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Date

page

09/30/98

1

Released under the John F. Kennedy

Assassination Records Collection Act of

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

B8613 Date: 03-18-2025

JEK ASSASSINATION SYSTEM

IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : INSCOM/CSF

RECORD NUMBER: 194-10001-10496

RECORDS SERIES : FOREIGN PERSONNEL AND ORGANIZATIONS

AGENCY FILE NUMBER : AB632604W - PAGES

DOCUMENT INFORMATION

ORIGINATOR :

FROM : EDIFANIO ROMERO-DELGADO

TO :

TITLE : DD FORM 398 - STATEMENT OF PERSONAL HISTORY

DATE: 01/18/63

PAGES

: 4

SUBJECTS : ROMERODELGADO, EPIFANIO

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 Docld:34528389 Page 1

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els

CR

#53348

DHI

STATEMENT OfFERSO

INSTRUCTIONS: Read the certification at the end

answers.

All questions and statements must be completed.

fact since the statements made herein are subject to verification.

attach additional sheets if necessary.

#Pring) FIRST NAME -MIDOLE NAME--MAIDEN NAME (1/ ANY) - LAST NAME

2.

MRS.

MISS

Edifanio ROMERO-Delgado

X CIVILIAN

STATUS

MILITARY ON ACTIVE DUTY

3. ALIAS(ES). NICKNAME(S). OR CHANGES IN NAME (Other than by marriage)

A. PERMANENT MAILING ADDRESS

Piche

1140 SW 9th St. Miami, Fla.

5. DATE OF BIRTH (Day, month, year)

PLACE OF BIRTH (City, County, State, and Country)

PLACE CERTIFICATE RECCRDED

21 Jan 1936

Candelario, PinardelRio, Cuba

Candelario, PinardelRio, Cuba

RACE

HEIGHT

WEIGHT

COLOR OF EYES

COLOR OF HAIR

SCARS. PHYSICAL DEFECTS. DISTINGUISHING MARKS

Cau

66"

165

Brown

NONE

6. ARCOTICS OR ESTEERA MENTAL OR NERVOUS DISORDERS? IT YES DALNO

NARCOTICS OR BARBITURATES? O YES

ANSWER TO ANY OF THE ABOVE IS "YES." EXPLAIN IN ITEM 20

7. U. S.

NATIVE

IF NATURALIZED. CERTIFICATE NO.

IF DERIVED, PARENTS' CERTIFICATE NO(S).

DATE. PLACE, AND COURT

CITIZEN

ALIEN

I NO

REGISTRATION NO

A13 108 636

NATIVE COUNTRY

Cuba

DATE AND PORT OF ENTRY

21 Sept 1962

Texas

8.

MILITARY SERVICE

ARE YOU PRESENTLY ON ACTIVE DUTY IN THE U. S. ARMED FORCES DRAWING FULL PAY? YES* NO IF "YES," COMPLETE THE FOLLOWING:

GRADE AND SERVICE NO.

SERVICE AND COMPONENT

ORGANIZATION AND STATION

DO YOU INTEND TO BECOME

A U.S. CITIZEN?

YES

TAT NO

DATE CURRENT ACTIVE

ERVICE STARTE

ARE YOU PRESENTLY A MEMBER OF A U.S. RESERVE OR NATIONAL GUARD ORGANIZATION? YES [& NO IF "YES," COMPLETE THE FOLLOWING:

GRADE AND SERVICE NO

SERVICE AND COMPONENT

ORGANIZATION AND STATION OR UNIT AND LOCATION

HAVES CONVICTE THE FOLDOUS OF EXTENDED ACTIVE OUTY, DRAWING FULL PAY, FROM WHICH YOU WERE DISCHARGED OR SEPARATED TO CIVILIAN STATUS' LE YES IE NO

COMPONENT

FROM (Date) TO (Date)

TYPE DISCHARGES OR SEPARATIONS- GRADE AND SERVICE NO.

9.

EDUCATION (Account for all civilian schools and military academies. Do not include service schools)

MONTH AND YEAR

NAME AND LOCATION OF SCHOOL

GRADUATE

YES NO

FROM—

Sep 46

TO

Jun 49

Escuela Publica San Cristobal

10.

FAMILY (List in order given

and place), children,

brothers and sisters,

even though deceased.

