO NER RS UPALY DS YON RECEIVE ANY ANNUITY DRO TRE Ce SAEs OR STRICT OF OM. SOLA COVERNWENT ONDER Ane Relite WENT aot OW Any PELASION 08 DOSER CUM AT NSA TM EM ELITES ADR AL LL Sf ebec Ee fF your ampewe set Vea’, £06 1% Jeema ly? Te gener for rer Bet. fast 2a age, eptianal fae diice. we be rewsnt of voluntary <e eefUrtely separation etree § ves so oreKe: amine of Pelirenen? pay, and undee w@ har POL. tm OE aod, arf rating. of cote frost military ae raced mrene aad HW en e a commen nae none ome caw @ XVCY Pou FED apr ica ray WOT. A TRG Ty Peas APN TEE AT RE VOUT Me TIRE PARGED OF POMC EO WR eth pL et BRET OR wetang | Fall HPCE BRM any PO TARR. : Uf suur answes is Fea", ge sm fees othe Race and addrace Of englozer, date and syearan an One h oa am. o rie YOU BFF9 ARarSTES iit PALO TERI HOCE Pig roa BAM TY LEE FINED Eg DiNa OA Rat ak Slide oS Ost ABS: SONCR FOU FILES ae roel RAM Pres tres apr eeu? M7 voar answer ia Yan. Pet Ob eres rewwe wader dream JO are 1 bach oe0e' (IY TRe ware ysl the me PCS EMD tone we eRe! (J) Ae nse arid bs.et cer ¢ NP Owiwel: (8) cae. AEE FING OR, Of MAD OM NA Ankgeeet ere aad the dase. | € GPs tod, peur Teagee ns es weed be tea ry . lone . yo o> fom a so a + . . fo. INSTRUCTIONS TO AFPOINTING Grritea Te? aypetating oft o befee atun ghee fuego g cortit ate iy onate ahead (9) Age TF Senmte age hens howe been Behe? fog the po watt edema Bete mine fo ly omen serente bbs TR be Ripe apgwasiwas.d aakt e Prerht tan © Getermanet that gpycbe woh st A mutenie the ege gaunge ag aneeargd, SS0 teS Ale ab 08 civebs Ele RRM Alacel Qeay Red bee, TB as Che teet ong, Whe Veal fetta e Bit, ae ete Crank Gren Rue od Beg lat ventas ens Unt: en. eh 88d Comer ene pres ain Cen ed ny tape’ Aah Tee en, teme ¢. Beed ear. _ ea a Lele i. } whee oe The es 3 . WE the Vine frees eamtt te che ted fe & a 33 oe. EPA eT TPT Tan Te wemwe of ida Ts Fre ends ayqey atin ata, BE twa OS Ay TOM Od peed dm Mergs oe a eRl. gad Barre sceeis fe the bee et vn mribaes cw eMtever fa teet povye awe penk as mvereetie poreedt ad i adoeoeg | SEE pera gr at etia tm Othe stomeisce vd saufic Mag Senteoe eda tasters a aene the UD) fiertity of saminne -2t te te dns 1d trpeeating extewe 19 BR$RE aad nore Bee wb S Tat Oe cam Tete | Bm chee Bene bee betes terres foe ' Brand gens! operm-natamn and tt cote amon tees md temaee re eb apet tte tat eA mg Pe ef ie Ahi Sen etek cw. ton on “eryevates re tht gpeme Prime w Eg eet ar at em? fee oe ek bee $0, Boer mees ot Paare’s fever 8 of ihe Ci Beet oe AS Dee kton thay mivetios & MEtetres amd omaha -cemg are be tw cuermgmnowl BlPh Fla a bf oto Bee eee ihe ae @ Fee. Far om am vo me beoa ad foun ty Beet emg Oe ee pee tsent fei & BD bat amin ae ob emt BO Meet & fewem anmet aye tem! cee aa! FEE otwmmst ties Bees ot oe Bers Fb & gE totes om Phse Bem Bde tee aman eeea twa of beh oe ee at et grunt the gs ae tmewed «2 par mage a Samet ne ect ath (he we ete alert, Gtk Smt Pug mend a E85 vt ae vent Tha ee owt meant APADS Ot ore 5S pene wed ood bead bos veer ge Reewame amar be che hed wy ewe doe gets cs tars Ba ymanten — Geeteseee + oe pee Atrses mene fb. sel teed Feen le ees weet Fcc, So SH Mead Cm Bee pis mee Betta pe Age ee nae ead GR be geet tetee ol we ee ete ont coe tne EX wd beware mat Med pel tes anh te . Wetcootnd & : Bint dee TRO Be ee VC nmmomiee mee ate kh, . BR ender tees meena Here res
a CONF ELDEN TIAL — - 2 (Bren Filles In} RESIDEXCE AND DEPENDENCY REPORT ‘pemmettenmmrces sree Sgn ated pi ace_at. $esetonce, ‘t INSTRUCTIONS: Subeat tn duplicate ehep ortared overseas af Ehenever de dependency status Changes,  F ie for@atron—t9—iaportantit deteisining feaoal eagenees alinweahio in connec. Flom-eth—fesee’ at Guvetneent eaponae, overseas duty, return to resistence upon Separation, and im detereining whee of famsty. franenoriation fipensea atlawah! in connection es th Bheppent of fewaine of eaployee ar we, (Facat3 t. NAME OF twrvorrg RES! DENCE_DATA. PLACE OF RESIDENCE santa apPainive - Last PLace oF RESIDENCE TN Continia tac U.S. (6? appointed ahraad) f- be (1f, tetdtn Magus PLACE 1% CONTINENTAL Us. DESIGNATES Paw SARITA. STAYUS Tn me CJ etmes PLACE OF GARATAGE pe waeesen o ; , ead ae 4 bint Tag LO PLACE oF DivoReE bite (7) et voaces A ene CO a ee re BATE SP0OUSE OLED : a enter tt rece PLACE S®oUSE OED 4. MEMBERS OF FAMILY MAME OF SPOUSE , AGLRESS (Nuaber) > (Streer) (Caty) (State) JEEFP ROR NAMES OF CHILDGEY Prod Fin Deep Venere’, EER. frre bor ipa OF FATHER (or male guardian) "aDDRiss {(Nomber) - eet) (Caer) : A . Net. tal LMG, A) ‘ Fre et 4 AME OF MOTHER for female duerdian) °STIETS —TNGREST) UStrooe Ot Err (State) vernon A TN as Af Lode ~ >. PEMSON TO GE NOTIFIED 18 CASE OF EMERGENCY oo ; pacieenlith lata a it ne eee Me ee, Seas RELATIONSH)e NAME . sergf’ jE fir Lotedl nde = - th ee eA ree ee ener te ere ADORESS (Yumber) (Steaeey ~ | (Crty} : . THE PERSONS -Waeeo—rN. = CASE OF EMERGENCY. iP SUCH NOTE FICA. TION ES NOT DEST RARL A, CUE FO HEALTH O# oTdte PERTININT REASONS, PLEASE 50 STarve UNDER “RM ARES. VOLUNTARY ENTRIES GENCY ENDORSE, ATION INSURANCE POL : ai E : “POLICY SHOULD BE EN PERE, : i COMPANY SHOULD A CLAIM AOCRESS OF MOG OFFICE » rn ee ee een z . S1Gsd0 ar ae see F0a6 ma, 61 Bere acts tome Bre se ° CONFIDENT EAL =e 7 , : iad ae tow Ba ike war ga vit. me Sitmmen., @Rageearepy, 51? amme = cat ee ey
