[1]14-00000
[3]104-10175-10179 | 2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992 |
[5]GACSF CATON
[7]SECRET PROCESSING
[9]FUSED
[11]Chief, Wh Division Eng recesng REQUIRED :
[12]pe | mea
[13]WAI ATTERS LEASE
[14]XX {thn 208 INOLLINS
[15]sanaenet of Station, >fexico Ci!
[17]a EUFF/l
[19]ACTION REQUIRED - REFERENCES
[21]REFERENCE: A. HMMW-I1321, 13 Fed 1963
[22]B. HMMA~20931, 22 Mar 1963
[24]1, Transmitted under separate cover truename attachments are the
[25]following forms to complete Headquarters' records on subject:
[27]a. Personal History Statement :
[28]; b. Personai nistory S.ctc...cut Uiggontiz 1) ' ,
[29]: c. Report of Medical History sO
[31]2. Subject was originally recruited as a cutout for the LIHUFE/2
[33]organization. However, his actual duties for KUBARK entail far more than
[35]: coatact and communication with LIHUFF/2. He is an outside agent, ‘in
[37]: ‘addition to acting as the contact between the Mexico Station and the LIEUFF/2
[39]‘ ‘Institute, LIHUFF/1 is responsible for organizing and directing the KUWOLF
[41]: student greups in the LIMUFF/2 project; printing and distributing of 1- <opa ganda;
[42]planning and initiating student harrassn.ent activities. Since LIHUFE, i's
[43]duties are those of an outside agent, nis salary was established to reimburse
[44]him for the amount of time it is necessary for him to spend on LIHUFF
[45]activities. In this regard, it is felt yzat the sum of $500. monthly is not an
[46]excessive amount, Hleadquarters is sequested te process a contract for
[47]subject in this amount. oc - f
[49]3. Subject's social security number i0)255- =58-50a4)
[51]Enclosures:
[52]as stated above (UNDER SEPARATF, COVER)
[54]taper 7h
[56]tare CeSPAtoeD
[58]29 Apr, 63 30 Apr 63
[59]OFSPATCH SYMBOL AND NLAEIER !
[62]CScopy . a : ‘ASAE SR
[63]» 201 0949953 a
[65]DATE TYFLD
[68]! = WH, w/encle
[70]14-0000
[72]SECRET
[74]SOCtAL SECURITY NO,
[75]IF SOCIAL SECURITY WO. 1S HOT AVAILABLE. SAVE FORM NO. S55
[76]3'255-58=5884 3 “APPLICATION FOR SOCIAL SECURITY ACCS-NTS," COMPLETED AS
[78]PROVIDED 1% DETAILED PROCEDURES.
[80][e\<4
[81]21. AOCRESS OF RECZRO (In U.S.) 22. aOD8TSS (foreign
[82]SIGNED ORIG. AND COPY + TO FINANCE: COPY + TO CFNTPAL COVER: COPY - TO SILE
[84]PISTRTE TION:
[87]ew B31ga cesorera eacvicus corrvens. SECRET
[89]rane 0005 S pe :
[94]14-0000
[96]Jag A As Lela Res Dh Cale ot renin ew at als n
[98]eee ae A OF ENR RENEE Cet a CEN SURETY, Nn Re SAO tan: nana aha wine NeeencuatedineemionT nha Elan iiaiiceths “ESA wad
[100]——— 7.
[102]- . . cy om, .
[106]. DO NOT USE THIS SPACE « THIS CATE (Fell'in)
[107]pee | PERSONAL HISTORY STATEMENT ~
[109]INSTRUCTIONS
[111]1. Answer ail questions completely or check appropriate box. If question is aot applicable, write “NA". Write “Un-
[112]known® only if you do not know the answer and it cannot be obtained from personal records. Use blank space at
[113]end of form for extra details on any questioa for which you have insufficient space.
[115]2. Type, print or write carefully; illegible or sacomplete forms will not receive consideration, _ 4
[117]3. Consider your answers carefully. Your signature at the ead of this form will certify to their correctness. Careful
[118]completica of all applicable questions w:) permit review of your qualifi : tions to the best advantage.
