## Page 1

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104-10129-10002

DO NOT USE

ISSUED BY

2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992

IHIS SPACE

THIS DATE (FMI In)

PERSONAL HISTORY STATEMENT

AUGUST 31,1961

INSTRUCTIONS

1. Answer all questions completely or check appropriate box. If question is not applicable, write "NA". Write *Un-

known" only if you do not know the answer and it cannot be obtained from personal records. Use blank space at

end of form for extra details on any question for which you have insufficient space.

2. Type, print or write carefully; illegible or incomplete forms will not receive consideration.

3. Consider your answers carefully. Your signature at the end of this form will certify to their correctness. Careful

completion of all applicable questions will permit review of your qualifications to the best advantage.

SECTION 1

GENERAL PERSONAL AND PHYSICAL DATA

1. FULL NAME (Last-First-Middle)

2. AGE

4. HEIGHT

RODRIGUEZ I

EMiLiO AMERiCa

3. SEX

5. WEIGHT

6. COLOR OF EYES

33 YEARS 8 MONTHS MALE

7. COLOR OF HAIR

B. TYPE COMPLEXION

SET.10IN

150/bs.

BROWN

BLACK

10. SCARS (Type and Location)

KUDDY

FEMALE

9. TYPE BUILD

MEDIUM

NONE

11. OTHER DISTINGUSHING PHYSICAL FEATURES

NONE

12. CURRENT ADDRESS (No., Street, City, Zone, State and Country)

9361 S. W.' 178 ST.

PERRINE 57, FLA

Ч.S.

14. CURRENT PHONE NO.

15. OFFICE PHONE NO. & EXT.

CEdaR 5- 8341)

NA.

17. NICKNAMES

113. PERMANENT ADDRESS (No., Street, City, Zone, State and

Country) AND PHONE NO.

19361S.W.178-57.1

PHONE:

PERRINE 57, FLA.

CEdAR 5-8341

4. 5. А.

16. LEGAL RESIDENCE (State, Territory or Country)

FLORIDA, 4.S.A.

18. OTHER NAMES YOU HAVE USED

NONE

EUGENIO

GONZALEZ,

19. INDICATE CIRCUMSTANCES (Including Length of Time) UNDER WHICH YOU HAVE EVER USED THESE NAMES.

FROM APRIL 1960 TO PRESENT IN HAVANA, CUBA ANO MIAMI, FLA. AS UNDERCOUER NAME

20. IF LEGAL CHANGE, GIVE PARTICULARS (Where and by What Authority).

N.A.

SECTION II

POSITION DATA

1. INDICATE THE TYPE OF WORK OR POSITION FOR WHICH YOU ARE APPLYING

CONTRACT

AGENT

2. INDICATE THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL

ACCEPT (You will not be considered for any position with a lower

3. DATE AVAILABLE FOR EMPLOYMENT

entrenco salary).

9,600.00

CONTRACT ALREADY SIGNED:

A. INDICATE YOUR WILLINGNESS TO TRAVEL

OCCASIONALLY

FREQUENTLY

XCONSTANTLY

OTHER:

5. INDICATE YOUR WILLINGNESS TO ACCEPT ASSIGNMENT IN THE FOLLOWING LOCATIONS (Chock (X) oach item applicablo)

WASHINGTON. D.C. X ANYWHERE IN U.S. X

CERTAIN LOCATIONS ONLY (Specify):

OUTSIDE CONTINENTAL U.S.

6. INDICATE WHAT RESERVATIONS YOU WOULD PLACE ON ASSIGNMENTS OUTSIDE THE WASHINGTON, D.C. AREA.

ADEQUATE PAY AND LIVING CONDITIONS FOR

SELF AND FAMILY

FORM 444 USE PREVIOUS EDITION.

11-58

(4)

-1.

---

## Page 2

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-2-

SECTION IN

CITIZENSHIP

1. DATE OF BIRTH

12. PLACE OF BIRTH (City, Stale, "Country)

3. PRESENT CITIZENSHIP (Country)

JAN. 27,1928.

HAVANA, CUBA

4.S

. A •

4. CITIZENSHIP ACQUIRED BY

_S. PREE NATURAL-

6. NATURALIZATION CERTIFICATE NO.

MARRIAGE X OTHER (Specily):NATURA. DECEMBER 15,1949

#6799255)

7. COURT ISSUING NATURALIZATION CERTIFICATE

|8. ISSUED AT (City, Stase, Country)

4.5. DISTRICT COuRT OF EASTERN DIST. OF LOUISIANA

New ORLEANS, LA.

9. HAVE YOU HELD PREVIOUS NATIONALITY

10. IF YES, GIVE NAME OF COUNTRY

XYES

NO

СИВА

11. GIVE PARTICULARS CONCERNING PREVIOUS NATIONALITY.

CUBAN BY BIRTH

12. HAVE YOU TAKEN STEPS TO CHANGE

YES

13. GIVE PARTICULARS

PRESENT CITIZENSHIP

N. A.

14. IF YOU HAVE APPLIED FOR U.S. CITIZENSHIP, WHAT IS

PRESENT STATUS OF YOUR APPLICATION (Firat Papors, Etc.)?

N. A

15. DATE OF ARRIVAL IN U.S.

16. PORT OF ENTRY

17. ON PASSPORT OF WHAT COUNTRY

VUNEG

1961

8. LAST U.S. VISA (No., Type, Place of Is que

MIAMI, FLA.

SWISS PROTECTIVE PASSPORT

19. DATE VISA ISSUED

SECTION IV

RESIDENT, H.S. EMBASSY IN HAVANA, CUBA

EDUCATION

Nov. 1942

1. CHECK (X) HIGHEST LEVEL OF EDUCATION ATTAINED

LESS THAN HIGH SCHOOL GRADUATE

OVER TWO YEARS OF COLLEGE -NO DEGREE

HIGH SCHOOL GRADUATE

BACHELOR'S DEGREE

TRADE, BUSINESS, OR COMMERCIAL SCHOOL GRADUATE

GRADUATE STUDY LEADING TO HIGHER DEGREE

TWO YEARS COLLEGÉ OR LESS

MASTER'S DEGREE

DOCTOR'S DEGREE

2. ELEMENTARY SCHOOL

1. NAME OF ELEMENTARY SCHOOL

2. ADDRESS (City, State, Country)

COLEGIO DE LA SALLE

HAVANA, CUBA

3. DATES ATTENDED (From-and-To)

Sep.

A. GRADUATE

1934

• to Nov. 1942

1. NAME OF HIGH SCHOOL

ALCEE FORTIER HIGH SCHOOL.

3. DATES ATTENDED (From-and-To)

XI

YES

NO

3. HIGH SCHOOL

2. ADDRESS (City, Stato, Country)

NEW ORLEANS, LA.