RELATION AND NAME

PRESENT ADDRESS. IF LIVING

FATHER

Felipe Romero

MOTHER (Maiden name)

Sagunda Delgado

SPOUSE (Maiden name)

Ilda Martinez

OTHER (Specify)

Arturo Romero

DATE AND PLACE OF BIRTH

date unknown

Conzolaciondel Sur, Cuba

date unknown

DECEASED

Finca Sabana La Mar

San Cristobal Pinardel Rio, Cuba

son

Balerio Romero

1 Feb 1936 Candelaria

Pinardellio, luba

11

9 May 1962

San Cristobal

Finar delRio, Cuba

"

Finca Sabana la MarSan

CristobalPinardelRio Cuba "

Jose Manuel Romero B

11

"1

76

11

Aniceto Romero

B

"1

"

B

18

11

"

11

DEGREE

U.S. CITIZEN

YES

NO

x

pantiago

Romero

NW803

Doela

3451

Page-Lous EDITIONS ARE OBSOLETE. •

Experied to Bureau OF The Bidget June 1960

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11.

RELATIONSHIP AND NAME

Juan Delgado

Pedro Delgado

Francisco Delgado

Niebe Delgado

Maria Delgado

12.

DATES

FROM-

29 Aug62

21Sep62

U

U

AGE

36

38

40

39

39

OCCUPATION

farmer

"

"1

housewife

ADDRESS

Consolasiondel Sur, Cuba

Candelaria Pinardel Rio, Cyba

Santa GrusPiaardel Rio, Cuba

11

11

FOREIGN TRAVEL (Other than as a direct result of United States military duties)

COUNTRY VISITED

PURPOSE OF TRAVEL

Mexico

in transit to USA

CITIZENSHIP

Cuban

==

13.

FROM-

Feb59

EMPLOYMENT (Show every employment you have had and all periods of unemployment)

MONTH AND YEAR

NAME AND ADDRESS OF EMPLOYER

TO-

JAME OF IMMEDIAT

UPERVISO

Equipos Quesada

Jan 60

PinardelRio, Cuba

Nestor Prieto

REASON FOR LEAVING

Foliticalreasons

CHARACTER

CREDIT

14.

GOVERNMENT, FIRM, OR AGENCY?

SOCIAL SECURITY NO.

463-74-2051

CREDIT AND CHARACTER REFERENCES (Do not include relatives, former employers, or persons living outside the

United States or its Territories.

NAME

(List 3 credis and 5 character)

YEARS

KNOWN

STREET AND NUMBER

(Business address preferred)

CITY

STATE OR

TERRITORY

NONE

Juan Noriega

Gustado. Acosta

10

1 0ma

1040 15thSt. Apt#15

1140sM 9th st.

Miami Beach

Miami

Flas

REMARKS.

NW 88613 Docld:34528389 Page 3

U.S. GOVERNMENT PRINTING OFFICE: 19600-573450

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15.

LIST ALL RESIDENCES FROM 1 JANUARY 1937

STREET AND NUMBER

MONTH AND YEAR

FROM-

Jan37

Aug62

то-

Aug62

Dec62

FincaSabanaLamar

1140 SW 9th St.

CITY

Pinarde1 1o

Miami

STATE OR COUNTRY

Cuba

Fla.

16.

NAME AND ADDRESS

PAST AND/OR PRESENT MEMBERSHIP IN ORGANIZATIONS

TYPE

(Social, frarornal, professional, otc.)

MEMBERSHIP

OFFICE HELD

FROM

Subject claims he assisted any and all organizations

against Castro, These were all in Cuba

то-

MRC CUBA

MDC CUBA

INIDAD REVOLUCIONARIA, CUBA

BOdeNov, CUBA

17.

YES

NO

ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF THE COMMUNIST PARTY U.S. A.. OR ANY COMMUNIST ORGANIZATIONS ANYWHERE?

ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF A FASCIST ORGANIZATION?

ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF ANY ORGANIZATION, ASSOCIATION, MOVEMENT, GROUP OR COMBINATION OF PERSONS WHICH ADVOCATES THE

OVERTHROW OF OUR CONSTITUTIONAL FORM OF GOVERNMENT. OR WHICH HAS ADOPTED THE POLICY OF ADVOCATING OR APPROVING THE COMMISSION OF ACTS OF FORCE

OR VIOLENCE TO DENY OTHER PERSONS THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES. OR WHICH SEEKS TO ALTER THE FORM OF GOVERNMENT OF

THE UNITED STATES BY UNCONSTITUTIONAL MEANS?

ARE YOU NOW OR HAVE YOU EVER BEEN AFFILIATED OR ASSOCIATED WITH ANY ORGANIZATION OF THE TYPE DESCRIBED ABOVE AS AN AGENT, OFFICIAL, OR EMPLOYEE?