[120]SECTION 1 _ GENERAL PERSONAL AND PHYSICAL DATA
[121]1. FULL NAME ‘Loer-Fitst-Auddie)SOSOSCSC~SOSSSSSSSOSCSOCOC AE 3. SEX -
[122]j t
[123]Yi herich Alfonso Rudolph io) ! 47 iX lvece | [rewaue
[124]a $. WEIGHT 6. COLOR UF EYES 1?. COLOR OF HAIR 56. TYPE COMPLEXION |%. TYPE BUILo
[125]6' 3" 185 Brown iBrow: Light Med, :
[126]10 SCARS ‘Type and Locatien) :
[127]None ho
[128]1h. OTHER GISTINGUSHING PHYSICAL PEATURES \
[129]Non
[130]14. CURRENT ADDRESS (No., Street. City, Zong, State and Country) {13. CERMANENT ATORESS CVo., Street, City. Zone, State end
[131]Toluca Highway - Kim 19-1/ Lo | ‘ountry) AND PHONE NO.
[132]1 Magueyito, Cuajiinalpa Same »s (12)- :
[133]Mexico DE, Mexico Phone S0-77- oF
[134]14, CURRENT PHONE NO. (1S. OF FICE PHONE NO. & EXT. 16. LEGAL RESICENCE (State, Terrajory of Camtry)
[135]20-77-4371 ©8 5-96-53, OF i Mexico
[136]17. NICKNAMES jre. OTHER NAMES YOU HAVE USED
[137]Pancho - A! Og { None
[139]—_ i
[140]19. INDICATE CIRCUMSTANCES ‘including Length of Tone) UNDER WHICH YOU HAVE EVES USED THESE NAMES. . 4
[141]{Pancha - through college -Wilice & Tucson Ariz, Aik Used to date. :
[142]. IF LE T CHANGE. GIVE PARTICULARS (#here end dy Whet Authority) . ‘
[143]OY i
[145]SECTION H POSITION DATA 3
[146]1. INDICATE THE TYPE OF WORK OF POSITION FOP aniCH YOU ARE APPLYING
[148]sete [ee mene Ak ee
[150]2. INDICATE THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL | 1k & PLOVMENT
[151]ACCEPT (Yar will not be conertered for uny positron mth a lowee * OATE AVAILABLE FOR EXPLOWME
[152]antranceée aztary). $s
[154]4@ INDICATE YOUR WILLINGNESS TO TRAVEL
[155]Joccasiowaucy lenequenter b 'SGNSTANTLY T_Jornen: i
[157]&. INDICATE YOUR WILLINGNESS TO ACCEPT ASSIGNMENT IN THE FOLLOWING LOCATIONS (Check ‘X) each item applicabhey
[158]ae are ciehiaiaaataaahanisennatiaananiae —_————
[159]WASEINGTON 0.C. PAN VONERE IM U8. TERTAIN LOCATIONS ONL ¥ (Specify:
[161]OUTSIDE TONTINENTAL UV & i
[162]6. INDICATE WHAT RESERVATIONS YOU BOULD PLACE ON ASSIGNMENTS OUTSIDE THE WASHINGTON. 0.C. AREA.
[165]a0 444 USE PREVIOUS EDITION, whe
[169]14-00000
[171]07, l®
[173]bre as
[177]SECTION lit CITIZENSHIP : e
[179]1, DATE OF BATH 2 PUCALE OF BIRTH (Cry, State, Counters | 3 PRESENT CITIZENSHIP (Councry)
[180]Oc:, 39, 1915; Chituasua, Chil, Mexico, (U.S. WA.
[181]4, CITIZENSHIP ATQUIRE F ACQUIRED B 5 ons NATURAL- | 6. WATURALITATION CERTIFICATE HU.
[182]= a
[183]| jem | Juasnmace | xoormee tect: derivitive, NA ‘ NLA
[184]7, COURT ISSUING NATURALIZATION CERTIFICATE +8, .SSUED AT (Coty, State, Countryz
[185]NA, | NA :
[187]9. HAVE YOU HELD PREVISUSNATIONALITY —[10. (F YES, GIVE MANE OF COUNTRY
[188]| [res ____{x jue NLA
[190]10, GIVE PAG TICULARS CONCERNING PREVIOUS WATIONALITY.
