PERSONAL HISTORY STATEMENT
Agency: CIA
Originator: CIA
Document date: 03/15/1965
Document type: PAPER - TEXTUAL DOCUMENT

## Page 1

JFK ASSASSINATION SYSTEM

IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : CIA

RECORD NUMBER

: 104-10104-10167

RECORD

SERIES

JFK

AGENCY FILE

NUMBER

80T01357A

DOCUMENT INFORMATION

Released under the John

F. Kennedy

Assassination Records

Collection

Act of 1992

144 USC 2107 Notel.

Case#:NW 53294 Date:

06-14-2017

AGENCY ORIGINATOR : CIA

FROM

TO

TITLE

DATE

PAGES

: 17

PERSONAL HISTORY STATEMENT

03/15/1965

SUBJECTS

: WITHHELD

PERSONAL HISTOR

DOCUMENT TYPE : PAPER

CLASSIFICATION: UNCLASSIFIED

RESTRICTIONS:

1A

CURRENT STATUS

: RELEASED IN PART PUBLIC - RELEASED WITH DELETIONS

DATE OF LAST REVIEW

07/26/93

COMMENTS: JFK37: F11: 1993.07.26.09:42:43:310620: THIS IS PHS

OF AGENCY EMPLOYEE.

IT INADVERTENTLY INCLUDED IN

JFK

MATERIALS.

[R] - ITEM IS RESTRICTED

104-10104-10167

HH 53294

DocId: 32398018

Page 1

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## Page 2

15%1

PERSONAL HISTORY STATEMENT

INSTRUCTIONS

-Do NOT attempt to complete this form until you have read the following instructions-

If the question is nor applicable, write "NA".

the answer and it cannot be obtained from personal records, write "Unknown'

' Use the blank space on

pages 15 and 16 for extra details on any question for which you

do not have enough space.

2. Type or print carefully; avoid using light color inks.

3. Leave blank any boxes or columns which are marked "FOR OFFICE USE ONLY".

of the form will permit review of your qualifications to the best

advantage.

of the form will certify

to its correctness.

5. Page 17 entitled "Personal History Summary" must be completed.

It is a brief abstract of information from other parts of

the form and will help to speed the processing of your application.

W. M. EDWARDS

SECTION 1

1. Full Name (Last-first-middle)

HUBER

Herbert Gottlieb

5. Nicknomes

None

GENERAL PERSONAL AND PHYSICAL DATA

2. Ago

3. Sex

34

XX Male

6. Other names you have used

None

7. Indicato circumstances (including length of lime) under which you have used the names noted in item & above..

NA

female

4. Social security number

218 26 5322

8. If legal change of name, give particulars (Where and by what outhority)

NA

9. Height

7411

15. Scars (Type and location)

10. Weight

201

11. Color of eyes

Brown

12. Color of hair

Brown

13. Type of complexion

Med ium

16. Other distinguishing physical features

14. Build

Medium

Append ectomy

17, Current address (No., Street, City, Stote & ZIP code-country if not U.S.)

90-A Azalea Drive

Shaw AFB, South Carolina 29152

20.

Permanent address (No., Street, City, State & ZiP code-country it nor U.S.)

221 Quaint Acres Drive

Silver Spring, Maryland

23. Office phone number

24. Office extension

Shaw AFB (775-1111)

7252 &

2144

SECTION I!

001

None

18. Current phone number

19. Long distonco

orea code

436-6150

21. Pormanent phone number

803

22. Long distance

area code

MA 2-0697

301

25. Legal residance (State, territory or country)

Maryland

POSITION DATA

Indicate the type of work or position for which you are applying

2. Indicate the lowest annual entrance salary you will accopt

3. Dates available for employment

Earliest: May 12, 1965

Latest:

Indicate your willingness to trovel:

Occasionally

Frequently

Constantly

Indicate your willingness to accept

Washington, D.C.

Anywhere' in U.S

XI Outside continental U.S.

assignment in the following locations -

chock (X) each item applicable

Certain locations only (specify):

6. Indicate any resiictions you would place on assignments outside the Washington, D.C. area

None (Preference for Southeast and Texas west in U.S. and Europe, overseas.)

FORM

3-64

(For Office Use Only)

444

USE PREVIOUS

EDITIONS

, —1-

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Page 2

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## Page 3

SECTION III

1. Date of birth

January 8,

1931

4. Citizenship

X Birth

acquired by:

Other (Specify):

7. Court issuing naturolization certificote

NA

9. If alien, give alien registration number

NA

11. Have you held previous nationality?

421

T

• Yes

X) No

13.

Give particulars concerning previous nationalities

NA

CITIZENSHIP

2. Place of birth (City, State, Country)

Baltimore, Maryland, USA

Marriage

5. Date naturalized

NA

8. Issued of (City, State, Country)

NA

10. Date of arrival in U.S

NA

12. If yes, give name of country:

NA

3. Present citizenship (Country)

USA

6. Naturalization certificate number

NA

14. Last U.S. visa (Number, type, place of issue)

15. Date visa issued

NA

NA

SECTION IV

MARITAL STATUS

1. Present status (Single, married, widowed, separated, divorced, annulled, remorried) specify.

Married

2. State date, place, and reason for all separations, divorces or annulments

NA

Wife, husband

or fance

If you have boon married moro ihan once (Including annulments) usa separato sheat for former wito or husband giving data required

balow for all provious marriagos.

Il martlogo contomplated, fill in appropriato information for lance.

3. Name of spouse

(First)

(Middle)

(Maiden)

(Last)

Bernadette

A. State any other names ever used by spouse

Marilyn

Early

Huber

None

Indicate eircumstances (including longth of time) under which any names noted In item 4 abovo were used. It logal chango, glve particulars (whore &

by what authority).

Use extra space provided on pagas 15 and 18 of this for to racord this Information.

5. Date of birth

6. Place of birth (City, State, Country)

December 15, 1932

Duluth, Minnesota,

, USA

8. Place of marriage (City, State, Country)

Duluth, Minnesota

10. Citizenship

USA

11. Former citizenship(s) (country|ies)]

None

13. Date U.S. citizenship acquired

14. Where acquired

* NA

NA

15. Date of arrival in U.S.

NA

7. Date of marriage

February 5, 1955

9.

