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Heleased under the John F. Kennedy

Assassination Records Collection Act of

1992 (44 USC 2107 Note]. Case#:NW

66613 Date: 03-18-2025

Date: 01/14/98

Page : 1

JFK ASSASSINATION SYSTEM

IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : INSCOM/CSF

RECORD NUMBER

: 194-10003-10338

RECORDS SERIES

: INTELLIGENCE/COUNTERINTELLIGENCE SOURCES

AGENCY FILE NUMBER

: PAGES 8-9

DOCUMENT INFORMATION

ORIGINATOR : USA

FROM : 59TH ORD GP

TO : USA ADVANCED WEAPONS SUPPORT COMD

TITLE : [ RESTRICTED ]

DATE: 09/16/71

PAGES : 2

SUBJECTS : KACZMARCYYK, GEORGE ..

DOCUMENT TYPE : PAPER, TEXTUAL DOCUMENT

CLASSIFICATION: UNCLASSIFIED

RESTRICTIONS : 3

CURRENT STATUS : RELEASED WITH DELETIONS

DATE OF LAST REVIEW : 03/09/95

OPENING CRITERIA :

COMMENTS :

NW 88613 Docld:34529121 Page 1

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## Page 2

NACC Use Only.

2661407

STARLE HERE

DEPARTHENT OR DEFENSE

NATIONAL AGENCY CHECK REC

¿ST,

LAST NAME - FIRST NAME - MIDDLE NAME

KAOZIRUZYK,

Edwerd NIN

3. ALIAS(ES) AND ALL FORMER NAME(S)

NONE

59

REQUEST DATE

Sep '71

A SOCIAL SECURITY NUMBER

143 40 1685

5. MONTH, DAY, YEAR OF BIRTH

Aug 06, 47

6. PLACE OF BIRTH

Bomblitz, rest Germany

7, SERVICE NUMBER

-A 1272 4692

8a SECURITY PROGRAM

MILITARY RAI

CIVILIAN

RETURN

Commending Officer

• INDUSTRIAL

RESULTS

TO:

liS-Arcy Advanced Weapons Support Command

b.

(Include ZIP

Code,)

AGIN: Intligenco Bronch

TO NY Coys?

ACCTH 5124

LOCAL FILES CHECKED

WITH FAVORABLE RESULTS

C. INITIATOR OF REQUEST.

Conmending Officer

59th Ord

Go

12.

CITIZENSHIP

RELATIVES

10.

DATE AND PL

F BIRTH

a FATHER

T2 NOV

T2

LAOZIAROZYK, Josef

Franpol, Foland

b. MOTHER (Full Maiden Name)

19 Mar 06

INAMONA,

Dorota.

Alexandrowsk, Ukraine

21:

PRESENT ADDRESS

300 Stone St

Dothan, Ala.

300 Stone st

¡other

Polish

Polish

& SPOUSE (Full Maider Name)

30 Apr 48

LASON,

Patricia Ann

Newport News,

Va.

Riverdale, Mid

13. RESIDENCES (List all from 18:h birthday or during past 15 years,

whichever is shorter. If under 18, list present and most recent addresses.)

a. FROM

b. TO

c. NUMBER AND STREET

d. CITY

Dec .64

Jun 65

OFR

Ft Dix

Jul

65

Feb

6'7

OPR

Evreux-TeuvilleAS

Mar

67

Jan

68

OFR

Patrick AFB

Jan

68

Mar

69

UPR

Ft Sill

Apr

69

Mar

OFR

Hue

US

e. STATE

NJ

France

Fla.

Okla

RVN

Aug

70

Aug

•71

4313 I Rose Terräce

Ft Knox

14. ENPLOYMENT (List all froin 18th birthday or during past 15 years, whichever is shorter. If under 18, list present and most recent employment)

a. FROt)

b. то

c. EMPLOYER

d. PLACE

Mar. 70

Jun

70

Unemployed

Jun 70

Aug 79

Briggs Co

Landover, Mid

CZIP NOT REQUIRED

DO NOT FORMARD TO FIEL

No Record

Arsen pec: "A1-904-417

Citizenshink

92.7/178,

¿i Has the subject ever been addicted to drugs?

18.

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

Cizm 79, Sep 7i - present;

orn,

Firnasens,

- Céntral Office - IS

Route to CORAIB = Room 240

Central Office - I&NS

HHU

10/34/64 m

822169

DiSCO

simany

8

182. 2: 8b.

docer Racmaroyia, Drous 2 Nov 60, Wre, N. Mien 2e8. A7904415

KiK

borote

-07 6

A904416

continued

REPLACES DA FORM 3027, 1 AUG 65, WHICH IS OBSOLETE

# GPO: 19670279-094

FORM

DD I DEC 66 1584

NW 88613 Docld:34529121 Page 2

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Pasterny, son no 1565

Tiest. derriany, SSil:

Shes A5ã, subject was naturalised on

2l: Not s9 in US Piotrict Court, Monol Ju,

Meredi, Naturalization To: 9271

INST 150.

Uncle,

Svenley Facaranezat,

35,

Aurity

Kobenden

222:1006

preparother, Ladini Shano:

: 0g0 vals,

Reto, 3ol0nd

i"??

Ches cow,

0rS?

Racerco,

12ST

200e 15c.

subject imagrated to United States with pereats on 25 Mor 50. Trom 19 "ec 55

natal 2 nor 60 traveled throngh ISS? end

Soland visibing Cartoo.

retained.

in 0a97 for & monds botore act mes perrinter.

Subject lert Polend cath

Card l

on 16 dor 57 to rebuen te-Undüed Sontes. Family (lacluding subjec

was Held

oves in Herbura, Test Gerang, ecting sponsorship to rahum to lnibed Suetes.

uhile in Gemany, subjeon visited Juton, Bedfordshire, Ingland, Bro: 17 Dec 58

until 12 har 59.

subject senatened the inited Suobes on 2 for de, 10, Jut, for purnose

legal residence.

Subjeci a1so visited Senada Bron 6'Aug 65 - 12 Ang 63.

31B: 150.

Active duty, is imy, 55, Dee 6l = Far 70, lug 70 io present.

- Céntrai Office - INS

No. Record

DO NOT FORWARD TO FIEL!

Route to GORAIB - Room 240

Central Office - I&iNS

citizershir

File at

Issued at

NW 88613 Docld:34529121 Page 3

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