4. GRADUATE

Nov. 1942

to

JuNe 1845

1. NAME OF HIGH SCHOOL

YES

2. ADDRESS (City, State, Country)

NO

3. DATES ATTENDED (From-and To)

A. GRADUATE

YES

4. COLLEGE OR UNIVERSITY STUDY

SUBJECT

DATES ATTENDED

NAME AND LOCATION OF COLLEGE OR UNIVERSITY

MAJOR

MINOR

FROM

TO

з воводу 2

TULANE UNIVERSITY OF LOUISIANA

Bychelezy Chewstay 1145

1948

TULANE UNIVERSITY OF LOUISIANA

Spanish Partynese 1549

1952

TULANE UNIVERSITY OF LOUISIAMA SpINSh FReNCh

1952

1954

SECTION I CONTINUED TO PAGE 3

DEGREE

REC'D

DATE

REC®C

SEM/ QTR

HOURS

(Specily)

B.S.

Juve 148. Sen hes.

M.A. JuNE1952 SeM heSe

NONE NIA. SeMhRs.

---

## Page 3

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.

SECTION IV CONTINUED FROM PAGE 2

AND BRIEFS DESCRIBE EPS EACH REQUIRED SUBMISSION OF A WRITTEN THESIS, INDICATE THE TITLE

EL EPITETO EN LAS OBRAS DE BERCEO

(DO NOT REMEMBER EXACT TITLE). A DETAILED;

STUDY OF THE MANY USES OF THE EPITHET IN BERCEO'S WORKS, A I2TH CENTURY WRITER;

INCLUDING A CROSS-REFERENCE

LISTING OF ALL EPITHETS AS SHOWN IN HIS WRITINGS.

6. TRADE, COMMERCIAL AND SPECIALIZED SCHOOLS

NAME AND ADDRESS OF SCHOOL

STUDY OR SPECIALIZATION

FROM

TO

MONTHS

N. A.

7. MILITARY TRAINING (FULL TIME DUTY IN SPECIALIZED SCHOOLS SUCH AS ORDNANCE, INTELLIGENCE, COMMUNICATIONS, ETC.)

NAME AND ADDRESS OF SCHOOL

STUDY OR SPECIALIZATION

FROM

TO

MONTHS

N. A.

8. OTHER EDUCATIONAL TRAINING NOT INDICATED ABOVE.

N. A.

SECTION V

1. LANGUAGE

(List below each language in

which you possess any degree

of competence. Indicate your

proficiency to Read, Write or

Speak by placing a check (X)

in the appropriate box(es).

FOREIGN LANGUAGE ABILITIES

COMPETENCE - IN ORDER LISTED

R-Read,

W-Write,

S-Speak

HOW ACQUIRED

EQUIV-

ALENT

TO

NATIVE

FLUENCY

R

W

FLUENT

OBVIOUSLY

FOREIGN

ADEQUATE

RESEARCH

ADEQUATE

TRAVEL

LIMITED

KNOW-

LEDGE

NATIVE

OF

COUNTRY

PRO-

LONGED

RES

IDENCE

CONTACTACADEMIC

(with

"TUDY

parents,

(all

etc.)

levels)

R

R

SpANish

PORTuGuESE

FRENCH

ITALIAN

2. IF YOU HAVE CHECKED "'ACADEMIC STUDY"' UNDER "HOW ACQUIRED", INDICATE LENGTH AND INTENSIVENESS OF STUDY.

FROM I948 tO 1954 STUDIED THE ROMANCE LANGUAGES AT THE GRADUATE

LEVEL

3. HE AOU YOUR COMPETENCE THEREIN.

FOR A LANGUAGE HAVING SIGNIFICANT DIFFERENCES IN SPOKEN AND WRITTEN FORM, EX-

N. A.

4. DESCRIBE

YOUR ABILITY TO DO SPECIALIZED LANGUAGE WORK INVOLVING VOCABULARIES AND TERMINOLOGY IN THE SCIEN-

ENGINEERING, TELECOMMUNICATIONS, MILITARY, AND OTHER SPECIALIZED FIELDS.

FAMILIAR WITH SCIENTIFIC AND ENGINEERING

TERMINOLOGY IN SPANISH.

S. YOU MCME EDELECT EDI

YOU HAVE NOTED A PROFICIENCY IN LANGUAGE, WOULD YOU BE WILLING TO USE THIS ABILITY IN ANY POSITION FOR WHICH

YES

→ NO

- 3 .

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## Page 4

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-4 .

SECTION VI

GEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL

BELOW ANY FOREIGN

ASSIGNMENT.

ROADS, INDUSTRIES, POLITICAL PARTIES.

RE ASSIGNMENTEN INDICATE TYPE OF KNOWLEDGE SUCH AS TERRAIN,"

KNOWLEDGE

HARBORS,

UTILITIES, RAIL

, RAIL

NAME OF

REGION

OR

COUNTRY

СивА

TYPE OF

SPECIALIZED KNOWLEDGE

DATES OF

RESIDENCE

OR TRAVEL

HAVANA + VECINITY POLITICAL

ECONOMiC + SOCIAL

STRUCTURE

COMMERCE-IMPORTATIONS. 1154- 1761

PLACE OF 570

OF STUDY

KNOWLEDGE ACQUIRED BY

RESI-

DENCE

TRAVEL STUDY

WORK

ASSIGN

MENT

N.A.

sagt

2. INDICATE THE PURPOSE OF VISIT, RESIDENCE, OR TRAVEL IN EACH OF THE REGIONS OR COUNTRIES LISTED ABOVE.

electric Ca.,

¡ of their HAvANA Office, in MANANA,

3. UNITED STATES PASSPORT NUMBER AND EXPIRATION DATE, IF ISSUED.

PAss. Nº: 1095961

Expired: Sept. 2 1960 (NOT RENewed)

SECTION VII

TYPING AND STENOGRAPHIC SKILLS

1. TYPING (wpm)

2. SHORTHAND (wpm)

3. SHORTHAND SYSTEM USED - CHECK (X) APPROPRIATE ITEM

SPEEDWRITING

STENOTYPE OTHER (Spocify):

2. INDICATE OTHER BUSINESS MACHINES WITH WHICH YOU HAVE HAD OPERATING EXPERIENCE OR TRAINE (Comptomator,

Mimeograph, Card Punch, EIC.). MIMEOGRAPH, ADDING MACHINE, CALCULATOR, DICTATING MACHINE.

SECTION VIII

SPECIAL QUALIFICATIONS

'. INEACH! HOBBIES AND SPORTS IN WHICH YOU ARE ACTIVE OR HAVE ACTIVELY PARTICIPATED. INDICATE YOUR PROFICIENCY

FISHING, HUNTING, SWIMMING (GOOD UNDERWATER RESISTANCE), PHOTOGRAAHY

(BLACK & WHITE AND COLOR), MUSICAL PLAY SEVERAL INSTRUMENTS BY EAR), FLYING,

Bowling,

Chess.

AVeRAgE IN ALL OF THE ABOUE.