Living

K/ Yes

1 No

12. If alien, give alien registration number

NA

16. Noturalization certificate number

NA

17. Date of death

18. Cause of death

NA

NA

19. Current address (Give last address, if deceased)

90-A Azalea Drive, Shaw AFB, South Carolina 29152

20. Occupation

Present employer (Also give formor amployer, or if spouse deceased or unemployed, give last two employers)

Wife and Mother

NA

22. Employer's or business oddress (Number, Street, City, State, Country)

NA

23. Dotes of military service

(From to--by month & year)

24. Branch of military service

25. Country with which militory service affiliated

Jan 52 to Jan 55

26. Details of other govemment service, U.S. or foreign

None

U.S.

*Air Force

USA

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Page 3

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## Page 4

SECTION

V

CHILDREN AND OTHER DEPENDENTS

1. Provide the following information for oil children and dependents:

Nome

Relationship

Bernadetto Marilyn Huber

Wife

Michele Gisella Huber

Dau

Mark Göttlieb Huber

Son

Stephen Edward Huber

Son

David Gottfried Huber

Son

Dote & Place of Birth

December 15, 1932

Duluth,

Minnesota

May 26, 1955

Washington, D.C.

July 16, 1956

Austin,

Texas

July 10, 1958

Houston, Texas

May 13, 1961

Wiesbaden Germany

Citizenship

USA

USA

USA

USA

USA

Address

90-A Analea 'Drive

Shaw AFB, S.C.

90-A Azalea Drive

Shaw AFB, S.C.

90-A Azalea Drive

Shaw AB, S.C.

90-A Azalea Drive

Shaw AFB, S.0.

90-A Azalea Drive

Shaw AFB,

5. 0.

SECTION

2. No. of children (include stepchildren & adopted children) who are

unmorried, under 21 years of age, and are NOT self-supporting.

3. No. of other dependents (e.g., spouse, parents, stepporents, etc.) who

4

depend on you for at least 50% of their support or children over 21

NOT self-supporting

VI

FATHER

(Give same information for stepfather and/or guardian on a separate sheet)

1. Full nome (Last-First-Middle)

Huber

Gottlieb NMI

2. State other nomes he has used

None

1

what authority).

3. Dote of birth

July 4, 1904

6. Date of death

NA

dicato circumstancos (including longth of timo) under which ony nomes in Item 2 above were usad. 'If legal chango, give particulars (where & t

so extra spaco provided on pages 15 and, 16 of this form to record this informatior

4. Place of birth (City, State, Country)

Unterschutzen, Austria

7. Cause of death

NA

5. Living

IX Yes

No

8. Citizenship (Country)

• USA

9. Former citizenship(s) (country(ies))

Austria

12. Naturalization certificate number

2929076

10. Date U.S. citizenship acquired

11. Where acquired (City, State, Country)

May 13, 1929

Baltimore, Maryland

13. If alien, give alien registration number

NA

14. Date of arrival in U.S.

April 1923

15. Current oddress (Give last address, if deceased)

221 Quaint Acres Drive, Silver Spring, Maryland

16. Occupation

17. Present employer (Give last employer if father deceased or unemployed)

Construction Superintendent

Oharles H. Thompkins Co.

18. Employer's business address or farter's business address if self-employed

16th Street, NW, Washington, D.C.

19. Dates of military service (From - to--)

NA

20. Branch of military service.

NA

21. Country with which affiliated

NA

22. Details of other government service, U.S. or foreign

None

SECTION VII

MOTHER (Give some information for stepmother on a separate sheet)

1. Full name (Last-First-Middle-Maiden)

Huber

Gigella

NMI

Graf

2. State other names she has used

None

ndicate circumstances (including longth of ilmo) under which any names noted In item 2 above were used. If legal chango, give particulars (whore & by

what authority).

Uso extra space provided on pages 15 and 18 of this for to récord this information.

3. Date of birth

4. Place of birth

Feb 17,

1909

Unterschutzen, Austria

6. Date of death

7. Cause of death

Nov 9, 1949

suicide

5.

Living

Yes

XX No

8. Citizenship (Country)

USA

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Page 4

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## Page 5

9. Former citizenships) (country(ies)]

Austria

12. Naturolization certificate number

4984929

MOTHER (Continued)

10. Date U.S. citizenship acquired

Sep 9, 1940

13. If alien, give alien registration number

NA

11. Whe._ quired (City, Stale, Country)

Baltimore, Maryland

14. Date of arrival in U.S.

Sep 1929

15. Current address (Give last address, if deceased)

Deceased - 615 Lycoming Avenue, Silver Spring,

Maryland

16. Occupation

17. Present employer (Give last employer if mother deceased or unemployed)

NA

NA

18. Employer's business address or mother's business address if sell-employed

NA

19. Datos of military service (From - t0-)

NA

20. Branch of military service

NA

21. Country with which affilialed

NA

22. Details of other government service, U.S. or foreign

None

SECTION

BROTHERS AND SISTERS (Including half, step-, and adopted brothers and sisters)

(2)

1. Full name (last-First-Middle - Maiden)

Huber

Walter

Ed ward

Brother

1. Date of birth

5. Place of birth (City, Stote, Country)

Jun 23,

1932

Baltimore, Maryland, USA

3. Citizenship (Country)

USA

6. Living

Ex/ Yes

No

7. Present employer (Give last employer if deceased or unemployed)

8. Current address (Give last oddress, if deceosed)

GSA' - Civil

Service

502 Calvin Lane, Rockville, Maryland

1. Full Nome (Last-First-Middle - Maiden)

2. Relationship

3. Citizenship (Country)

Hubor

Alfred

Grat

Brother

USA

4. Dote of birth

5. Place of birth (City, Stato, Country)

6.