[192]N.A.
[195]12. HAVE YOU TAKEN STEPS 10 CHANGE {_[ves | 1. GIVE PARTICULARS
[197]PRESENT CITIZENSHIP oo see
[198]nw i NO N A i
[199]14, 1F YOU MAVE APPLIED FO® U.S. CITIZENSHIP, WHAT IS PRESENT STATUS OF TOUR APPLICATION (First Papers, Etc.}*
[200]— NAL
[201]18. DATE OF ARRIVAL INUS. (16. PORT OF ENTRY ~ 17. ON PASSPORT OF WHAT COUNTRY .
[202]1916 | _El Paso, Texas Unknowa
[204]16. LAST U.S. VISA (No,
[206]SECTION iv EDUCATION
[207]1. CHECK (X) HIGHEST LEVEL OF EDUCATION ATTAINED
[208][cess rasn wig scnooreaapuare _—=—=~—SS”SCS*d:Csd even no ve ans ow ecouteae wo oreree |
[210]EMiGe SCrOOL GRADUATE x BACKELCS'S DEGREE
[211]TRAGE, SUSINESS, OR COMMERCIAL SCHOOL GRADUATE | [ SRacuare STUDY LEADING TO HIGHER DCCAEE
[213]Type Place of Inaus)
[215]{. 19. DATE Visa ISSUEO
[217]wae VEODS COLLEGE OE KEES
[219]| wasvecrs neqore PnAeTORs OECOEE
[221]2. ELEMENTARY SCHOOL
[223]ME C* ELEMENTAPY SirsoL
[224]Willcox Grammar School
[225]3. GATES ATYVENODED (Fromans ia
[226]3922-1930
[228]1. MAME OF HIGH SCHOOL
[230]Willcox Union Hi
[232]3. Bite: Aa TENDED (Fromenc rod ” 4. GRADUATE
[234]1930-1934 . txfees to
[236]1. NAME OF HIGH SCHOOL 2. ADORESS . City, State, Country)
[238]8. DATES ATTENDED (Faonm-ens-Taj
[240]4. COLLEGE O8 UNIVERSITY STUDY
[242]DEGREE
[243]RECO
[245]SECTION IV
[247]CONTINUED TO PAGE
[249]a
[251]s
[253]4
[255]g
[257]1
[272]seer ate
[276]io
[280]a
[281]“—_
[284]14-0000
[286]Aone aeons he tnntreerintenttnerammmiennieetcnneetcns + +
[288]ere cma -
[291]. SECTION IV CCAITINUED FROW PAGE 2 . .
[292]S. UF A GRADUATE SEGOLE HAS BEEN NOTED IN ITEM &
[293]CE BUA E SEGEEE AAS BEEN NOTED) WATEM ¢ MHICH REQUIRED SUBMISSION OF A WRITTEN THESIS, (NDICATE THE TITLE
[295]& TRADE, COMMERCIAL AND SPECIALIZED SCHOOLS
[296]STUDY GR SPECIALIZATICN
[298]NY
[300]7, MILITARY TRAINING (FULL TIME DUTY IN SPECIALIZED SCHOOLS SUCH AS ORDNANCE, INTELLIGENCE, COMMUNICATIONS, ETC)
[301]NAME AND ADDRESS OF SCHOOL i STUOY CR SPECIALIZATION ! reo Te MONTHS
[303]Cav. School - Basic | Troop Duty lion | 3 |
[304]Et Riley. Kansas _———-—Harse § Mechanized . 1941
[306]Command & Gener. nh Kah G-2 - C&GS 1943 | 3
[308]8. OTHER EDUCATIONAL TRAINING KOT INDICATED ABOVE.
