PERSONAL RECORD QUESTIONNAIRE PART II (ILLEGIBLE)
Originator: CIA
Document date: 01/01/0000
Document type: PAPER - TEXTUAL DOCUMENT

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104-10218-10180

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

"SEORSECRET POK

PRO NO.

5.

PERSONAL RECORD QUESTIONNAIRE

PART II - OPERATIONAL INFORMATION

DISPATCH NO.

INSTRUCTIONS TO CASE -FFICER

Thes

fors suat be falled in by

the case officer of appropriate authority on tha basse of the beat availablo ima

issue an approvas uniest requester

furniates

gradera to all

questions

provisional approval may be obtagned by complying outh the ap

126 and i2d.

Theroaltei

the

usual nornos lo

document or coo-

FR

fill

en all.

for iper.

CRYFTONYM

if

side

in subsc pa bonderstine, il portable, and 100 (2) c00-

idqua

10150 (2) coples

i son oberia do appropread l emplocable anure "va." Il addecional apoco required

2. PSEUDONYM

SECTION I

COMTACT AND DEVELOPMENT

1. INDICATE HOM, ANEM, OHERE, MMY, AN BY WHOM SUBJECT HAS FIRST CUNTACTEO OR DEVELOPED.

....:..

i :

::::

INDICATE

HANDLING.

ANETHER SUBJICT COULD

IF 50.

PADICATE TO ANOM.

BE TURNED OVER QUICKLY AND IN A SECURE MANNER TO ANY RESPOASIBLE CASE OFFICER FOR

line thrilland.

LIST OTHER CASE OFFICERS MHO HAVE MAMOLED SUOJECT OR WHOM HE ANDAS OR HAS ANORN.

GIVE NAMES

AY MICH THEY HAVE

BEEN KADAN.

7099 1050a

S..:

?,t.

SECRET

18-201

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-÷.

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SECTION 11

HOT

IVATION

AND COATROL

ESTIMATE SUBUICT'S MOTIVATION, (Be derailed, if posseble cere

evidence. Du suf une srock content bich as

..

INDICATE DNA: CONTROL, IF ANY, EXISTS OVER THE SUBJECT. (11 nO COMErOS.

or il there in a lack of real control

explain. )

SECTION 111

COVER

1. COVER USEO BY SUBJECT AND CASE OFFICER IN THEIR MEETINGS.

i:..

i..

2. COVER USEO EN SUBIECT IN OSTRINING HIS IAFORMATION

AND IN CONTACTINS HIS INFORUITS.

:::".

-:

J.- INDICATE SERVICE FOR AMICH SUBJECT THIMES NE (UIll MOrA) (IS GOrKInE).

!!:'

SECTION IV

INTELLIGENCE CONNECTIONS AND TRAINING

EXPLAIN SUBLET'S ANONY PAST OR PRISENT CONGCCTION MITH ANY OIMER INIELLIGEACE SERRICE.

SUCH CONNLESIJA IS ANONY OVERTLY.

THE EXTENT

LIST OTHER

INDIVIQUALS (Arents.

relatives, friends) 4нО х43e 0F

SUBJECT'S PRESENT

INTELLIGENCE ACTIVITIES.

3.

EXPLAIN AAY

TRAINING SUBJECT HAS HAD IN CLANDESTINE OPERATIONS.

"'т.

1:1001d:

...

kai

SECTION Y

1.

INDICATE OTHER

ASSOCIATIONS.

EXPLAIN.

COLLABORATION POTENTIAL

FOREICH POMER SUBJECT MOULD BE MOST LIKELY TO COLLABORATE DITH

cLus

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SECTION VI

SUBJECT

i to

SECRET

OPERATIONAL USE -

CONTACT

BEEL

USED DA COMTACIED BEFOR", "ADICATE ACTIVITY IN MNICH ME MAS FAGAGEO AND THE IURE OF INTON.

..di...

.??i."

!!'..u

_UPAS

littal...

INDICATE HOM AND FROM DHOW SUBJECT OBTAINS INFORMATION.

3. MEDICATE ANAY HAS BEEN TOLD SUBJECT AS TO THE DISPOSITION OF INSORMATION ME FURNISMES.

DETAIL

SUBJECT'S PROPOSED FI ORCI

TYPE USE OR DUTIES.

S. DETAIL SUBJEC-S PASPOSED PA-PU TEPE USE OR DUTIES.

1car

SECTION VIL

PROPOSED LIAISCH OR OPERATIOMAL ACTIVITY

1.

DETAIL SUBJECT'S PASPOSIO LUDISOS TYPE CONTESI OR DRERATIONAL USE.