Living

Apr 13,

1935

Baltimore, Maryland, USA

X] Yes

No

7. Present employer (Give lost employer if deceased or unemployed)

8. Current oddress (Give last address, if deceased)

DNA - Oivil Service

3131

Christine Ave, Beltsville, Maryland

1. Full Name (Lost -First-Middle - Maiden)

2. Relationship

3. Citizenship (Country)

4. Date of birth

5. Place of birth (City, State, Country)

6. Living

(3)

Yes

No

7. Present employer (Give last employer if deceased or unemployed)

8. Current address (Give last address, if deceased)

1. Full Namo (Last-First-Middle - Maiden)

2. Relationship

3. Citizenship (Country)

(4)

4. Date of birth

5. Place of birth (City, State, Country)

6. Living

1 Yes

! No

7. Present employer (Give last employer it deceased or unemployed)

8. Current address (Give last addross, it deceased)

1. Full Name (Last-First-Middle - Maiden)

2. Relationship

3. Citizenship (Country)

Date of birth

3. Place of birih (City, State, Country)' : 1

(5)

6. Living

• Yes

7. Present employer (Givo last employer it deceased or unemployed)

8. Curren address (Give lost dross, if doceased)

1. Full Nomo (Last-First-Midollo--Maiden)

2. Relationship

3. Citizenship (Country)

(6)

4. Date of birth

5. Place of birth (City, State, Country) !:

6. Living

7. Presont employer (Give last employer if deceased or unemployed).

8. 'Current oddress (Give last codress, if deceased)

(For Office Use Only)

74 53294

DooId: 32398018

Page 5

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## Page 6

SECTION

IX

FATHER-IN

«W' (If marriage contemplated, fill in information for futi

ther-in-law)

1. Full nome, (last-first-middle)

Early

Bernard

Joseph

2. State other names he has used

None

Indicate circumstanced (Ineluding longth of time) under which any names noted in item 2 abovo moro used. I logal change, givo particular lwhore a by what

authority).

Uso extra spaco provided on pagas 15 and 16 of this form to record this information.

3. Date of birth

4. Place of birth

5. Living

Jul 6, 1900 (?)

Duluth, Minnesota

6. Dote of death

7. Cause of death

Dec 26, 1934

Tuberculosis

& NO

8. Citizenship (Country)

USA

9. Former citizenship(s) (country(ies))

None

12. Naturalization certificate number

NA

15. Occupation

Unknown

13. If alien, give alien registration number

NA

16. Present employer (Give last employer if father-in-law deceased or unemployed)

Unknown

14. Date of arrival in U.S.

NA

17. Current address (Give last oddress, if deceased)

Deceased - 307 9th Ave. West, Duluth, Minnesota

SECTION X

TEREST

MOTHER-IN-LAW (ff marriage.contemplated, fill in information for future mother-in-law)

1. Full name (Last-First -Middle - Maiden)

Early

Mae

Virginia

Beach

2. Stale other names she has used

None

Indicate circumstances (Including length of time) under which any names noted in item 2 above were used. It legal chango, give particulars (whore a by what

authority).

Uso oxtro space provided on pages 15 and 18 of this form to record this information.

3. Date of birth

4. Place of birth

May 31, 1905

Virginia,

Minnesota

6. Date of death

7. Cause of death

NA

NA

5. Living

Li Yes

No

8. Citizenship (Country)

USA

9. Former citizenship(s) (country (ies)).

None

12. Naturalization certificate number

13. If olien, give alien registration number

NA

15. Occupation

Officeworker

10. Date U.S. citizenship acquired

11. Where acquired (City, Stato, Country)

NA

NA

Tá. Date of arrival in U.S.

NA

NA

18. Present employer (Give last employer if mother-in-low deceased or unemployed)

Plaunt Plumbing Co, Duluth, Minnesota

17. Current address (Give last oddress, it deceased)

810 N 8th Ave.

East, Duluth, Minnesota

SECTION XI

RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (1) LIVE ABROAD,.

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

1. Name (Last - First-Middle)

2. Relationship

3.

Date of birth

Huber

John

NMI & family

Uncle:

Unk

4. Place of birth (City, Stote, Country)

Unterschutzen, Aus

5. Citizenship (Country)

(1)

Austria

7. Employed by

Self (farmer)

1. Name (Last-First-Middle)

Huber

. Edward

5. Citizenship (Country)

2)

Austria

7. Employed by

Self (farmer)

1. Name (Last-First - Middle)

Kurtz, Hermina

NMI

5. Citizenship (Country)

(3)

Austria

7. Employed by

Self (farmer)

8. Frequency of contact

Seldom

2. Relationship

NMI & family

Uncle

6. Address or country in which relative resides

#70 Unterschutzen, Austria

8. Frequency of contact

Seldom

2. Relationship

& family

Aunt

6. Address or country in which relative resides

#46 Unterschutzen,

Austria i

8. Frequency of contact

Seldom

3. Date of birth

Unk

9. Date of last contact

Dec 1964

4. Place of birth (City, Stato, Country)

Unterschutzen, AUs

3. Date of birth

Unk

9. Date of las! contact

Dec 1964

4. Place of birth (City, Stote, Country)

Unterschutzen, Aus

9. Date of last contact

Tr: Dec. 1964÷

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Page 6

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## Page 7

REL: IVES WITH FOREIGN, CONNECTIONS (C

nued)

1. Name (Lost-First- Middle)

2. Relationship

3. Däte of birth

Graf

Leopold

NMI

& family

Uncle

Unk

4. Place of birth (City, State, Country)

Unterschutzen, Aus

5. Citizenship (Country)

4

6. Address or country in which relative resides

Austria

#3 Unterschutzen, Austria

7. Employed by

8. Frequency of contact

Self (farmer)

Seldom

1. Name (Last-First - Middle)

2. Relationship

Karner Gerts NMI (Huber) & family

Cousin

3. Date of birth

Unk

9. Dale of last contact

Dec 1964

4. Place of birth (City, State, Country)

Unterschutzen, Aus

5. Citizenship (Country)

6. Address or country in which relative resides

(5)

Austria

#22 Unterschutzen, Austria

7. Employed by

8. Frequency of contact

Unknown

Seldom

9. Date of last contoct

Dec 1964

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

SECTION XII

SERVICE OF THE UNITED STATES

1. Nome (Last-First - Middle)

Huber

Walter

(1) 5. Citizenship (Country)

USA

1. Name (Last-First - Middle)

Huber

Alfred

2) S. Citizenship (Country)

USA

1. Name (Last-First-Middle)

Huber

Erwin

3) 5: Citizenship (Country)

USA

2. Relationship

Edward

Brother

6. Äddress (Number, Street, City, State, Country)

502 Calvin Lane

fir:

Rockville, Maryland

• 2. Relationship

Graf

Brother

6. Address (Number, Street, City, State, Country)

3131 Ohristine Avenue

Beltaville, Maryland

2. Relationship

Unknown

Cougin

6. Addrass (Number, Streel, City, State, Country)

6615 48th Street NW

Tacoma, Washington 98467

3. Date of birth

4. Place of birth (City, State, Country)

Jun 23, 32

Balto Md USA:

7. Type and location of service (If known)

GSA - Civil Service

Washington, D.O.