[310]War Dept. Mis-X - Intelligence
[311]Fort Hunt, Washington, D.C, 1943 - 6 monzhs
[313]i
[314]4
[315]i
[317]SECTION V FOREIGN LANGUAGE ABILITIES . e
[318]COMPETENCE - IM ORDER LISTED : :
[320]0. LANGUAGE R-Reod, W-Weite, $-Speok HOW ACQUIRED | , :
[322](List delow each langusse in = - t :
[324]which you possees iny degree Equiv. FLUENT t
[326]of competence. Indicote vax | “LENT BUT ADERUATE | ADEGUATE) UNoe.” | carve |, PRO CONTACT, cApemid
[328]Proficiency to Read. Wee of NATIVE | FONEION. Reseancn TRAVEL weoce oF LONGED | twin siuav
[330]Speck by plocing a check (X) | FLUENCY { _ COUNTRY) | mes ! porents: | eweles
[332]in the appecoriate boxes? wisfarwfsfeiatsfearwispriwts ‘ :
[334]Spanish ~
[335]2. IF YOU HAVE CHECKED “ACADEMIC STUDY * UNDER "ROW ACQUIRED”, INTICATE LENGTH ANDO INTENSIVENESS OF stuor.
[337]4 years ‘high school
[339]PLAIN TOUR COVPETENCE THEREIN. = _
[341]ast DESCRIBE. “FOUR ABLITY TO DO SPECIALIZED LANGUAGE BORK INVOLVING VOCAGULARIES AND TERMINOLOGY ™~ t
[343]7
[345]TVIFIC. ENGINEERING, TELECOMMUNICATIONS, MILITARY, AND OTHER SPECIALIZED FIELSS.
[346]Business terminology - write. - speak - read & translate,
[347]Soclo-Economics - write - speak ~ read & translate,
[349]Sl iF VOU HAVE NOTED A PROFICIENCY IN LANGUAGE. @OVLD TOU GE SILKimG TO USE THis BILITY IN ANY COSI TION, FOR BHICH
[350]VOU MIGHT BE SELECTED? { ?
[351]X ves
[353]meats t
[356]ene f
[357]i
[358]i
[359]4
[363]i
[365].
[369]14-0000
[371]@ | SECTION VI GEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL . e
[373]£. LIST BELOW ANY FOREIGK FEGIONS OR COUNTR.ES Ib SMICM YOU HAVE TRAVELLED OR GAINES (hOMLEDGE AS A RESULT OF
[374]RESIDENTE, STUDY C8 OLX ASSIGNMENT. (WOSCATE TYPE OF KNOKLEDGE SUCH AS TERRAIN, HARBTAS, UTILITIES, RAIL-
[375]ROADS, INDUSTRIES, POLITICAL PARTIES, ETC. ,
[377]~~ | H KACce e
[378]cates or | CWLEOGE ACQUIRED OY
[379]i
[381]* MAME OF i TYPE OF "  @esiDENce DATZS AND 7 work
[382]REGION OR COUNTRY | SFECIALIZED KnowLEocE ‘| SaTraveL | PLACE OF StuDr | SES | Tavenstupe | adic
[384]: rs eeinone [ee c
[385]Mexicn - 5c ana Economia Present Ne A. xX |x (xX 7x
[389]{2
[390][Panama Business 1945-1949 NLA, [_x |
[392]|
[394]China ferrin. di 1943-1945: Noa, | x
[396]: . ntral Am Teer Condi on '1946-Present _N,A,. f
[398]2 INDICATE TRE PURPOSE OF wisit, RESIOENCE OR TRAVEL IN EACH OF THE REGIONS OR COUNTRIES LISTED ABOVE.
[400]: Mexico - Business - Work Assignment ” “
[402]{> {Panama - Business - Work Assigameat
[404]{ 2
[406]: China - Army,
[408]. 2. UNITED STATES PASSPCAT NUMBER ANDO EXPIRATION CATE 1€ ISSUED.
[409]O% |_/#118058- Expired August 20, 1962
[411]“@ | SECTION VI TYPING AND STENOGRAPHIC SKILLS e
[412]1. TYPING (epay . 2. SHORTHAND (wpry | 2. SHORTHAND SYSTEM USED - CKECK IX) APPROPRIATE ITEM .
[414]kx Unknown i No { [emecs | Iseecomarinc | isTENOTYPE [| !OTHEP (Specify: 2
[416]2. INDICATE OTHER BUSINESS MACHINES BITH WHICH TOU MAVE HAD OPERATING EXPERIENCE OR TRAINING (Complometer,
[417]Micwogaps, Card Punch, Etc.