ARE YOU NOW ASSOCIATING WITH, OR HAVE YOU ASSOCIATED WITH ANY INDIVIDUALS, INCLUDING RELATIVES, WHO YOU KNOW OR HAVE REASON TO BELIEVE, ARE OR

HAVE BEEN MEMBERS OF ANY OF THE ORGANIZATIONS IDENTIFIED ABOVE?

HAVE YOU EVER ENGAGED IN ANY OF THE FOLLOWING ACTIVITIES OF ANY ORGANIZATION OF THE TYPE DESCRIBED ABOVE: CONTRIBUTION(S) TO. ATTENDANCE AT OR

PARTICIPATION IN ANY ORGANIZATIONAL, SOCIAL, OR OTHER ACTIVITIES OF SAID ORGANIZATIONS OR OF ANY PROJECTS SPONSORED BY THEM: THE SALE, GIFT. OR DIS-

TRIBUTION OF ANY WRITTEN, PRINTED. OR OTHER MATTER, PREPARED, REPRODUCED. OR PUBLISHED, BY THEM OR ANY OF THEIR AGENTS OR INSTRUMENTALITIES?

IF "YES,' DESCRIBE THE CIRCUMSTANCES. ATTACH ADDITIONAL SHEETS FOR A FULL DETAILED STATEMENT. IF ASSOCIATED WITH ANY OF THE ABOVE ORGANIZATIONS, SPECIFY NATURE

AND EXTENT OF ASSOCIATION WITH EACH, INCLUDING OFFICE OR POSITION HELD. ALSO INCLUDE DATES. PLACES. AND CREDENTIALS NOW OR FORMERLY HELD. IF ASSOCIATIONS HAVE

BEEN WITH INDIVIDUALS WHO ARE MEMBERS OF THE ABOVE ORGANIZATIONS, THEN LIST THE INDIVIDUALS AND THE ORGANIZATIONS WITH WHICH THEY WERE OR ARE AFFILIATED.

18. HAVE YOU EVER BEEN DETAINED, HELD, ARRESTED. INDICTED OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING. OR CONVICTED. FINED. OR IMPRISONED OR

Has been in Jail without trial in the G2 of Pinar del Rio, Cuba about 18 days from

22 April 1961 for political reasons.

i 5,

19. ARE.THERE ANY INCIDENTS IN YOUR LIFE NOT MENTIONED HEREIN WHICH MAY REFLECT UPON YOUR LOYALTY TO THE UNITED STATES OR UPON YOUR SUITABILITY TO PERFORM

HE DUTIES WHICH YOU MAY BE CALLED UPON TO TAKE OR WHICH MIGHT REQUIRE FURTHER EXPLANATION? YES E NO IF "YES." GIVE DETAILS

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19. ARE.THERE ANY INCIDENTS IN YOUR LIFE NOT MENTIONED HEREIN WHICH MAY REFLECT UPON YOUR LOYALTY TO THE UNITED STATES OR UPON YOUR SUITABILITY TO PERFORA

THE DUTIES WHICH YOU MAY BE CALLED UPON TO TAKE OR WHICH MIGHT REQUIRE FURTHER EXPLANATION?

• NO

IF "YES." GIVE DETAILS

20. REMARKS

ITEM #1O

Fernando Romero B

San Cir to balPinardelio

FincaSanta AmaliaSabana LaMar

San CristobalPinardel io, Cuba

Sabina Romero

S

Augustina Romeros

"

"

GOOD FAITH THUNDERSTAND THAT A NO WING ONE WIEL FUL FALSE STATEMENT OR PEGS FORM CENTE PUNISHED YEE OR IMPRISONMENT OMAROTIN

See U. S. Code, title 18, section 1001

SIGNATURE OF PERSON COMPLETING FORM

DATE

18 Jan 63

seya

21.

THIS SECTION TO BE COMPLETED BY AUTHORITY REQUESTING INVESTIGATION

BRIEF DESCRIPTION OF DUTY ASSIGNMENT AND DEGREE OF CLASSIFIED MATTER (rop secret, sec

pet, etc.) TO WHICH APPLICANT WILL REQUIRE ACCESS

RECORD OF PRIOR CLEARANCES

DATE OF CLEARANCE

TYPE OF CLEARANCE

AGENCY THAT COMPLETED INVESTIGATION

REMARKS.

U.S. GOVERNMENT PRINTING OFFICE: 1960 0-573450

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