3. Date of birth

4. Place of birth (City, State, Country)

Apr 13, 35

Balto Md USA

7. Type and location of service (ll known)

DNA. - Civil

Service

Washington, D.C.

3. Date of birth

4. Place of birth (City, State, Country)

Unk

Canada (?)

7. Type and location of service (lf known)

USAF - Military

McChord AFB, Wash State

SECTION XIII.

EDUCATION

ELEMENTARY SCHOOL

1. Name of elementary school

2., Address (City, State, Country)

3. Years attended (From --1o -) 4. Graduate

XX Yes !:

OJ.No

Alex Hamilton #65

Name of high school

Baltimore, Maryland

HIGH SCHOOLS

2. Address (City, State, Country)

Feb 37-Feb 43

3. Years attended (From-to--)

Gwynns Falls Jr High #91

1. Name of high school

Baltimore, Maryland

2.. Address (City, State, Country)

Feb 43-Feb 46

3. Years ottended (From to -)

Baltimore City College

Name and location of college or university

Baltimore, Maryland

COLLEGE OR UNIVERSITY STUDY

Subject

Years attended

Major

Minor.!,

From-

To ques

Feb 46-Feb 49

Degree

Received

Year

Received

University of Maryland

College Park, Md & Germany.

Bus Adm

Educ

Sep 49 -

Mar 63

BA

June

1963

4. Graduate

4x Yes

I No

d. Graduate

SEX Yes

D No

Grode or

Number of

Point

Sem./Qtr.

Average

Hours (Specify)

• upper

level

courses

Unk

128

sem

Mississippi Southern at.:

Biloxi, Misaissipp1

Math

Sep 57 -

Nov 57

No

NA

4 gem

University of Texas

Dec

56-

Austin, Texas

Math

May 57

No

NA

A. It o graduate degree has been noted above which required submission

written thesis, indicate the title of the thesis and briefly describe its content.

NA

A

6 sem

stay.

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Page 7

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## Page 8

EDUCATION (Continued)

TRADE,

COMMERCIAL AND SPECIALIZED SCHOOLS

Name and address of school

Study or specialization

'University of Benjamin Franklin

Washington, D.C.

Accounting and Bus Law

University of Benjamin Franklin

Washington, D.C.

Accounting and Bus Law

From

To

No. of months

.. I

eat 54

Des 54

3

Sep 50

Dec 50

4

MILITARY TRAINING IN SPECIALIZED SCHOOLS SUCH AS ORDNANCE, COMMUNICATIONS, ETC.

Name and address of school

Study or specialization

Ground Electronic

Countermeasures

Aug 57

Feb 58

No. of months

1. AB 30330

Keesler AFB, Mississippi

2. AB 641XX

LOWry AFB, Colorado

7

Air Force Supoly

Mar 51

May 51

3

3.

Other education or training not indicated above

FR-700 Ampex Video Tape Recorder Operation and Maintenance

On-duty Manufacturer's representative conducted training in Operation and Maintenance

of Electronic Data Analysis Equipment

SECTION XIV

FOREIGN LANGUAGE ABILITIES

Level of Skill

List below the foreign language or languages on whicht:

you possess any degree of competence.

Indicate your i

proficiency in each of the five skill factors shown (read-

ing comprehension, writing ability, etc.) by noting the

number most indicative of your level of skill under the

factor being considered.

If your proficiency relates to a particular dialect of a

major language, identify this dialect by noting it in

parentheses after the language on the same line.

If you have no proficiency in any foreign

language, check (X) box at right and leave -

other items blank.

(Slight)"

2

(Native)

5

3

0 = No proficiency in a

specific skill factor

SKILL FACTORS

HOW ACQUIRED

(Check (X) Box(es)

which apply}

Reading

comprehension

Writing

ability

Pronunciation

Conversational

ability

Oral

comprehension

Prolonged

residence

Contact (with

parents, etc.)

Academie

study

German

2

1

4

2

2

X

X

German (Burgenland dialect)

3

2

Russian

1

X

2. If you have had experience as a translator, interpreter or instructor

-explain

None

3. Describe your ability to do specialized language work involving vocabularies and termitology in the scientific, engineering, talecommunications, military and other specialized fields.

None

. If you have noted a proficiency in longuage, would you be willing to use this _ i

bility in any position for which you might be selectec

I NO

NW 53294 DooId: 32398018 Page 8

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## Page 9

SECTION XV

GEOL APHIC AREA KNOWLEDGE AND FOREIG RAVEL

List bolow any forolgn rogions or countrios in which you havo travelled or galned knowlodgo as d result of residenco, study or work assignment.

Indicato type of knowiedgo such as terrain, harbors, Industrios, utilitles, raliroado, political partios, etc.

Knowledge acquired by -Check (X)

Name of Region

or Country

Type of Specialized

Knowledgo

Dotes of Travel

or Residence

Dates & Place

of Study

Resi-

dence

Travel

Study

Work

Assign-

ment

Eng & Scotland

Limited

Jan-May 56

Germany

General

Jun 59-63

Holland

None

Apr 63

Austria

Limited

61,62,63

2. Indicate the purpose of visit, residence or travel in each of the regions or countries listed above

Eng & Scotland - Military Assignment

Austria - Visit Relatives

Germany: ...