Pre SECRET. _ Lo. a Cee -- ~ - . 7 (Wren Filled Bt t. DATE Ge wrQques? REQUEST FOR MEDICAL EVALUATION . 2 May 1968 [ 2. Mawes (Law, Firat, Mosite) —— = - PS POSITION FiTue — *. GHADE — 7 MCCOAD, JAMES Way RR __ | ne : “Orrice, Ovisions, BAANCH . é. EMPLOTERS EXT. sre _ : a = omens ees pene ~ _ . - PUWPOSE OF EVELE ATION ( j HOOS/ TOY PRE-EMPLOYMENT { } OVERSEAS ASSIGNMENT ENTRANCE ON OUT Y STATION TOY, OR PCS TOY 37 anoay fTiPE OF OF COveR SPECIAL TRAINING NO. OF GEPENDENTS TO ACCOMPANY ¥O ACCOmMPany hrs OF DEPENDENTS’ REPORTS OF MEDICAL pwerees (SF 89) ATTACHED eet ANNUAL EXECUTIVE co . RETURN TO DUTT : I ] RETURN FROM OVERSEAS FITNESS FOR DUTY . SPATION MEDICAL RETIREMENT MO. OF OE R.°S UOQCEOaoadg $. OVERSEAS PLANNING evalua TION (One biuck maat be checked) % - PE QUES TING OFFICER ‘ SIGR A PURE ee nr nrg ere C7 Ro ROOM MO. ® SUILOGNG 19, COMMENTS Tevereei eb Je FOR TOY (TAM ee T UNTIL ZA. tl, MEWPORY OF EVALUATION , To 2 ? — : : | | | i i ez voy oe =~ Tetomatueé pom car OF Be OIC AL BT APF Qe §O8e 259 sujresyrous SECRET boy ue Boek edaag,
i 4 ; (Ber PBebled ind a bATR OF BEA 6 Key 1706 REQUEST FOR MEDICAL EVALUATION a 2. MAME (Laat, Firat, Michie) MeCord,. danes He, a. Ovenseas PL AnMtNG evatua Thom fone blocs bidendeidl be checked) 2 OV stor, DRANC IG PRE-EMPLOYMENT ENTRANCE OM OUT Y TOY STANDBY SPECIAL TRAINING ANNUAL’ Q Executive RETVURN TO DUTY PITNESS POR BuTY MECICAL RETIREMENT 3. POSTION FITOR overt tran ‘Room A bE.63-- Cy MOQ@S/ Poy C ] OVERSEAS ASStONMENT OF ?. PURFODSE, ar t Evacuation fey on Pea ‘V¥ee oF Coven NO. OF DEPENDENTS TO ACCOMPANY NO. OF DEPENDENTS’ AU PORTS OF MEUITAL HISTORY (SF 89) ATTACHED RETURN FROM OVERSEAS anne snpaantarenattetnterer net Re VA ct HR Se ® REQUESTING OFFICER 8 vas WO 19. COMMENTS Ue Pas vIOUE fOrrigns, SIGNATURE POR paar ° OF mT CIC al stare
AE EEERERREEESED GAG DVT AH fell re encoreee (aati id wih 5X a. AME (Lnet, Firat, Miata? _NCCORD, JAMES) __ UO 3. OVERSEAS PLANNING @YALUATION [One block must be checked} Wision, HRANC 84 C) wal SECRET . “oe. {When Filled ind ( ) t, PURPOSE oF EVALUATION PRE-EMPLOYMENT ENTRANCE ON DUTY TOY 3¥4nN08F SPECIAL TRAINING ANNUAL RETURN TO OUT FITNESS FOR OUTY MEDICAL RETIREMENT Ti Re PORT OF EVALUATION Foaw 1698 259 ( ] as TOY “] QvE O56 86 ASSIGNMENT Lae? Sration TYPE OF COVER | re Meron sea | , MIST ORY (SP 8%) ATTACHES LOOPING REVURN PROM OVERSEAS ; p00. cP a yION FPRAKKFURT 40, OF OEP.g SON aATuRe ROOM NG, & ULL GING 1 BORG? CoRR On QUALIFIED FOR " DEPARTHENTAL WO. OF DEPENDENTS TO SECOMPANY 9. AR QUESTING CFFICER “SUTIES et Ente te an «Sage f oe ag roa Crier oe ME OIE He €F ‘ape SREP aa Se po, GF GEPEMOENMTS’ BEPORID OF meoiean Ss AR A, EMP SETIGR LI eT SE “MPD, NE SZEae PEER De SAE ESI agate ctr ane RAR AE CI ATER LENS Th WO INR ARTY Eat een, PX ENE ET
. MAME (Last) i attend eee ae a a PORINON THLE §. REQUESTING “orricni ¥. TYPE “OF “EV VATION C) OYFARTAS «1D “a TA TION iP ae so op % ome: (7 rev otanvay Stee at Pacer ad | RETUAN TO DUTY BA, REPORT OF MEDICAL EVA ue OF C) OISQUALIFIED +t. COMMENTS | et ee RAPER 00 8 Na way,” C] PRE-EMPLOYMENT [] extaance on oury { } OVERSEAS RETURN C7 SPECIAL TRAINING fog@iava Cr] FITNESS FOR OuTY ree SO CQED, Jaace i. CJ MEGICAL RETIREMENT ee ae LL UATIOM 1 mere SPREE Ue eR ec Es ECP FEA SECRET Gvwaee vs wed Lie ry peas REQUEST FOR MEDICAL EVALUATION ° (Fringes (Mines [4 Orrick. miytstow AMD BRANCH | Socurlay Po puiotne ANU HOY fe “pene oF “vauation: AND RtpoRT a a ee roe ya. OATE OF REQUEDT Al Meb, §S) b GHADE Ciel @ EXTENSION hMl COMMAMCE HIT MH 16-400 = eaahanettererenen terete IRSA asAfEEDARAAA Nee ener tender muti tpttethe ms» 1GA. HEFORT GF OVERUEAG PLANNING EVALUATION mn . nines enone UA LIPO C] BiG QUALIFIED 9 re ne [3G OVER OEAG PLANING RVALUATION “OES HED IN Tae center erent eng a TAT sisi tem mc av cnssrarnedntesusesmemmeamaems Sd 259 ONBOLETE Pea Vis GICs. SECRET tkor = eer tite terete eR ne eeeneeniente
14-00000 4 SECRET REQUEST FOR MEDICAL EVALUATION HAMEUASI OS” DEL if DATE OF R : MCCOND JANES Weg dhs | 15 Jamacy 1962 ‘ Ltt RHO RANGH “ig GRADE | Eneurtty GS~15 2 VOSITION THLE Pa Orrice. D Becurity Officer : gj. panes desta ase ama a RALBIAT ANE nei ho! “ ST ext cnBION | 43 Langley” 5643 CTYPE OF EVALUATION AND peroer @, erm” fel overspeed PLANNING EVALUATION DEMbeis I AGe ha ' GURDANCE Wilrt RB 1S-c00 { FAR-EMFLOYMENT— C7 ENTRANCE ON DUTY eee ae et nrc EEA ert PETAR STATION . ToY-rcs eater itt EAL C] OVERSEAS RETURN © B rt (y TOY GTANDEY C] OPECIAL TRAINING Cj ANNVAL C7 RETURN TO DUTY a FITNESS FOR OUTY Cj MEDICAL RETIREMENE . : i PAC REPORT OF MEDICAL EVALUATION 0 QUALIFIED ai GUALIFIE® C] SOISQUALIFIED Cl DIGBQUALIPIED yi > 2 a 9 ce] 2 4 is] % Es) < rR F 5| ® > a a] 2 >» 2 z z cs] mn : < : > 5 g Fy i a EE DATS OF EVALUATION 6 SECRET tea! Boia 259 Bes OBGOLETE PREWIOUS BONTIONS.
