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104-10117-10076

2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992

PERSONAL, HISTORY STATEMENT - (Appendix I)

Listed below are names of organizations identifed by the Attorney General, under his responsibility pursuant to

secutire Order 10150, dated 21 April 1953, to Ist the names al esch foreign or domestic organization, associatior

anvement, group ar combination at persons which he designates as Totalltarian, Fascist, Communist, or subversive

Tas baring adopted or having shown & polly of advocating or approving tae: commission: Oi acts al larce or vio

ence to deny others their rights under. the Constitution of the United States, or as seeklog to alter the form. o

gavernment. of the United States by uncontitutional means.

Each applicant ar employee and spouse (If any). must revler: the following list of organitations lor certification

purposes, and sign: on the last page

Abraham Ilncain Argado

Abrahama. Ilnoon. School, Chicago, Illnois

Actlon Cammittes ta: FIDa Sprin NoM

Alabama. Peoples BAlontional. Anocation (500 Communla Pollti-

cal Association)

Amarican Chdottan, Natonallet. Party

Ameras: Commaltion far Suropean Marteni Bellet (oso socialies

warted Puty)

Amedera COMmItTOO:SOT PratAatIOnI al Farelga B00a

Amortcan:Committos for Spanish. irascan

AmerIcan CoumiItos for. tha-Bettlemant of Jowa la:Blabidian, Ine.

American Camunitico fUr PagodsT: Ballet, Ino:

American Committoo ta Buoroy, Labor: Conditions: 1s Suropo

Amerton Cousoll:for & Demonada: 010000. larcerty now as the

Grest Amertoat: Connell:: Crock Amartorn: Committes lor NA

Hanst Unity

AmErIEND: COULDal: On 80010ti Bolatlone

American Crostar Confron

American Leagur Agalnes Met and Fascien

AMPETIAn IRAgUA IDE PERCE ANd' DOTOCINY

American. Hatland. Labor intty

AmerIcan MotionAl Bactallet Isagre

American Nellonal Boctallet Party

American Hatlonallet Party

Amadcan. Patriass, Inc

ALETIONA PERCO MObIllEstION

AmArIONA. POleS fOr PaRce

American. Ballah. Labar Councl

Amedesn. Polish. League

Spanlad: Ald Committes)

ADEMICAD-RUAdAn FratarIAl. SOCLetY

Amertean. Buedlan. Institute; Now Yark, diso kaoma de the Ament.

cAn Russian Institute for. Cultural Relations with the Borior

Union

Amarican Russian instituto; Palladelpala

Amerton Russian Instltito of. Bar: Eraselsoo

Amertza BusdAD: Instrate al Bouthera Calllorals, L0s Argeios

AsserteRn Blar Congress

American WOmen fOT PERCo

Amaron. Youth. Congreas

Americ Youth far Democracy

ArMenIAs PrOfIASSITO LEAgUE Ol ADOrICA

Assoctarod Elans of Amertos

Association: of Coargla Hians

AssodatIon Of. CoMara: Netlandla (Paschodeutacho Varain/guag)

ALlaRd-OTJADIATOR deT NEDAP: Onersos Branch o1 last Party

Baltimaro Fartm

Banjamin Davis Iraedam Committoo

Black Dragon Bostoty

PORM

18-57

. 4440 VER PREVIOUS EDITIONS

Botan. Echool for Mardet: Studios, Boston, Massactrusetts

Bridgot-Bobertoon-Schraldt. Dalenes Counslitos

Buigarlan Amarions: People's Longue of the Valted Blates at

allarla Smergency Deleno. Commalter

SalllarDia Labar Bohool;, IDA, Il: Divisadero Streot.. BAR PrAnoa

Callfornia

Carpatha-Bussian: Propto's Bocloty

Central. Cousell of Amadona. Woman: al Tastina Dosacal, also

toona: as. Central Cousell Of: Amertcan Grantlan Worea, Na-

Contral I2p12000: Asscelation (Boltatu: Ohua Muponfia: Hal)

Chattal: Impanoca desolatton: ol Bautters: Californe.

Contarl: Objanitation: at ths Gorman Amarcan Nadonal: Alilanoe

(Deltabo Anorttealota, tintoltatront)

Carranter: Eratoral: Bociety

Chlns. Helf813 Amponl; Inc

Chopin Cultural Center

attens-Committee-for: BAtt, irlagas

atten Committea of the Uppen MoRt. Bide (Now Tork (lIy)

attem. Committes to Eras. Lad Bronder

Attena-Door anor. Datanss Conterenco

art: Ilberties Sponsortng Committes a Pltreburgh

Oril Bight Congros and lt aulated arganisations. Including:

Cral Blahts. Congress for 1800s

Vererans Afalnts. Discrimaton. of. Gril: Blghta Congress al

How Yort

Cirl Rights Congress. for. Texas (Dos Cirll Rights Congress)

Columbians

Comito Coordinador Pro: Bepublica Espanals

Comito Pro Derschos. Clulles

(8ea-Puarto BIoN Carito PTO Llbortados iriles)

Commitica-for a Damocratic PAT Basiera POlley

Committes for Constitutional and. Pallfleal. Froodam

Committoo.for: Natosslist Artton

Committos for Pesos and Brotherhood. Footival In Philadelphla

Committoo for tha Defenso al the Pittaburga. 8ix

committoa.ror:tha tha Negro.in tho Arte

Committos {0r tho-Frotoatlon.dl the Bill of Blghts

Committos for. World Monthifttendahip and Cultural Exchange

Committoo to Abollah Discriminatlon In Marjlana

(Boo. Congross Against. Diacrimiration; Maryland Coreross

Agalost Discamlation; Provietonal Committoo to Abollab

Discratnation In the Stato Of Maryland)

Committos. to Ald the Elghting: Bouts

Committon to Delend Marte Blchardaas

Committoo so Defend lie Biebts and Freedom of Pittsburgh's

Palltical Prisonera

Oommituss' to Upbold tha: Bl at Bleate

Commonwealth Collego: Mens, Arkansas

Commuales Partyi. U. B..A, 1t8 subaitialons, subeldiartes, and

amliatos

- 1 -

(4)

tara 659: 55-5-7-4346494

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Commurles Palltical Assoclallon, the subditions, auberdiarios.

and saltatos, includlag:

Mabama Poople's EdUcAllonal AesoCiaLiON

MOTIOS PTASE NAS EdUCALLONe LEAgUE

Oblabama Langue lar Palitical Iducation

propios Educational dad Prons Association Of Texas

Vuidnts League 107 toople's Iducation

Congrora Against Discriminalon

(B0a Committoo to AbOliAh DIsCIIMIDAtIOn lI MATyLAnd)

Congrors al American Bevoluttonary Writers

Dongross of Amerces Women

Contrass of the Uneraployod

Conneotteut Committos to slA Victlme of the Bmits Act

Connecileur Brats Youth Conferenco

Countll f0r Jobs, Ballet and Houring

OURSEll 107 PRA-AMETICAN DEDDOCIAGY

Cornell of Grock Americans

Croatian Benevolent Frateralty

Dal NIppOn BUTOKU BAl (MUllAY VIrTUe BOcloty Of JADAN OT SAll-

Tary Art Bocloty af Japan)

Dally Worker Press Club

Dantols Dafenso Committee

Danto Allgalert Boclety (bettreen 1035 and 1940)

Danst Delenso Committee

Dotrall louth Assembly

BRES BAJ PERCO COMMItTER

HAROTO PIOgICETTO LEAGUE

SmergenCy COnferenCs to Bare Bpanish Refugees (founding body

of tho Narth American Spanlah Ald Committee)

Everybod& Dommittoo to Outlaw War

Families of the Baltimore Bmalth Act Victless

pamilies of the Smith Act Victims

Poderation of Itallen War VEterAns ta the D. B. A, INC. (Associa.

soDa NRElOnelo Combattentl Itailanl, Moderalono degll Btall

Unit d'Amerles)

Finnish-American Mutual Ald Boclety

Florida Press and Educationel Lesgue (sos Commuslet Pollilos)

Association)

Froderick Douglass Iducstional Gentor

Froedom Stage, InC.