- Military Assignment

Holland

- Visit as tourist

3. United States Passport Number & Expiration Date, if issued -

NA

SECTION XVI

TYPING

AND STENOGRAPHIC SKILLS

1. Typing (WPM)

2. Shorthand (WPM)

3. Indicate shorthand system used -check (X) appropriate item:

30

\ Stenotype

4. Indicate other business machines with which you have hod operating experience or training (comptometer, mimeograph, cord punch, etc.)

General office machines

SECTION XVIl

SPECIAL QUALIFIGATIONS

1. List all hobbies and sports in which you are active or have actively participated: Indicate your proficiency in each.

Swimming, Bowling, Flehing, Dancing - Anateur, but "hold my own"

2. Indicate any special qualifications resulting from experience or training which might fit you for a particular position or type of work..

Education, training and work experience in techniques and procedures of Electronic

Data Readout, Analysis and Evaluation, Maintenance and Operation of associated

Equipment.

3. Excluding business equipment or machines which you may have listed in item d, section XVI, list any special skills you possess relating to other equipment and machines such = ‹?

as operation of radio transmitters (indicate CW speed, sending & receiving), offsel preis, turret lathe, scientific & professional dovices.

Maintenance and Operation of Electronic Data Analysis and Readout oquipment

4. Are you now or have you ever been a licensed or certiffed member of any trade or profession such as pilot, alectricion, radio operator, teacher, lawyer

Yes

CPA, medical fochnician, psychologist, physician, etc.?

S. If you have answered "Yos"' lo item 4 above, indicate kind of licenso or cartification and the issuing State, municipality, ofe.

6. First License / Certificate (year of issue)

(Provide license registry number, if known)

NA

7. Latest License/ Certificate (yeor of issue)

NA

NA

8.

List any significant published materials of which you are the author (do NOT submil copies unless réquested): Indicate the title, publication date, and type of writing (non-;

fiction or scientific articles, general interest subjecis, novels; short stories, etc.)

NA

9. Indicate any devices which you have invented and state whether or not they are patented.

None. "i!

10. List public speaking and public relations experience.

None, other than college requirements and military training, as student and instructor

11. List ony profossional, acadomic or honorary associalions or societies of which you are now or, were formerly a member.

List academic honors you hove received.

Dean's List - University of Maryland

•-8.

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## Page 10

SECTION XVIII

1. Are you registered for the Draft under the Uni-

X

versal Military Training & Service Act of 1948

(as amended)?

4. Local Selective Service Board Number and Address

#53, Jessup-Blair House, Silver

MILITARY SERVICE

CURRENT DRAFT STATUS

Yes

2. Selective Service classification

No

11-0, 5-A at discharge

3. If deferred, give reason

NA

Spring, Maryland 20910

MILITARY SERVICE RECORD

Complore the following itoms for current and/or past active duty milltary sorvice with the Army, Novy, Air Forco, Marina Corps, Coast Guard, Merchan?

Morino, Notlonal Guard, Alr Notlonal Guard, or forelgn (non-U.S.) military organizatton.

for foreign military organization, spacity both nationality and

organization in Itam 1 balow.

1. Militory organization (Army, Nary, efc. -spacity)

2. Branch or Corps

3. Dates of service (extended active duty) Discharge effective

Moy 11, 1965

Present

Air Force

NA

A. Status. (Rogulor, Reserve, efc.-

specify)

5. Rank, grade or rato (at separation

6. Serial, service: or file number

if past service)

Regular

MSgt (P-1) E-7

AF13371224

From- Jan 8, 1951

7. Type of separation from

activo duty (insert number for,

type which applies-s0o

list below)

1954 -1

1959

8. Brief description of military duties (record the duties and skills which best describe your work or function in the militory service)

30173 - Electronic-Warfaro Technician, with duty in Meintenanco and Operation of

: Electronic Data Analysis equipment, Technical Advisor and Instructor inj

equipment maintenance and operation and analysis, mission and equipment

and technical requirements, problems and procedures.

64173 - AF Supply Supervisor, responsible for management, supervision and operation

of various organizational supply activities.

1. Military organization (Army, Nary, of. -specify)

2. Branch or Corps

3. Dates of service (extended active duty)

NA

A. Status (regular, reservo, eto.-

specify)

NA

NA

5. Rank, grade or rate (at separa-

tion if past service).

NA:

From - NA

To-

6."' Sérial, sorvice or Ale number

7: Type of separation from,

active duty (insert number for

type which applies- see

.. list below it

• NA

(2)

8. Brief description of military dúties.

÷1:

*: 01

NA

r'se.

Types of separation from

active duty -record

opplicable number in

items) 7 above

1 - Honorable discharge

2 - Release to inoclive duty

3 - Retirement for age

A - Retirement for service

5 - Retirement for combot disability

6 - Retirement for physical disability

7-Undue hardships

-Other-specify in

item 7 in lieu of

number

MILITARY RESERVE, NATIONAL GUARD & R.O.T.C. STATUS

Complora pha following |9oms il (1) yoù now hava reserve starus, (2) you aro a member of tha Narional Guard of Air National Guard, or (3) you áro a

member of the ROTC.

Check (X) Reserve, Guard or

ROTC organization to which

you belong

1. Current rank, grade or reto

Army

Marine Corps

Navy

Air Force

Date of appointment in current rank

NA

NA

National Guard

Air Nat'l Guard

3. Expiration date of current

reserve obligation

• NA

Coast Guord

Army ROTC:

4. ROTC cotegory number

Nary ROTC

Air Force ROTC

"NA":

5. Check (X) current reserve category

Ready Reserve

Standby (active)

Standby (inaclive)

0. Brief description of military reserre duties (record the dulies and skills which best describe your work, or finction in the militory service)

Retired

NA

7. Ií you are currently assigned to a Reserve, National Guard, or ROTC Training Unit,

identity the unit and its address

NA

8.

If you have a militory mobilization assignment, identify the unit and its oddress

NA

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## Page 11

SECTION XIX

EMPLOYMENT HISTORY

NOTE: LIST LAST POSITION FIRST.

Indlcate chronologica/history.ofemplo-montforpost15-years.se

/ with currant or most recent position.

Accouns

for all periods including casual employment and all portods of unemployment.

1o what you did during porlods uf unemploymone.

List all civilion employment by a forelgn govornment, rogardloss of datos.

