WITHHELD
Originator: CIA
From: WITHHELD
To: C/WHD
Document date: 06/05/1959
Document type: PAPER - TEXTUAL DOCUMENT

## Page 1

104-10073-10073

2022 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992

DISPATCH

FOR SYMBOL AND MO

• (.)- 67

FRE NO

2:-=1-2.

TO

INFO

FROM

SUBJECT

16-16%

DATE

rationali

art 1 Son arla lydia DiAN Rocha do 1lzerrect

ACTION REQUIRED

• one

ICEIS!

MARKED FOR UNDEING

NO NDEKING LEGUINED

NDEXANG CAN SE LIDGE

•DY QUALFIED HO IES: CAL

Phelosed are four condés

"i.

of

f?

Pâr

Lior mic data on's

Dias R. Bynac

I: *

by WeBo

4D IT. H.)

0910 1209"

bition:

wat:

31:6".

1PS

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INDEX

11.

1G.

-21d59

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## Page 2

14-0000Osi

atutd Mid tiil"

coia.

Ttf, 4 corls

5 " ie.

29

.→)

2priartins

4üe,

w/att as sta.g

?-÷le5

Cui sis

de.a

INDEX

1-0. 87.93

ree: + 170 -59 18-18i-

raatekit tie!

ORAA

1057 53

(40)

USE PRFVIOUS EDITION.

REFLACESFORMS

31.201

51 28A AND 31 29

WHICH ARE OBSOLETE.

CASSIRCATON

Cs CUrT:

1

Dlia l. Brn

by WiBD

•f..

ii.,

tials

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Racd NO

JONTANUE

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## Page 3

14-00000

RSONAL RECORD GUESTIONA TRE

PART I - BIOGRAPHICAL

writo clearly.

Anewor all questione completely.

Is question does!

not apply, urite

"not' applicablo"

Attach blank pages 11 additional apace le needed.

lach:

correca

1. Full Name.

Name in sative script

Aliases, nicknames, legal changes (State briefly time, reason and

place

of me..

09

10

s. a Dato of biren (el sarch 1939) b. Place of biren a Far, Bolivia)

7. Nationality at birth. and any subsequent

nationalitien lle dupforeptin

FEB M- 1962

3. Present realdence (ouner, tenant, ioub-tenant.).

A (Benancia Burieu to rumber

HOOSENE BORATIN SEECE

9. Permanent address (18 different from 8.)

20. Prespot occupation fur 1a, oar or sorter e tree too

ei overnment (298 730)

11.

Naturalization of subject or of, close relatives in the United State®.

(Give date and name in which certificate granted.) _

12. Relatives, friende, correspondents in United States. (Esplain re-

iationship).

500. 40: 31-050

I june, 59

90, 947382

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AFTER USE

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## Page 4

14.00000

220

A 22 PROLE

13. Fether & Pull name occupation, present reeldence, year and place

lacedonio Daran, feti

06

red, (Benansia Surgoa,) no nunter:

Bolivien.

144

Mother

same, Information as

Carta dora, ho senio, (endrela suda, no humor a

413

dato and place ot marriage, ratsonals a

at birth and any subseguent

nationalitied present residesce,, divorce

annulment. (G1ve data

Lor all preylous

aarriagee.)

Omar sent 172)

Coc nuanba, olivia (I May 1919.)

16. Chidren full names, sex, year

and place of birth, nationalfty

(Rocio y

17-

Prothers and closera

- Same information

as 16.

-E ctober 1932) -Ca

raz)

06

2

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tagonies, is rato

161178

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## Page 5

14-00009€

(Car 3201 / PROLE

28. Relation de orrica of su loversent, tames and role das bold.

19. Let all official Identity papers hold

with dates, numbers, place

of lasue

and duration of veildity.

20.

Religion - decree practiced, memberehip la religious ordere eli

Catholic

21. Present and pastipolitical affiliation

22. Travel outeide country of present.

re81d

ence

-country, dates

purpose, people and firma viested.

To Antofu asta for lealth reasons in

Dicember 1958.

23.

Education- school, location, course, dogree, dates

Graduated fron (Colerso Lour es", in la Par.

-V4-25425

24. tenguages

and dialecte (indicato proficiency as good, fairi poor.)

Language Spantch Speak (NAtIVE delHUAGS )E

Understand

Language.

Speak

_Read

Understand

Language_

Speak

Read:

Understand

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## Page 6

14-00000

2s. Manitary dervico datos, country, unt) rank, duty, where

service portora decorational won dochargod, i give.

dotailo Le over prisoner of war

26. Present and past membership in

orga

political,

otc

3)

izations (professional social,

??.

Spocial ek11le, abilitiee, hobbies (radio, photography, etc.)

Steno raphy,.

cres smaking

29•

Euployent blatary - type of vork geelary, dates, omployere, ad

dresson, rossons sar leavine include nployment by may covermont

об.

Secratary os

Knister,

Hover

int)

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## Page 7

14-00

00

:3

29: (Continued):

30. Bae subject done any writing?

8,

booke, articlos, publishers,

•dates.

Give dotaile Including titlee of

31. Ilot persone 1171ng et anno eddredo clone aasociatee, (inditiduale or

groupe, correspondente at home and abroad.

32. Liet five character references. /

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5N9: 801-25-582

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## Page 8

14:0000009

1.14.

02) - 2291 moL

1 33 .

dout record cour, dato, arronto, chargod, puntohmonts

sentoncet, acquittals, donazification,

34. Description (Use American etande

Apparent age Laur

Height

Eyes

bark brown

Loas

Face - shape

Complexion

SOT

Bale

Coneral appearanco -

Prominent Peatures

Other Identifying features -

urement, il poseibie.)!

Posture

Brect

Weight 22 1051

Teoth _ fren

Halr -

Scare -

Lione.

-Dandod

Build

: 35€

data

and comenta

125%

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