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Released under the John F. Kennedy

Assassination Records Collection Act of

992 (44 USC 2107 Note). Case#:NW

B6613 Date: 03-18-2025

Date

: 01/20/98

Page

: 1

JFK ASSASSINATION SYSTEM

IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : INSCOM/CSF

RECORD NUMBER

:194-10004-10143

RECORDS SERIES

: DOD-AFFILIATED PERSONNEL INCIDENT INVESTIGATIONS

AGENCY FILE NUMBER

: PAGES 384-385

DOCUMENT INFORMATION

ORIGINATOR : USA

FROM

HEADQUARTERS, USAINTC

TO

:

TITLE

: [ RESTRICTED ]

DATE

: 01/18/67

PAGES

: 2

SUBJECTS : FROMER, DAVID R.

LEGAL ADVICE

DOCUMENT TYPE : PAPER, TEXTUAL DOCUMENT

CLASSIFICATION

: UNCLASSIFIED

RESTRICTIONS

: 3

CURRENT STATUS

: RELEASED WITH DELETIONS

DATE OF LAST REVIEW : 03/07/95

OPENING CRITERIA

COMMENTS

NW 83613 Docld:34523584 Page 1

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US ARMY REQUESI FOR

itt

1. DATE OF REQUEST

18 Jan 67

51

(AR. 38%0135;

2. CONTROL OFFICE: DOD NAC Center, FO

2ox 4,

Hort Holabird, Md. 21219

3. LASI NAME FIRSTINAME - MIDDLE NAME • ALIASIES) • NICKNAMES - CHANGED NAME

FROMER, David Reed

5. DAY. MONTH. YEAR OF BIRTH

6. PLACE

OF BIRTH

21 July 1942

Chicago, Cook, Illinois

8. RELATIVE'S NAMES

9. DATE AND PLACE OF BIRTH

O. FATHER

12 Jul 1913

Irving Fromer

Cincinnati, Ohio

b: MOTHER (maiden name)

31 Dec 1909

Katherine Rhodes

Estherville, Iowa

14

10. PRESEN? ADDRESS

13 Rhonda Way

Mill Valley, Callf.

13 Rhonda Way

Mill Valley, Calife

c. SPOUSE (maiden name)

None

4. SOCIAL SECURITY NO.

564-58-8137

7. SERVICE NUMBER

11. CITIZENSHIP

U.s.

U. Se

12. RESIDENCES (List all from loth birthday or during last 15 years, whichever is shorter)

a. FROM

b. то

c. NUMBER AND STREET

d. CITY

e. STATE

1950

1960

1960

1961

1932 Cabrillo St.

San Francisco

Calif.

2450 Bencroft Way

Berkeley

1961

1962

881 Clayton St.

San Francisco

Cal1f.

Calif.

1962

219 N. Basset

1963

Madison

Wisconsin

215 Lake Lawn Ave.

MadISOn

7866

1864

1a27 Initersity Ave.

Madison

1SCONS1

1965

1966EMPLOYM#55 /Wt aNorthlaweirthday or during last 15 years, wasticagoshorter)

Illinois

a. FROM

b. то

C. EMPLOYER

d. PLACE

DEC 1959

Dec 1959

Paul Dler Bookstore

San Francisco, Callf.

Summer

' 60

San Francisco Council Camp Fire

• Girls San Franoisco, Callf.

1960

1961

Fairmont Hotel

San Francisco, Callf.

1961

1962

Foster's Restaurant

San Francisco, Callf.

Summer 1962 & 1963

Madison Board of Education Rec.

Madison, Wisconsin

Fa11 1962

Clark Service Station

14. LAST CIVILIANIEO

OOL

TO

cupy

Madison, Wisconsin

o.

FROM

b.

C. NAME

1966

Present

University of Wisconsin

YES

NO

IGATION

Ud. PLACE

Madison, Wisconsin

15. ITEM ("Yes" answers are expanded @pRemarks) " an

IS THE SUBJECT AN ALIEN OR A NATURALIZED CITIZEN OF THE UNITED STATECHNI

b.

ANY FOREIGN CONNECTIONS, INTERESTS, EMPLOYMENT OR MILITARY SERVICE?

C.

ANY FOREIGN TRAVEL OTHER THAN FOR THE UNITED D

Spoon

d.

EMPLOYMENT BY A FIRM HAVING A CLASSIFIED US GOVEENMENT

KATY CENTER

23202

e.

FORMER US GOVERNMENT EMPLOYMENT OR MILITARY

f. ANY QUALIFICATION OF DO FORM 398 OR DD FORM 987

El'ffolabird, Md.

g. ANY ARREST OR COURT RECORD?

16. REMARKS

(If additional space is needed, continue on plain paper)

Item 12.

1966 to Present

13 Rhonda Way, Mil

1966 to Present

140 Langdon Street, Madigon, Wisconsin

Item 13.

Oct 65 50 June 66

tome chee

Cooks Cupboard, 1718 Walls, St., Chicago, Illinois

Employer: Bob Geroge Reason:

Return to S.Ÿ.

Item 15.

Registrant refused to execute DD Form 98 and explained in the remarks section

Also refused to answer Item 17 and answered affirmatively Itemi19 and

explained in the remarks section.

Refused to be fingerprinted

a150. (NE:)

17.

CONTROL OFFICE USE

18. FROM:

nac completed

HEADQUARTERS, USAINTC

ATIN: ICOP-III -31

FOR THE DIRECTOR. KElL FEB 1 8 1967

Fort Holabira, Ma. 21219

(6.353-6004

FORM

DA, FUG 6 3027

FINGERPRINT CARD FD 258 MUST BE ATTACHED

REPLACES OR FORM 34A

0238 MUST BE BACHOEV l 705100/212 80,

Erom automatio termination, 230

NW 83613 Docld:34523584 Page 2

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## Page 3

(6353-6004) 18 Jan

67

FROMER, David Reed

DPOB:

21 Jul 42; Chicago, Ilinois

Con't - Item 16 (Remarks)

Item 15 - SUBJECT explained in the "Remarks" section as follows: "(I have not

done anything that 1 am not proud of) - I have been advised by my attorneys that

I cannot sign this form without placting myself in jeapardy: Peter Franck -

personal attorney, Vincent Hallinan - family attorney."

FBI reports, San Francisco, California, titled: David Reed FROMER, with

Bureau File #: 100-433071, dating from 3 May 1960 to the latest dated 23

November 1966, are in the possession of this office. Request any additional

and/or subsequent information.

385

2

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