[419]tad
[420]tad
[422]None)... Tonle gare M2 ee : i
[424]SECTION Vill : SPECIAL QUALIFICATIONS Sd ‘
[425]1. LIST ALL HOBBIES AND SPOVTS IN WHICH YOU ARF ACT VE OD MAYE ACTIVELY OAS ISIPATED, INDICATE YOUR PROFICIGNST
[427]M456r Achletics - Good ; on
[428]Riding Horseback - Good : . . :
[429]Horse shoes - Good . . . .
[430]Gardening - Fair : :
[431]Bridge ~ Fair : : : v
[433]2. INDICATE ANY SPECIAL QUSLIFICATIONS RESULTING FROM EXPERIENCE or TRAINING WHICH MIGHT FIT YOU FOR A .
[434]PARTICULAR POSITION OR TIPE OF BORK.
[436]NAN PS Oe Oe Sane erento ete meee rem etes
[438]we WR ee en nn
[440]32. EXCLUDING AUTINESS EQULIPHENT OR UAC HINES SMITH YOU MAY MAVE LISTED IN ITEM 2, SECTION VI', LIST ANY SPECIAL
[441]SEER EPS yous POSSESS RELATING TO OTHER EQUIPMENT AND MACHINES SUCH AS OPERATION OF SHORTWAVE RAMO Cindin ‘
[442]cote ed, sedge and rececemng),OF FSET PRESS, TURRET LATHE SCIENTIFIC AND PROFESSIONAL DEVICES. ‘
[444]oe Ee
[446]eaten NB EHS
[449]14-0000
[451]- eee eee ee na ea eenerasanaeesanpeaenpennaed
[452]: SECTION VIN CONTINUED FROM PAGE €
[454]4. ARE (OU NOW OR NAVE YOU EVER SEEN 2 LICENSED GF CERTIFIEC MEMBEF LF ANY TRADE OR PROFESSION, SUCH as PILOT,
[455]ELECTRICIAN, RADIO CPERATOR, TEACHER, LAWYER. CPA, MEDICAL TECaN ciAN, ETC? —_— .
[458]S.1F YOU HAVE ANSWERED “YES$* TO ABSYVE. INDICATE MIND OF LICENSE AND STATE ISSUING LICENSE (Provide Lacense Regisizy
[459]Number, if known). . .
[461]| NA.
[463]6. FIAST LICENSE OR CERTIFICATE (Year cs feece) 7 LATEST LICENSE OR CERTIFICATE (Year of leaus) .
[464]NA NLA
[467]6. LIST ANY SIGNIFICANT 9UBLISHED WE TESIALS OF WHICH YOU ARE THE AUTMS® (Do NOT aubmi? copies unlens requested). INDICATE
[468]THE TITLE, PUBLICA TON DATE, AWE TYPE OF, WRITING (NoerF iction of Sceentifc erticias, Género! Interest subjects, Novela,
[469]tories, Etc.).
[471]NA,
[472]9. INDICATE ANY CEVICES @HICH YOU HAVE INVENTEO AND STATE WHETHER OR NOT THEY ARE PATENTEO. ~
[474]NLA.
[475]10. LIST PUBLIC SPEAKING BUF PYRU IH CF! Ewinwe EVOCoTE re
[477]Throughout Cotlege and business career,
[479]V1. LIST ANY PROFESSIONAL, ACADEMIC C2 “ONORARY ASSOCIATIONS OR SOCIETIES IN WK!
[480]A VEMBER. LIST ACACEMIC HONORS YOU NAVE RECEIVED.
[482]Alpha Zeta - Hoaorary .
[483]Bob Cats } [University of Arizoay
[484]Scabbard & Blad2 ss) .
[486]cH YOU ARE NOW OR WERE FORMERLY
[488]O€
[490]SECTION 1X EMPLOYMENT HISTORY
[492]NOTE: (LIST LAST POSITION FIRST.) Indicate chronological history of employment for past 15 years. Account for all periods
[494]including casual employment and ai! ceniods of ememployment. Give address and state what you did during periodsof
[495]anemployment. List all crvilian exstoyment by a foceign Govemment, regardless of dates. Incempleting item 9, “De-
[496]scription of Duties® cansider your etzenence carefully and provide meanmgtul, objective statements,
[498]3. INCLUSIVE DATES (from end To - 8) Me amd ¥e.} 2 NAME OF EMFLOTING FIRM COR AGENCY
[500]1/1/63 - Present JAmerican Chamber of Commercé
[502]3. ADDRESS (No., Street, Csty, State, Countrs?
