Date: JFK ASSASSINATION SYSTEM IDENTIFICATION FORM 01/26/05 AGENCY RECORD NUMBER RECORD SERIES AGENCY FILE NUMBER AGENCY ORIGINATOR FROM TO TITLE DATE 7 PAGES SUBJECTS DOCUMENT . TYPE CLASSIFICATION RESTRICTIONS CURRENT STATUS DATE OF LAST REVIEW COMMENTS oe 06 of AGENCY INFORMATION CIA 104-10112-10093 JFK : 80TO1357A DOCUMENT INFORMATION Released under the John Kennedy Wss5assination Records ollection Act of 1992 (44 U5¢ 2107 Note). ase#: NW 53294 Date: 6-14-2017 FORM: PERSONAL HISTORY STATEMENT OF CONEIN, LUCIEN EMILE CIA CONEIN, LUCIEN 09/25/1961 16 CONEIN, LUCIEN PAPER UNCLASSIFIED 1A 07/22/93 JFK41 : F2 RELEASED IN PART PUBLIC - RELEASED WITH DELETIONS 1993.07.22.18:47:22:590390 [R] HW 53294 Docld:323992765 Page 1 - ITEM IS RESTRICTED 104-10112-10093
‘a ae fF 4 - ~ ° alee i™ t : ~ . wt L i ‘DO NOT USE THIS SPACE THIS DATE (Fili In) ISSUED BY , PERSONAL HISTORY STATEMENT : 25 Septenber 196L_ ' INSTRUCTIONS 1. Answer all questions completely or check appropriate box. — If question is not applicable, write “NA”, Write “Un- known” only if you do‘not know the answer and it cannot be obtained from personal records. Use blank space at end of form for extra details on any question for which you have insufficient space. De aw ate 2. Type, print or write carefully; illegible or incomplete forms will not receive consideration. Fs 3. Consider your answers carefully. Your signature at the end of this form will. certify to their correctness. Careful completion of all applicable questions will permit review of your qualifications to the best advantage. , : @ [SECTION | GENERAL PERSONAL AND PHYSICAL DATA ; _ 1. FULL NAME (Last-First-Middle) 2. AGE 3. SEX CONEIN, Iucien Bile - Iiyrs K[wace | Jrewace H 4. HEIGHT ; WEIGHT 6. COLOR OF EYES 7. COLOR OF HAIR 8. TYPE COMPLEXION . 9, TYPE BUILD { S11" 175lbs | blue . brown _ fair mediun k 10. SCARS (Type and Location): . “Tt ~ =F appendectomy, hernia, rt. side of body i 11. OTHER DISTINGUSHING PHYSICAL FEATURES ; - first jointr rt. index and middle finger amputated H 12. CURRENT ADDRESS (No., Street, City, Zone, State and Country) 13. PERMANENT ADDRESS (No., Street, City, Zone, State and ' : . Cc t AND PHONE NO. , _ ‘5011 Hanes Street Sountry) HONE NO McLean, Virginia ~ ~ 1905 North 1Oth Street Elmwood 6-811 Kansas City, Kansas ; . 14. CURRENT PHONE NO. 15. OF FICE PHONE NO. & EXT. 16. LEGAL RESIDENCE (State, Territory or Country) Elmvyood 6-);811 OXford 5772 Kansas i 17. NICKNAMES . . . , 18. OTHER NAMES YOU HAVE USED | INDICATE CIRCUMSTANCES (Including Length of Time) UNDER WHICH YOU HAVE EVER USED THESE NAMES. tl . . 1F LEGAL CHANGE, GIVE PARTICULARS (Where and by What Authority). e [SECTION I POSITION DATA 1. INDICATE THE TYPE OF WORK OR POSITION FOR WHICH YOU ARE APPLYING . \ Position commensurate with past training and experience ' a INDICATE THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL 13. DATE AVAILABLE FOR EMPLOYMENT ACCEPT (You will not be considered for any position with a lower entrance salary). $ 11, TOO. OO FR X- 1 October 1961 4. INDICATE YOUR WILLINGNESS TO TRAVEL [occasionaLLy [x FREQUENTLY | CONSTANTLY OTHER: 5. INDICATE YOUR WILLINGNESS TO ACCEPT ASSIGNMENT IN THE FOLLOWING LOCATIONS (Check (X) each item applicable) | WASHINGTON, p.c.| [ANYWHERE IN U.S. CERTAIN LOCATIONS ONLY (Specify): X| ouTsipE CONTINENTAL U.S. . 6. INDICATE WHAT RESERVATIONS YOU WOULD PLACE ON ASSIGNMENTS OUTSIDE THE WASHINGTON, D.C. AREA. s Fors 444 use PREVIOUS EDITION. -1- HW 53294) Docld:323992765 Page 2? y