2. INR TAUE AR POSITION QUALEICATIONS RESULTING FROM EXPERIENCE OR TRAINING WHICH MIGHT FIT YOU FOR A

POSITION OR TYPE OF WORK.

TRACHING AND ADMINISTRATIVE EXPERIENCE SECURED AT THE UNIVERSITY

LEVEL AND IN FOREIGN TRADE MANAGEMENT RESPECTIVELY, ALSO

САРАСТу TO CARRY OUT INDEPENDENT RESEARCH AT THE GRADUATE LEVEL.

SKILLS YOU POSSESS RELATING

cato CW spood, sending end receiving), OFFSET PRESS, TURRET LATHE, SCIENTIFIC AND

PROFESSIONAL

DEVICES.

FAMILIAR WITH GENERAL SCiENTiFiE APPARATUS AS MAY BE PRESENT

IN A MEDICAL RESEAGEN LABORATORy. BEckmAN Spectophotametty.

(DIE ONETYEAR RESEARCH AT TULANE MEDICAL SERAL))

SECTION VIII CONTINUED TO PAGE 5

---

## Page 5

4-00000

SECTION VIII CONTINUED FROM PAGE 4

TRADE OR PROFESSION, SUCH AS PILOT.

EYES

[NO

S. NumbOr, HAVE AWERED "YES® TO ABOVE, INDICATE KIND OF LICENSE AND STATE, ISSUING LICENSE (Provide Licondo Rofiatry

Student Pilot Centificate N°S-293957

6. FIRST LICENSE OR CERTIFICATE (Year of Isaue)

2-18-54

|7. LATEST LICENSE OR CERTIFICATE (Year of Issue)

N•A-

N. A.

9. INDICATE ANY DEVICES WHICH YOU HAVE INVENTED AND STATE WHETHER OR NOT THEY ARE PATENTED.

N. A.

10. LIST PUBLIC SPEAKING AND PUBLIC RELATIONS EXPERIENCE.

IN COLLEGE AND AS A JUNIOR EXECUTIVE IN FOREIGN TRADE

11. LIST ANY PROFESSIONAL,

ACADEMIC OR HONORARY ASSOCIATIONS OR SOCIETIES IN WHICH YOU ARE NOW OR WERE FORMERL'

A MEMBER. LIST ACADEMIC HONORS YOU HAVE RECEIVED

Phi SignA Iota, National Menon Sociaty of Romanas hanguages.

Aimerican Associatin of Teachess of Spanish and Portuguese.

Gandate solo at fre by test we in and Tale demerite.

(UNDER WHICH I DID

•HONORRRY MENTiONS AND MEDALS.

SECTION IX

EMPLOYMENT HISTORY

(LIST LAST POSITION FIRST.) indicate chronological history of employment for past 15 years.

Account for all periods

Giveaddress and state what you did during poriodsof

List all civilian employment by a foroign Govemment, regardless of dates.

In completing item 9, "De-

scription of Duties® consider your experience carefully and provide meaningful, objective statements.

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)

2. NAME OF EMPLOYING FIRM OR AGENCY

FPR41454

- Oct. 1960

3. ADDRESS (No., Streot, City, Stato, Country)

(CENTURY ELECTRIC COMPANY

1806

48A.

4. KIND OF BUSINESS

PINE ST., STI LOUIS, MO. NAME OF SUPERVISOR ARNESTON. RODRiGUEZ, DiSt. Mu

MANUFACTURER OF MOTORS. GENERATORS, ETE:

MA. CHARts C. White, Extet Mannere

B. TITLE OF JOB

7. SALARY OR EARNINGS

8. CLASS. GRADE(Il Fodoral Sorvico)

Assitert DISTRICT

MANAGER

51/000. |PER MARTH NANO)

•. DESCRIPTION OF DUTIES TO PROMOTE AND SERVICE THE SALE OR CENTURY MOTORS, GENERATORS.

AND RELATED EQUIPMENT IN THE TERRITARY DE CUBA, ANY TO LOOPERATE IN COLLECILINS

WHEN NECESARY. TO MANAGE THE HAURNA NSTRICT SALES NAPICE IN FULL RESANSABILITY IN

THE ABSENCE Of THE DISTRET MAGR. TO LOOK AFTER THE ANTAREST OF CENTURY ELEC. COL IN CUBA.

10: REASONS FOR LEAVINO PRESENT CONDITIONS IN CUBA NO ACCEPTANCE)ASSIGNMENTS

AS PRINCIPAL MIGENT IN CUBA FOR C.I.A.

SECTION IX CONTINUED TO PAGE 6

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## Page 6

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5

2

SECTION IX CONTINUED FROM PAGE 5

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)

2. NAME OF EMPLOYING FIRM OR AGENCY

FEB.

1950

MARCH 1954

3. ADDRESS (No., Streef, City, Stato, Country)

TULANE UNIVERSITY,

4. KIND OF BUSINESS

ST. CHARLES ST.,

NEW ORLEANS

4. s. A.

COLLEGE

6. TITLE OF JOB

DR. John E. Englekiak; ChArmAN Sp. Dept.

7. SALARY OR EARNINGS

GRAduAte Asst.

8. CLASS. GRADE (1f Foderal Servico)

9. DESCRIPTION OF DUTIES

TEACHER OF BEGINNER AND INTERMEDIATED SPANISH INTHE

COLLEGE LEVEL. TO ASSIST WITH REGISTRATION AND DEDARTAMENTAL FUNCTIONS.

10. REASONS FOR LEAVING

TO ACCEPT ABOVE POSiTION

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)

2. NAME OF EMPLOYING FIRM OR AGENCY

JUNE 194I

- JENE 1 950

3. ADDRESS (No., Streel, City, State, Country)

BERLITZ' SCHOOL OF LANGUAGEZ

B. KIND OF BUSINESS

(INTERNATIONAL TRADEMART, NEW ORLEANS, LA, 4.S.A.

5. NAME OF SUPERVISOR

LANGUAGE SCHOOL

6. TITLE OF JOB

MR.

HALLi DIRECTOR

7. SALARY OR EARNINGS

PROFESSOR

8. CLASS. GRADE (11 Fodoral Sorvico)

$ 3.00 | PER 4R.

À DESCRIRTION O DUTIES TO TENCH THE SRAMSH LANGUAGE DY TEL

BERLITI METHUD. .

10. REASONS FOR LEAVING TO ACCEPT ABOVE POSITION AND PURSUE

AN ADVANCED DEGREE

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)

JAN.

1849

JUNE 1944

3. ADDRESS (No., Stroot, City, State, Country)

2. NAME OF EMPLOYING FIRM OR AGENCY

TULANE UNIVERSITY MEDICAL SCHOOL

I TULANE

A. KIND OF BUSINESS

AVE:, NEW ORLEANS, LA

ч.S.А.