Istands al the Now Germany (Proundo dos Nolen Deutschlando)

Ertendo al the Borles Unlon

Garibaldl American irateran society

Goorgo Washington Carrer School, New York City

German-American Bund (Amertkadeutscher Volksbund)

German-American Republican lesgue

German-American Vocatlonal Lesgue (Deutacho-Ameritualacne

Berufagemelnschart)

Chuardian Club

Harlem Irade Dalon Counell

Hawall Civll Ilbertles Commalttoo

Helmushs Kel, aloo known as Nokubel Helell Olmushs Kal, Zelbel

Nbanjin, Hedyaku Olmushs Bal, and Zalbel Helmuahe Kal (Jap-

ADESO REsidIng Is America Mllitary CaDACTiptS AssOCiAtIOn)

Hellenic-American Brotherhood

Hinode Hal (Imperial JapAnese ReserVista)

EnOmArS HAL (RUADE BUn FlAB BOCIetY - A GrOUP O1 japArose

War

Vererans)

Hokubel Zaigo Bboke Dan (North American Reservo Ollcera Asso

clarion)

Hollywood Willers Mobilitation 1OT Delenso

HUDgArLAD-AmerICAn COLDCH fOT DemOCrACY

Hungarlan Brotherhood

Idabo Panton Unlas

Independent Party (Besttle, Washlagton)

(Bee Independent Peoplo's Party)

Independent Poople's Party

(800 Ladependant PArty)

madustrial Warkers of the Warld

Laterallonal labor Defenso

Interaalonal workers Order, lee rubasticlone, rubelderles

acollates

ead

JapaRese ARBOClAtIOn Ol America

japanose Overacas Central Boclety (Kalgal Dobo ObUO al)

Japanes Orereces ConTEntIon, TOtyo, Japan, 1940

JADAROSs PrOPOCHiTO AETACLALIOR (RoCrultinE Organisation)

jaratIon schoal ol Boclal sclenco, Now TOrk Olty

Jowles Culturo Boclety

jones pooplo s Committes

Jeriles Poople's Fraternal Order

JJoku Ilaial (IDe Caramitlos for the Crols)

Johnson-Parest ArOuD

(Bas Jabnsonitos)

Jabasonitos

(Bee Johnson-Forest Group)

S0118 Anti-Pasclot Befuges Committoo

301as Council of Progressire Itallan-Americane, Inc.

Joseph Wedemeyer Bchool of Boclal Belence, Bl. LoUlk, Mlesourt

Elbel BOlDEn RAI (ASSOCiALlOn Of U. 8. ClUlIAns Of SapAnese AD-

cotty who bate returnod to Americs after studylag In Japaa)

Enlights of tha Mallo Camellla

Ku klux than

Kyarouser, ass known as Kylheruser Loagus (Sheeuser

Bund), Kyubaouser Pallohlp (Kyihrouser Karstradachart)

Esthouser War Ballel (EUMbrouser KMegahllisterk)

LAbOr COULDeLl lOS MezTO Bighto

Labor Research Assoctation, Inc.

Labor louth League

Lesgue for Common Bense

Leaguo of American Wilters

Iletor Boclety (Itallan Black Bhirts)

Macodanian-American People's League

Marlo Morgantini Cirelo

MarlElme LAbOr COmmittee tO DePeNd Al LANDON

Maryland COngress Against Dlecrimination

(Bes Committee to Aboltsh Discrimination in Maryland)

Massachusatta Committoo for the BILl af Bighes

MASSAChUSeTtA MINUTO MOTEN lOT PERCO (DOs CONDeCIEd Mil the

Minuse Women of the U. B. A., InC.)

Michigan Clill Rights Federation

Michigan Council for Peace

Michigan School of Boclal Eclence

Nanka Telkoku Gunjudan (Impertal Mlitary Ftlends Group or

southern Calllorais

, War Vererang)

NALIONAl ASSOCIALIOD OI MEIICAN AMETICANS (ALSO KDOWA AS ASOCLA-

clan Neclonal Mexico- Americana)

MaSJODAl BlUA BURS MOthers OS America (DOt tO Do CODFused With

the Blue Star Mothers Of America Organized la Pebruary 1912)

Nallanal Commltros for Freedom of the press

Natlonal Committee fos tbe Defense Of Palltical Prlsonera

NatIOnal Committee to WID AMDeSTY fOS BMIth ACt VIetime

NaIloRal COmmItTes to Wis the PeACo

Natlonel Conferenco on American Palley la China and tha for tast

(e Conference called by the Committos fOr a DemOCTAlle PAS

Bastera Polloy)

Natlonal Council of Americans ol Croatlan Descont

Nailonal Council of American-Borlet Frendabip

National Federation for Constitutional liberties

National LAbOr COnfeTENCe fOr PERCO

NatIODal Negro Congress

Jarlonel Negro Labor Coune!

F8110na1158 Action Leagu

- 2 -

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## Page 3

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NALlODAlISI PATTY OI PUErLO RICO

Natura Prende of America («laco 1935)

Masto Labor, Victary Committeo

Non Commlitea lO Publicatons

NIChiDal $08J0 KAlaDe (The Orest FUll Thestre)

Marta Ameriora Committos to Ald SpanlaD Democracy

Marts American Spanish Ald Committos

Norts Palledalphls Farum

Nartbmast Japanosa Assoclatlan

Oblo school of Boclal Bclencos

Orlabans Committes lo Defend Pollical Prisoners

Oriabors Irague for Polltical EducatIon (sse Communlot PollEl-

cal Assoclation)

Origianl Bouthers Klare, Incorporatod

Pactic Narthwest Labor Bchool, Bestila, WAshinETOD

PalO AltO PeRco Club

Partido del Pueblo of Panams (operating in tbe Canal Z020)

Pesco Information Center

Posos Moremont al Ethlopls

propios Drama, inc

PROplE's EdUCAtlaDAl and PTEOS ASSOCIAtION Of TAILA (100 Comu-

plat Polltical Assoclation)

Propies Educatlonal Association (1aoorporatod under DAmo Los

Angelos Educational Association, InC.), aisa known as Poople's

Educational Center, Poople's Uniteraity, Foople's Bebool

Poople's Institute of Applied Religion

Pooples PrOgTams (Beattle, Washlagton)

Prople's Badio Foundstion, Inc.

Peopled Bights Party

Philadelphia Labor Committes for Negro Righis

Philadelphla school al Bocial Sclance and Art

PhOtO LARgUe (NoT York City)

Pittsburga Arts club

PolItIcal PtisonerE Malfaro Coramitteo

PalaRIa Boctaty of tDe IWO

PTOGTEASTTO GUTTAN-AMETICRDA, AlEO MIOTI dI PrOgreSSITO CheT-

man-Americans of Obicago

Prolerarian Party di Amarica

Protestant War Votarans al the Unitod Blates, lac.

ProlaloRal COmmIttEO al ClElIenE lor Pesce, Bouthrest Aron

ProTisIonal Committos an LAtin AmerICAn APAlTa

Provialonal Committes to Aboliah Discrimination in tha Btato al

Maryland

..

(8eo Committes lo Abolian Discrimination in Maryland)

Puerto Rican Comito PTO Llbertades Ciriles (CLO)

(Bes Comito Pro Derechos Cirlles)

Puertoriquenos UnIdos (Puerto Ricana Ualled)

Quad City Committeo for Pesco

Queenebridgo TaRAnte ICigue

ReTOlUtIOnATy Workers Inague

ROmAnIAR-AmerICAn PrAterRAl Bocloty

Busdas American Baclety, InC.

Batura Bal (Patrlotie Boclety, Or Cherry Assoclation - comporsd

0f TOtETaDA Ol BUsso-JapADese MAr)

Bamuel AdAms Bchool, Boston, Massachusetts

Bapca Barbara Pesce Parum

Bchappes Defense Committe

Echnolderman-Darty Defenes Commalttos

school of Jowian Bludler, New Tort Clty

Boatlle Labot School, Beattlo, Washlngton

BerDlan-AmerICAn FrATernal Bocloty

Berblan Vidordan Council

Ebinto Teraples (limitad to Btata Shinto abollabad la 1043)

Buter Ebirt Logtan al America

Ble tie Councl of Bourbera Calltoraia

Blovat Workers Boclety

BOTERÍAD-AmerICAn NALIORAl COUnCIl

Bociallot Workers Party, Including American Commlttoe for Euro

peas Workars Bellet

Boratu Kal (Fatherland Boclety)

Boutbera Negro Youth Congress

Bulto Sha (BesetTO Oficers ARsociatian, Los ARgoles)

Tom PalDa Schoal al Boclal Bclenos, Phlledelphia, Pannoritanis

Tom Palna School of Westchester, New York

Trade Uslas Committes for Perco

(800 Trade URloDlotA fOr PERCO)

Trado Ublanlato for Pesce

(Bee Trado Unlonlota foT Pes0s)

IM1-Btata Megro Trado Unlan Counci

Union of American Crostans

Unlan ol New York Veterane

United American Spanish Ald Committos

Unitod Committee al Jerloa Bocetles and Landomanachaft pod-

erations, alss tnowa ss Coordinatlon Committos al Jowles

Landsmanschaftes and Iraternal Organisations

United Committee al Bouth Blatte Amerloens

United Datenso Counell al Boutbero Callfamis

UnIrEd FArlem TORAntA and CONEUMATE OTFADIIaLIOD

United May Day Committes

United Negro and Allled Vetersos al Amerios

Veterans Agalast Discriminstion al Ciril Rights Congress al Now

Yark (800 (1rll Rights Congress)

Veterans of the Abraham Lincola Brigado

ViTEINLA IRAgUO lOI PROple'S EdUCAtiOn (8CS Communlet POlIEICRi

Association)

Folce 0f Froodom Committee

Walt Whitman School of Social Sclence, Newark, New Jerbey

Washington Bookshop Association

Masalagton Committeo for Democratic Action

Washington Committee to Defend tha Bull of Righta

Washington Commonwealth Pederation

Washington Pendos Daton

WlacoRala. ConferenCe OD Bocial Legislatlor

Workers Allianco (alace April 1938)

Iiddisher Fuitur Farbanc

Toung Communist League

Yugoslat-American Cooperslire Home, Inc.

