Agency: HSCA
Originator: HSCA
Document date: 10/23/1977
Document type: PRINTED FORM

## Page 1

JFK Assassination System

Identification Form

Agency Information

AGENCY: HSCA

RECORD NUMBER:

180-10107-10131

RECORD SERIES: NUMBERED FILES

AGENCY FILE NUMBER :

003016

Document Information

ORIGINATOR :

HSCA

FROM:

TO:

TITLE:

DATE :

PAGES:

SUBJECTS :

10/23/1977

1

SHIELDS, EDWARD

DOCUMENT TYPE: PRINTED FORM

CLASSIFICATION: Unclassified

RESTRICTIONS: 3

CURRENT STATUS:

Redact

DATE OF LAST REVIEW: 10/24/1995

OPENING CRITERIA:

COMMENTS:

Cover sheet for interview transcript.

Box 71.

v9.1

HH 54756

DocId: 32262062

Page 1

Date:

10/1/201

Released under the John

*. kennedy

Assassination Recorde

Collection Act of 1992

i44 USC 2107 Notel.

Case#:NW 54756 Date:

10-31-2017

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## Page 2

003016

INVESTIGATION INTERVIEW SCHEDULE

1.

Identifying Information:

Name EDWARD DIELSS

Address /439 STIRLING DR

city/State DA//DS TEXAS

Date of Birth 9-17-22

social security 457.16-783

2. Physical Description:

Height

59

weight 1FY

Ethnic Group

Date 10-23-77

Place

RES, DENCE

PL 943-7050

MOr S

MARRIEN <

Spouse

WillIE MAE.

Children

color Byes BaN

Special Characteristics

3.

Personal History:

a.

Present Employment:

TEXAS BooK

Address 8301

ABASADia RoW -

Telephone 415 631-2946

b.:

Criminal Record

1. Arrests

2. Convictions

4.

Additional Personal Information:

a. Relative(s): Name

Address

22 YEARS

b. Area frequented:

c. Remarks:

Investigator

Date

NN 54756 DocId: 32262062 Page 2

FOrm.#4-B

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