3. NAME OF SUPERVISOR

MEDICAL

SCHOOL

B. TITLE OF JOB

DR.

Woo

7. SALARY OR EARNINGS

8. CLASS. GRADE (Il Fedoral Servico)

Medicil Resenach

Technittan

$ 200.00

9. DESCRIPTION OF DUTIES

PER MONTA

IN CHARGE OF SPECTROPHOTOME TRIC ANALYSIS IN THE CARDIO-

VASCULAR RESEARCH LABORATORY.

10. REASONS FOR LEAVING

CONCLUSION OF RESEARCH

• 1.

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)

3. ADDRESS (No., Street, City, Stato, Country)

4. KIND OF BUSINESS

B. TITLE OF JOB

2. NAME OF EMPLOYING FIRM OR AGENCY

5. NAME OF SUPERVISOR

7. SALARY OR EARNINGS

SECTION IX CONTINUED TO PAGE 7

B. CLASS. GRADE(I| Podoral Sorvico)

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## Page 7

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SECTION IX CONTINUED FROM PAGE 6

8. DESCRIPTION OF, DUTIES

5

10. REASONS FOR LEAVING

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)

3. ADDRESS (No., Street, City, Stato, Country)

4. KIND OF BUSINESS

6. TITLE OF JOB

9. DESCRIPTION OF DUTIES

12. NAME OF EMPLOYING FIRM OR AGENCY

15. NAME OF SUPERVISOR

7. SALARY OR EARNINGS

IPER

8. CLASS. GRADE (I1 Federal

Service)

10. REASONS FOR LEAVING

1. INCLUSIVE DATES (From and To - By Mo. and Yr.)

3 ADDRESS (No., Street, City, State, Country)

4. KIND OF BUSINESS

6. TITLE OF JOB

9. DESCRIPTION OF DUTIES

12. NAME OF EMPLOYING FIRM OR AGENCY

5. NAME OF SUPERVISOR

$

7. SALARY OR EARNINGS

IPER

I8. CLASS. GRADE (I{ Foderal

Service)

10. REASONS FOR LEAVING

8. NUMELOR SF ICE CREDITABLE FORA O VEECHEN SERVICE RETRY MEND! CA KNOWN.

9. HAVE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN FROM ANY POSITION.

_YES

HAVE YOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH YOU DESIRE TO EXPLAIN? YES NO.

IF YOUR ANSWER TO EITHER OR BOTH QUESTIONS IS "YES", GIVE DETAILS

=

-7.

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## Page 8

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SECTION X

1. ARE YOU REGISTERED FOR THE DRAFT UNDER.

UNIVERSAL

TRAINING AND

SERVICE ACT OF 1948 (Adamended)

4. IF DEFERRED, GIVE REASON

DIABETES MELLITUS

- 8 -

_ MILITARY SERVICE

1. CURRENT DRAFT STATUS

2. SELECTIVE SERVICE CLASSIFI

3. SELECTIVE SERVICE NO.

NO

4-F

16-45-28-53

5. LOCAL DRAFT BOARD NO. OR DESIGNATION AND ADDRESS

Nº 45, ORlean PARIsh, New Gelenus, LA.

2. MILITARY SERVICE RECORD

1. CURRENT AND/OR PAST ORGANIZATIONAL MEMBERSHIP

MARINE

CORPS

AIR

COAST

FORCE

GUARD

MERCHANT NATIONAL AIR NAT'L

MARINE

GUARD

GUARD

FOREIGN

SERVICE (Spectly):

OR MIL.

CHECK (X) AS

APPROPRIATE

ARMY

NAVY

HAVE SERVED

NOW SERVING

2. BRANCH OR CORPS OF ABOVE CHECKED ORGANIZATION(S)

3. DATE SEPARATED FROM EXTENDED ACTIVE DUTY/(Past service)

4. TOTAL LENGTH OF EXTENDED ACTIVE DUTY IN U.S. ARMED

FORCES (Past

end current service)

5. DATE

ENTERED

ACTIVE

DUTY

PAST SERVIdE

CURRENT SERVICE

LENGTH OF ACTIVE DUTY IN FOREIGN MILITARY OR-

SJANIZATION

7. RANK, GRADE OR

RATE

PAST SERVICE

CURRENT SERVICE

8. SERVICE,

rent number) RIAL OR FILE NUMBER (Il now sorving, provido cur

• PRIMARY MILITARY OCCUPATIONAI

PECIALTY (MOs

or Designaton AND TITLE

SERVICE

CURRENT SERVICE

10. SECONDARY

MIL.

PECIALTY (Mos or Designator) ANI

TITLE

PAST SERVICE

CURRENT SERVICE

11. BRIEF DESCRIPTION OF MILITARY DUTIES (indicate whether applicablo to past pe current services

12. CHECK (X) TYPE OF SEPARATION FROM ACTIVE DUTY

HONORABLE DISCHARGE

RELEASE TO INACTIVE DUTY

RETIREMENT FOR AGE

RETIREMENT FOR SERVICE

UNDUE HARDSHIPS

RETIREMENT FOR COMBAT DISABILITY

OTHER:

RETIREMENT FOR/PHYSICAL DISABILITY

13. CHECK (X) COMPONENT IN WHICH YOU SERVED

REGULAR

RESERVE (Including the National and Air National Guard)

| OTHER (Including AUS)

3. MILITARY RESERVE, NATIONAL GUARD AND ROTC STATUS

1. DO

RESERVE STATUSI

YES

2 ARE YOUND. OR ME REF OF THE

YES

NAT'L. GRD.

_ 3. ARE ROU NOW A MEMBER OF

NO

GRD.?

YES

X NO

4. IF YOU HAVE ANSWERED "YES" TO ITEMS 1, 2 OR 3 ABOVE, CHECK COMPONENT MEMBERSHIP BELOW

ARMY

MARINE CORPS

NATIONALGUARD

COAST GUARD

NAVY ROTC

NAVY

AIR FORCE

AIR NAT'L. GUARD

ARMY ROTIC

AIR FORCE ROTC

MERCATE ROTE CATEGORY NUM

5. CURRENT RANK, GRADE OR

6. RANE OF APPOINTMENT IN CURRENT

7. EXPIRATION DATE OF CURRENT RESERVE OBLIGA-

B. CHECK (X) CURRENT RESERVE CATEGORY

READY RESERVE

[STANDEY (Activo)

STANDBY (Inace/vo) RETIRED

3. PRIMARY MILITARY OCCUPATIONAL SPECIALTY (MoB or Dpaig-

retor) AND TITLE

10 SECONFARE MALTARY OCCUPATIONAL SPECIALTY (lOs Of DoG-

11. BRIEF DESCRIPTION OF MILITARY RESERVE DUTIES

1Z. ARE YOU CURRENTLY ASSIGNED OR ATTACHED

TO A

RESERVE. NA

GUARD OR ROTC TRAIN

ING UNIT

IA. HAVE

AENTI

YOU A MILITARY MOBILIZATION ASSIGN-

16. INDICATE TOTAL MILITARY SERVICE

FOR

LONGEVITY PURPOSES INCLUD

ING ACTIVE AND INACTIVE

DUTY

YEARS

AA

YES

NO

YES

XINO

MONTHS

NA.