Yugoelar Beamen's Club, Inc.

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nte....

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• DO NOT USE THIS SPACE

ISSUED BY •

THIS DATE (PIll ba)

PERSONAL HISTORY STATEMENT

September 6, 1961

INSTRUCTIONS

OFSER/UOS

1. Answer all questions completely or check appropriate box. If question is not applicable, write "NA".

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.

2. Type, print or write carefully; illegible or incomplete forms will not receive consideration.

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 1

GENERAL PERSONAL AND PHYSICAL DATA

1. FULL NAME (LaSt-First-Middle)

2. AGE

3. SEX

FLORES, Daniel

26

B. HEIOHT

S. WEIGHT

6. COLOR OF EYES

7. COLOR OF HAIR

i 8.

5° 8"

Brown

Black

XMALE

•APE COMPLEXION

Dark

FEMALE

9. TYPE BUILD

165 pds.

Medium

1Q. SCARS (Typo and Locallon)

Right cheek,

one-half inch soar;

left upper lip, one-

quarter

inch

scar; both received playing football

OTHER DISTINGUSHING PHYSICAL FEATURES

None

12. CURRENT ADDRESS (No., Street, City, Zone, State and Country)

(2828 Connecticut Avenue, N.

W.

#203

Washington 8, D. C.

13. PORTy AND PHONE NO, Strol, Cley, Zono, Stgro and

Country) AND PHONE NO.

2828 Connecticut Avenue,

N. W.)

#203 - Washington 8, D.C.

IA. CURRENT PHONE NO.

(265-8322) 06

15. OFFICE PHONE NO. & EXT.

None

16. LEGAL RESIDENCE (Stato, Territory or Colniry)

Washington, District of Columbia

17. NICKNAMES

18. OTHER NAMES YOU HAVE USED

Dan

None

19. INDICATE CIRCUMSTANCES (Includine Length of Time) UNDER WHICH YOU HAVE EVER USED THESE NAMES.

Personal acquaintances

twelve years

20. IF LEGAL CHANGE, GIVE PARTICULARS (Where and by What Aulhority).

NA

SECTION II

POSITION DATA

1. INDICATE THE TYPE OF WORK OR POSITION FOR WHICH YOU ARE APPLYING

1.15

Any phase of communications; administration; or personnel

work.

3. DATE AVAILABLE FOR EMPLOYMENT

ACCEPT (You will not do conaldorod for any

antrenco salary).

4.250.00

Immediately

•. INDICATE YOUR WILLINGNESS TO TRAVEL

OCCASIONALLY

AFrEQUeNTLY

CONSTANTLY

OTHER:

5. INDICATE YOUR WILLINGNESS TO ACCEPT ASSIGNMENT IN THE FOLLOWING LOCATIONS (Chock (X) each itam applicablo

X WASHINGTON. D.C.|

CERTAIN LOCATIONS ONLY (Specily):

ANYWHERE IN U.S.

XOUTSIDE CONTINENTAL U.S.

6. INDICATE WHAT RESERVATIONS YOU WOWLD PLACE ON ASSIGNMENTS OUTSIDE THE WASHINGTON, D.C. AREA.

I would be willing to travel within the United States provided

said travel would not involve a permanent move whereby my legal

residence would be changed. However, It 1s my wish to live overseas

on a permanent basis.

FORM 444 USE PREVIOUS EDITION.

11-88

3/00

OY COONEY"

491

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## Page 5

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SECTION 1II

CITIZENSHIP

1. DATE OF-BIRTH

12. PLACE OF BIRTH (Cily, Sloto, COuRITy)

August 4) 1935 10 (San Marcos, Texas

A. CITIZENSHIP ACQUIRED DY

S. OLES MATURAL.

X BIRTH

MARRIAGE

OTHER (Specity):

7. COURT ISSUING NATURALIZATION CERTIFICATE

NA

9. HAVE YOU HELD PREVIOUS NATIONALITY

10. IF YES, GIVE NAME OF COUNTRY

YES

11, GIVE PARTICULARS CONCERNING PREVIOUS NATIONALITY.

NA

•

3. PRESENT CITIZENSHIP (CounIry)

United States of America

6. NATURALIZATION CERTIFICATE NO.

YES 13. GIVE PARTICULARS

12. HAVE YOU TAKEN STEPS TO CHANGE

PRESENT CITIZENSHIF

14. IF YOU HAVE APPLIED FOR U.S. CITIZENSHIP,

WHAT IS PRESENT STATUS OF YOUR APPLICATION (Firal Papero, Etc.)?

NA

15. DATE OF ARRIVAL IN U.S.

NA

16. PORT OF ENTRY

NA

18. LAST U.S. VISA (No., Typo, Placo of lasue)

NA

17. ON PASSPORT OF WHAT COUNTRY

NA

19. DATE VISA ISSUED

NA

SECTION IV

LESS THAN HIGH SCHOOL GRADUATE

HIGH SCHOOL GRADUATE

TRADE, BUSINESS, OR COMMERCIAL SCHOOL

GRADUATE

TWO YEARS COLLEGE OR LESS

1. NAME OF ELEMENTARY SCHOOL-

(San

Marcos) Elementary School

3. DATES ATTENDED (Fram-and-To)

Sept. e 1942 - Maye 1951

EDUCATION

1. CHECK (X) HIGHEST LEVEL OF EDUCATION ATTAINED

OVER THO YEARS OF COLLEGE - NO DEGREE

BACHELOR'S DEGREE

GRADUATE STUDY LEADING TO HIGHER DEGREE

MASTER'S DEGREE

DOCTOR'S DEGREE

2. ELEMENTARY SCHOOL

2. ADDRESS (Cly Stato, Country)

San Marcos, Texas, USed.

A. GRADUATE

1. NAME OF

SCHOOL

San Marcos High School

8. DATES ATTENDED (FroMandIO)

Sept.,

1951 - May. 1955

1. NAME OF HIGH SCHOOL

NA

3. DATES ATTENDED (FrOn-and TO)

X YES

NO

3. HIGH SCHOOL

2. ADDRESS (City, Seato, Counity)

San Marcos,) Texas, U.S.Ai

A. GRADUATE

2. ADDRESS (City, Stato, Country)

A. GRADUATE

NAME AND LOCATION OF COLLEGE OR UNIVERSITY

YES

4. COLLEGE OR UNIVERSITY STUDY

SUBJECT

DATES ATTENDED

MAJOR MINOR

FROM

TO

I NO

RECE

EM/QT

(Spocily)

SECTION IV CONTINUED TO PAGE 3

50

61.0

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## Page 6

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..

SECTION IN CONTINUED FROM PAGE 2

S. IF A REAPESTS DE BEEFAS BESE NBEERS CONFEN WHICH REQUIRED SUBMISSION OF A WRITTEN THESIS, INDICATE THE TiTLE

NA

6. TRADE, COMMERCIAL AND SPECIALIZED SCHOOLS

MAME AND ADDRESS OF SCHOOL

STUDY OR SPECIALIZATION

FROM

TO

MONTHS

NA

7. MILITARY TRAINING (FULL TIME DUTY IN SPECIALIZED SCHOOLS SUCH AS ORDNANCE, INTELLIGENCE, COMMUNICATIONS, ETC.)

NAME AND ADDRESS OF SCHOOL

STUDY OR SPECIALIZATION

MONTHS

Marine Security Guard

Schaal - Henderson Hall

Hq. Marine Corps,

Saturday Co day Security Guara

Washington 25, D.9.

Training

9/28/58

10/31/58

(5-Wkos)

B. OTHER EDUCATIONAL TRAINING NOT INDICATED ABOVE.

Weapons Training In Marine Corps.