[504]3. NAME OF SUPERVISOR
[505]Executive Committee
[507]7. SALARY OR EARNINGS /8. CLASS. GRADE! Federal Service)
[509]Pe. DESCRIPTION OF DUTIES
[511]Management & direction Gf Chamber) P, rdDefend free enterprise systems) {O¢
[512]Coordinate committee work, /Promote trade develop good will. oy:
[515]10. REASONS FOR LEAVING
[517]N.A,
[519]” foamed
[521]14-0000
[523]+e th a eae Acimacnetn mess nineteenth Ree LENIN OU RAT cant bot
[529]we CER oa
[531]-RIVON XY CONTINUED FROM PAGE §
[532]+ INCLUSIVE CATES Fs mand Te Gp 40 and ¥r2 (2 NAME CF EMPLOYING F.2i CR AGENCY
[534]‘Sept. 1949 - Dec al 1962 j_fR.C, Cola Company? 2?
[535]pa ORESS (40, Street, City, State, Courssy?
[537]1 regia
[539]% KIND OF BUS NESS . $- NAME GF SUPERVISOR
[541]lo oG.
[544]ITLE OF 5 1. SALASY OR EARNINGS 18 CLASS. GRADE Fodoral Service)
[545]ned
[547]Gen, Mzr, Roval Crowa, S.A of “+ 12, 009 "©" year _:
[549]Te DESCRIPTION CF SUTIES
[551]:Direcrion of manufacturing concentrates, Marketing. Advertising.
[552]Development of sales, Franchising, Mexico and C. America,
[554]1 isedjbortling plants} O&
[556]13 REASONS FOR LE AGING
[558]4
[560]Transfer to States - Preffered M2xico.
[562]3. INCLUSIVE DATES (From and Jo- By slo and Yr) 2. MAME OF EMPLOYING FIRM OR AGEKTCY
[564]‘Dec, 1946 - Sept, 1949
[566].2- AGORESS(No., Seree:, City, Stare, Coancrys
[568]Panama - Keo de Pana
[569]16D OF Business 3. NAME er SUP eAY OK
[571]1
[574]B og & Sales oft drink Qs Board of Directo
[576], 8 TITLE SF so8 . i 7. SALARY CR EARNINGS ,8. CLASS. GRADE (Tf Federal Service)
[577]a! F195" 000, Per year!
[579]2. DESCRIPTION OF CUTIES
[581]Direction of Company.
[583]10. REASONS FOR LEAVING.
[585]{Unfavorable climatic conditions,
[586]|
[588]1. INCLUSIVE DATES (From and To- By Mo. and Yer} j 2 NAME CF EMPLOYING FIRM OR AGEKCY
[589]on nee re
[590], 3. ADGRESS (No, Sereet, Caty, State, Ceauntryz
[592].
[593]i KING OF BUSINESS 3. NAUE OF SUPERVISOR
[594]H :
[596]| & TITLE OF 208 7. SALARY OR EARNINGS | 8- CLASS. GRADE (II Federal Seevica)
[597]'
[598]H
[600][el cescrierion oF OUTIES
[602]|
[604]1 1S. REASONS FOR LEAVING
[606]t. INCLUSIVE OATES (Fron and Te - Br Ma end Yr} 2. WAVE CF EMPLOYING FIRM OR AGENCY
[607]2
[609]3. ADDRESS (No., Sereet, City, State, Coumtry) .
[611]bd j 4. KIND OF BUSINESS S$. NAME OF SUPERVISOR '
[612]oot HY
[616]? GAL ae OF EARNINGS (0. CLASS. GRADEII Federal Service)
[618]s Tren { i
[619]SECTION IX CONTIACED TO PAGE 7
[621]| 6. TITLE OF OR
[623]Sante
[626]14-0000
[628]Te ee She
[630]9 GESCRIPTION OF DUTIES
[632]$6 REASONS FOR LEAVING
[634]1. INCLUSIVE OATES (From and To- Br Mo and Ye.)