13. AND ADDAYS ANSWERED "YES" TO ITEM 12, GIVE UNIT OR AGENCY

5. IF YOU MAVE ANSWERED YES TO ITEM 14, GIVE UNIT OR AGENCI

IND ADDRESS

17. WHERE ARE YOUR SERVIÇE RECORDS KEPTI

---

## Page 9

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SECTION XI

FINANCIAL STATUS

1. ARE YOU ENTIRELY DEPENDENT ON YOUR SALARYI

Z. IF YOUR ANSWER IS "NO"' TO THE ABOVE, STATE SOURCES OF OTHER INCOLNEE

I NO

N. A.

3. BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS

NAME OF INSTITUTION

ADDRESS (City, Stato, Country)

Whitney Nat. Bank of New Geleans

New Galeans, LA., U.S. A.

The AiRpeat Bank of MiaMi

MiAMi, FLA, U.S.A.

The RoYAL BANk Of CANADA

HAVANA, CUBA.

4. HAVE YOU EVER BEEN IN, OR PETITIONED FOR, BANKRUPTCY.

L] YES

5. IF YOUR ANSWER IS "YES"' TO THE ABOVE, GIVE PARTICULARS, INCLUDING COURT AND DATE(S)

N. A.

6. GIVE THREE CREDIT REFERENCES IN THE UNITED STATES

NAME

ADDRESS (No., Stroot, City, State)

Whitmey NAt. Bank of New Galears

News

Galeans, hA, 4.5.A.

DM.HOLMES Ltd. (Department Stere)

New Galeans, LA. U.S.A.

MAISON BlANche (DepaRtment Stone)

New

Palaus, ha. U.S.A.

7. DO YOU RECEIVE AN ANNUITY FROM THE UNITED STATES OR DISTRICT OF COLUMBIA GOVERNMENT UNDER ANY RETIREMENT

ACT, PENSION, OR COMPENSATION FOR MILITARY OR NAVAL SERVICE?

D]YES

8. IF YOUR ANSWER IS "YES" TO THE ABOVE QUESTION, GIVE COMPLETE DETAILS

XNO

N.A.

•. DO YOU HAVE

OR WITH U.S.

YES

CORPORATICKS OR BUSINESSES HAVING SUAS CONTEC FOREIGN INTERES CORPORATIONS OR BUSINESSES: OR IN

X NO

(11 onavor "YES", fumieh dotallo on nopararo aho or.)

MARITAL STATUS

1. PRESENT STATUS (Singlo, Marrlod, Widowod, Soperatod, Divarcod, os Annulled) SPECIFY:

2. STATE DATE, PLACE, AND REASON FOR ALL SEPARATIONS, DIVORCES OR ANNULMENTS

MARRIED

N. A.

WIFE, HUSBAND

OR FIANCE:

If you have been married more than once - including annulments - use a separate sheet for former wife or

husband giving data required below for all previous marriages. If marriage contemplated, fill in appropriate

information for fiance.

8. NAME

(Firat)

(Middlo)

• PAULINE

(Maldon)

(Laot)

JUANITA

ROSS

RODRIGUEZ

A. STATE ANY OTHER NAMES EVER USED

INDICATE CIRCUMSTANCES (Including length of timo) UNDER WHICH ANY

PAULA

¡(NICKNAME SINCE CHILHOOS)

OF THESE NAMES WERE USED. IF LEGAL CHANGE GIVE PARTICULARS

(Whore and by what suthority). USE EXTRA SPACE PROVIDED ON PAGE 18

OF THIS FORM TO RECORD THIS INFORMATION.

S. DATE OF MARRIAGE

8. PLACE OF MARRIAGE (City, Stato, Country)

JUNE 10.11948

T. HIS OF HERI ADDRESS BEFORE MARRIAGE IVO, Strei, Cli Sual, County; 4. 4.S. A

ORleanse

DAKUM ST.

EDENTON, N.C

O: bATE OF DEATH

4. S. A

T1O. CAUSE OF DEATH

N.A.

11. CURRENT ADDRESS (Givo last addresa, 11 decoasod)

9361 S.W. 178 St

12. DATE OF BIRTH

< PERRINE 57, FLA. U.S.A.

18. PLACE OF BIRTH (City, Stato, Country)

JAN. 2,1923

BOGALUSA!

LA.

U.S.A

SECTION XI CONTINUED TO PAGE 10

-9 .

1A. CITIZENSHIP

4.S.A.

---

## Page 10

14-00000

• 10.

SECTION XII CONTINUED FROM PAGE 9

14. IF BORN OUTSIDE U.S. DATE OF ENTRY

15. PLACE OF ENTRY

N.A.

16. FORMER CATIZENSHIPISI

N.4.

19. OCCUPATION

N.A.

17. DAOEIRED CITIZENSHIP 18. WHERE ACQUIRED(Gly, Stole, Country)

N.A.

N.A.

20. PRESENT

EMPLOYER (Also

HOUSEWIFE

21. EMPLOYER'S OR BUSINESS ADDRES (No., Street, City, State, Country)

N. A.

22. DATES OF MILITARY SERVICE (Fromand to - By Mo, and Yr.)

N. A .

A

23. BRANCH OF SERVICE

N.A.

25. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN

24. COUNTRY WITH WHICH MILITARY SERVICE AFFILIATED

N. A.

N.A.

SECTION XIII

CHILDREN AND OTHER DEPENDENTS

1. PROVIDE THE FOLLOWING INFORMATION FOR ALL CHILDREN AND DEPENDENTS

NAME

RELATIONSHIP DATE AND PLACE OF BIRTH

CITIZENSHIP

EMILIO AMERICO RODRiGUEZ J.R.)

JOSEPH ROSS RODRIGUEZ

SON

SEPT:18,1951, New Dalesus, Lal

4. S.A.

SON

PATTI MICHELLE RODRIGUEZ

DAUG THER

OCT. 23,1554, Havana, Cuba

4.S.A

PAUL MARSHALL

RODRIGUEZ!

SON

NOVEL 1957:, HAVANA CUbA

4. S. A.

ADDRESS

9361 SW.17857.

PERRINE 57, FLAI

43615W.17857

PERRINESZELA:

8366 50.078 97:

PERRINE S7, FLA.

9361 sW.178S7.

PERRINE 52, FLA.

2. NUMBER ONE COPE OPEN SONNE ARE

UNMARRIED

UNDER

OF AGE.

AND NOT SELF-SUPPORTING.

4

3. NUMBER OF OTHER DEPENDENTS (Including spouse,

parento,

stop-paranto,

alator,

FOR AT LEAST

ofc.)