Acted as partisan during cold weather training at Bridgeport,

California (Pickle Meadows - USMC) •

SECTION V

FOREIGN LANGUAGE ABILITIES

1. LANGUAGE

COMPETENCE - IN ORDER LISTED

R-Road,

W-Writo,

S-Spook

(Liat bolow oach language in

which you poosons any degree

of competenco.

Indicato your -

proficiency to Read, Write or

Speak by placing a check (X)

in lho appropelato box(os).

EQUIV-

FLUENT

ALENT

BUT

TO

OBVIOUSLY

NATIVE

FOREIGN

FLUENCY

R

ADEQUATE

FOR

RESEARCH

ADEQUATE

FOR

TRAVEL

HOW ACQUIRED

LIMITED

KNOW

LEDGE

NATIVE

PRO-

LONGED

CONTACTASADEMIG

(with

COUNTRY

RES

parents,

IDENCI

fall

etc.)

levols)

RIws

Spanish

2. IF YOU HAVE CHECKED "'ACADEMIC STUDY" UNDER

"HOW ACQUIRED", INDICATE LENGTH AND INTENSIVENESS OF STUDY.

NA

FLUENCY

3. HE XON HOUR CODPETENCE THEREIN

FOR A LANGUAGE HAVING SIGNIFICANT DIFFERENCES IN SPOKEN AND WRITTEN FORM, EX

PIFIC, ENGINEERING.

AG TELECOMMUNICATIONS.

OTHER SPEC LOCAB LARDES AND TERMINOLOGY IN THE SCIEN-

Could act as literal interpreter at almost any level.

3. YoU OU MAYE OTERCAEDORICIENCY IN LANGUAGE, WOULD YOU BE WILLING TO USE THIS ABILITY IN ANY POSITION FOR WHICH

DALYES

ENO

.3.51

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## Page 7

14-00000

SECTION VI

GEOGRAPMIC AREA KNOWLEDGE AND FOREIGN TRAVEL

ASSIGNMENT.

ADICATE TUSH OF KWOWE EDAY SUCH AST EARER, "MORDERS LASE RESU FADE

ROADS, INDUSTRIES.

POLITICAL

PARTIES,

REGION dE COUNTRY

Bolivia

Per

DATES OF

SPECIALiZED KNOwLEDGE

RESIDENCE

OR TRAVEL

11/13/58 to

General knowledge

1314760 t

General knowledge

671/20/60

PLACE ES STUDY

KNOWLEDGE ACQUIRED BY

DENCE TRAVEL sTUDY AggaK

MENT

Chile

Argentina

6/30 /59

to

•

Marine Security Guard - American Embassy - Bolivia and Peru

Vacation - Chile; Argentina; Uruguay; Panama

3. UNITED STATES PASSPORT NUMBER AND EXPIRATION DATE, IF ISSUED.

No. (17485008

(SP-85575) Passport has been cancelled.

SECTION VII

TYPING AND STENOGRAPHIC SKILLS

2. SHORTHAND (upm

3. SHORTHAND SYSTEM USED - CHECK IXI APPROPRIATE ITEM

Thermofax, mimeograph, switchboard

SECTION VII!

SPECIAL QUALIFICATIONS

" IEACH! MOBBIES AND SPORTS IN WHICH YOU ARE ACTIVE OR MAVE ACTIVELY PARTICIPATED. INDICATE YOUR PROFICIENCY

Foot ball

-

good

Basketball

- fair

Swimming

•= •good

Reading

- average

Contract. Bridge - very good

INDICATE

PARTICULAR POSITION OR TAPE CATIONS.

RESULTING FROM EXPERIENCE OR TRAINING WHICH MIGHT FIT YOU FOR A

None to my knowledge

None

SECTION, VIII CONTINUED TO PAGE 5

52

---

## Page 8

14-00000

SECTION VIll CONTINUED FROM PAGE 4

•ALE YOU CION ABAY PER FUE PEREAL CAMPER EARSIER EACH CANE GRADE OR PROFESION, SUCH AS PILOT,

DYES

DINO

S Neer, HANE ANSWERED "YES" TO ABOVE, INDICATE KIND OF LICENSE AND STATE ISSUING LICENSE (Provido L ICOnDo ROBiONy

NA

8. FIRST LICENSE OR CERTIFICATE (Yoar of lague)

NA

7. LATEST LICENSE OR CERTIFICATE (Year of losue)

None

8. INDICATE ANY DEVICES WHICH YOU HAVE INVENTED AND STATE WHETHER OR NOT THEY ARE PATENTED.

None

10. LIST PUBLIC SPEAKING AND PUBLIC RELATIONS EXPERIENCE.

Have spoken in my father's church and other churches approximately

150 times. Met and assisted public in Embassies during my tour of

duty with the Marine Security Guard.

11. LIST ANY PROFESSIONAL.

ACADEMIC OR HONORARY ASSOCIATIONS OR SOCIETIES IN WHICH YOU ARE NOW OR WERE FORMERLY

• MEMBER. LIST ACADEMIC HONORS YOU HAVE RECEIVED.

None

SECTION IX

EMPLOYMENT HISTORY

nemployment, List all civilian employment by a foreign Govemment, regardless of dates.

cription of Duties® consider your experience carefully and previde meanine ful, objecties statemepleting item

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)

TOm -241 t0 112

(E11lburn's|Drug Store

• ADDRESS (No., Streos, City, Stato, Countr)

1º (San Marcoss Texas

4. KIND OF BUSINESS

Drug Ston

3. TITLE OF JOI

Fountain attendant

3. NAME OF SUPERVISOR

Mr. WIlliam (Hullburn)

7. SALARY OR EARNINGS

8. CLASS. GRADE(I1 Federal Service)

3700.00 PER month

8. DESCRIPTION OF DUTIES

Employee at soda counter

10. REASONS FOR LEAVING

To participate in school events (football).

SECTION IX CONTINUED TO PAGE 6

-5 -

53

3/00

.

---

## Page 9

14-00000

2

SECTION IX CONTINUED FROM PAGE 5

1. INCLUSIVE DATES (From and To - By Mo. and Pr.)

2. NAME OF EMPLOYING FIRM OR AGENCY

July 1954-June 1955

Diamond) Grocery Store

3. ADDRESS (No., Stroot, Clly, Stero, Country)

(South Guadalupe St. San Marcos, Texas

4. KIND OF BUSINESS

5. NAME OF SUPERVISOR

Grocery Store

Mr. (Ignacio Gonzales) 06

6. TITLE OF JOB

7. SALARY OR EARNINGS

8. CLASS. GRADE (11 Fodoral Servico)

Butcher

330.00

TPeR Week

9. DESCRIPTION OF DUTIES

Slaughtering and preparing meat for sale as well as

actual

selling.

10. REASONS FOR LEAVING

To attend college

1. INCLUSIVE DATES (From and To -By Mo. and Yr.)

Maye

1955 - September, 1956

3. ADDRESS(No., Street, City, Stato, Country)

San Marcos! Texas

. KIND OF BUSINESS

Private School

6. TITLE OF JOB

Painter's Assistant

9. DESCRIPTION OF DUTIES

Painted dormitories in the Academy

2. NAME OF EMPLOYING FIRM OR AGENCY

(San Marcos) Baptist Academy

5. NAME OF SUPERVISOR

7. SALARY OR EARNINGS

$ 35.00 PER WeeK

10. REASONS FOR LEAVING

To attend school

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)

September, 1956 - July, 1957

2. NAME OF EMPLOYING FIRM OR AGENCY

Economy Department Stores

3. ADDRESS (ND., Stroes, City, Stato, Country)

San Marcos Texas

KIND OF BUSINESS

Clothing Store

B. TITLE QF JOB

Sales Clerk

9. DESCRIPTION OF DUTIES

3. NAME QF SUPERVISOR

Mr. Max Mendlovitz

7. SALARY OR EARNINGS

D. CLASS. GRADE (1l Fedoral Servico)

• 30.00 IPER week

Assisted customers in selecting and buying goods.

10. REASONS FOR LEAVING

To join the Marine Corps.

1. INCLUSIVE DATES (From and To -By Mo. and Yr.)

1957 - JULy 2ze 1901

2. NAME OF EMPLOYING FIRM OR AGENCY

United States Marine Corps

country

Marine Corps Schools, Quantico, Virginia

4. KIND OF BUSINESS

S. NAME OF SUPERVISOR

M111 tary

Col. John Magruder

B. TITLE OF JOB

T. SALARY OR EARNINGS

18. CLASS. GRADE (11 Fodoral Sorrico)

Marine Corps Museum Attendant

$ 180.00 PER month

Cp1. (E-4)

SECTION IX CONTINUED TO PAGE 7

34

00/11

---

## Page 10

14-00000

6

7

SECTION IX CONTINUED FROM PAGE 6

9. DESCRIPTION OF DUTIES

Acted as guide to all visitors entering Museum, explaining

Marine Corps history, etc.