In completing itom 10, "description of dutles", consider your exporionco

caratully and provide meaningful, objoctive statoments.

1. Inclusive dates' (From- 1o- by month & year)

Jun 64 to Present

3. Address (Number, Street, City, Slote, Country)

2. Name of employing firm or agency

Electronic Warfare Center

4. Indicate specific area or place of employment if other than address noted in ilem 3

363 Tac Recon Wg

Shaw ArB, South Carolina

NA

5. Kind of business

6. Name of supervisor

Electronic Intelligence

Edward Baumann, Captain, OIC Center

(1)

7. Tille of job Non-Commissioned Officer In Charge

8. Salary or earnings

9. Class; grade if Federal Service

and Chief, Maintenance and Supply

3273•50

_permon t allow

MSgt (P-1)

10. Description of duties responsible for overall operation of lenter, personnel duty assignments

and performance, coordination with related activities. Management and supervision of

procurement, installation, modification and maintenance of equipment. Accountable for

all Government property• Instructor to technicians and analysts. Technical Advisore

11. Reasons for leaving

Obtain civilian position

1. Inclusive dates (From — to— by month & year)

Jun 63 to Jun 64

3. Address (Number, Street, City, Stata, Country)

2. Name of employing firm or agency

Electronic Warfare Center

4. Indicate specific area or place of employment if other than address noted in item 3

363 Tac Recon Wg

Shaw AFB, South Carolina

NA

5. Kind of business

6. Nome of supervisor

Electronic Intelligence

Frank M Hayes, I/Lt Chief Maint & Supply

7. Title of job Non-Commissioned Officer In Charge

8. Salary or earnings

9. Closs; grade if Federal Service

Maintenance and Supply Section

$ 335.00 permon t allow

TSgt (P-1)

18: Dascriptien of duties Reaponsible for aupervision and

scheduling of installation, modification,

and maintenance of equipment and supplies, procurement of supplies and equipment.

Instructor to technicians and analysts on equipment operation and maintenance.

Iochnical Advisor on analysie, missione equipment and Technical requirementa se procedure

11. Reasons for leaving

Received promotion

1. Inclusive dates (From - to- by month & year)

Jun 61 to Jun 63

3. Address (Number, Street, City, State, Country)

2. Nome of employing firm or agency

USEUCOM Electronic Intelligence Center

4. Indicate specific area or place of employment if other than address noted in item 3

APO 633, New York, NY

NA

5. Kind of business

6. Name of supervisor

Electronic Intelligence

Leonard R Kver OWO Chief Maint & Supply

(3)

7. Title of jobNon-Commissioned Officer In Charge

8. Salary or earnings.

9. Class, grode if Federal Service

Maintenance Section

s 335.00 pomon t allow

TSgt (P-])

10. Description of dues responsible for supervision and scheduling of installation, modification.

and maintenance of equipment. Instructor to technicians and analysts on equipment

operation and maintenance. Technical Advisor on analysis and maintenance problems

and procedures. Execution of Special Projects.

11. Reasons for leaving

Overseas tour completed

1. Inclusive dates (From -to- by month & year)

Jun 59 to Jun 61

3. Address (Number Street, City, State, Country)

2. Name of employing firm or agency

USEUCOM Electronic Intelligence Center

4. Indicate specific area or place of employment if other than address given in item 3

(4)

APO 633, New York, NY

5. Kind of business

Electronic Intelligence

7. Title of job

Assistant NCOIO, Maintenance Technician

NA

6.: Name of supervisor

Harold W Orum MSgt NCOIO Maintenance

8. Solary or earnings

9. Class, grade if Federal Servico

s 270.00 por mon tablew

SSgt (P-1)

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Page 11

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## Page 12

EMPLOYMENT HISTORY (Continuer

10. Description of duties Assistant to NCOIO in supervision and scheduling of Maintenance Section

activities. As Maintenance Technician - Install, layout, modify, inspect, perform

preventative and corrective maintenance on operational equipment as directed by the

NCOIC. Instruct technicians and analysts in equip operation and maintenance procodures

11. Reasons for leaving

Received promotion

1. Inclusive dates (From - To - by month & year)

2. Name of employing firm or agency

Mar 58

to

Jun 59

Det it, 10 RAdar Bomb Scoring Squadron

3. Address (Number, Street, City, State, Country)

4. Indicate specific area or place of employment if other than address noted in item

Detachment has since moved. Squadron

McCarty Drive (Highway 90)

Headquarters at Carswell AFB, Texas

Houston, Texa

5. Nome of business

6. Name of supervisor

USAF (SAC) Radar Bomb Scoring and ECM

Huey P Porsche, SSgt, NCOIC ECM Section

7. Title of job

B. Salary or earnings

8. Class; grode i Fedoral Servico

Orew Chief, ECM Section

s 220.00 permon fallow

sSgt

10. Doscription of duties Supervisor of ECM Operatione and Maintenance Crew. Supervision ofoperation

and emergency maintenance during "on-watch" time, preventative and corrective maint.

daily on ground intercept and transmission equipment. Instructor for on-the-job and

cross training. Assistant to Detachment 00 on Supply difficulties.

11. Reasons for leaving

Reassigned (volunteer) overseas

1. Inclusive dotes (From - To - by month & year)

Jul 57 to

Feb 58

3. Address (Number, Streel, City, State, Country)

2. Name of employing firm or agency

3411 Student Squadron ::

4. Indicate specific area or place of employment if other than address noted in item 3

Keesler AFB, Mississippi

5. Kind of business

USAF Technical School

7. Title of job

Student

10. Description of duties UaSo Air Force Course No. AB

Specialist.

NA

6. Name of supervisor

NA

8. Salary or earnings

9. Class; grade it Federal Service

s 210.00 perIon f allew

SSgt

30330, Ground Electronic Countermeasures

11.

Reasons for leaving.