14-00000 seme ~ SECRET . wo i] CWHOE AC PELL ECD deve —_—_——_—————— neo o REQUEST ‘FOR MEDICAL EVALUATION TWAME Waste Waste wD . Ta Oatr Or weGuaar KeCOsp JS We | 18 Lecember 1961 , 2. OF FICK, DIVIDIUN AND BHANGH | 0. UHADE- 3. POSITION TITLE, Security Officer - ; Security . ib=15 ©. AEQUESTING OFFicEn ss BUILUING AMD ROOM NG. eT ER TREN OION = { bj 4}63 Langloy . SOA TYPE GF EVALUATION AND REPOAT ‘9. typa Gr EVALUATION” ° re 710. Ovinaraa MLANOINMG EVALUANON OEBIREO IN . : CUMVANCE WIIM  £8-299 AGe C PRE-EMPLOYMENT | ‘ [[] entrance on bury 7 Cc) OVERGEAD RETURN C) TOY STANDOY { j OPECIAL TRAINING C] ANMUAL {] neturs to ovry Q) FITNEGS FOR BUTT CO MEDICAL REMARK MET eo ae a ne cen aca eee eeamtetten en mmterenminn terreno ) aes eaten eee a ee ne ee eee eee teen %&. REPOAT OF MEDICAL EVALUATION 104. REPORT OF OVERDEZEAR PLAM MIPS EVALUATION C] QUALIFIES O QUALIFIED t C] DIisQVaLirieo { ] DIGQUALIPIED 1. COMMENTS ‘ . . I ~ F ATOM : “TV premaTUad POR Corer, Ma OiCAL BTARB =e | . +c SIC oP Sn a RCM i . err) € £ : pea” 259 cngarara puaviove auitans olCRET ‘ger
CO FY 1 8 oe. ° C . ” a“ SECRET ON Hy {Whee Bi tlol ny ” = i ovare oF ae uuEse REQUEST FOR MEDICAL EVALUATION | - ee 43 _Auguat 190 ___ 2. MAME Lael, Pisel, Millay PSE DETER |" GRADE . ee, BO damea . Be davestigater.. si! GeoRSS 8. OF FICR, Ot eraieate, fa Be tye pe }¢ EMPLOY E?S Ear, - 4 eee ee une nose we ‘ auuarigg oe — we - Ser ree na enalapril nee eee : | | a { | PME -PMOLY rupeey H Hi CHR MSEAS ASSIQNMENT i pn ne i | EuTeasce ov OUT ~ | : oe _ oe ' - i : H : i | Ovense 49 me TURN | TEs rt a ; c [FIR e be Coven ‘ TOV STauogy? F fat i I SPEAIAL TRAiniING a 1 | ] AmNU aL . : ( | egruen roeury ; a Five $s FORM OTP : - ; . . oan 5 3 : 4 cad f MIOCSL MATINEE RT é i 8. OvERseas PL suming @ ¥4LUA 110% {ome Bloch m cheek ‘ a a G X a te enone ee Bioeh iin . meet ae a arg anne ga een ! te ‘
74-90000 oo" SECRET (Phoa Pslied fa} - MEDICAL ACTION REQUEST AND REPORT i REQUEST FoR PAYSICAL ExMMINATION’ By . 1. mamg diases . ; | iFivrare "teh ggte? ?. Gare _MeCord - Janes Nag Jr, 19 June 1956 3. TO POSiTION s+ OFFICE, Division, 89 ANC H Bs Gaace Investicator (cr) ; Securit G3-]) 6. Fyeg oF Foe Re Ceatgare Foa Co copactwontat Crhoe-- , Co JP re-taptaynant [—TJe.s. rete Exa) urorsens (CTJ trues CT Toversoss CTT aetureee Oi CValuarica { Toeatieteg for Full Outy iGeserais CS ouativtes for Departaontss Outy Onty Memerhen teat 4a quali Gd for May be re-evaluat. ed won (TH specter ispe CT hovattstes for Fall Buty CSpactaty Choi squert ties chfya Uararcnontnl a Fequeat, ities and ty 1 months, (6/26/56) Haepgerg stoi} ——
14-00000 MEDICAL ACTION REQUEST AND REPORT 1 REQUEST: FOG PHYSICAL 8 PHYSICAL ERMMINATION Ga aR ESIC AR EXAMINATION BY ——___. \ ep — —_ Pe oNfwE  Laata UFiraes twiddier - Po ues MeCORD JAMES VALTER JR. Septeriter 195 Bn et = an an dn OE EOE te FD Post ric we CRRICE, Obetsite, guaure be ue aLe 0 a bs WPE GF PositiGN ; pcurity. + €valuars gop [([TJoepartaentat (C7 }r00 : ‘ (oJ or e-tapicywont Ce. s. Fietg (TJ overseas - \ Co Jeverseas Saturnee ~ . ; "Sort es tipecitys , . y 1 REPORT OF mEDICAL Evaluation - re RG - CR evalities for full Outy iGeneraly Loo i | an Doren rey fe Batt Cc Jdeatiotes for Sepertmental Outy Oniy : : Seip iipecials CT issaetitteg ‘ Remarks; FULL duty/Gen-1n1 (9-28-54) mes ¢ ABA ee eke CREE |
Wo SECRET fm -, then Bittae fas QUALIFICATIONS UPDATE READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING, TYPE OR PIUINT, AVOED USING LIGHT COLORED INKS ‘ } Now Ohat pour qualifications are a matter of cortputer record, they must be pertodically updated. This ts dune auto- matically for much information, howerer, some must be obfained directly frum you. TaAis form is for that purpose. Section £ must be completed im all cases, You need prorsie ether usfermanon only if there have been changes since you submilted your Form 4443, “Qualifications Supplement to the Personal Histary SQstement” ura previous update farm. a ff votoare in doubl whether information has be eu pre iv.gubt ed. enter ilin the appropriate section. The signed cand dated form should be returned through adminutradive channels to the Fle Room, Office of Personnel, Room 5E-13 Headguarters, whether information ts added or not. Additionally, c quatificutions update may take place af any iim by cumpleting and returning an update jorm on your ‘initiative. e there is information to be added or changed simply section | 4 B1OGRAPHIC aad POSITION BATA aye. SER. AQ, maw (Last-Fivat-widdie) : DATE OF BiOT 058124 | MC CORD, James Walter, Jr. coccte wes ura nnn 126 “January 1924 “ection tt) SOS _ ecucaTiON . - HIGH SCHOOL “LAST MIGH SCHOOL AYTERDED toe . | dagogess (City Stare Country) YEARS ATTENDED ( Fro v- Tex) GRAOQUATE | . i ves C] no ne a et Re neetrnsnunanenntee patgnnsttg ttt meee ns a COLLEGE OR UNDVERSITY study NAME 45ND LOCATION or COLLEGE - oR UNEVERSITY fo seeaeer SUBSECT YEARS arteapeo | Decace veap {|&O, Sru/Qrea. sees | wisoe | srom- TO.