Also on several occasions acted as

Interpreter for visiting military personnel from Latin America.

10. REASONS FOR LEAVING

Dis charged

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)

2. NAME OF EMPLOYING FIRM OR AGENCY

July 28,

1961 - August 30, 196]

00 Ohio Valley) Engineering Company

9. ADDRESS (No., Stroot, City, Stato, Country)

S.

Capitol and I Streets,

S. W.),

Washington,

D. C.

7. KIND OF BUSINESS

5. NAME OF SUPERVISOR

08

Construction

6. TITLE OF JOB

Mr • L. G. Bruce) 06

7. SALARY OR EARNING!

18. CLASS. GRADE All Foderal

Service)

Laborer

$ 2.17

PER hour

9. DESCRIPTION OF DUTIES

Handynan for Company

-

10. REASONS FOR LEAVING

Temporary work while seeking permanent employment.

T. INCLUSIVE DATES (From and To - By Mo. and Yr.)

2. NAME OF EMPLOYING FIRM OR AGENCY

3 ADDRESS (No., Stroot, City, State, Country)

A. KIND OF BUSINESS

15. NAME OF SUPERVISOR

B. TITLE OF JOB

7. SALARY OR EARNINGS

IPER .

B. CLASS. GRADE (It Fodoral

Servico)

9. DESCRIPTION OF DUTIES

10. REASONS FOR LEAVING

• HUMBOR FRYCE CREDITA LEO FON, SO YEREN SERVICE RETRYMEP. SA KNOWE.

D. HAVE YOU EVER BEEN UISCHARGED OR ASKED TO RESIGN FROM ANY POSITION.

*YES

HAVE YOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH YOU DESIRE TO EXPLAIN? EYES

IF YOUR ANSWER TO EITHER OR BOTH QUESTIONS IS "YES", GIVE DETAILS

Honorably discharged from United States Marine Corps.

7 1/2 years

ONO

LINO

-

-

3/F2

-1.

55

---

## Page 11

14-00000

SECTION X°

1. ARE YOU REGISTERED FOR

THE DRAFT UNDER

THE UNIVERSAL

MILITARY TRAINING AND

SERVICE ACT OF 1948 (As amended)

4. IF DEFERRED, GIVE REASON

NA

CHECK (X) AS

APPROPRIATE

ARMY

NAVY

MILITARY SERVICE

1. CURRENT DRAFT STATUS

YES

2. SELECTIVE SERVICE CLASSIFI

3. SELECTIVE SERVICE NO.

IV-A

41-65-35-187

об

5, LOCAL DRAFT BOARD NO. OR DESTÉNATION AND ADDRESS

#65 - 101 1/2 E. San Antonio St.,J08

2. MILITARY SERVICE RECORD 10 Lockhart,) Texas

I. CURRENT AND/OR PAST ORGANIZATIONAL MENBERSHIP

MARINE

CORPS

AIR

FORCE

COAST

GUARD

MERCHANT NATIONAL AIR NAT'L

MARINE

GUARD

GUARD

FOREIGN ORGAN. OR MIL.

SERVICE (Spocity):

HAVE SERVED

NOW SERVING o

None

2. BRANCH OR CORPS OF ABOVE CHECKED ORGANIZATION(S)

Personnel Administration

3. DATE SEPARATED FROM EXTENDED ACTIVE DUTY (PASt BerVico)

4. FORCES PNGTH OF EET EMPEROS

ACTIVE DUTY IN U.S. ARMED

25 JulJe 1961

4

5. DATE ENTERED

PAST SERVICE

CURRENT SERVICE

ACTIVE DUTY -

6. TOTAL LENGTH OF ACTIVE DUTY IN FOREIGN MILITARY OR

GANIZATION

26 July, 195%

7. RANK, GRADE OR

RATE

PAST SERVICE

CURRENT SERVICE

Cp1. (E-4)

• CRIMARY MILITARY OCCUPATIONAL

PECIALTY (Mos ot Designator AND TIT

8. SERVICE SERIAL OR FILE NUMBER (11 now aorvine, provido cur

CURRENT SERVICE

I PAST SERVICE

0141 - Chief Clerk

10. SECONDARY

MIL.

OCCUPATIONAL

PAST SERVICE

SPECIALTY (Mos or Designatos) AND

CURRENT SERVICE

TITLE

None

11. BRIEF DESCRIPTION OF MILITARY DUTIES (indicato whether epplicable to paot or current servico)

Past Service:

Clerk - Maintained personnel service records.

2 years as Security Guard in the American Embassies in

La Paz, Bolivia and Lima, Peru.

12. CHECK (X) TYPE OF SEPARATION FROM ACTIVE DUTY

HONORABLE DISCHARGE

RELEASE TO INACTIVE DUTY

RETIREMENT FOR AGE

RETIREMENT FOR SERVICE

UNDUE HARDSHIPS

RETIREMENT FOR COMBAT DISABILITY

OTHER:

RETIREMENT FOR PHYSICAL DISABILITY

13. CHECK (X) COMPONENT IN WHICH YOU SERVED

REGULAR

RESERVE (Including tho National and Air National Guard)

OTHER (Including AUS)

3. MILITARY RESERVE, NATIONAL GUARD AND ROTC STATUS

1. DO YOU

NOW

HAVE

RESERVE

YES

STATUST

& NAT'L. URD. "OR AIR NAF.OFTHE

NAT'L. GRD. OR

YES

_3. ARE YOU NOW A MEMBER OF

YES

I NO

1. IF YOU HAVE ANSWERED -YES" TO ITEMS 1, 3 OR 3 ABOVE, CHECK COMPOMENT MEMBERSHIP BELON

ARMY

MARINE CORPS

NATIONALGUARd

COASTGUARD!

NAVY ROTC

INDICATE ROTC CATEGORY NUM

NAVY

AIR FORCE

AIR NAT'L.GUARD

ARMY ROTC

AIR FORCE ROTC BER

5. CURRENT RANK, GRADE OR

6. DATE OF APPOINTMENT IN CURRENT

RATE CDI. (E-4)

RANK MaTe

1959

7. FXRIRATION DATE OF CURRENT RESERVE OBLIGA-

January 20, 1962

8. CHECK (X) CURRENT RESERVE CATEGORY

READY RESERVE

STANDEY (ACeIvOs X /STANDBY (Imactive)

9. PRIMARY MILITARY OCCUPATIONAL SPECIALTY (MOS Or DOBIE-

nator) AND TITLE

10, SECONDARY MILITARY OCCUPATIONAL SPECIALTY (MON OS DOO-

0141

None

11. BRIEF DESCRIPTION OF MILITARY RESERVE DUTIES

None

1Z. ARE YOU CURRENTLY ASSIGNED OR ATTACHEC

TO A RESERVE, NAT'L.

GUARD OR ROTE TRAIN

ING UNIT

18. MANF, YOU A MILITARY MOBILIZATION ASSIGN-

13. ANTOURAGE ANSWERED "YES" TO ITEM 12, GIVE UNIT OR AGENCY

ADDRESS

16. INDICATE. TOTAL MILITARY SERVICE

YEARS

•FOR

LONGEVITY PURPOSES INCLUD

ING ACTIVE

AND INACTIVE DUTY

X

NO

YES

X

NO

MONTHS

7

13. IF YOU

AND ADDRESS

HAVE ANSWERED "YES" TO ITEM 1A, GIVE UNIT OR AGENCY

17. WHERE ARE YOUR SERVICE RECORDS KEPTI

Headquarters Marine Corpse 25, D.C.

washington

3/100

---

## Page 12

14-00000

•

SECTION XI

- FINANCIAL STATUS

1-ARE YOU ENTIRELY DEPENDENT ON YOUR SALARY?

DrES

2. IF YOUR ÄNSWER IS "NO" TO THE ABOVE, STATE SOURCES OF OT MER INCOME

Wife's Income

ENO

NAME OF INSTITUTION

The Bank of California, N.A.

Union Trust Company

3. BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS

ADDRESS (City, Slate, Country)

330 S.W. 6th Avenue,

Portland, Oregon

15 and H Streets,

N.W.,

Washington, D.C.

4. HAVE YOU EVER BEEN IN, OR PETITIONED FOR, BANKRUPTCY

D YES

IX NO

5. IF YOUR ANSWER IS "YES" TO THE ABOVE, GIVE PARTICULARS, INCLUDING COURT AND DATE(S)

NAME

General Motors Acceptance Corp.

