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Released under the John F. Kennedy

Assassination Records Collection Act of

1992 (44 USC 2107 Note). Case#:NW

B8613 Date: 03-18-2025

Date : 01/14/98

Page

: 1

JFK ASSASSINATION SYSTEM

IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : INSCOM/CSF

RECORD

NUMBER: 194-10003-10335

RECORDS SERIES : INTELLIGENCE/COUNTERINTELLIGENCE SOURCES

AGENCY FILE NUMBER : PAGE 3

DOCUMENT INFORMATION

ORIGINATOR : USA

FROM : 59TH ORD GP

TO : USA ADVANCED WEAPONS SUPPORT COMD

TITLE : [ RESTRICTED ]

DATE : 11/17/71

PAGES : 1

SUBJECTS : KACZMARCYYK, GEORGE-

RESULTS OF NATIONAL AGENCY CHECK

DOCUMENT TYPE : PAPER, TEXTUAL DOCUMENT

CLASSIFICATION : UNCLASSIFIED

RESTRICTIONS : 3

CURRENT STATUS : RELEASED WITH DELETIONS

DATE OF LAST REVIEW : 03/09/95

OPENING CRITERIA :

COMMENTS : CONTINUATION SHEET INDEXED SEPARATELY.

NW 88613 Docid:34529118 Page 1

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'$ 10/1.5784

NACC Use Only

2661407

STAPLE HERE

DEPARTMENT Q$ DEFENSE

NATIONAL AGENCY CHECK REQUEST

1. LAST NAME - FIRST NAME - MIDDLE NAME

MOZHAROZYK,

Edward NMN

3. ALIAS(ES) AND ALL FORMER NAME(S)

NONE

REQUEST DATE

16 Sep 71

2 SEX

Male

4 SOCIAL SECURITY NUMBER

143

140) 1685

5, MONTH, DAY, YEAR OF BURTH

Aus 06, 47

6. PLACE OF BIRTH

Bomblitz, West Germany

GE

ets

7. SERVICE NUMBER

A 1272 4692

8 & SECURITY PROGRAM.

AALI MILITARY

RETURN

Commending Officer

CIVILIAN

RESULTS

INDUSTRIAL

TO:

U3. Army Advanced Weapons Support Command

D.

(Include ZIP

Code)

ATIN: Intelligenco Branch

TO NY C.:S?

LOCAL FILES CHECKED

WITH FAVORABLE RESULTS

C. INITIATOR OF REQUEST

ACCT# 5124

Commanding Officer

HHC, 59th Ord Gp

9

RELATIVES

10.

DATE AND PLACE OF BIRTH

LEATHER

2 Noy. 12

300 Stone Si

PRESENT ADDRES

12

CITIZENSHIP

RESULTS OF NATIONALI

AGENCY HECK

This request for a NAC was completed by USAINIC on,

with results

checked below:

NOV 1 Y 1971

FAVORABLE

FAVORABLE DETERMINATION

SEE ATTACHED SUMMARY

SEE ATTACHED COPY OF DOSSIER

NO DA FORM 873 IN DOSSIER.

DA FORM 873 IN DOSSIER FOR

GEORGE TOBIAS

MAJ, MI

CHIEF, USAREUR IN TM

NOV

YES NO! 16

X

Jun 64

Tilson Jr HS #TZ

D.

Has the subject any foreign connections, employment or military service?

Has the subject had employment requiring a security cleafance or investigation?

e. Is the subject now or has he ever been in the Federal Civil-Service or Armed Forces!

f. Has the subject qualified DD Form 398, 98, 48-1, or similar security form?

Has the subject ever been addicted to drugs?

18. REMARKS (If additional space is needed, continue on plain paper.)

ITh # 13. Sep 71 - present, OPR, Pirmasens,

ermany

3

Checerprints

X

X

ITEv fí8a. & 8b.

Josef Kaczmarzyk, DPOE: 2 Nov 6D, NYC, NY,

Alien reg. #A7904415

Dorota Iwanowa Kaczmarczyk, DPUE: 2 Nov 6D, NYC, NY, Alien reg it A7914416

continued

FORM

•L 1 bec se 1584

REPLACES DA FORM 3027, 1 AUB 65, WHICH IS OBSOLETE

$ GPO: 1967 0 279-091

NW 88613 Docld:34529118 Page 2

REASON

BASIC TRAINEE

FRE-COMMISSION

NUCLEAR

вІ.

SECRET

CLEARANCE

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