+ [OECEIvED] MECEt¥LOL MRS. (Specify) . | | ee po eee Ff & GQADUATE CEGHEE HAS BEEN NOTEO ABOVE BHICH REQUISED SuaMESSION OF a enivten THESIS. INDICATE Ff YETLE CH Tose THESIS AND OMIEFLY BESCRIGE #1S COMTimer. TRADE, COMMERCIAL AND SPECIALIZED SGHCOLS eu MAME AND ADDGSESS OF SCHOOL . Sfuorrce SPEC ALI £atTion FRO; fo B39. OF MORTHS ____ OTHER HON- AGENCY ECUCATION OR TRAINING ROT INDICATED ABOVE “‘sAwE a%D ADOPESS OF SCHOOL ] sfunr CM SFECEAL EP? ATION . FeOw i his) pes OF BON THS ee LL ee a me ec ES News erm +— rT ‘cmeremennanens to i a a pee eee oe a sob = one oe me oe ee ee te a ____! ! SECTIOm Get MARITAL STATUS 1 PRESENT STATUS (Ssngle Varried Pivowed, Separate? fa Eavagecert, daculled Resnargese.f) SPECEB¥: PU Naweor sPouse (Fie) TET Ps nn 2 POY Pee - S. GATE OF Brats “Ya. peace or aintw (City State Country) - - orate mae ———---- $. OCCUPA I Ga F. Cava ds meee “SCTiOn ve eg y . _ meet pTta atic sways a Pxace se are {CTs cansnee ey Pa twast et an ee ss ee ee tenn enter a fp ee A Foe tt ne Ree eee teers eer wenn ie matinee Megan ene mee ec eieaeettennt epee an ats . ; . ‘ . . i i Gaare i ; i (J severe : | . '. “936 1 rr a a: is as : i
i: Children (CEC) SECRET Cohen pitted fn} enol — aoe = — fas eee eee: tt SECTION ¥ . GloGaaPnic “aRLA aROw EDGE “amt FORRIGh Faves ° i es ia: ie BONS Prrrvarnrry nar Peart ns art whee OF ATs { *orpr 8 SPL ea PaO APES OF teavetl Tate & Puane Se pean pence — ™ ne eountey ' enpeltoce eo pessursee | CH yteny. nn eT eern | atune pot i L i ous : : ‘ ‘ : ' i owe ee . her--t = ire abl ey an as . i i | , i i i ne ane nce ena CR En ene Sten eee el Eee EES DoS i ae . ae ae _ Pe ee he SECTION ¥E TYP UG Ano STEROGRAPHIC “SKILLS To TePine TePUD YT onOaTwaws OFT. TMOICATE SuOOtuay Svitiu Uslyee CHET eT TN) aD OCP ETRE TT aw ; (] cece (]errirecsrime __ Up sreserver [lances ee fe tee ne meen ee ee SECTION Vil "SPECIAL QUALIFICATIONS PROeTUE INFORMATION Of #583225 TELPTS, LICENSES PUBL ISHEU wari ew FALS OG YEVICAS Beton Wau way ave tel oFtO SECTION Vidi “MILITARY SERVICE : - ~~ QURRenT “DRAFT ¥ status t. aS YOUR SELECTIVE SOO PILE TLBL LIF TL ATION Chanter DE Tp wed CLASSIFICATION ; . Cl ves ma , D. LOCAL SELECTIVE SUAVICE 326% MUMOE® AMD ADOATSS . [Oe be tna GIT REASON - ee nee ns ne een ere nee bee eee veer ate ne ee ee oa ere nn eee ere ee em atm MILITARY RESERVE, BATIORAL GUARD STATUS | . CHECK PESERVE OF GARD GO4201- CC aamy (] waeina cones coast cused’ Cy NATronal Guano TATION TO BHICH VOU BELG Ss CO) wavy [] ate poece Cl (atm watiowac Guare 1. CURRENT Rasa. GRADE C® 367 vatc Of APPOINTMEmT IN Ciuaat aT Bama 2. EVPIRAY Rw OAll OF CURRENT Obi 1Ga Tt! Me 4 (7) at any wescave C Manta viet) _ STA BY (mae tae metic “t oy ai DISCHARGED &. CuMECK CURRENT RESERVE Cate o a ee — oro oe - SD. MILE TARY MUUILI ZATION AGS E Wheat a@estavt UNIT TO BuitH ASSIGNED on Wrtacnea . of aa Ceeilian; ee bee MILITSHF SOROOLS COMPLETED (fatonded Getive, Reserve Du “gtuce Cm SPECEAL IZATION oath CowPprereo pa pete ene ee nent a nae Sale wo Genie: NATE AND ADDSETE FP UC MOOL [pater [ | betecre Gasoseg SECTION &X : _ . PROFESSIONAL SOC | Eves “and OTHER ORGANIZATIONS - og rs ee ee GF wiwerasniP MAUT CAND CHAPTE® | ADDeTS3 (Nuwmhor Steest City State Country} Solemn Souncil on Exce pas fonal [1201 16th Street, NW —} _Washington, D.C. National Association ont 450 Lexington Avenue 2 Retarded Children {ARC)New York City. “1968 | 1969 eerste oan tte eee tet eaten tenn em nt cote ammeter Rea te SECTICN : BPH pe Nests ren ermtrprnaarer tg momar cesar cae Veresaruae 68 per oeee 17 April 1969 pO Pas SECRET td sonra ae nee 1 1S mR are U eeme 2 IR: eee Re AIT eet Ltn Acie NRn* ANN sete erent etnies