Gulf 011 Corporation

Ninde Furniture Company

6. GIVE THREE CREDIT REFERENCES IN THE UNITED STATES

• ADDRESS (No., Strool, City, State)

1310 S.W. Yanhill Street,

Portland 5, Oregon

P.О. Box 7245,

Atlanta %, Georgia

917 Caroline Steet,

FredericksburgYirginia

8. IF YOUR ANSWER IS "YES" TO THE ABOVE QUESTION, GIVE COMPLETE DETAILS

I YES

NON-U.S.

CORPORATIONS OR BUSINESSES: OR IN

CORPORATIONS OR BUSINESSES HAVING SUBSTANTIAL FOREIGN INTERESTS

(Il onower "YES", tumish detaila on separato ahcar.)

7I NO

SECTION XII

MARITAL STATUS

1. PRESENT STATUS (Single, Married, Widowod, Soperatod, Divorced, or Annullod) SPECIFY: Married

2. STATE DATE, PLACE, AND REASON FOR ALL SEPARATIONS, DIVORCES OR ANNULMENTS

NA

WIFE, HUSBAND If you have been married more than once - including annulments - use a separate sheet for former wife or

husband giving data required below for all previous marriages. If marriage contemplated, fill in appropriate

3. NAME

(Maiden)

_(Last) •

Dorothy

Anne

06 Arnett?

Flores

4, STATE ANT OTHER NAMES EVER USED

06

INDICATE CIRCUMSTANCES (Including length of limo) UNDER WHICH ANY

OF THESE NAMES WERE USED.

IF LEGAL CHANGE GIVE PARTICULARS

(Dorothy A.

Moran

(Where and by whas suthorily). USE EXTRA SPACE PROVIDED ON PAGE 16

OF THIS FORM TO RECORD THIS INFORMATION.

3. DATE OF MARRIAGE.

PLACE OF MARRIAGE (City, State, Country)

November 14, 19601

Lima, Peru J 10

7. HIS (OR HER) ADDRESS BEFORE MARRIAGE (NO., Sireel, City, State, Country)

American Embassy,

La Paz, Bolivia) 10

8. LIVING

9, DATE OF DEATH

10. CAUSE OF DEATH

- .

X I

NO

11. CURRENT ADDRESS (Give last addrons, ll doceadod)

(2828 Connecticut

Ave., N.W.,

Washington rD.C.

12. DATE OF BIRTH

19. PLACE OF BIRTH (Cily, Stare, Country)

January 31, 1935

Portland, Oregon

SECTION XII CONTINUED TO PAGE 10

•9.57

United States of

---

## Page 13

14-00000

-10.

SECTION XII CONTINUED FROM PAGE 9

15. PLACE OF ENTRY

14. IF BORN OUTSIDE U.S. - DATE OF ENTRY

NA

16. FORMER CITIZENSHIP(S) [COUntries)

NA

19. OCCUPATION

Legal Secretary:

17. RETURE, CITIZENSHIP 18. WHERE ACQUIRED (Gly, Stato, Country)

PRESENT

EMPLOYER (Also give former employer, os il epouse deceased o

momployed give last two employers.

Boykin and De Francis)+308

Former:

Department of State

21. EMPLOYER'S OR BUSINESS ADDRESS (No., Streol, City, stato, Country)

1000 16th Ste, N.W.l

Suite 603

Washington 6, D.C.

22. DATES OF MILITARY SERVICE (From and 1o - 3y Mo, and Yr.)

None

23. BRANCH OF SERVICE

24. COUNTRY WITH WHICH MILITARY SERVICE AFFILIATED

25. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN Foreign Service - Jan., 1958 - Oct.,

1960; CIv1l Service - April 1961 - June 1961

SECTION XIII

CHILDREN AND OTHER DEPENDENTS

1. PROVIDE THE FOLLOWING INFORMATION FOR ALL CHILDREN AND DEPENDENTS

NAME

RELATIONSHIP

DATE AND PLACE OF BIRTH

CITIZENSHIP

ADDRESS

None

2. NUMBER OF

UNMARRIED.

AND NOT SELF-SUPPORTING.

CHILDREN

SELF-SUPPORTING.

SECTION XIV

1. FULL NAME (L001-Firol-Middlo)

(Jose Sa Flores

3. STATE OTHER NAMES ME MAS USED

FATHER (Give same infornation, for Stepfather and/or Guardian on a separate sheet)

2. LIVING

3. DATE OF DEATH

TA. CAUSE OF DEATH

X. YES? NO

INDICATE CIRCUMSTANCES (including length of lino) UNDER WHICH HE HAS

EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Inoro

and by what authority).

USE EXTRA SPACE PROVIDED ON PAGE 18 OF THIS

None

FORM TO RECORD THIS INFORMATION.

B. CURRENT ADDRESS - Give laal addrese,

Il doceaood (NO., Sirool, City, State, Country)

201 S.

Guadalupe Streete San Marcos

Texas

DATE OF BIRTH

PLACE OF BIRTH (CiTy, Stato, Country)

D. CITIZENSHIP

December 20.

1898

Mier y Noriega,

1D. IF BORN OUTSIDE U.S. - DATE OF ENTRY

May 24, 1918

12. FORMER CITIZENSHIP(S)

Mexican

Unknown

19., DATE U.S. CITIZENSHIP

114. WHERE ACQUIRED (Cley, Stato, Country)

1957

Texas

PRESENT EMPLOYER (GIvo laot omployor, 1l Fathos la doconsod os nemployo

Baptist Minister

Mexican Baptist Church

T. EMPLOYER'S BUSINESS ADDRESS OR FATHER'S BUSINESS ADDRESS IF SELF-EMPLOYEE

501 S. Guadalupe

San Marcos

June Street SENATO SERVICE

Texas

20, COUNTRY

'to"

never

58

---

## Page 14

14-00000

SECTION XV

1. FULL NAME (LaRt-FireI-Middlo)

Flores, Agustina ) 06

S. STATE OTHER NAMES SHE HAS USED

MOTHER (vive same information

for Stepmother on separate sheet)

2.

VING

3. DATE OF DEATH

A. CAUSE OF DEATH

1 yEs

VX NO

June 1939

Unknown

IND CATE CIRCUMSTANCES (includine longth of tino) UNDER WHICH SHE HAS

EVER USED THESE NAMES, IF LEGAL CHANGE, GIVE PARTICULARS (Where

and by what au

hOrItY). USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS

None to my

knowledge

FORMITO RECORO THIS INFORMATION.

B. CURRENT ADDRESS - GIVE LAST ADDRESS, IF DEÇEASED (NO., Strool, Chr Stato, Country)

S. Austin and Lee Streetse

OoSan MarcoS+

Texas

7. DATE OF BIRTH

8. PLACE OF BIRTH (City, Stato, Country)

September 20, 1903 Mier y Noriega, Nuevo Leon, Mexico

ENSATA

Mexican

10. IF BORN OUTSIDE U.S.- DATE OF ENTRY

11. PLACE OF ENTRY

Unknown

Unknown

12.

FORMER CITIZENSHIP(S)

(Contry(los)

DATE U.S. CITIZENSHIP

14. WHERE ACQUIRED (City, Stato, Correz)

NA

ACQUIRED NA

NA

15. OCCUPATION

16. PRESENT EMPLOYER (Givo lael employor, il Mother la docensod or unemployod)

Housewife

NA

17. EMPLOYER'S BUSINESS ADDRESS OR MOTHER'S BUSINESS ADDRESS IF SELF EMPLOYED

NA

18, DATES OF MILITARY SERVICE (From-end-TO)

19. BRANCH OF SERVICE

NA

20. COUNTRY

NA

21. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN

NA

SECTION XVI

1. FULL NAME (Last- Firal-Middlo)

Patlan, Frances Jou

BROTHERS AND SISTERS (Including Half-, Step- and Adopted Brothers and Sisters)

2. RELATIONSHIP

Sister

.

(631 S. River St.,

1. FULL NAME (Last FirosMiddlo)

Renteria, Rachel)06

2. RELATIONSHIP

Sister

A, CURRENT ADDRESS (No., Streal, Clty, Zono, Stato, Conntry)

1311 Lambert stor

0 San Antonio) Texas

1. FULL NAME (Laot-Firef-Middlo)

2. RELATIONSHIP

3

Black, Rebecca Mary) >6

Sister

4. CURRENT ADDRESS (NO., Straos, City, Zono, Stato, Country)

501 S.

Guadalupe St.,

oo San Marcos, Texas

1. FULL NAME (Last-Fiat Middle)

2. RELATIONSHIP

Flores,

(Samue]) 06

.

