CONTRACT INFORMATION AND CHECK LIST.
Originator: CIA
From: CHIEF, WH/4/PERSONNEL
To: CHIEF, WH/4/SUPPORT
Document date: 07/26/1961
Document type: PAPER - TEXTUAL DOCUMENT

## Page 1

10000

104-10180-10124|

2022 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992|

UNCLASSIFIED

IN- INAL

THEY

KOUTING AND RECORD SHEET

CONFI. STIAL

SECRET

SUBJECT. (O09-006:

FROM.

Contract Incornetton & Check 11st - sle Aserto Blis

105 0475. Bye

DATE

26 JUL 1981

1O: (Officer dungreter room number, and

burkdung)

DATT

OFFICERS

scrons column after pach cammant.I

1.

2.

Chlos, HE/WSupport

ly 1

1. Tour Signature, please,

Contract Approving Officer.

They

TO cISE CrriCER

"ELIST

ticl

Mich

R::"

Must in

FEO2AA0 ANd Did Cü:

4-5

10.

18.

12.

13.

TA.

1S.

CONFIDENTIAL

FyI

45 leonidl

riss 44-11-72-313411

1s illi is frigin

i ai

INTERNAL

USE ONLY.

Tain

UNCLASSIFIED

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## Page 2

CONTRACT INFORMATION AND CHECK LIST

• 72.

SICI

MAME

1 118

USEI6IE

8, Ga. Scohefer.

181056.296

ARPE4SICM

4502

171/4

rari

-86-502ty-1947

a. 5108 n0.

PREVIOUS CIA PSELOCHIN CA ALIASES

ЗA. PROJECT

IMITE

TO. DIMAGINT STATION

BaadquArters

AUROTMeNT NO.

25355000.8024

and salaey.)

coatrect. aros (104) ah.82,600 Der-a

P. SECURITY CLEARANOR (TAPe ARS daLe)

MEDICAL CLEARANCE

CONTRACT IS TO BE BRITTE

at pretad 30 2m0 1960

1X1.01.00.

l..

"CISTROLLED-CONDITIONS"

10.

PROPOSED CATEGORY (COntRACe apenE.

MOURS AWAY FROM

SUBJICT'S MOME

AND PERFORMED UNDER PHE

SUPINVISION OF A

STATE EMPLOVEE OR STAFF AGENT

contract

coployee.

afc.)

Coutrnot agent

SECTION 1I

CITIZEMSNIP

18.

нат u.s.

NENT RESIDENT ALIEN

13. LeGAl Restonce Cily and alare or country?

Eato gra carlina 10

I7 sInceR

10. MUMBLA OF DEPESDENTE OR inclodore individual,

RELATIONSMIP AND AGE!

PERSONAL DATA

IMDIVIOUAL IS A PERMA.

788

18. DATE OF BIRTH

(27 2 02 1923) 19

сомпьет)

Edentor, Harta 68r0ll02 ) 10

AR MURARO

IATED

18.

INDIVIDUAL

TED TO A STAFE

EMPLOYEE.

STAFF

AN INDIVIDUAL

CAPACITY

CURRENTLY

AGENT ON

CAPACIONS "

(TO KING FOR THE AGENCY IN SOME

Fina (5) & v150 and f0ar children

SECTION 111

20. RESERVE

¿1. VETERAN

23. BRANCH OF SERVICE

SECTION IT

27. DASIC SALARY

2A. PANK OR GRADE

MA

u.s.

MILITARY

STATUS

22.

IF RETIRED, INDICATE

CATEGORY (LONDAVIlY, CORDOR dIA-

abilley, aerolce disabilley

non-conbat)

23. DRAFT ELIGIOLE

0'1°

2e.

DRAFT DEFERMENT OBTAINED

BY CIA

СД..

COMPENSATION

28.

POST DIFFERENTIAL 28.

COVER (Rroaddoor, 11 any)

79,600

MA

30. FEDERAL TAX VITHACLDING

COVER

CIA

ves

SECTION V

J1. QUARTERS

ALLOMATES (NORMALLY GRANTED ONLY TO RESIDENTS OF THE UNITED STATES)

32. POST

33.

OTHER

JA. COVER (Breakdoon, if any)

SECTION VI

35.

TYPES

TRAVEL

37.

pres

ННЕ

• BE SNIPPED

MHE TO BE STORED

J0, MITH DEPENOENTS

[I".

STATE DEIA MONE

res

DO. IF MITM DEPENOOTS STATE RELATPONSMIP, CITIZENSHIP, AGE AND DATE OF BIRTH

yoo old, u.s.

-SalllO serlcO Podrl¿Ues, JrOLO yro old, U.s.

PAYMENT ANO ACCOURTADILITY DILL DE

Heroere

SECTION VII

PURCHASE DE INFDANATIIN

FORMANCE BITH

1.08.

OPERATIGNAL EXPERSES

IAMEN:

-1CS-

361604049)58

204

SECRET

(a1

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## Page 3

(CONTINUEO)

MITH

+ir-55075

207000-2908

18808081070,108

•entedil perdonnes.

injury end donsh heiartia (la lles os duls) not to escaed $,000.

SISTION

COVEN ACTIVITY

г494T

culTura.

PRECIO SE NEINRUNSARAL ASIS

Dromeerra

PRESET OF INCOME

30.

alcorhod heraro. y

PAGUE ANO STAGE CONLUOGOTS PRAIVEO PANO CONTO ACTIVITIRS CES JODE PRAS COROS, SUARORE 1R

SECTION XI

FERN

TERMIMATION ANTICE PRONTOT OF dATO,

SECTION «7P Sagr

30.

PRIMANY FUNCTION (CF. F1, PP. Order)

191997.79822 0R RETUAN TARVEL TER

FUNCTION

SECTION XIII

S9. GRNERAL DESCRIPTICM DE DUTIES TO DE PERFORMEO

Dovelopreas, recruitaers sed bendilas al YI ezento.

PRIOR TO CONTRACI TIRMINATIOI

SECTION YIV

-carentenes

JLALIFICATIONS

sulfoat una osa of tha arlucion) ajents al the II sol la vaba atter tha tresi 1a

dirlasatlo ralaticos.

S9, COUCATION

(creet Mercas)

AD. LANGUAGE COMPETI

LENGUAGE

alances oronte

'ITE

Peora!

afreo Comparons

-Spas1as

I

AAL A KNONLEDGE

Desacte

Italian

INCLUSIVE DATES, POSITION POYLE DO TUPE MORE

B080U6T6

CONVIDUAL ORIGIN

COUNTRY OF

.........

Cobr

I

1956-2940 1ã0 a456j0r di aCochlred liena Disirict Bales ardos for tordos

Uo5, Siria,) Liscosa astlartel Al abest 110,000 jourty.

-APA

acidadi,

AF"G"NAL

SECRET

2/NJ

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