SECRET QUALIFICATIONS UPOATE \ wae ates tne tt, ay « Ae OnE as go TAts. 14 dose adndae is for thad purpose af there have been changers 4 wun ae a Pe iOGHs hy rotupeinio section, The s my ainve uf Mersunned, Rote ob Ch COMPT TYPE OK PRINT. AVOID USING CAREREL hey mas tee Gt comnaler recard, t mist he for need cuaas iomuth he compledec edo your Farre 443. » doubl * het nee creche ai hether inter : a qualifications wy y fake pince gaiasy frome fheoe is informants te be agded ue changed 8 forme on yoiel title tre. . : S102 RIC fal POSITION fata pease as prrere i 1 66 dan 192: efif ane n ADNeR LT Fite Neure veuriged No Change COLL ES? 8 varveRsiTy STU sTycy ar Ol peer are WAT BSD RO ATION OF COLLEGE O& orrobasity ; Ho Change Pep tuewisston Of 8 eeieeee raasts werrerer Tae Tate eG OF tue r8 B FEATURE GEGeld HAS BETH ANTES bone Buics ae % Ter sts esc SMIEPL] GESCAEBE ETS COuTERT, TRADE, COMME at and SPLCLALIE Ae aes: AUGRESH Ch acerca 1g GO TRAINIG BIT detsCaTED agcve cece: ey ON Tes OTmE? &> wawE ART BDU SS OF Fee ree aPeceay { i t : nc apeereneernann evinegne try cman eenenimen Aen e sete eee eae Rie meri et mete ct oe ates (tenet tte arom d meen ap eetames a fee gets mean + : i i ue STatus S Peewee ree! Ame ribs Fay sy ee status Chengte weeraet ® F BawE Ce ster {Poidons Lt O8 Biete «Cage Sears Vewrtres soe ee rong cee ten ge tear meat naan ese enienee me ntee Ft nem RPE Sig Sean ent enmn mint mete ey e Dapyen? fwrLarss Bo teh eho ee we te I i i e @tampe ¢ Frit ape- vist Cee at gee @ ts aga 7 . and sou ri eaiein
SECRET : rtheasr Fettod tan) . 1 reese ee GCEeohaPwr Cc ape a pawl fire amd FOSTICa Teavet fea on tn t tere me Shee rar ase nares fe teaver? per a Peace, La i coe pas : “4 ate POLL OGE fe Be SEE aE | ne he 4 og i en ne { ' tow l- ae 4. __ . | ae th ce ~—F free nee ee | gee ee ee eee ee ban een ocean ere wee _ cr cence hice ae merece eth mee fection va . “TYP ERG Aal SIE ACB APHIC ons : ; ra eet oe. . renwire 7a CITC ET Te ke 1 aes & Ofure Oe cremut ere 7 7] geeciny, (. Jtrirvesrtins ‘SgcTion ¥ii , ~___ SPECHAL (Ubi. ATiOnS ALS OM OL VICES BieiCer ey MAY BRE PNY ENTED POEs IOE parser sl Se HOHHELD, SPLHTS, LICH HTES rrris “yautts watost he Change ectios vill, ng fame seevace arene “tuvotef gear svams rf seareorenent tree neemitttinetstaf titel eta ASAS Pere MOY VSEH SOLE TIVE SEMWICE cLatlsh I CAT ION Cuanient " mde CLASSIP ICHAT EO O, Glee Gt paum SELECT Ose BEBVICE eoaol BLwmEe “bho WD ADORE SS ; EL TARY Resteve, “WAT IOWAL GUARD: $FATuS oe Satta BFASee? Ge Gua GEG At- . Lj sate (j wambigk COGRS Cl coast Guasp oO ATE OMA, Guaeb iy PATIS@ PS Sait YOU BELORG 7 . : " fl saver are rece (I) ata wationay Guat 1. €uparet wama. CHAGL OW MATEIR Bete VF ASP UIE MEF de fo, 6b tel awe 1s A SPIRAL Pte LATA 14 Cused ef ON IGA PtOn ot aes Befanacties Oo PINCH ABEZD td ig aoe MEER Cy sinter wt} {a aE SERVE unit 19 Baan S23 1GRED GA ATTACHED ann me ree ee nn dene art ee tne ee mtd SS et ey “MILITARY 30008 COMPLETED oO atankad tive. Bosorve Duty, os 28 Civilsan} Bf RIAL [Oe ae gee CiaAL TATION Lopate CouPLeTen $Y a9 a0bOLS4 OF Retmcr seonguene Add Air Creclal Warfare CoOAres i SECTION 12 PROFESS IGRAL SOCrRT HES ane “OMMER ORG AMI as . DATT OF WLuat age a Bes B80 Cmahte & H . . . . etaes te No Chanye } Hi 7 . : fermetce gy oa mre eet : i YY Sloped fea
SECRET Whea f coy te Pete CE PRT BCH 58 END COLORS ipies BEAD INSTRUCTIONS CABEIULLO ALEGRE COMPLETING BUGCAPRUC AND FOSHAN Data TOSS Sie aia a |_PCCCRE JAMES 4 JA ML 92425724 | 98 245206 To Lgyates Cite { 78. TY RaO te [Rr ASS NOEN! Supe | SEC AGENCY | OVERSEAS § seavice SaiaEananeieansant teas SECTION I yO ALCS Cer PE EET REE ae mae JECTON ff ee ED ee eee tae wara ner re . taQe oO ss FT —TETR OPER A ri ee —b—apys gg $67 07704 86708705 “BURCPEAN ASEA ; TOY :34 : 89/80/03 =| 39710727 FURCPEAN AREA - j.. Toveas ' 90408715 | -69/08/42 BUACPEAN AREA , ‘TOY 24 ' 1/03/22 | «63705782 ‘EURCPEAN AREA - TOY :24 - 8706/22 ~ 1 647067289" ‘EUROPEAN AREA i vovead | gh vagros 61/10/36 EUROPEAN AREA Toy 194 | 2404/04 62/04/34 GERMANY PCS.-36 | 62/086709 64/06/52 DATE: INITIALS | ! VSL LI — LES I : | SECHON mt Ot late heat 108 F rks : a oe eS NOC COLLEGE. WaGREe UN RECORD” | +-Internationabea HS ES pa wee BO MTS Mas shington- Unive polty—i , Business Administration | University of Texas [1 :
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' : : : : rer : : tO . Stcres H : ° When Filed ia ' eens Amat prensa ee SECTS IY . Lot tot Pare Aaa ENOWLEDG a ars Fo . . 3 . : ee ere area teCGE aneti, ar Cuice fh tanta BIC trarr & sade wn “te - Wop” aye Coa es ce emor Cet taaeth Shue asian 1 (Cerny 2 GOP . i . x i TRB wr |) eae eae ee weer ‘ : fue @ (Cl etee, (7) wtto anne ore nee er cen teee etennmeen to ete A - ha EovEMERE OF TRAD AAS ‘eetplos eter, Someogiuyh seed pweih, ofr i. * + SECTIONS VE SPECIAL QUALIFICATIONS eet en eT ap eceeeene meena ener ee 1 LSE al, ROBES AND SPORTS IN Weta YOU b2e aC teh 4,3 wade AC iver PARnC PATIO Ire Cath ¢ OUR PRORICRGCY iM gated rt Golf - fatr . gaan apres ms i fan Sn en me neg ef eR EE EEE ed . Fis BUS PASS EGP a st OB RMAC HIES Heel Ce a RE 2 Ut atse SOP C tar SAALS COW oe res SUCH AS CPRRATION OF RADIO TRANSMITTED 0 be wa OW ouaed rermny Brae: CAPeeat wOESS, PUsQET