Brother

1. FULL NAME (LAB(-Firat-Middlo)

FOreS

(J00J06

2. RELATIONSHIP

•Brother

4. CURRENT ADDRESS(a., Strood, City, Zono, Sipto, Country)

Route 2e Box 320

San Marcos, Texas

r. FULL NAME (Las-Firal-Middlo)

2. RELATIONSHIP

Brucer

O Esther'

Sister

A. CURRENT ADDRESS (IVo, Seraol, Cly, Zono, Stalo, Country)

7252 mOre

. St

Springfiela Virginia

FULL NAME (Lao Frat-Middle)

2. RELATIONSHIP

Flores, Eleazar)06

Brother

A. CURRENT ADDRESS (NO., Sirool, City, Zono, Sialo, Colniry)

Dec eased

1. FULL NAME (LaotEtrolliddlo)

Flores, Juan 06

2. RELATIONSHIP

Brother

* A. CURRENT ADDRESS (No., Streol, City, Zono, Stato, Coumery)

De Coased

3. CITIZENSHIP (COUnTy)

U.S. of America

3. LIVING

B. AGE

X YES NO

41

3. CITIZENSHIP (Country)

U.S. of America

B. LIVING

6. AGE

X YEs |

INO

39

3. CITIZENSHIP (Country)

U.S. of America

5. LIVING

16. AGE

X YES NO

34

3. CITIZENSHIP (Country)

U.S. of America

5. LIVING

6. AGE

X YES NO

32

3. CITIZENSHIP (ColmIry)

U.S. of America

S. LIVING

6. AGE

X/YES NO

29

3. CITIZENSHIP (Country)

U.S. of America

3. LIVING

16. AGE

X YES I

NO

27

J. CITIZENSHIP (Country)

U.S. of America

S. LIVING

6. AGE

YES X NO

7

3. CITIZENSHIP (Corniry)

U.S. of America

3. LIVING

B. AGE

IYES TXI NO

NA

•11.59

16/pF

•

---

## Page 15

14-00000

SECTION XV!!

FULL NAME (LaSt-Firer-Middlo)

Arnett, Carl Raymond 06

5.

STATE OTHER NAMES HE HAS USED

FATHER-IN-LAW

2.

LIVING

3. DATE OF DEATH

4. CAUSE OF DEATH

X YES

I NO

INDICATE CIRCUMSTANCES (Including length of sime) UNDER WHICH HE HAS

EVER USED THESE NAMES.

IF LEGAL CHANGE, GIVE PARTICULARS (Where

and by what authority).

USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS

FORM TO RECORD THIS INFORMATION.

CURRENT OR LAST ADDRESS (No., Streel, City, Stale, Country)

4505 washington Ste, Mlwauklo, 2,Eregon

DATE OF BIRTH

8. PLACE OF BIRTH (Cily, Stato, Country)

January 2,

Minot, North Dakota

9. CITIZENSHIP

U.S. of smerica

110. IF BORN OUTSIDE U.S. - DATE OF ENTRY

11. PLACE OF ENTRY

NA

NA

12. FORMER CITIZENSHIP(S) (CountryTies)

13. DATE U.S. CITIZENSHIP

14. WHERE ACQUIRED (City, Stato, Country)

ACQUIRED

NA

13.1

OCCUPATION

Warehouse Foreman

I SECTION XVI!!

1. FULL NAME (Lool-Piral-Middle)

Tompkins,

Alma Dean 06

Г3. STATE OTHER NAMES SHE HAS USED

16. PRESENT EMPLOYER (Give loal employer, il Father-in-Law is doceasad or unemployod)

(Rudy Wilhelm Inc,

Portland, Oregon

MOTHER-IN-LAW

LIVING

3. DATE OF DEATH

A. CAUSE OF DEATH

YES

NO

INDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH SHE HAS

EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Whore

and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 18 OF THIS

(Alma Dean Arnett)

FORM TO RECORD THIS INFORMATION.

CURRENT OR LAST ADDRESS (No., Streot, City, Stato, Country)

23920 S.E. Portland Vlew Place, Portland 36, Oregon

DATE OF BIRTH

8. PLACE OF BIRTH (City, Stato, Country)

May 4e 1910

Portland, Oregon

D. CITIZENSHIP

U,S. of America

10. IF BORN OUTSIDE U.S. - DATE OF ENTRY

PLACE OF ENT

12. FORMER CITIZENSHIP(S) (Country(les))

19. DATE U.S. CITIZENSHIP

14, WHERE ACQUIRED (City, Stalo, Country)

ACQUIRED

NA

PRESENT EMPLOYER (Give last employer, Il Motherin-Law le deceased or unemployod)

15. OCCUPATION

Homemaker.

SECTION XIX

FULL NAME (LAst-First-Middle)

RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (I) LIVE ABROAD.

(2) ARE NOT U.S. CITIZENS OR (3) WORK FOR A FOREIGN GOVERNMENT

T2. RELATIONSHIP

None to my knowledge

4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES

5. EMPLOYED BY

3. AGE

6. CITIZENSHIP (COUMPTy)

7. FREQUENCY OF CONTACT

TB. DATE OF LAST CONTACT

1. FULL NAME (LaSt-First-Middle)

2. RELATIONSHIP

3. AGE

4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES

5. EMPLOYED BY

3

6. CITIZENSHIP (Country)

7. FREQUENCY OF CONTACT

8. DATE OF LAST CONTACT

1. FULL NAME (LaB!-First-Middle)

T2. RELATIONSHIP

3. AGE

4. ADDRESS OF COUNTRY IN WHICH TELATIVE RESIDES

5. EMPLOYED BY

6. CITIZENSHIP (COURITY)

7. FREQUENCY OF CONTACT

18, DATE OF LAST CONTACT

1. FULL NAME (LaBi-Firs! Middle)

2. RELATIONSHIF

3. AGE

4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES

5. EMPLOYED BY

5

6.'CITIZENSHIP (COMMITY)

7. FREQUENCY OF CONTACT

B. DATE OF LAST CONTACT

SECTION XIX CONTINUED TO PAGE 13

40

6/00

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## Page 16

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SECTION XIX CONTINUED FROM PAGE 12

'SPECIAL' REMARKS, IF ANY, CONCERNING RELATIVES NOTED IN SECTION XIX ABOVE

NA

SECTION XX

1. NAME (LOOr-FirsiMidallo)

Arnett, Raymond Wesley. 06

5. ADDRESS (No., Seroel, City, Stato, Country)

U.S. Army Depot, Pueblo, Colorado

1. NAME (Last-Pirat-Middlo)

2

Miller, Claude o6

5. ÁDDRESS (No., Straer, City, Stato, Country)

Air Station,

Quantico, Virginia

1. NAME (LASt-Firat-Middle)

RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO ARE IN THE MILITARY OR CIVIL

SERVICE OF THE UNITED STATES

2. RELATIONSHIP

13. AGE

TA. CITIZENSHIP

Bro-in-law

24

U.S. Of America

6. TYPE AND LOCATION OF SERVICE (11 known)

2. RELATIONSHIP

3. AGE

4. CITIZENSHIP

2nd Cousin

Unk

Ü.S. of America

6. TYPE AND LOCATION OF SERVICE (11 known)

2. RELATIONSHIP

A100 - 1st Set e

USMC

3. AGE

CITIZENSHIP

S. ADDRESS (No., Stroel, CIty, Stato, Country)

6. TYPE AND LOCATION OF SERVICE (11 known)

SECTION XXI

REFERENCES, ACQUAINTANCES, AND NEIGHBORS

1. LIST FIVE CHARACTER REFERENCES, NOT RELATIVES, IN THE U.S., WHO KNOW YOU INTIMATELY

NAME

(Last-Firat-Middle)

BUSINESS ADDRESS

(No., Stroel, Cily and Stato) 0 d

RESIDENCE ADDRESS

(No., Stroot, City and State)

Mr. and Mrs. (Josè Esplhose)

(S. Guadalupe St.e

San Marcos, Texas

(San Marcos, Texas

Rev. (Carlos Paredes)

First Baptist Church

AustiRe Texas

Austin, Texas

2430 E. St.,

N.W.J 08

(3742 Jason Avenue,)об

Mr. Thaxter I. Goodell)

Washington, D.C,

Alexandria, Virginia

Mr. AlFred Beats)

1711 Massachutes Ave.

Dept, of Agriculture

Washington, D.C.

The American Embassy,

172 Bartolome HerreraDo&:

Cp]. Michael Henness

Lima, Peru

Miraflores, Lima, Peru

2. LIST FIVE PERSONS, IN THE U.S. WHO KNOW YOU SOCIALLY - NOT RELATIVES, SUPERVISORS OR EMPLOYERS

NAME

(Last-First-Middlo)

BUSINESS ADDRESS

RESIDENCE ADDRESS

(No., Sipoor, Clly and Slato)

(No., Stroot, City and Siato)

Mr. Howard Wickland Jre)

Department of State,

Hilltop House,

Washington 25, Dole

Mr. (Max Pine)

MIss (Mary Ann Newman)

Department of State,

Washington 25, D.l.