DEPEND

50% OF

CHILDREMOVER ST ERS. OF AGE SE NOT

ON

SELF-SUPPORTING.

/

SECTION XIV

1. FULL NAME (Laat-Firat-Milita)

RODRIGUEZ,

ARMESTE

5. STATE OTHER NAMES HE HAS USED

w.2.

FATHER (Give same information, for Stepfather and/ or Guardian on a separate sheet)

2. LIVING

9. DATE OF DEATH

NAPOLEON

4. CAUSE OF DEATH

INDICATE CIRCUMSTANCES (Including length of tino) UNDER WHICH HE HAS

EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where

and by what authorlty).

FORM TO RECORD THIS INFORMATION.

USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS

6. CURRENT ADDRESS - Give imes adirono, Il docoated (No., Street, City, Stato, Country)

The ORleANiAN Apto wetel

ST. ChARLES AM.

8. PLACE OF BIRTH (City, Stato, Country)

Onleans, La.

HAVANA

10. IF BORN OUTSIDE U.S. -INTE OF ENTRY

M. PLACE OF ENTRY

9. CITIZENSHIP

Cuban

Nov. 196=

12. FORMER CITIZENSHIP(S) COxTt5(100)]

13. DATE U.S. CITIZENSHIP

New

OR/eanS,

N.A.

14. WHERE ACQUIRED (City, Stato, Country)

N•A

N.A.

15.

OCCUPATION

16. PRESENT EMPLOYER (Givo loat employer, il Father le deceasad or unemployod)

RETIRED

17.

EMPLOYER'S BUSINESS AIRESS OR FATHER'S BUSINESS ADDRESS IF SELF-EMPLOYED

ESSARES ARE CentuRy Elect Co..

1806 PINEST...

IT. LOUIS

1o.

4. S-H

18. DATES OF MILITARY SERVES (Ramand-TO) 10. BRANCH OF SERVICE

20. COUNTRY

11. DETAILS OF OMER GONNARN SERVICE, US OF FORRIGA JUTRUELE-AGENT, FOR 415. EMBASSY iN

HAVANA, CUBA DURINE NORLO WAR I, WORLS WAR II, AND RECENT CASTRO RELOLUTION

---

## Page 11

14-00000

8

SECTION XV

MOTHER (Give same information for Stepmother on separate sheet)

1. FULL NAME (Laat-Firee-Middlo)

CASANOVA

EMiLiA

3. DATE OF DEATH

5. STATE OTHÉR NAMES SHE HAS USED

4. CAUSE OF DEATH

INDICATE CIRCUMSTANCES (Including length of timo) UNDER WHICH SHE HAS

EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where

N.A.

and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS

FORM TO RECORD THIS INFORMATION.

6. CURRENT ADDRESS - GIVE LAST ADDRESS, IF DECEASED (No., Streel, City, Stato, Country)

Apt. Hetel,

7. DATE OF BIRTH

ST. Chanles Ave.

8. PLACÉ OF BIRTH (City, Stato, Country)

New Galeans, LA 4.5.4

JUNES

1701

10. IF BORN OUTSIDE U.S. - DATE OF ENTRY

HAVANA

CubA

PLACE OF ENTRY

Cuban

Qer: 1, 1450

12. FORMER CITIZENSHIP(S) [Country(les)

New

13. DATE U.S. CITIZENSHIP

Qaleans

GA. U.S.A.

IV.A.

ACQUIRED

14. WHERE ACQUIRED (City, Stato, Country)

N.A.

15. OCCUPATION

N.A

PRESENT EMPLOYER (Give last employer, il Mother le deceased or unemployed)

HOUSEWIFE

N.A.

17. EMPLOYER'S BUSINESS ADDRESS OR MOTHER'S BUSINESS ADDRESS IF SELF EMPLOYED

1B. DATES OF MILITARY SERVICE (FrOm-and-TO)

N. A.

.N.A.

20. COUNTRY

NM.

21. DETAILS OF OTHER GOVERNMENT SERVICE, US, OR FORE' SI (Sp. MAIL) CENSOR IN NEW ORLEANS

CENSORSHIP OFFICE DURING WORLD WAR III

SECTION XVI

1. FULL NAME (LaBt-Firet-Middle)

BROTHERS AND SISTERS (Including Half-, Step and A dopted Brothers and Sisters)

RODRIGUEZ, ARNESTO JOSE

BROTHER

8. CURRENT ADDRESS (No., Straol, Clty, Zono, Stato, Country)

212 MAPLE Rd. ,

1. FULL NAME (Laat-First-Middle)

METAIRE:+

LA.

Ц. s. А .

2. RELATIONSHIP

3. CITIZENSHIP (Country)

Ч. s.

B. LIVING

YES |

INO

3. CITIZENSHIP (Country)

•6. AGE

38

2

4. CURRENT ADDRESS (No., Stroot, Clty, Zono, Stalo, Country)

1. FULL NAME (Last-Fire(-Middle)

2. RELATIONSHIP

S. LIVING

YES NO

3.

CITIZENSHIP (Country)

6. AGE

4. CURRENT ADDRESS (NO., Stroot, City, Zono, Stato, Country)

1. FULL NAME (Last-Fira(-Midolo)

Z. RELATIONSHIP

S. LIVING

YES

INO

3. CITIZENSHIP (Country)

+6. AGE

4. CURRENT ADDRESS (No., Strodi, City, Zono, Stato, Country)

1. FULL NAME (Last-First-Middio)

2. RELATIONSHIP

• 5. LIVING

YES

3. CITIZENSHIP (COliTy)

16. AGE

4. CURRENT ADDRESS (No., Strool, CIty, Zono, Stato, Country)

1. FULL NAME (Laat-Firet-Middlo)

2. RELATIONSHIP

S. LIVING

YES|

INO

3. CITIZENSHIP (Country)

6. AGE

4. CURRENT ADDRESS (No., Stroor, Clty, Zono, Stalo, Country)

1. FULL NAME (La01-FIrat-Midalo)

2. RELATIONSHIP

S. LIVING

YES.

iNO

3. CITIZENSHIP (COMIET))

6.

AGE

4. CURRENT ADDRESS (NO., Strool, City, Zono, Stato, Country)

1. FULL NAME (Last-Flet-Middlo)

2. RELATIONSHIP

S. LIVINO

YES

3. CITIZENSHIP (Country)

6. AGE

4. CURRENT ADDRESS (No., Strool, City, Zono, Sinio, Country)

BO LIVIMO

B. AGE

- 11.

---

## Page 12

14-00000

-12.

SECTION XVII

FATHER-IN-LAW

!. 'FULL NAME (LaBI-Firel-Middle)

2. LIVING

8, DATE OF DEATH

4. CAUSE OF DEATH

Ross

SAMUEL

5. STATE OTHER NAMES HE HAS USED

SANFORD

XI NO

JUNE 30,1958

HEART ATTACK

INDICATE CIRCUMSTANCES (Including longth of time) UNDER WHICH HE HAS

EVER USED THESE NAMES.

