FORM: REQUEST FOR NAME CHECK
Agency: CIA
Originator: STAT
From: PARIS
To: VISIT OFFICE
Document date: 02/28/1964
Document type: PAPER-TEXTUAL DOCUMENT

## Page 1

104-10519-10178

DEFARE

OF

STATE

TORRION CERVICE OF IME UNISO BATSE OF AVETE

REQUEST FOR NAME CHECK

Dopartene al State

→ Visa Ofibro

HGRANT

NONIMMIGRANT

Jeo aume, allaser, ele.

&. DATE

Fabrusry 17/66

TROI

PARIS

ACTION ARQUIETED®

ADVIBONT

MISAS PIRINKEr and

B. PLUCK OF BIRTH

". DATE OF BIRTN

pastedos de GuiDos, Las Villas, Cuba 12/31/36:

D. ASSENT ADEREN

so souiovard soundano parto 1ho. Pranco

Đ: 89 Tema 2n

8D. RIFI

SO NONNO MARNE OF TONIFICATION

18. 904/ 12 MARITAL GTATUE

-M:

Hert dod.

16: OCCUPATION (Inciada nume gad godi

IS. HETIONALITY

Physlotan

Cuban

10. DESTINATION OR ITINERARY IN U. A.

3096 Nontrand Avenue, Brooklyn 29, lou Yerte

17. READON FOR REQUEST, OR TYPE OF PAOBRAN

Cuban National

20, FATHER'S NAME

EIIZ FONSICA, PodrO

AT. MOTHER E MAIDEN NAME

QUINT DO, Roga Merl

z2.

epouis (Maldes nane)

DNEAe. Angola:

23, APPLICANT TO DI ACCOMPANIED BY:

viêe & Bon

10. LENGTH OF STAY

19: TYPE PASSPORT,

Parmanant

Cuben

26. RESIDENCES PAST 1S YARE (Doles, streel addremes, chios countrion

1936 so 9568, Santo Dolcio, Les VIliAe, Cuba.

1961 20 1966, para a0 11.90

2-28-44

2B. RELATIVKS IN U. S: (Mamas, streal midrescos, eldos, statos):

MIgnaL ANGI GONEZ SILVA, 1459 Nolol la Stest, Miori, Florida,

Frani PIETRO, Tha vost End Plasa, 378 lest eà Meo Antis0, Mou York 2i, M/I.

78. AFPILIATIONE

lione-

bd

¡REQUESTUYS OFFICER

DATE

• Bours to Vea Offes

RESULTS OF THIS RIQUEST.

[] NO RECORD

I NO DEROGATORY INFORMATION

CHECKED BY

(For use of DEiw di Serraly)

L SECURITY INFORMATION ATTACHIO

[OTNER (Sto Delow)

DATE

REMARKE

ND

6 Parch 64

2.91. P.

FORA FS-493

10-01

107016

FILE IN 201-3211947

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