D.l.

3571 Section Road, 06

Cincinnati 36, Obio

Allen Lee Hotel, 23rd & 06

Wash., D.t.

Miss (Ruth F. Stewart)

Boulder, Colorado

Mrs. (Bea Lux)

173 Bartolome Herrera, 06

Miratores, Lima, Peri

3. LIST THREE NEIGHBORS AT YOUR MOST RECENT NORMAL RESIDENCE IN THE U.S.

NAME

(Last-Firat-Middle)

Miss Nancy Payne 06

Lt.

and

Mrs. Willem Faulman

•BUSINESS ADDRESS

RESIDENCE ADDRESS

(No., Stroot, City and State)

(No., Streas, City and Stato)

402 Hanover St., 50

Fredericksburge

Virginia

p/o Lee Pelts,

Boute 1, Kennett 08

Mo.

- 13 -

61

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## Page 17

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.4=

SECTION XXII

CLUBS, SOCIETIES, AND OTHER ORGANIZATIONS

NOTE: List names and addresses of all clubs, societies, professional societies, employee groups or organizations of any kind

(Include membership in, or support of, any organization having headquarters or branch in a foreign country) to which you

• belong or have belonged.

DATES OF MEMBERSHIP

NAME AND CHAPTER

ADDRESS

(Number drea.

City, Slate, Country)

FROM

San Marcos

High School,

Spanish Club

San Marcos

Texas

0ô San Marcos) High School,

Distributive Education Club

San Marcos, Texas

First Mexican Baptist)бб

Baptist Youth Organization

Church, San Marcog,

Texe

Sept. 1954

Sept.,:

1954

Jan.,

1957

TO

May

1955

May

1955

May

1957

SECTION XXIII

RESIDENCES FOR THE PAST 15 YEARS

ADDRESS - LAST RESIDENCE FIRST

(Number, Streol, City, State, Country)

(4736 Kennore Ave., #201) Alexandria, Virginta

L02 Hanover Sted Fredericksburg, Virginia

(112 Bartolome Harrera, Mirallorestalle

Ilma Potosi,

USIS Buildinge 3ra & 4th Floors,

La Paz, Bolivia

"F" Company, Headquarters Marine

Corps,

Henderson

Hall, Washington 25, D.C.

Cold Weather Training Battalion, Pickle Meadows,

Bridgeport, California

Marine Corps Base, 29 Palms, California

Marine Corps Recruit Depot, San Diego, California

Marine Corps Base, Camp Pendleton, California

501 S. Guadalupe St., San Marcos, Texas

Howard Payne College, Brownwood, Texas

501 S. Guadalupe St., San Marcos, Texas

INCLUSIVE DATES

FROM

TO

March, 1961 jAuge, 1961

Dece, 1960 Mara, 1961

Jan.,1960 Nava, 1960

NOVe 1958 Janee 1960

Sept. 1958 Nov, 1958

Jana, 1958 AUGe, 1958

Dece: 1957 Janee 1958

JulJee1957 NoVee 1957

Nover 1957

Deces 1957

May 1956

July, 1957

Septes 1955 May, 1956

1946

Septer 1955

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## Page 18

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• SECTION XXIV

ADDITIONAL INFORMATION

IZATION WHICH ADVOCATES OR TEACHES THE OVERTHROW OF THE GOVERNMENT OF

2. IF YOU HAVE ANSWERED "YES" TO THE ABOVE QUESTION, EXPLAIN

YES

X NO

4. IF SO, TO WHAT EXTENT?

YES

NO

S. DOER USES NARCOTICSOU

YES

6. IF SO, TO WHAT EXTENT?

NO

7. HAXFION DEYES ACTEM ANEMBER OF, OR SUPPORTED, OR HAD ANY CONNECTIONS WITH A FOREIGN INTELLIGENCE ORGAN-

YES

XINO

IF ANSWER IS "YES", GIVE COMPLETE DETAILS.

• ELOYMENT SINCE MAHES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO WHICH YOU HAVE APPLIEDFOR EM

I served 4 years in the United States Marine Corps.

8. AGENCY HE TOLER LATE DATE AROYE AGE SONATITED AN INVESTIGATION OF YOU, INDICATE THE NAME OF THE

An investigation (I do not know by whom) was conducted prior

to my departure for Bolivia where I was attached to the American

Embassy. This investigation took place during August and September

of 1958.

NOTE SPECIAL

INSTRUCTIONS

If your ansmor is "YES" to the following Questions 10, 11 or 12, provido the information roquested for each

vestion on a separate, signed shoet and attach the sheet to this form in a sealed envelope.

YES

IN ACCORDANCE NETH THE SPECIAL INSARUCTION TELLATE, NATURE OF OFFENSE AND DISPOSITION OF CASE

11. HAVE YOU EVER BEEN ARRESTED. COUR AND PROVIDE DATEST OF O

MATIONY TF SO, DESCRIBE INCIDENT(S)

CORDANCE WITH SPECIAL INSTRUCTIONS ABOVE.

Yes

12.

ARE THERE AN UNFAVORARE IN INTO MURDE

NOT MENTIONED ABOVE.

wHICH MAY BE DISCOVERED

IN SUBSEQUENT INVESTIGATION.

INVOLVED OR NOT, WHICH MIGHT REQUIRE

PLANATIONT

IF SO,

SATION MINE YOU PER TETEYSIOE OCCURRENCE ON SEPARATE SHEET IN AC-

CORDANCE WITH SPECIAL INSTRUCTIONS ABOVE.

YES

XINO

SECTION XXV

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY

1. NAME (Firse-Middlo-Last)

2. RELATIONSHIP

Mrs. Daniel Flores

3. HOME ADDRESS (No. Sire!, "My, Zone, Stato, Country)

HOME PHONE NO.

2828 Con, AVO., #203 Washington Be

D,C.

(265-8322 J 56

Couniry) - INDICATE NAME OF FIRM OR B. BUSINESS PHONE NO. & EXT.

Boykin and De Francis

2000 16th St., Suite 603)

Washington 6, D.C.

(017-5444)

715 SEES HER ENEMISE

HE HELLE OR OTHER REASON ST

PLEASE SO STAY ALSO BE NOTIFIED. IF SUCH NOTIFICATION

In all cases wife:

Relative, Mrs.

Vicente Patlan) 631 S. River Stal 08

1o (Seguin), Texas

Telephone

Er 9-1087 J00

• 15 .

43

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## Page 19

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SECTION XXVI

CERTIFICATION

YOU ARE INFORMED THAT THE CORRECTNESS OF ANY STATEMENT MADE IN THIS APPLICATION

WILL BE INVESTIGATED.

hove read and understand the instructions. I Certity that the toregoing answers are true and correct to the best of mi

nowledge and belief. I agree that ony misstatement or omission os to muterial fact will constitute grounds for immediat

How (u.S. Corei Fion T8, Section 1001).

Title 18,

section 1001

1. DATE OF SIONATURE

2. SIGNATURE OF APPLICAN

Stoc

• SIGNED AT (City and Stato)

Washington, District of Columbia

aucyle Cooles

NOTE: Use the following space for extra details. Reference each continued item by section

sign your name at the end of the added material. If additional space is required ust extra pages the same size as this

page and sign each such page.

MARITAL STATUS:

Item #4, Section XII

06

September 1, 1956 to October 6, 1956.

Married toLt. Col. Joseph G.

Moran) In Portland, Oregon, by Circuit Court Judge.

Used name

of (Moran)

unt1l November I, 1960, when changed to Flores.

FATHER-IN-LAW: Item #5, Section XVII

Short name for Raymond

GEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL: Item #1, Section VI

Argentina

2 July 1959 to 3 July 1959

Travel

Panama.

10 November 195ü to 13 November 1958 Travel.

SEE ATTACHED SHEET FOR PERTINENT INFORMATION RELATIVE TO STEP-MOTHER.

1961.

Signed at Washington, D. C., this f' day of september,

damel Dan

Flores

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## Page 20

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- :

...

ATTACHMENT TO FORM NO. 444 - PERSONAL HISTORY STATEMENT

Section XV - STEPMOTHER

Full name: Concepcion P. Flores

Living: Yes

Other Names She Has Used: None to my knowledge

Current Address: 501 S. Guadalupe Street, San Marcos, Texas

Date of Birth:

December 8, 1914

Place of Birth: Mexico

Citizenship:

Mexican

If Born Outside U.S. - Date of Entry: December 8, 1922

Place of Entry: Unknown

Former Citizenships: None

Occupation:

Homemaker and Missionary

Present Employer: (Mexican Baptist Church, SanMarcos, Texas

Never served in Military or other Government service to my knowledge.

This paper is

attached to and hereby made a part of Form No. 444.

65

3lpd

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