## Page 1

Released under the John F. Kennedy

Assassination Records Collection act of

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

BaR 3 Date: 09-18-2025

Date

Page

:

01/14/98

1

JFK ASSASSINATION SYSTEM

IDENTIFICATION FORM

AGENCY INFORMATION

AGENCY : INSCOM/CSF

RECORD NUMBER: 194-10003-10336

RECORDS SERIES : INTELLIGENCE/COUNTERINTELLIGENCE SOURCES

AGENCY FILE. NUMBER

: PAGES 4-5

DOCUMENT INFORMATION

ORIGINATOR : USA

FROM : 59TH ORD GP

TO : USA ADVANCED WEAPONS SUPPORT COMD

TITLE : [ RESTRICTED ]

DATE: 11/17/71

PAGES

: 2

SUBJECTS : KACZMARCYYK, GEORGE

RESULTS OF NATIONAL AGENCY CHECK

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:34529119 Page 1

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## Page 2

ND 10/1

59/84

NACC Use Only

266-1407

STAPLE HERE

DEPARTMENT OF DEFENSE

NATIONAL AGENCY CHECK REQUEST

LAST NAME - FIRST NAME - MIDDLE NAME

KACZMARCZYK, Edward INMN

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

NONE

REQUEST

DATE

16 Sep 71

YEARN MA

15

230022 c

Male

4 SOCIAL SECURITY NUMBER

143/40 1685

5, MONTH, DAY, YEAR OF BIRTH

Aus 06, 47

6. PLACE OF BIRTH

Bomblitz, West Germany

GE

7. SERVICE NUMBER

*1272 4692

8 & SECURITY PROGRAM

XXX MILITARY

HIM

CIVILIAN

RETURN

Commanding. Officer

RESULTS

TO:

INDUSTRIAL

U3. Army Advanced Weapons Support Command

b.

(Include ZIP

ATTN: Intelligence Branch

Code)

MRO NY 09107

ACCT# 6124

LOCAL FILES CHECKED

WITH FAVORABLE RESULTS

C. INITIATOR OF REQUEST

Commanding Officer

He, 59th Ord Go

12.

CITIZENSHIP

9.

RELATIVES

a FATHER

12 Nov 12

DATE AND PLACE OF BIRTH

KACZMARCZYK, Josef

Frampol, Poland

b. MOTHER (Full Maiden Name)

19 Mar 06

IWANOWA, Dorota

Alexandr

5K,

Ukraine

C. SPOUSE (Full Maiden Name)

30

A

8

NCE

EASON, Patricia Ann

Newpo

NewS,

Vari

13. RESIDENCES (List all from 18th birthday or during past 15

a. FROM

b. то

c. NUMBER AND STEE

65

3oo stone SiT ADDRESs

Dotham Afa.

300

Agine st

andra Le Ha #115

Riderdale, M

Orter. (If under 18, list present and most recent addresses.)

d. CITY

Bolish

Polish

Dec 64

Jun

OPR.

Jul 65

Feb

67

OPH

Mar 67

Jan

68

ARMY

Jan 68

Mar 69

INAC under

Apr 69

Mar

70

OrK

completed

KENNETH E.

psI Diussyatrick AFB

"yreux-FauvilleaD

Ft Sill

Hue

US

e. STATE

Ne

France

Fla.

Okla

RVN

4313 I Rose Terrac

1a, EMPLOYMENT /List al from 181h dirtiday or during past is veals nichel i shorter, l under 18, lu present and most recent employment)

a. FROM

b. то

c. EMPLOYER

d. PLACE

Mar 70

Jun

70

Unemployed

Jun 70

Aug 70

Briggs Co

15.

a. FROM

Nov. 60

YES NO:

16.

b. то

Jun 64

c. NAME

Is the subject an alien or naturalized citizen?

b.

Has the subject had employment requiring a security clearance or investigation?

Is the subject now or has he ever been in the Federal eivil selvice or Ahmed Forces sp

f. Has the subject qualified DD Form 398, 98, 48-1, or similar security form?

X | & Has the subject ever been addicted to drugs?

18. REMARKS (1f additional space is needed, continue on plain paper.)

till fig

Sep 71 - present, OPR,

Pirmasens,

X

X

REASON

BASIC TRAINEE

PRE-COMMISSION

NUCLEAR

BI.

SECRET

CLEARANCE

ITEM

#8a. & 8b.

4

Josef Kazmarczyk, DPOE: 2 Nov 6D, NYC, NY, Alien reg-147904415

Dorota Iwanowa Kaczmarczyk, DPOE: 2 Nov 6D, NIC, NY, Alien reg # A79$4416

FORM

DD 1 DEC 68 1584

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

# GPO: 1967 0 279-094

NW 88613 Docld:34529119 Page 2

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## Page 3

DD FORM 1584 - continu

KACZMARCEYK, Edward NMN, DPC

West Germany, SSAN: 143-40 1685

Aug 06, 47, Bomblitz,

Arem #15a. Subject was naturalized on 24 Oct 69 in US District Court, Honolulu,

Hawaii. Naturalization No: 9271178

ITEM 15b.

Uncle,

Stanley Kacmarczyk, age 66, Sluchowo, Poland

Aunt,

Ann Artabolowska

, age 67, Charkow,

USSR

Aunt,

Kshania Hitriowa

age unk, Charkow, USSR

Stepbrother, Wladimir Iwanow

, age unk, Charkov, USSR

ITEM 15с.

immigrated to United States with parents on 25 Nor 50. From 19 Dee 55

until 2 Nov 60 traveled through USSR and Poland visiting family. Detained

in USSR for 9 months before exit was permitted. Subject left Poland with family

on 16 Apr 5? to return to United States. Fanily (including subject) was held

over in Hamburg, West Germany, awaiting sponsorship to return to United States.

While in Germany,

subject visited Iuton, Bedfordshire, England, Pröm 17 Pec 58

until 12 Mar 59.

i?%.

Subject re-entered the United States

legal residence.

Subject also visited Canada from 6 Aug 63 - 12 Aug 63.

12 Nov 60, NYC, NI, for purpose of

ITEM 15e.

Active duty, US Army, E5, Dec 64 - Mar 70, Aug 70 to present.

266

wins

FBI investigative files based

data submitted located no identifiable

information pertinent to your inquiry. Not

be considered as a clearance.

To check

arrest records request must be submitted to

'BI Identification Division. Fingerprints

are necessary for positive check.

NW 88613 Docld:34529119 Page 3

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