[636]& HAME OF EMPLOYING FIRU CR AGENCY
[638]3. ADDRESS (No . Sireee City. State, Cocmrys
[640]4. KIND OF BUSINESS i RSME OF SUPERVISOR
[641]& TITLE OF JOD 7. SALARY OR EARNINGS "8. CLASS. CasOE (if Federal i
[643]6 s {pee 5 :
[644]o CESCRIPTION OF DUTIES
[646]‘ i
[647]30. REASONS FOR LEAVING :
[649]{ 0. INCLUSIVE DATES (Feces and To - Br ihe end Yr} 2 RAME OF EWPLOVING FIRY OR AGENCY
[651]3 ADORESS (No. Sirees. Cay, State, Cornry)
[653]4. KIND OF BUSINESS _ S. AME OF SUPERVISOR .
[654]i 4
[656]@ TITLE OF [OB 7. SALARY GR EARNINGS 8. CLASS. GRACE if Federal
[658]Service) :
[660]7 3 iPER
[661]9. OESCRIPTION OF DUTIES
[663]. ;
[664](0 REASONS FOR LEAVING
[666]6. IF PRIOR SERVICE BITH THE FEDERAL GOVEANMENT (5 NOTED ABOVE, INDICATE THE
[667]NUMESROF YEARS CRECITABLE TOPAGS U.S. CIVIL SERVICE RETIREMENT, IF KHOUN.
[669]8. HAVE YOU EVER SEEN CISCHARGED CR ASKED TO RESIGN FRI ANY POSITION.
[671]HAVE TOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH "CU DESIRE TO EXPLAIN? [ves Kjno -
[672]1F YOUR ANSWER fO ELTHER OR BOTH QUESTIONS IS “YES*, GIVE DETAILS
[676]webs ee
[678]we
[680]14-0000
[684]Beet A Loin mal eh ee IEA an tend a CR AT SE CN SepENA eneN tre memeetee—nene mmarteerente nt Santi hehe ert = te
[686]Tearpe evens
[688]J
[689]3
[691]SECTION X MILITARY SERVICE
[692]1 CURREKT OparT status = NLA,
[694]1. ARE YOU QEGISTEPED FOR THE SPAFT UNDER jves) 2: senecr ivé SERVICE Cisse | 3. SELECTIVE SERVICE WO. |
[695]THE UNIVERSAL MILITARY TRAINING AND me
[696]SERVICE ACT OF 1548 (Ae srendedy . uo
[698]aol
[700]4. 1F SOEFERRED, GiVE REASON S$ LOTAL DRAFT eoaad w2. OR SESIGNATIO“N AND ADORESS.
[702]2 aul {TARY SERVICE RECORD
[704]asy PSANIZATE HAL i wees £95n0P
[708]a
[709]7 MARINE - AIR
[711]CHECK (XD AS
[712]wavy | corps ' Force | cuaRD wARINE 1 Guses i
[714]SFPROPRIATE
[716]‘OALT WERCHANT. NATICWAL AIR NATIL, FSPEIGN ORGAN. OF mil.
[717]be 5 T'k, SEAVICE (Spesityi:
[719]T
[720]H ARMY
[722]XX.
[724]$e
[726]{ 1 i i
[728]HAVE SERVED
[730]ed - .
[731]NOW SERVING & j : .
[732]2. BRANCH OR CORPS OF ABOVE CHECKED ORGANIZATION(S) .
[733]avalry - MIS___ _
[734]2. DATE SEPARATED FROM EXTENDED ACTIVE DUTY (Past service, £. TOTAL LENGTH DF EXTENDED ACTIVE OUTY IN-U.S. ARMED
[735]CES (Pest and carrent servic
[736]6-46 ! . years ;
[738]5. SATE ENTERED | PAST SERVICE T CURRENT SERVICE 6 TOTAL LENGTH OF ACTIVE OUT OUTY IN FOREIGN MILITARY Cae
[739]ACTIVE DUTY =m) i i GANIZATION
[741]‘Jan, 1941 ' a
[742]1 Bane, GRADE OR PAST SERVICE CURRENT SERVICE 6. SERVICE. SEMIAL O° FILE MUNBER 2 now verving, provide <r
[743]_ pave 7 OO: : 277220 Of
[745]s. PaiMaRry MILITA) CCUP A’ al : PAST SERVICE :CURREN AVICE
[746]SPECIALTY (Moe or Deelgnator) AND TITLE MIS i
[748]Mu. “ZECOMDARY MIL. OCCUPATIONAL 1 PAST SERVICE pOURRENT SERVICE
[750](ower Dengnatey AND) ig oe ° 7
[752]RA oe Ne £
[753]tt, BRIEF DESCRIPTION OF MILITARY DUTIES (Inticate whether applicable ta peet or currens service) Past.
