BRENNAN, BERNIE.
Originator: CIA
Document date: 06/02/1969
Document type: PAPER - TEXTUAL DOCUMENT

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104-10174-10019

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RESPONSE TO GREEN LIST

REQUEST NO 101092

Bernde ERSTAN

ALIASES,

DARIEN; IFELLINGS.. CTO NUMBERS. ETC.

Lansanit

Berrie. ERENAR

3. BIRTH DATE.

BIRTM PLACE

5.

CITIZENSHIP:

€= PRESENT ACTIVIT:

* LOCATION

Avlation Editor:

Mland Beach Sun

Data: Florida

7 OCCUPATIONAL SPECIALTIES, COUCATION"

8- MILITARY SERVICE

SERVICE IF*. COUNTRY

CAST: OCCUPATIONS.

ACTIVITY

REQUEST FROM

MIME. OF ORIGINATI

SG OFFICEN

03

CFFICE DESIGODTOR

NH/4

"TENSICA

2c1l Barton

HAS CON TRUING SEASO EQUESTED?

-TES

:5.

TYPE OF REQUEST

FIRST TIME SÜRMITTED

ZE_AOD ITIOTAL DATA

_COVER,

26. INTEREST IM SUBJECT.

A ESPIONAGE OR GE ACTIVITY

OPERATICNAL CLEARANGE

INFOPMATION RECUIRED

SPECIALTY

LOCATION

DATES

LOCATION

"DATES

- NO

10. DESCRIPTION:

'(HEIGHT)

(WEIGHT.):

•11: -SPOUSE (IF WIFE. GIVE MAIDEN NAME)

12. OTHER MEMBERS OF iNESIATE FAMILY; AND ASSOCIATES:

13. CTMER SIGMIFICART CATA (POLITICS, RELIGION, ETC)

• (EYES)

(HAIRY

(RACE)

• (OTHER):

ATTACH EXTRA SHEETS WHEM NEEDED

INSTRUCTIONS:

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SEE CSI-10-7..

FORM

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