A. PHERE SUBJECT IS IN OFFICIAL MEMBER OF A FOREIGY GOVERNMENT:

B. SHERE SUBJECT IS AN OFFICIAL MEMBER OF AN ODYOKE AGENCY.

SECTIOR VIVI

AGENCY RELATIONSHIP WITH SUBJECT

" PERSONNEL

NATURE OF AGENCY

AUREN TO SENSE PELATIONSHIP MITH SUBJECT: I.E. TRAINEE, OPPOSITE NUMBER, REMUNERATION. IF ANY, AGENCY

Maniacold Contridages,

149/5720-41.12

!

no til la manitred insisten,

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SECTIGN IX

QUALIFICATIONS FOR GHER OPERATIONS

INDICATE

SPECIAL ABILITIES, PALENIS, DA QUAI

FOR OTNER

OPERATIONS.

-ACATIIN- POSSESSED DY SUBJECI OMICA COULD LONCEIVADLY BE OF VALUE

SECTION X

COMHITHENTS

IF IT IS PROPOSED

COUMODITIES.

sUASIdY

OR

SUBJECT A REGULAR

SALARY.

INDICAT

THE MEENLY AMOUNT, IF PAYMENT TO DE MADE ON EXCHANGE

OTHER MEINOD, SPECIFY AND GIVE DETAILS.

EXPLUG ANY PROMISES, OTHERMISE NOS COVERED HEREIN, MADE TO SUBJECT. (ExaRDle: CoRdilments roRnedIna crecuatIon

No commitments.

Monstei

SECTION XI

CE AND SECURITY

LIDICATE THE FIELD AGENCILS AND FIELO FILES WITH WHICH

SUBJECT'S NAME HAS DEEM CHECRED AND THE RESULTS.

Nude

INDICATE UTMER INVESTIGATIVE MEASURES TAKEN TO VERIFY BIOGHAPHICHL INFORMATION FURNISHED BY SUBJECT.

Subject was LCiLUrDeRed & beniquarters (sec Resiganers' tits).

PROVA STORE OR PRAY SION A CREDALLO DO APPROVAL OR OPERATIONAL ARI

FOR SUBJECT'S USE HAS

DA. DATE APOROVAL OSIRINEÙ

EVALUATE SUBJECT'S CHARACTER, RELIABILITY AND SECURITY, CITING EVIDENCE NVERE POSSIBLE.

During the perica arijeer has nortod in biexico, dhe his come arrack id li very decu

conscious arr periabir.

A haugh sub..

CD::

neerge or ENLUCh ho subjacts promiscuit: boun a thied to ecurly.

41, st0-1486

6. EXPLRIN

ANY SITUATION

OR INDISCRETIDN IN UNICH SUBJECT MAY HAVE BEES INVOLVED OMICH MUST BE EVALUATED FRON A

CE/OPERATIONAL SECURITY VIEMPOINT.

Subjecis close relicenship wüh Llock.

Subject a ovuri (magazin, article) alidering the Castro Regae has Wearened her

posicion elong the Castro folliers in Maxico.

Subje

Molic notoriety la aisc

mart di conomieration (see Parade article-, ugust 1963).

SUBJECT'S PERSONAL MADITS

SECTION XLI

8. USE OF LIQUOR, DRUGS: GAMBLING, PARAMOURS.

Subjeci is known to drink socially. (uve Hendquarters fliss re Subject's past.)

Excladid iT:

donagt":

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SECTION XIII

AVOCATIONAL INTERESTS

1. INDICATE SUBJECT•S MOBBIES ER INTEREST IN SPORTS, MUSIC, ETC.

Subjeer is inrensated in the aris in genurol.

SECTION XIY

GENERAL

HOLLATE

HAK THER -0.0101, 14400601

ABILITIES

OF A COUNTRY OR REGION OTHE

THAN HIS ORN.

AND

OTHER CHARACTERISTICS.

ARE SUCH AS HE COULD PASS

AS

EXPLAIN.

No

INDICATE

WHETHER INFORMATICE

10 PRO PARTS I AND 11 MAS OBTAINED BY RESTARCH, CLANDESTINE ASSESSUENT. FILES.

CORRESPONDENCE OR OTHER MERAS.

Sunteer provinci tho intormarion contained in PRO Par i.

2N0 Pari Il win: Cutalned from Headquati ra' file dad ta: Care Orficoi.

ROUTINE ACTION IS REQUIRED, IF AND ANEN TERMINATION OF SUBJICT IS EFFECTED, PLEASE EXPLAIN. (AITO

supra,)

No

SECTION XV

EMERGENCY CONDITIOMS RECCNTACT ARRANGENENTS

GIVE FULL DETAILS I.E, RECOESITION SIGNALS, SINI MHERE COULD CONTACT BE MADES SHAT BORA FIDES COULO INDIVIDUAL

MAKING CONTACT USE?.

In as much s: subject le an utericon clilien, emergone; contact plan is

subjeci cen max: contact wich the caso oricer di tac

CDACID insteilcion.

SECTICK XVI

MISCELLAKEOUS OPERATIOHAL DATA AND REMARKS

DATE

SIGNATUR

a. muse :66?

Stusseton

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