SAM (NIKNANE SINCE CHILDHOOD)

IF LEGAL CHANGE, GIVE PARTICULARS (Where

and by what authority).

USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS

FORM TO RECORD THIS INFORMATION.

6. CURRENT OR LAST ADDRESS (No., Streel, Cliy, State, Country)

Route

Box

EDENTON

N.C.)

Ч.S.1.

7. DATE OF BIRTH

8. PLACE OF BIRTH (Cily, Stato, Country)

JuLy 21

MOBILE

10. IF BORN OUTSIDE U.S. - DATE OF ENTRY

11. PLACE OF ENTRY

N.A

12. FORMER CITIZENSHIP(S)

(Country(100)

N..

A.

u.s. A.

N.A

13. DATE U.S. CITIZENSHIP

14. WHERE ACQUIRED (City, Stato, Country)

ACQUIRED

NIA.

N. A.

16.

PRESENT EMPLOYER (Give last employer, ll Father-in-Law is deceased or unemployed)

RIP. BAER

AND Ca., EDENTON..

N.C.. U.SA.

MOTHER-IN-LAW

ALABAMAL

9. CITIZENSHIP

4. S.A.

15. OCCUPATION

SAWYER

SECTION XVIII

1.

FULL DIAME (Last-First-Middle)

BONTAL

PATTI JUANITA

3. DATE OF DEATH

4. CAUSE OF DEATH

5. STATE OTHER NAMES SHE HAS USED

INDICATE CIRCUMSTANCES (Including length of timo) UNDER WHICH SHE HAS

N.A.

EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where

and by what authority).

USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS

FORM TO RECORD THIS INFORMATION.

B. CURRENT OR LAST ADDRESS (NO., Stroet, City, Stato, Country)

Route 2. Box 500, EDENTONI N.C.,

U.SA.

7. DATE OF BIRTH

8. PLACE OF BIRTH (City, State, Country)

: Dec. 221.18994

LAUREL.)

Miss.

4.S.А.

10. IF BORN OUTSIDE U.S. - DATE OF ENTRY

Tri. PLACE OF ENTRY

9. CITIZENSHIP

u.S. A

NIA

N.A.

12. FORMER CITIZENSHIP(S) [COLMiTyCiOs)

NIA.

15. OCCUPATION

HOUSEWIFE

SECTION XIX

19. DATE U.S. CITIZENSHIP

14. WHERE ACQUIRED (City, Stato, Country)

ACQUIRED

N.A.

N. A

16. PRESENT EMPLOYER (Give last employer, if Mother-in-Law is deceased or unomployed)

A.

RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (1) LIVE ABROAD

(2) ARE NOT U.S. CITIZENS OR (3) WORK FOR A FOREIGN GOVERNMEN

1. FULL NAME (Last-Firal-Middle)

LOPEZ

ELENA

3. AGE

33

4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES

2/2 MAPLE RO., METALRE, LA. U.S.A.

6. CITIZENSHIP (Country)

7. FREQUENCY OF CONTACI

MEXICAN

ONCE YEARLY

1. FULL NAME (Last-Firet-Middle)

SISTER IN LAW

5. EMPLOYED BY

BERLITZ SCHOOL OF LANGUAGEZ

8. DATE OF LAST CONTACT

(41)

JUNE 1961

2. RELATIONSHIP

3. AGE

3

4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES

B. EMPLOYED BY

6. CITIZENSHIP (Country)

7. FREQUENCY OF CONTACT

8. DATE OF LAST CONTACT

1. FULL NAME (Last-Firer-Middle)

2. RELATIONSHIP

3. AGE

4. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES

5. EMPLOYED BY

6. CITIZENSHIP (Country)

7. FREQUENCY OF CONTACT

TB. DATE OF LAST CONTACT

1. FULL NAME (Last-Fire:-Middle).

2. RELATIONSHIP

3. AGE

5

4. ADDRESS OR COUNTHY IN WHICH RELATIVE RESIDES

5. EMPLOYED BY

6. CITIZENSHIP (Country) •

7. FREQUENCY OF CONTACT

jO. DATE OF LAST CONTACT

SECTION XIX CONTINUED TO PAGE 13

---

## Page 13

14-00000

SECTION XIX CONTINUED FROM PAGE 12

6. SPECIAL REMARKS, IF ANY, CONCERNING RELATIVES NOT ED IN SECTION XIX ABOVE

Aboue selntive his beei a continuous sesident in the 4.S.A. Since 1945 in New

Celesus, ha.

SECTION XX

RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO ARE IN THE MILITARY OR CIVIL

SERVICE OF THE UNITED STATES

1. NAME (Last-First-Middlo)

B. CITIZENSHIP

ROSS,

JOSEPH

ALBERTI

BROTHER IN LAW

5. ADDRESS (No.. Streol, City, Stato, Country)

6. TYPE AND LOCATION OF SERVICE (Il Anown)

Route 2, Box 595H, PensAcolA, FLA, USD

MARINE PILOT AND PHOTOGRAPHER INSTRUCTOR

PENSACOLA

NAVAL

1. NAME (Laat-First-Middlo)

STATION

2. RELATIONSHIP

2

5. ADDRESS (No., Street, City, State, Country)

6. TYPE AND LOCATION OF SERVICE (I{ known)

1. NAME (Last-First-Middlo)

2. RELATIONSHIP

13. AGE

14. CITIZENSHIP

5. ADDRESS (No., Stroet, CIty, Staro, Country)

6. TYPE AND LOCATION OF SERVICE (Il known)

SECTION XXI

REFERENCES, ACQUAINTANCES, AND NEIGHBORS

1. LIST FIVE CHARACTER REFERENCES, NOT RELATIVES, IN THE U.S., WHO KNOW YOU INTIMATELY

NAME

(Last-Firat-Middle)

BUSINESS ADDRESS

RESIDENCE ADDRESS

(No., Street, City and State)

(No., Street, City and State)

N. S. A.

A.C. White

J.S. MENEELY

P.M. ARTHUR

10125 MARKHAM ST.

WASHINGTON , D.C.

SILVER SPRING, Md.

U.s. N.

1601 ARDEN WAY

USS SARATOGA EPO N.Y.NY. (VA-O) FACKSONUILLE, ELA

INTELLIGENCE

DRAWER Ki

ET. AMADOR SANAL ZONE

HOUSEWIFE

210W. PREsident, Apt. 4,

DOROTHY MANESS JONES!

iC. A. ZEHNDER

NAME

(Last-First-Middle)

J.W. BARNES:

GREENWOOD, MISS.

EBASCO SERVICES N.Y.

"P.O. Bax 285

UNK.