School completed

1. Inclusive dates (From -To- by month & year)

Jan 51

to Jul 57

3. Address (Number, Street, City, State, Country)

2. Name of employing firm or agency

Various AF unita

4. Indicate specific area or place of employment if other than address noted in Item 3

NA

5. Kind of business

USAF - Organizational Supply

NA

6. Name of supervisor

NA

8. Salary or earnings

Supply Supervisor or Specialist

s 210.00 per Ion t allew

9. Class; grade if Federal Service

Put to sSgt

10. Description of duties Supervise or work in various Air Force organizational supply activities.

Majority of assignments were in a supervisory. capacity

NOTE: Detailed listing of assignments on continuation sheet

11. Reasons for leaving

Retrain (volunteer) to Electronics field

If prior service with the Federal Government is noted above, indicate the number of years creditable

toward U.S. Civil Service Retirement, if known

(For Office Use Only)

Unk

=11=

PRES

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## Page 13

SECTION XX

CLUI

SOCIETIES, AND OTHER ORGANIZATIONS.

NOTE: List namos and addressos of all clubs, roclotlos, professional soclorios, employeo groupa e

havo balongod (include momborship In, or support of, any organization having hoadquartors or branch in a forolgn country).

ganizations of any kind to which you bolong or

Name and chapter

Address (Number, Street, City, State, Country)

(from)

Date of membership

(10)

None

SECTION

XX

1. Are you entirely dependent on your salary?

Yes.

2. If your answer is ''NO"' to the abore, state sources of other income

NA

FINANCIAL STATUS

No

3. Credit references (banking institutions, charge accounts, etc.)

Name of institution

Address (City, State, Country)

Madison & Bradford Ste Build & Loan Assoo

Baltimore, Maryland

South Carolina National Bank

Sumter, South Carolina

Prudential Life Insurance Co

Silver Spring, Maryland

Metropolitan Life Insurance

Co

A. Have you ever been in, or petitioned for, bankruptcy?

Yes

XX NO

5. If your answer is "YES" to the above, give particulors, including court and date(s)

NA

Silver Spring, Maryland

6. Do you receive on annuity from the Unifed States or District of Columbia Government under any retirement dict, pension, or compensation for military or naval servico?

No

7. If you answer is "YES" to the above question, give complete details

NA

8. Do you havé any financial inferest in, or official connections with, non-U.S. corporations or businetses or in or with U.S. corporationi or businesses hoving substantial foreign :

interests?

. Yos

I NO

Ill answer is "YES", furnish details in space bolow - Continue on separate sheel, if necessary)

10.19"°

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Page 13

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## Page 14

SECTION XXIII.

RESIDENCES FOR THE PAST 15 YEARS Including Reside.

maintained while in Military Service)

Address - last residence first (number, street, city, state, country)

Inclusive dates (month & year)

то-

90-A Azalea Drive, Shaw AFB, South Carolina 29152

42-B

Orchid Drive, Shaw AFB, South Carolina 29152

# Neptunestrasse, Orestview Housing, Wiesbaden, Germany

#3 Aschenbrodelweg, Wiesbaden, Germany

810 Kilroy Avenue, Houston, Texa

From --

Oct 63

Present

Jul 63

Oct 63

Nov 59

Jun 63

Jun 59

Nov 59

Apr 58

May 59

Rt #l, Box 93-A, Gulfport, Mississippi

220 McWhirk Blva, Bergetrom AFB, Texas

405 N 38th Street, Austin, Texas

221 Quaint Acres Drive, Silver Spring, Maryland

2024 Naylor Road SE, Washington, D.O.

SECTION XXIV

Aug 57

Jul 56

Mar 58

Jul 57

Jun 56

Jul 56

Dec 55

Jun 56

Jul 55

Dec 55

Name (last-first-middle)

Slyder, Richara L, Captain

REFERENCES

1. List five character references (not relatives) in the U.S. who know you intimately

Business Address

Genreal Delivery

Mather AFB, Callfornia

Unknown

544 Recon Tech Sq (SAO)

Offutt AFBe Nebraska

Defense Intell Agency

Washingtone D.0.

Residence Address

McClures Frank Be Major

Unknown

408 Kramer St SE

Borden, Thomas We Major

viennas

Virginia

617 Lycoming Street

Biebusch, Viola

Unknown:

Silver Springe Maryland

1715 E 30th Street

Buchholtz, Carl

Unknown

Baltimore, Maryland

2. List five persons in the U.S. who know you socially (not relatives, supervisors or employers)

Nome (last-first-middle)

Business Address

Residence Address

149 University Terrace

Bouchard, Paul B

Univ of South Carolina

Columbia, South Carolina

3215 Bennington Ave

Buchholtz, Horbert

Unknown

Fasadena, Texas

14 Washington Court

Chavez, Paul

Unknown

Mt. Pleasant, Michigan

124 Cherokee Trail

Earp, George

Uninown

Smyrna, Georgia

6734 Marmaduke Street

Schmitz,

Frank A

Unknown

St. Louis, Missouri

SECTION

XXV

PERSONAL DECLARATIONS

Do you adrocate or have you ever advocated, or are you now or have you ever been a riember of, or have you ever supported or been associaled

with ony political party, individual or organization which advocates or leaches the overthrow of the government of the United States by force, violence,

or other unconstitutional means, or sooks by force or violence to deny persons their rights under the Constitution of the United States?

• Yes

2 Il you have answered 'YES" to the question abore, explain

NA

X/ No

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## Page 15

3. Do you use or have you

ever used intoxicants?

XX

Yes

No

5. Do you use or have you

ever used narcotics?

Yes

PERSONAL DECLARATIONS (Continued)

4. It so, lo what extent?

Limited

6. It s0, 10 what extent?

No

Have you ever been a member of, or eupported, or hed amy con dectins with o foreign intelligence organization or its activities?

', give complete details:

8. List the nomes of Government departments, agencies or offices to which you have applied for employment since 1945

NSA - 1965

DIA - 1965

USAF- 1951, 1954, 1959

9. Il to your knowledge, any of the above have conducted an investigation of you, indicole the name of the agency and the approximate date of the investigalion

USAF-Top

Secret-BI 27 Feb 60 OSI Diat 70 USAFE Filod OSI Dist 4 Bolling AFB Wash DO

Secret-NAC 26 Jul 56 OSI Dist 4 bolling AFB Washington DO

Note Specia

If your answer is "Yos" to the following questions 10, 11 or 12, provide the information requestod for euch question on a separato,

Instructions

signed sheet and attach the shoot to this form in a sodlod envelopo.

