FORM 313A.
Originator: CIA
Document date: 09/22/1961
Document type: PAPER - TEXTUAL DOCUMENT

## Page 1

104-10180-10219

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

EllIo ArorIco Hodrinion] 04

PART I

COMPENSATION AND WITHMOLDING DATA

•SOURCES O+

CONVERSATION PAYULPTS ICHAR

FIELO ALLOTMENI

T85

cora racer.

PATMENTS TO BIGIM (DOSO)

15 July. 1961

BEEKLY

- HA

BACONE TAXES.•

HELD BY COVER FACILITY FROM COMPENSA

PERIOD

108.8180

PAID

• SECURITY IFICAS MITMMELO.

NAME OF COUNTRY

WILL NOT-REPORT

COMPENSATION SUBJECT TO A FOREIGN TAX

:COVER, FACILITY WILL REPORT COMPENSATION AS FOLLOWS (SPO

(lan 16 beloo)

FORM N-2

PA FORM 1000

THE AGENCY

REPORT .COMPENSATION AS FOLLONS (Ser iROn 16 Dolou)

COVERT (Il covere arily.

DECLARATION OF ESTIMATED INCONE TAX (ChAC" ano)

HAS "BEEN FILED

_MAS. NOT DEEM FILED

PIT NOT APPLICADLE

PART 11 DEPENDENCY DATA

"O. IS PEPENDEMTS, INCLUDING BEER, CLAIMEO WITH COVER

і рё. но.

INCLUDING SELF.

FORM JIS OR

SPENDEN SO NGULD NE SEAT SCANN

CLAIMED ON

"MARITAL STATUS (Complete .

SINGLE

1830019288

MARRIED

DATE'OF DEATH

appropriato)

WIDOwED

DATE OF DECREE

DIVORCED

-LEGALLY SEPARATED

ANNULLED

RESIDENCE DF SPOUSE (COUMITY)

S.

14..

DEPENDENTS

IN NUMBER

DOFILATIONSHIR (NO PARDO)

HOn

daugitor

BĐH

DEPENDENTS

DECLARED ABOVE (Omi.

self and ap

TAX RETURNS WHO MAY OR MAY NOT BE INCLUDED

35 BIRTH

1.5.

COUNTRY OF

RESIDENCE

t. 5.

t. S.

год

7. 5.

To So

15- MEMARKS

16.

APPROVAL OF CENTRAL COVER DIVISION

47.

FOAM PREPARED BY

Norescras

The employer's names and methods

for

DATE

PART I CERTIFIED CORRECT

SIGNATURE OF OFFICIAL

reporting compensation shown. in Items 8,

and/or 9, ahove are approved.

DATE

82 lipter

1.1

SIGNATURE AND TITLE

PART 1I

CERTIFIED CORREÇT (Explain when noe nianed)

DATE

SIGNATURE OF INDIVIQUAL (PAGUÍONYA)

FORM

8- 60 313а

DISTRIBUTION:

SICNED ORIG. AND COPY -

• "TO FINANCE: COPY - TO CENTRAL COVER: COPY • TO FILE

SECRET

130)

it way:..

SECRET

PART 111

3883

NOTE:

DETACH THIS PORTION OF FORM AND OISTRIBUTE SFPARATELY

1D. SOCIAL SECURITY NO.

SOCIAL

SECURITY NO. IS MOT AVAILABLE

MADE FORM

"APPLICATIGA FOO

SOCIAL

¿CCOLAIS.

PROVIDES I9 DETAILED

PROCECURES.

20. CITIZENSHIP.

0. So

81. aboMIss or ReCORD (in U.S.)

88. ADDRESS (FORGIAN)

9361 34 178th St. Ferrino, Floride

RA

DISTRIMITION. SIGNED ORSE AND COPY • TO FINANT: COPY • TO ITSTEN CUTER: COPY • TO FILE

085 313а

SECRET

1308

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