Sate, COP an OleER SC: [NEE Ca deca Ei sora GEVICES t - peepee eer ee eet ttt RT I SR I TST A Bag 9Oel vere CO rave VOU EVER BEtG ad eerste & Cebivhts Ob ater teh SEC ie are Bade ee Rata, Fak RB Laaehe Cha sof Cort ahs Cee ee ne ee er Oe emer ine a ama beast G8 CERNE CANE tre hhh tafe] AES OE eee ¢ NSEICEOTBICATE “sees of ance care Sor; ak ahs ha yEd' 1 tea y 40OVE we ate ee Boar PALSY, ETC iP pende toemne rape eve ber oh bate renee LATER LECEMSEICEANE CATE rena of acigne ene eee nt ct (tnd DAE. PueCalGn CATR, Are THE CH wali eve ern aeeaenateteen wets ane seucorted FOIE US alee EGP RICANT F WME wale alg OF mele 6TH Bart "eek Oly” ace bv tnga ae se-getts ortutee gover ed torent aelussty menos ae! ste as ote anh meee! tna) Oo areas Te OOK cere. Precentations ai Poche waco Internally at Atency eupon rarer iy
SECRET Wan Fp ets MILITTAGY SCUVICE SECTION Vit JPSEST ORATT SFATUS ARE oO! Sty ee - ke ee Mm ORO LSSED GFE REASIN | F UCCah SEES E ~_ - Jenene a MALLIFAG@Y SERVICE RECORD “ayn « Derm Oi, 1 : POGATES GF MEEVAE osesuee mee ay TP OMAETAGY DAG ANS AN aeey Oegee ot7 swords i. Beate Le est ree DED 1D Army 4 STATOS Begeto, Core se of Regular PN OR MENEAME DUTIES coma d Me dots wad chee ott Seat dourde cus cove o & BREF DESCAS! vate cmece neg ge wad NOMORMBE Suite arst ore [7] enced raatseeey mca fee oF ’ ; sep agarCN (Ty eeetase to mace oat (C sitevint oe covsat capi [Ll] Ommts feet . Os Cj REMEE ME be RE [OT che ceserns Oe Seis cay So Saanity f Tustow oe Oto sermne : Active Duty - Navigator - Sombardier duties Reserve - Intellijence Officer MILITARY QESTRVE, NATIONAL GUARD STATUS CHECK RESERVE O8 Gu aad OG AM ° pave ] caaaiset CORES NATAL GUARD - LATION TO Write YOu BftOraG La ae = [7] coast Guaco 0 . : CJ csave Px) at ecece (ae senonn Guat : £. CURRENT Sane G@até OR RAls | 3 cata “BPOQINEMEN! IM CUGELT Garg 3 ERFIRANION DATE OF CURRENT RESERWE OB GAO . rygr es woo Major jy face : © CmECK CURSENT BESERE CAGES fed agate sesesct Lo} gratcge armee ] STAMOS saat se Pjeena | Ep eacesaces : Me OF ATR ZY BECE RSE CUBS coe 8 ote Fee on cad sails hae Bell ertebe oer werk at bom tone Me adngry 18 ree : . Intelligence Officer __- pee er nero teen rene i BovCay AGE CURGENTY ASHGOD 1D @ BELER EE GO tan hea, GUARS aN Leet eesti fee ter? ahs th ances gy ‘ : i Los \ MAI BET ACHOOLS COMPLETED ase ce Oty Boners MAUL A ALES 4 - Ge vere ae ifontyomery, Ala, SECRET | . ’ Par: . “
14 ot 3 ih . . SECRET ° . iWhea Filled ts AGE ACY EMPLORMENT HISTORY SECTION Vit - TONGGGAE CATES fren Tenby moar B emer “Aoaene Plo 2 opesoant 3 Ce Os NOS Coneren Cte ' 2 UV SECIONAE OSCE CS Doe ON BRAT gion, DAC. i OfPrechniaal Liviston $ GEADES HED ie Ita Chiet. Technica @ OLyCaesticry CF OVULD : fa, Supervision of the Citice of Security oroyram domestically anid rsea: is res) (3 t a i ° * INCLUSIVE CATES from- fo. bp woark & peo! 2 TOCATION Heworry, Coty! OPEC 1ORa'£- OF FiCE G8 OMIGON, BRANCH Aug 64-Aug 65 Montaomery, Alabama A a time OF 108 T Baaces RED is 408 : student-Air War College GS-1 6, DESCRIPTION CF DUNES :- | Agency-sponsored - student at Air War College, study of r naticnal strategy @ international i INCLUSIVE DATES ifsem. 19 -bp mouth & see) ZT ALCCATION Cowarg, Cry} 2 UWECIORATE OF FICE O8 ONMISION, BRANCH a June G2-Auy 64 Germany, Frankfurt @ TRE OF 708 9 GeaCks WELD ie Ca Chief, Security Branch, German : GS-15 6 DESCREnON OF GUNES Chief of Security Branch activities in behalf of the Ger:ngn Station and supervision ‘ of certain security functions, such as/ | performed élsewhere in Western European area for tne Agency. : SECRET : sD Ee,
: SECRET thee Filled In” SECTION Vil ACENCY EMPLOTMENT HISTORY (Coat a} YT INCIUSE CATES Ferm Ta-Be moe 8 pom Toe SN Vase on IM Se dees Jun ek Us ig Reseurch Stait Deputy Chief ry S DESC ERT iON OF Sones Deputy Staff Chief, supervision of security research activities in benalf of the Office of Security ° 1, INCLUSIVE DATES Bram. Te. by want B peor: é LO canons iCogntes, Cotpi =e OSESTE C® OIVISION, BRANCH Aug 63-Jun 60 uSA/AVashington, D.C. Research Staff a. te OF 108 ~ Security Research Officer : 8, DESCRIPUON CF OUNES : Security research in behalf of the Oifice of Security ee ee ee ; d, INCLUSIVE DATES sFram-Fo-by moert & peo! BP sOCaO%s Country, Coty! 2 TeETICS aE -RRICE OF DW ISION BRANCH : Jun 68 -Auq 53 SA fMashingt : @. TE OF IB Investigator 6. DESCRPTION OF DUTIES * Investigative supervision of. certain field investigations o