PINE BLUFF, ARKANSAS

2. LIST FIVE PERSONS, IN THE U.S. WHO KNOW YOU SOCIALLY - NOT RELATIVES, SUPERVISORS OR EMPLOYERS

BUSINESS ADDRESS

RESIDENCE ADDRESS

(No., Street, City and Stato)

(No., Street, City and State)

MANUFACTHRER REPRESENTATIVE

uNK.

6938 Colbeat.st.

New Orleans, 4s.

EBASCO SERVICES, ,N.Y.

420 PARK

Ave.

L. T. WOLF !

J. BRUNO

DOROTHY BOETTCHER!

UNK.

SWARTH MORE, PA.

CIVIL SERVICE

3310 CASTIGLIONE

UNK.

New Galesus, ha.

HOUSEWIFE

839 PALERMO Ave.

UNK.

CORAL GAbleS, MinMi, AL

1211 W. ARKANSAS LANE

A. TAWATER

RE 2e BOX16, ARLINGTONIAS

3. LIST THREE NEIGHBORS AT YOUR MOST RECENT NORMAL RESIDENCE IN THE U.S.

NAME

(Laat-Firat-Middlo)

BUSINESS ADDRESS

RESIDENCE ADDRESS

(No., Streot, City and Stato)

(No., Streot, City and Stato)

Ds. C. Peebles

D. White

C. MACE

TULANE MEDICAL SCHOOL

2207 BROBWAY Aup.;

RETIRED

CIVIL SERUCE

TULANE UNIVERSITY

SPANISH DEPARMENT

- 13.

4.

512 WALNATS

New Galeans; LA.

unk.

---

## Page 14

14-00000

-14.

'SECTION XXII

CLUBS, SOCIETIES, AND OTHER ORGANIZATIONS

NOTE: List names and addresses of all clubs, societies, professional societies, employee groups or organizations of any kind

(Include membership in, or support of, any organization having headquarters or branch in a foreign country) to which you

belong or have belonged.

NAME AND CHAPTER

Phe SigmA Iota

Ameran Ass. of Tachers of Spain « Pestigure

ADDRESS

(Number, Street, City,

State, Country)

TULANE UNIVERSITY

unk

DE PRUW UNIVERSITY

unk.

DATES OF MEMBERSHIP

FROM

TO

1451

Present.

1552к.

PResent

SECTION XXIII

RESIDENCES FOR THE PAST 15 YEARS

ADDRESS - LAST RESIDENCE FIRST

INCLUSIVE DATES

(Number, Stroot, City, State, Country)

FROM

•FOCSA BLDG. APT. 284, 17VM ST., Vedade, HAvANA CUbA

Oct. 1956

June 1961

Fenca Emilita, Klm 13 Central ligkway, Sou Francise de Pal, there Cuba. April 198 - OchKs

20 Newcomb Campus; New Galessis, LA, 4.5. A.

Augh. 1951

April 1954

510 Walunt St., New Galeans, ha., U.S. A.

144. 1900

Aug. 185°1

2305½ Almonester Ave:, Hew Galeans, bA., US. A.

Get: 1949

Gon. 1950

510 Walunt Sti, Hew Galeans, LA:, 4.S.4.

1100.1943 @ct.I845

(

---

## Page 15

14-00000

SECTION XXIV

ADDITIONAL INFORMATION

YES

IZATION WHICH ADVOCATES

OR TEACHES THE OVERTHROW OF

THE GOVERNMENT

OF THE UNITED STATES BY

FRECR RIGHTS UNDER THE CONSTITUTTON OF TAE MAND SFATESKS BY FORCE OR VIOLENCE TO DENY PERSONS

2. IF YOU HAVE ANSWERED "YES" TO THE ABOVE QUESTION, EXPLAIN

N. A.

NO

YES

4. IF SO, TO WHAT EXTENT?

X NO

SPER SEE COTESOU

YES

6. IF SO, TO WHAT EXTENT?

N-A

T. MAX FION DRYEE RETEN GEER OF, OF SUPPORTED. OR HAD ANY CONNECTIONS WITH A FOREIGN INTELLIGENCE ORGAN

IF ANSWER IS "YES", GIVE COMPLETE DETAILS.

8. PLOYMENT SINCE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO WHICH YOU HAVE APPLIED FOR EM-

CI.A., STATE DEPARTMENT, PAN AMERICAN UNION, CIVIL SERVICE,

USIA.

S. LGENCY REELER NATE DATE TOYEE'AVE STATITED AN INVESTIGATION OF YOU, INDICATE THE NAME OF THE

UNK.

NSTR SCFCIAS

You nome do YEs i the follow ind echone loll le prede he infer nol requested for oach

YES

I SCCORDAN CEME OF COU SPECIAL INSTRUC FOU ARO LATE. NATURE OF OFFENSE AND DISPOSITION OF CASE

NO

YES

" LONGINE CHER PEGACTS ECHO AHOREONE DATE BY OCCURRENCE OR SEA SHE A

NO

12. ANTONE MEANO NO GREEN PROVE RESTOP OCEANGE ON SEA MASTE STEEPER SO

YES

CORDANCE WITH SPECIAL INSTRUCTIONS ABOVE.

NO

SECTION XXV

PERSON TO BE NOTIFIED IN CASE OF EMERGENCY

1. NAME (Firat-Middle-Last)

2. RELATIONSHIP

PAULINE JUANITA

RODRIGUEZ;

WIrE

3. HOME ADDRESS (No., Street, City, Zone, State, Country)

A. HOME PHONE NO.

(CEdAR-5-8341)

9361 SO 178 SA PERINE S7, F- INDICATE MAME OF PIAM OR C BUSINESS HOSE NO: & EXT.

BUSINESS ADDRESS (NO.

EMPLOYER, IF APPLICABLI

NIA .

N-A.

7. I5 NOT DESIRATER, ENEXUSE

SE OF HEALTH OR OTHER REASON, PLEASE SO' MAY ALSO BE NOTIFIED. IF SUCH NOTIFICATION

MA-

- 15-

---

## Page 16

14-00000

• 16.

SECTION XXVI

CERTIFICATION

YOU ARE INFORMED THAT THE CORRECTNESS OF ANY STATEMENT MADE IN THIS APPLICATION

WILL BE INVESTIGATED.

I have read and understand the instructions.

knowledge and belief.

I Certify that the foregoing answers are true and correct to the best of m

agree that ony misstatement or omission as to material fact will constitute grounds for immediat

dismissal or rejection of my application. I also understand that any false statement made here in may be punishable by

law (U.S. Code, Title 18, Section 1001)

1. DATE OF SIGNATURES

Sept.

5,1861

3. SIGNED AT (City and Stato)

2. зістивої ра

arilio

4. SIGNATURE OF WITNESS

MIAMI, FLA.

Faula R. Podrique

NOTE: Uee the following space for extra details. Reference each continued item by section and item nuber to hich it relates,

sign your name at the end of the added material. If additional space is required use extra pages the same size as this

page and sign each such page.

---