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104-10117-10075

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

SUPPLEMENTAL PERSONAL HISTORY STATEMENT

INSTRUCTIONS

SECTION 1.

Submit in duplicate.

Answer all questions completely. If question does not apply, write "NA." Write "UNKNOWN" only if you do not

know-the answer and it cannot be obtained from personal records.

If additional space is required use extra pages the same size as this

page and sign each such page. Reference each continued item by section and item number to which it relates.

1. FULL NAME (last-first-middle)

2-DATE OF BIRTH 3. PLACE OF BIRTH (City,State,Country) 4.

SOC SEC NO.

Flores, Daniel

09 1 Aug 1935 San Marcos, Texas

460-48-6239

5. PRESENT STATUS (Single, widowed, divorced,

annulled) SPECIFY: Married o

30

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

"NA"

SECTION 11.

SPOUSE

1. NAME OF SPOUSE (last-first-middle-maiden)

Flores,

(Dorothy Arnett)06 di

DATE

BIRTH

3. PLACE OF BIRTH (spouse)

1935

Portland, Oregon

A- DATE AND PLACE OF MARRIAGE

5. GEnRENSalize spousell etue lized, indicate date de place

18 November 1960

(Lima, Peru) 10

USA

6. STATE DATE, PLACE.

REASON FOR ALL SEPARATIONS.

DIVORCES OR ANNULMENTS

"NA"

8.

PRESENT EMPLOYER

7.

OCCUPATION

Legal

Secretary

Arnold and Porter) 08

9. EMPLOYER'S OR BUSINESS ADDRESS (No., Street, City, State & Zip Code - Country if not U.S.)

(1229 19th Street NW. Washington, D.C.

SECTION 111.

RESIDENCE (Since date of last PHS, il overseas residence indicate only city and country)

ADDRESS • LAST RESIDENCE FIRST (number, street, city, state, country) lud. Aplo #

INCLUSIVE DATES (month & vear)

FROM.

то.

Guayaquil, Ecuador 10

May 1969

May 1971

(Lima, Peru) lo

Sept. 1971 Feb. 1974

I Vienna, Va (8151 Larkin La.)

Feb. 1974

SECTION IV.

CHILDREN AND OTHER DEPENDENTS (Provide information for all children and dependents)

NAME

06 (Kendra) Flores

06 (Zola Marie) Flores

RELATIONSHIP,

DATE & PLACE OF BIRTH

CITIZENSHIP

08

ADDRESS

Daughter

3 March 1971

8151 Larking La,

USA

Washington, D.C.

Vienna, Va.

Daughter

15 March 1974

USA

"

Washington, D.C.

(4)

FORM

12. 70

444e so oN

PREVIOUS

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MARRIAGE OR

SECTION V.

'J. NAME. (Lasp-First-Middle)

GUERRERO, RIChaLdO

5.

(1)

CITIZENSHIP (Country)

USA

7. EMPLOYE Army

1. NAME (Last-First-Middle)

ABROAD,

GOVERNMENT

• FELATIONSHIF

Neoney

sta, Country)

ADDRESS

COUNTRY IN WHICH RELATIVE RESIDES

Ansbach,

Germany

• Berredic

CONTACT

#2_-RELATIONSHIP

"MATCh 19Y 4ONTACT

3. DATE OF BIRTH A. PLACE OF FIRTH (City, State, Country)

5.

CITIZENSHIP (Country)

6.

ADDRESS OR

COUNTRY IN WHICH RELATIVE RESIDES

(2)

7.

EMPLOYED

BY

8. FREQUENCY OF CONTACT

9. DATE OF LAST CONTACT

1. NAME (Last-First-Middle)

2. RELATIONSHIP

3. DATE OF BIRTH

A-PLACE OF BIRTH (City, State, Country)

5.

CITIZENSHIP (Country)

6. ADDRESS OR COUNTRY IN WHICH RELATIVE

RES IDES

(3)

T. EMPLOYED BY

8. FREOUENCY OF CONTACT

9. DATE OF LAST CONTACT

SECTION VI.

PERSONAL DECLARATIONS

HAVE YOU BEEN ARRESTED.

INDICTED. OR CONVICTED FOR ANY VIOLATION OF LAW (Other than for

minor traffic riolation) SINCE, THE: DATE OF YOUR LAST PHS

YES (explain X

belon).

2.