14-00000 f genes . 7 Pearl OF (3 DATE OF grote 1927 4 SCCuPAnOr. Housewife FO CUE eee SECREY Wien Filled fn MAT TAL $-APUE SECTION & iT CHUDREN AMD OFPE: . 7 babe’ BEL ANON GED : hatte aug acti OF Bs PER AAS tel AODEESSE . ; ; .., Oakland, | Michael Steven McCord | Son 3) ane 07) 1 Springtield, Va _ . Washington; ” Carol Anne McCord lwbg De 7 tf US " . Do . _, Washington J os i Nancy Ellen McCord aE 43S " . i i pe | j ‘ ij 1 } en een te i 3 — i SECTION 21 ” PROFESSIONAL SOCHTIES AND OTHE O0G Broz ANIONS ee “ . - ” DATE OF mEMNE RSP i ‘ (NMIAE AMO COADTER AUGOESS IMnber, tear te Mote, Coentes! FaGm j Air Force Association LL. Washington, D.C. . 5] Press i - - | A Dale SIGNATURE OF EPL OVee ~ P3% Sane | C Webra GL 3 ems © owe 7 | SECRET 7. i a *
14-00000 PMSA EL SEDER NY, j wae, oy 8 fe CERTIFICATION FOR LANGUAGE AWAP ~ 192 Loa ae Sethe AS al erence nena ae tnt. . anne we ti omep CLaet, Fie at, Bitioy | |; here Ge prety (Ment hb. Bay, Peor) __ WcCORD, Janes walter _Sanuary 26, 1928 B CAMELS S28 4aPuN fa. 4p & CoMPONeNT | tai 08 fe no ene St ep a pa ee te me Bee meee wen gon meen aie care Erneta Sent aan te Me ue ee LaNaoacn. pcace i mare ci tesrp gion eh, Bay, Voarrle. ANN LSE aay ate (Worth, Dor, oars Russian 1 65% | August 29, 1957 leartixe ae. TES? REROTNG PPROSEUNO RATION " $coRes Eg 10. : COUP BLING ENE - [Ror QuaLTFEED af A@ARD ABLE arenes bree eeriains aurereranar i anneal ma weweed aay LEVEL es. . ie, * : « Laver ae | sre patas feyaw eutae tan : ! 3. f CERTEPY FUNDS O86 AVAILABLE Ul. b Crafary tear tra AGOVE waMtO fee wo Lf POE CS ELtatace fom THe aan UN. ‘ DICATIO, Havits WET aL FRE REQUIAES MENTS 7O8 S410 ABaaD. ° . Date SIGNATURE LOOREGATION @EF NO.1 STUN ATUOE CMARGE ALLOTMENT NO, DATE fa. PS. EMPLOYER Parveen NO. FEDERAL TAX DEDUCTION TF. GL GEMENP OF ASZICNVENT STATE/OC TAX OLOUCTION 9. CealCR NuMBsEe ISsuad vate NET AMOUNT OF AWARD PAIO FOR#AAD CHECK TO C8 97g! SECRET las)
Fue a. fone ’ wet omy ras an PERSONAL HISTORY STATEMENT : t 7 sentra eee wee i Instructions: 1. Anawer all smestions completely, If question fa not applicable write “NA.” Write : “unknown” only if you do not know the answer auc cannot obtain the answer from ' i ; sec. 1. PE ¢. D. personal recerca. Use the blank pages at the end of this fourm for extra details on fuy question vy qaestionn for which you do net have auffielent room. oo: .. Type, print, or write carefully ; iWegible or fucumplete forms will not receive consid- 2 eration, : AVE YOU READ AND DO YOU UNDERSTASN THE INSTRUCTIONS? ooo : You or Nod RSONAL DACKGEOLAL : cn, : Telephone: OMe occas Mine'@ ~- state , -FULNAME Me. FOS. PUDGop CGO Mh SP eet. tUee Nu AP iene ahtae pore Saltials) ‘2 Hoine PRESENT ADDRESS |... a LS somittog UI : . tot and Wyeteert eCity . stated (County), : a be " , 2 PERMANENT ADDRES | || Mado tay CBA . PL and amber) eCsepe tit seta} (Country) NICKNAME ....8de2 00) WHAT OTHER NAMES HAVE YOU USED?.. DONO | | see teeennmecnenes US DER WHAT CIRCUMITANCES HAVE TOU EVER USED THESE 7G HOW LONG? _.........-__.. IP A LEGAL CHANGE, GAVE PARTICULARS |... veonesenesunnecetseramessns coven saws ras pa candrevcseresconreo to LP OR Oe ces Moret eter e net nn en ar ese me rene eeusnaneraeee tanscoeeeee nan, tra woe retrns . «iy what authority) DATE OF BIRTH MeL. PLACE oF HintHt.. ds Ske om UDA EG at gy tBtate) “(Waumry) PRESENT CITIZENSHIP an Vee... B YRIRTHE 0. GG BY MARRIAGE? oo cecssseeee Cuustry) ey BY NATURALIZATION CEZTIFICATE NO... oo occccccene.- PESCED ons |) Cae (irate) tart} AT TTT te ais stseeee aes samme ennnmncmicnnnatee ane aiteeenieen setae acen es statenraseat anes mene tngeeceranuecenmentaseperd suassceesrsressseseccuseeence iChts} . (Etete) + {Country} HAVE YOU HAD A FREEVIOUS NATIONALITY? —..... 20. ao ecselela ian ceeseenmuseesutece caetesaeeaeceenee t¥eo ur Mas (Country } HELD BETWEEN WHAT DATES? _..00..... TOL... ANY OTHER NATIONALITY? __.__.. we WCauntey GIVE PARTICULABS re neta seen ene nan nen a nem ate tas ane HON end dng Vane oe neu ee eaeesnseaon smtsuasonenscsancans ve HAVE YOU TAKEN STEPS TO CHANGE PRESENT CITIZENSHIP? __ 10 GIVE, PARTICULARS:
14-00000 whe le me (3) 194 EF monn OUTSIDE-U, S&S. WHEN DID YOU FIUST ARRIVE IN THES COUNTRY? nS LS. oe PORT OF ENTRY? tee GN PASS POICE OF WHAT COUNTRY? st aeeee tee atten LAST UR VISA Oe, we ry ace ee HEIGHT SELON werene cay £0 En _ EYES PPO HAM P0423. COMPLEXION Oddie: SCARS ee PRREUG nen wf, Poon BUILD et woe OTHEE DISTINGUISHING FEATURES AOU ce cere soeenes Sec, 3° MARITAL STATUS *ASSINGLE oo MARRIED ceermeeetin 2 DIVORCED WIDOWED woo. State Date, Puck anu Reason Fon ALL Sevanations, Divonan on ANNULMENGH tre PRONG ee eee B. WIFE OR HUsRAND UP YOU HAVE REEN MAIQUED MOLE THAN ONCE.