WITHHELD
Originator: CIA
From: WITHHELD
Document date: 07/07/1959
Document type: OFFICE PAPER, ROUTING SHEET, PHONE MESSAGES

## Page 1

104-10073-10081

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

MIS

BLANK FORM IS CLASSI

1. SUBJECT (NAME, IN ROMAN LETTERS AID IN NORMAL ORDER)

SECRET

Z. ALIASES: VARIANT SPELLIMGS, CIC-NUMBERS, ETC.

NA

09

3. BIRTH DATE

(27 March 1925)

4: BIRTH PLACE

5. CITIZENSHIP

(LA BAD BOLINE XPEDITE

BoliviAn

6. PRESENT ACTIVITY AND LOCATION

Benancia Burgos, no nunber

Secratary of Miniator of Governnent:

OCCUPATLONAL SPECIALTIES, EDUCATION

Graduated 19o Colegio "Lourdes")in

La Pas

8.

MILITARY SERVICE

: SERVICE ARM, COUNTRY:

SPECIALTY

NA

9. PAST. OCCUPATIONS

ACTIVITY

(Socrotary of Miniater of Goverzont'

RESPONSE TO GREEN LIST

REQUESTN®

92985

DATE OF REQUEST _ 1 JOlT 1959

REQUEST FROM

NAME

OF SRIGIMATING OFFICER

OFFICE DESIGNATOR

WH/I

ROOM, BUILDING

EXTENSION

2122 Barton, Hatl

4913

14. WAS CONTINUING SEARCH REQUESTED?-

YES

но?

15. TYPE OF REQUEST

ELFIRST TIME SUBMITTED

ADDITIONAL

DATA

COVER

16.

INTEREST IN SUBJECT

ESPIONAGE OR CE ACTIVITY

I OPERATiONAL CLEARANCE

OTHER

17°

INFORMATION REQUIRED ArU Intelligenc

or Carmintot astirity.

LOCATION

DAtES

DATES.

LOCAT I.,N

Pas

V/N

10. DESCRIPTION

: (HEIGHT)

(WEIGHT)

÷5'1"

99 108

SPOUSE (IF WIFE, GIVE MAIDEN NAME)

Cormen

AiserTeCa Rivas ) 0b

12. OTHER MEMBERS OF IMMEDTATE: FAMILY, AND ASSOCIATES

Children:

Rocardo. 06,06

H0e10

(EYES) .:

Ork Ern

(HAIR) -

(RACE) :

Black

THER)

13. OTHER SIGNIFICANT DATA (POLITICS, RELIGION, ETC)

ATTACH EXTRA SHEETS WHEN MEEDED

Cathollo

INSTRUCTIONS:

INSERT CARBON; FILL. OUT FORMS COMPLETELY.

SEND BOTH SHEETS TO FI/D.

SEE CS1-10-7

AFTER USE TEN

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