10. Have you, or to your knowledge has your spouse, ever been detained, arrested, indicted, or convicted for ony violation of the low other than a minor traffic

violation (in which the fine was less than $25.00) in the U.S. or abroad?

If so, state name of court, city, State, country, date, nature of offense and

disposition of case in occordance with special instructions above.

Yes

No

1. Have you ever been arrested, court martialed or otherwise punished under military law or regulation? If so, describe incidents and provide date(s) of oc-

currence on a seporate sheet in accordance with instructions above.

Yes

No

2. Are there any incidents in your life (unfavorable) not mentioned above which may be discovered in subsequent investigation, whether you were directly

involved or not, which may require explanation?

If 50, describe incident(s) and provide date(s) of occurrence on separato sheet in accordance with special

• instructions above.

Yes

No

19. Have yeu ever been dismissed or asked te resign from any pesition?

Have you left a position under circumstances which you desire to explain?

14. If your answer to either or both questions in Item 13 above is "Yos,"

give details

X. No

NA

SECTION

! XXVI

PERSONS TO BE NOTIFIED IN CASE OF EMERGENCY

1. Name (Last-First--Middle)

Huber

Gottlieb

3. Home address (Number, Street, City, Stato, ZIP Codo)

J0I.

221 Quaint Acres Drive, Silver Spring, Maryland

5., Business address (Number, Street, City, State, ZIP Code) - indicate name of firm or employer, if applicable

2. Relotionship

Father

4. Home telephone number

MA 2-0697

6. Business telephone number & extension

Charles H. Thompking Co.

16th Street, NW, Washington,

DO

Unk

In case of emergency, other close relatives (spouse, mother, father

•) may also be notified.

If such notification is NOT desirable because of health or other reasons, please

identify. the persons not to be notified and the reason.

NA

SECTION XXVII

CERTIFICATION

YOU ARE INFORMED THAY THE ACCURACY OF ANY STATEMENT MADE IN THIS APPLICATION.

WILL BE INVESTIGATED

I have road and understand the instructions.

I corflly that the foregoing onswers are true and corract to the best of my knowledge ond bollet.

logros

Phat ony misstatoment or omission as to material fact will constitute grounds for immediato dismissal or rejection of my application.

I also understand

that any falso staremont mado heroin may be punishable by law (U.S. Codo, Tille 18, Section 1001).

1. Date of signatures

2., Signature of applicant

3.

ase

Signed at (City and State)

15

1263-1

best 3. tale

A. Signature of witness to identify applicant

Shaw AFB, South Carolina

Edivard

aumani

Capt. USAF

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Page 15

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## Page 16

Use the following space for extra details.

Reference each continued ilem by the section and item number to which it relates and sign your name

at thie end of the material.

If additional space is required beyond page 16, use extra pages the same size as this page and sign each such page.

SECTION VII

STEPMOTHER

1. Huber Elise B (Unk) Widow - Polzin Maiden - Unk

2. None

3. Oct I4, 1901

4. Stuttgart, Germany

5. Living 6. NA

7o NA 8. USA 9. Germany

10. Nov Il, 1950

1l. Baltimore, Maryland

12. 6094163

130 NA

14. May 1925

15. 221 Quaint Acres Drive, Silver Spring, Maryland

16 thru 22. NA.

SECTION XI

RELATIVES ABROAD

(6) 1. Levinsky Louise (Graf) & family 2. Aunt 3. Unk 4. Unterschutzen, Austria

5. Austria

6. Bezirk 2 Bocklingerstrasse 96 Vienna, Austria

7. Self (Bakery)

8. Seldon

9. Dec 1964

(7) Details of Step-mother's family in Germany unknown.

One contact only - July 1959,

alter driving vacationing parents from Rhein-Main airport to Stuttgart, Germany

SECTION XIX

EMPLOYMENT HISTORY

(7)a. Jun 56 to Jul 57

b. Jan 56 to Jun 56

Oct 54 to Dec 54

c. Aug 53

to Oct

d. Feb

53

54

to Aug

53

e. Aug 51

to Feb

53

f. Jun 51

to Jul

• 51

go Mar 51 to May 51

ho Jan 51 to Mar 51

(8) Oct 54 to Dec 54

523 Strategic Fighter Squadron, Bergstrom AFB, Texas

Det #4, 1110th Air Support Group, APO 214, New York

see (8)

3508 Periodic Maintenance Squadron, Greenville AFB, Mississippi

3506 Maintenance Squadron, Greenville AFB, Mississippi

3405 Food Service Squadron, Goodfellow AFB, Texas

3405 Air Base Group, Goodfellow AFB, Texas

AB 64IXX AF Supply Technical School, Lowry AFB, Colorado

Basic Training, Lackland AFB, Texas

Student - University of Benjamin Franklin, Washington, D.C.

Part-time Produce Clerk, Giant Food Stores Inc, Wash, D.C.

Re-enlist USAF

(9) Sep 50 to Dec 50

Student - University of Benjamin Franklin, Washington, D.C.

•Enlist USAF

(10) • Jun 50 to Sep 50

Summer Job - Laborer, Charles H Thompkins Co, Washington, D.C.

(11) Sep 49 to Jun 50

Student, University of Maryland, College Park, Maryland

SECTION XXIII

RESIDENCES

2315 Naylor Road SE, Washington, D.C.

9823 Dallas Avenue, Silver Spring, Maryland

615 Lycoming Street, Silver Spring, Maryland

1007. Dukeland Avenue, Baltimore, Maryland

Feb

55

May

5

Jun

48

Jan

• 31

to

to

to

to

Jul 55

Feb

May

55

51

Jun 48

Lurts.

(Signature)

Space for extra details continued on page 16-

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## Page 17

SECRET CLEARENCES

TOP SECRET - Mar 9, 1960, BI - February 27, 1960, OSI Dist 70 USAFE

Filed OSI Diatriot 4, Bolling AFB, Washington, D.O.

SECRET - Auguet ?, 1956, NAO - July 26, 1956, OSI Diet 4 Wash, D.0.

74 53294

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Page 17

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