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Released under the John F. Kennedy

Assassination Records Collection Act of

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

B8613 Date: 03-18-2025

Date : 01/20/98

Page : 1

JFK ASSASSINATION SYSTEM

IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : INSCOM/CSF

RECORD

NUMBER

: 194-10004-10142.

RECORDS SERIES : DOD-AFFILIATED PERSONNEL INCIDENT INVESTIGATIONS

AGENCY FILE NUMBER : PAGES 382-383

DOCUMENT INFORMATION

ORIGINATOR : USA

FROM : HAYASHIDA, MYRON K.

TO : USA INTELLIGENCE COMMAND

TITLE : ( RESTRICTED ]

DATE : 02/21/67

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 88613 Docid:34528583 Page 1

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US ARMY REQUES

REQUE

IT FEB 967

CONTROL OFFICE:

PRobul, David Read

DAY, MONTH, YEAR OF BIRTW

E1 Jul 19:2

A, RELATIVE'S NAMES

GAFATHER.

Irving Fronai

S; MOTHER (moidan nomo)

Katherite Thodes

SPOUSE (maiden nomot

Nore

• BIRTH di

Chicago, Cook,

I111n018

31-S A-BI

9. DATE AND PLACE OF BIRTH

1p. PRESENT ADDRESS

12 Ju1 1913

13 Fhonda Way

Cincimatt,

Oh1o

Mill Valley, Calli.

31 Dee 1909

13 Rhonda Way

Estrarville, Iowa

Mll Valley, Calife

564-58-8137

7. SERVICE NUMBEN

realiti

11. CITIZENSHIF

Ve Se.

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

Or FROM

b. TO

c. NUMBER AND STREET

d. CITY

2950

1960

1960

1932 Cobrillo St.

San Francisco

1951

2450 Beneroft Way

2961

Berkeley

1962.

156₴

881 Clayton REQUEST COPY OF RESULTS

Ban Francisco

219 N. Basset

1963

IC

fadison

1962

di FROM

в. то

020 2959

Doc 1959

dall Dier Bookstore

investigative

Sunter

1960%

1051

1961

1962:

Suncar 1962 &.1963

9117. 1062

B. STATE:

Ca11f.

calff. "

Calff.

Wisconsin

NiECONTIN

147

Falimont Hotel

Foster'& Restaurant

Madison Board of Educati

flaT gardenStation

16.

14. LAST CIVILIAN

OL

Madison, Wisconsin

Hartoon sitincontin

1966

YES

TO

Present

C.. NAME

Univereity of Wisconsin

13. ITEM: ("Yes"

IGATION

ОДУ.

PLACE

Malison, Wiscongin

answers are

0. IS THE SUBJECT AN ALIEN OR A NATURALIZE

expanded @i/gmarks)

CITIZEN OR ARE UNUTER STATEO CR

D. ANY FOREIGN CONNECTIONS, INTERESTS. EMPLOYMENT OF

ITARY SERVICE?

ANY FDREIGN TRAVEL OTHER THAN FORTHEN ED E

WENT

di EMPLOYMENT BY A FIRM HAVING A CLASSIFIED US GOV

Уколіта

0., FORMER US GOVERNMENT EMPLOYMENT OR MILITARY

t. ANY QUALIFICATION OF DO FORM 398 OR OD FORM

g..

ANY ARREST OR COURT RECORDI.

• REMARKS

(ll addiltonal space is needed, continuo an plat paper)

CONDuCT FBI-S WHICH WAS OMITTED AREN

DRIGINAL NAC. NO ADDITONAL DATA LUI FILES

I

PERTINENT TO YOUR INCORY.

Subsequent

11-23-66.

17.

CONTROL OFFICE USE

nac completed,

MAR 6 9 196°

FOR THE DIRECTOR & KIll MAR 091967

18. FROM:

DCofS, Operations

Headquarters, USAINTC

ATTN: ICOP III

19.

THRU:

Fort Holabird, Maryland 21219

38₴

FEB 2 4 1967

240

FINGERPRINT CARD FD 258 MUST BE ATTACHED

IMPLACES DA FORM 340.

DA 143027 6353-6000

1 DEC 58. WHICH IS OBSOLETE.

0953/51

NW 88613 Docld:34528583 Page 2

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- (6953-6004) 18 Jan

FROMER, David Reed

DPOB:

21 Jul 42; Chicago, Dlinois

Con't - Item 16 (Remarks)

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

done anything that I 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

lovember 1966

and/or subsequent information.

2

383

-T7r1549 1-

NW 83613 Docld:34523583 Page 3

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