SINCE THE DATE OF

YOUR LAST PHS, HAVE THERE BEEN ANY UNFAVORABLE INCIDENTS IN YOUR LIFE

YES (explain

WHICH MIGHT REQUIRE EXPLANATION.

below)

3. NAME OF YOUR PRESENT IMMEDIATE SUPERVISOR (include Room Number and Extension) Mr. Nestor Sanchez y

X-7451

RV 3D30

SECTION VII.

PERSONS TO BE MOTIFIED IN CASE OF EMERGENCY

T. NAME (Last-First-Middlame as previous PHS.

2. RELATIONSHIP

3. HOME ADDRESS (Number, Street, City, State, ZIP Code)

A. HOME TELEPHONE NUMBER

• NO

NO

BUSINESS ADDRESS (Number,

Street, City, State, ZIP Code) - INDICATE NAME OF

BUS INESS TELEPHONE NUMBER & EXT.

IN CASE OF EMERGENCY, OTHER CLOSE RELATIVES (spouse,

... › MAY ALSO BE NOTIFIED.

IF SUCH NOTIFICATION

IS NOT DESIRABLE BECAUSE OF HEALTH OR OTHER REASONS, PLEASE IDENTIFY THE

PERSONS NOT TO BE NOTIFIED AND THE

REASON.

SECTION VIII. '

ADDITIONAL REMARKS:

::..

DATE

SIGNATURE OF

EMPLOYEE

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SUPPLEMENTAL PERSONAL HISTORY STATEMENT

NAME (First-middlo-last)

Dandel (sma) 'Floras

2.

MARITAL STATUS

SINGLE

MARRIED

OTHER

2A F.

MARRIED

06:1

NAME OF SPOUSE. (First-middle(naiden) last) :

Dorothy 1. Moran Flores Mi

OF MARRIAGE.

PLACE MAN PEASE

110

d.

RESIDENCE (Since

of last

PHS.

SINCE (Date)

PRESENT

August 1961

MARRIAGE

Hovenber 1960

overseas residence indicate only city & country)

AND STREET

CITY AND STATE

2828 Comocticut ATe.,

N.w.

Wabhington, D.C.

27753

FEROM:

t/MG05

DATE TO DATE

NUMBER

AND STREET

CITY AND STATE

DATE TO DATE

NUMBER AND STREET RI

CITY AND STATE

FROM

Br.20n

BEEN ARRESTED:

•INDICTED: FOR :CONVICTED: FOR-ANY:VIOLATION OF LAW (Other than for

5 mayor traffic violation) SINCE THE DATE OF YOUR LAST PHS

8. SINCE MIGHT REOUT E EE LASATPOS. HAVE THERE BEEN ANY UNFAVORABLE INCIDENTS IN YOUR LIF

> THESE YU MALONE EDIATE SUPERVISOR

EXY7176

8. ADDITIONAL REMARKS (USe SeVerDO if nocessary)

:20008

YES 88xploin X

yes explain y

RM. 305l

NO

NO

1

DATE

29 March 1967

FORM 444e

d-61

(4)

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14-00000

1. NAME (First-middlo-last)

Daniel (nm) Flores

IF MARRIED

SUPPLEMENTAL: PERSONAL HISTORY STATEMENT:

2.

MARITAL STATUS

BINGLE!!

•MARRIED

(First-niddle (maiden) - 1a88)

MOrANjILOrEE

PLACE

OF MARRIAGE

Lima, Pera) l0

A. RESIDENCE (Since date of last PHS,

SINCE (Date)

PRESENT

August 1961

DATE TO DATE

DATE OF MARRIAGE

18 November 1960

if overseas residence indicate only.city.d.country)

NUMBER

AND STREET.

CITY AND. STATE

(2828 Connecticut Ave.,

Wakhil ngton, DiC.

20008

NUMBER AND STREET

CITY AND: STATE."

FROM

DATE TO DATE

NUMBER AND STREET

CITY AND STATE

FROM

YOU BEEN ARRESTED, INDICTED. OR CONVICTED FOR ANY VIOLATION OF LAW (Other than for:

minor traffic violation) SINCE THE

DATE

OF YOUR LAST PHS

6. SINCE THE DATE OF YOUR LAST PHS. HAVE THERE BEEN ANY UNFAVORABLE INCIDENTS IM YOUR EUSE

MIGHT REQUIRE EXPLANATION

' Marry T. Man oney MEDIATE SUPERVISOR

• • Manonsy

8. ADDITIONAL REMARKS (USE SEVerBe if necessary)

so low

;?(Explai,

belor.

EXT - 7176 RM-#3054.

NO

ETURN PHS AND ATTACHMENTS

10 HEADQUARTERS

DATE

29 March 1967

FORM 444e

4-61

(4)

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