~INCLUDING ANNUL- MENTS—USE A SEPARATE SHEET FOR FORMER WIFE OR HUSHANU GIVING DATA REQUIRED BELOW FOR ALL PREVIOUS MARRIAGES) NAME OF SPOUSE Sepa ERB SIRI IE cocci ren ATOM Pcaceecceseeee 4 aula . Tash €Ptrayy . Mobiles PLACE AND DATE OF MARRIAGE hOB g VORB g Vidya Bp ANB ccd HIS (OR HER) ADDEESS nEFORE MARRIAGE Uoute Go. Ix cosa Goce oo .. ee Bief Nurnber) eCity) (State) (Country) MVING oR DECEASED Ddyvdne. vATE OF DECEASE vee tetecneeecenreseonnes CAUSE ov ceccscccccccuees PRESENT, OR LAST. ADDRESS 220. Pae8io. wo. Alecds Calta veseaes Us... (Ht and Meseabare due; istates (Country 9 DATE OF HIRTH be PLACE OF HIRTH Deerige|n Ob ow LUA “ . {Country} aCinye (Rtate) IF HORS OUTSIDE U.S. INDICATE DATE AND PLACE OF ENTRY ec ceeecsememess CITIZENSHIP Ce Sa WHEN ACQUIRED? _ D4>%2300 WHERE? veces ec eeteveanencsee eng : tChtyd)  CHeate) {Country} OCCUPATION GoguetoyeLCnG.. LAST EMPLOYER inivorsdiy of dyicumis EMPLOYER'S OR BUSINESS ADDRESS oo Jorealeys Colivopata ceseeeee iNtate} ° (HQ. weet Number} (City? (Cusntrg) BULITARY SERVICE Fro DOG TO vo. BRANCH OF SERVICE there ameeeee ees estececee . (Date) Brake} COUNTRY Tire rrmarimesemecrccuecnees DETAILS OF OTHEL GOVT, SERVICE, U. 8. On FOREIGN Voreo Contin, = ane ihete 2 iOVe to we ois CST fl eto ges
14-00000 este ee ra rr: = é See. 4. CHILDEEN OR DEPENDENTS (Include partial dependents) ¢ aa ’ soley ee aes : * deny L NAME TINO, 80 HOC ONSS OCOD RELATIONSHIP oe ee oe AGE oo... Sian oe ; “(ke and Number) (fliers te mio? Etergnteyh Be NAIK es cece neem e cater seanecsnecnepueeneeaescueeeen RELATIONSHDP ooo coco cues successes AGE, checcccccce ‘ CITIZEN BHEP occ cece e ADDRESS |. hccetts vette tastes eae . . “GRt ant | Sater tfieys ‘Piete§ 3 : B. NAME oo ceccecssssvessesncceesesetssseesouessenepraseutesiveeee. RODATIONSHIP : CITIZENBIIP eee. ADDRESS |. ve tevumeeveurise tncaseaseanen : ' Erato 5 efyuaatey 9 . RR TS EN ES SEER AR ERA RE Ti ers ne AE yea Sy . Sea, §& FATHER (Give the same information for stepfather and/or guardian un a separate aheet) . : FULL SAME. 8 MOB ato: vce Oe Ba ! Peay “Odidliey Leash) : i LIVING Oi DECEASED / DATE OF DECEASE wocccccaocne CAUBK -.. . : t I. a : wen H PRESET, OR LAST, ADDRESS .. seccenesnacenese wrens nc ondt EPO) Fy cee ven eet . . (M48. and Nerbies} , iti Rte } & y H : oe epee oe ; pateoy navn Lb peackor sunt . SS OT TTS) : | : , ivity} SB j (anntry) ; JF HORN OUTSIDE U.S. INDICATE DATE AND PLACE OF ENTRY oo abc cee concceeccccee. : { Ue. 5 CPR vate ty crraesnuny U8 3° wien acguimepe 2 1 oe WHEBE? ..... OCCUPATION . BOL2OL <6 caren LAST EMPLOYER leereereeceeeed EMPLOYER'S Of OWN BUSINESS ADDRESS ns Maras ae H qHu and Numbert {Chery ‘thas § H MILITAEY SERVICE Fro... ONO 76 voseneeeesery MBANCH OF BERVICE oe eel csaescee i « : i Late) CLbate . i . j COUNTRY —.._.. . DETAILS OF OTHER GOVT. BEEVICE, LL 8. OB FOREIGN { i i “Uynaay oe iis *. carp oyaee eon rmecnecee LIVING OR DECEASED lying. a DATE GF DECEASE woes cece anes CAUBE orc ec ccsetecssee : PRESENT, OR LAST, ADDRESS | vee PE A ; : {St end Nesters ers sel) ot rw ts ty), , : DATE OF BIKTH Lo)... PLACE OF BIRTH Tet, FA. eitizessHip Yo De owen acquinep? 2st: wiaenee, . — : ttle: | (Stmue: sComatey a ff HORN OUTSIDE U.S. INDICATE DATE AND PLACE oF EXTRY | —=**_ a . 43) 3
(4) OCVUPATIOS TCU ENENS nae EMPLOYER EMPLOY PR! Ga, OWN HUSINESS ADDERS Meee (8h aed Numbers rene eae (Country? ary MILITARY Spisviey FROM | at Co, TO RRANCH OF SERVICK ll cece COUNTRY Uo. sv rteemtres ecm DETAILS OF OTHER GOVT. SERVICE, U.S. On FOREIGN AN EE SST, Sen ene  ag TES CLARET SERS He I ee RA UE ee, embnuse ey i SEC, 7, BROTHERS A'S) BISTERS (including half., step, and adopted brothers and fisters) : F (Fie) oe aisht e oe ° ue ‘aety ee wee flies patel geD \ a 1G | tétate? {Country y | we on QFULLNAME SEES TOR Gayle GLO. eee Bo . CFleat} iMaskdles . thet > PRESENT abbots [OO wong. UGA LY gnc re conse : ¢ imbeer (Cry States . (Countess Bra Ei ; ; CS agers ee, Pad 8 FULL NaME SStbiee vere AQ Siw AGE DO H , Mayceye: tu 4 >», PRESENT aAbbDwEKe | rs ease ee aes Se SarIOrnren CT ORY ae 1 Ba ember} acing} a, State) {Countess . * iCWisenabig) Pleat} , hawt : (Country) (Citizenship) PRESENT ADDRESS |... (St gad Numbers 5 FULL NAME 4 Pireth OE Meaty tLast} PRESENT AbDiras es. oererenewtsnete eee oor ane, SST TA TRE SO Ee ee ERR SSS A hg Se ge: Sie ab TS aE ae ae SEC. 8. FATHER-IN. LAW te ; thanat PRESENT, on Last, avoness Y43  Vooth Lyty Meg Temesn EN, amd “Number tape tateter 5 val + , . (Uowatey! DATE OF ninTHTAL A= E7 PLACE OF met DUenoth Coicy | eC ’ IF HORN OUTSIDE Vv. s. INDICATE PATE AND PLacr OF ENTRY Jo béae ve Tere wae CITIZENSHIP TT WHEN acquinep? ea WHERE? | ad oe wae om wets OCCUPATION “OT ane, ee LAST EMPLOYER 8 ¢-- FET RT ATE