[755]Troop duty - troop and squadron - horse and mechanized cavalry,
[756]Military Intelligence - War Dept, Assigned CBI (MIS-X)
[758]12, CHESK {x) TYPE OF SEPARATION FROM ACTIVE SUTY
[760]_———-—
[761]| HONORABLE DISCHARGE RETIREMENT FOR SERVICE *j WOUE MA. 2SHIPS . :
[762]} RELEASE TO INACTIVE DUTY ly | RETIREMENT FOR COMBAT D'SASILITY eTner: .
[764]| RETIREMENT FOR AGE i | RETIREMENT FOR PHYSICAL MCUSABILITY ]
[766](CHECK (X) COMPONENT IN WHICH YOU SESVES
[767]one! and At: ronal Guacd) ae. “MER (including ATS) AU
[769]1 REGULAR | XI RESERVE (Includmg the J
[771]3. MILITARY RESERVE, NATIONAL GUARD AND ROTC STATUS
[772]1 o.vou Now Mave y Ives 12. Ives 3. ane yo! |
[773]REcERROE Mavic Ives 1 ane voyaens emrgenper-® [ves 36 yeu now amewaen or! ves
[774]4. IF YOU HAVE ANSWERED °YES*® TO ITEMS 1,2 OR 3 ABCVE, CHECK COMPCHEMT MEMBERS? BELOW
[775]| Xikamd — parine conrs, "wATIONAL GUARG COASTGJAPD.waWY ROE INDICATE ROTC CATEGORY Muse
[776]ibs ANE chido Ahaha cae
[777]AiR FORCE [AIR NATIL.GUARD ARWY ROTC / iain FORCE RotTcd BER
[778]5S. CURREMS-RANK, GRADE OR "6 DATE OF APPOINTMENT In CURDENT |7. EXPIRATICN DATE OF CURCENT RESERVE OBUIGA
[779]sate ft Lr, CoLhlOg . FAK 1944 i
[780]8. CHEC! URQENHESERVE CATEGORY "READY RESERVE STANDEY(Actrwes X | STANDBY Seective) [Revers |
[781]9. FRIMARY MILITARY OCCUPATIONAL SPECIALTY (Sos or Dealg- /1D. SECONDARY MILiTASY OCCUPATIONAL SPECIALTY (ioe oF Dee-
[782]nator} AND TITLE Mi lapatecy AND TITLE |
[783]Far OWT)
[785]44. GRIEF DESCRIPTION OF MILITARY RESERVE OUTIES
[787]N.A.
[789]12. A@E YOU CURSENTLY ASSIGNED OR ATTACHED 19. 1F YOU HAVE ANSWERED "VES" TO ITEM 12, GIVE UNIT O98 AGENCY
[790]Te URESERVE: NAT'L. GUARD OR ROTC TRAIN: ? AND ASORESS a
[792]1S. 1F YOu HAVE ANSWERED eet TO Tew te, owe unit OR AGENCY
[794]AND ADORE:
[796]16. INDICATE TOTAL MILIT ARY SERVICE, YEARS 17. SHEQE ARE YOUR SEMVICE RECORDS KEPT?
[797]FOR LONGEVITY PURPCSES INCLUD Unk
[798]ING ACTIVE AND INACTIVE OUTY | TTY Unxnown
[801]14-0000
[803]Bato
[805]DATE AA AAA AAR Oe CU at teenies Mniblie tment An tthe Bate ne!
[807]STE A MAREN Me ete a mR Efrem a Me mL
[809]q
[812]@ | SECTION xi FINANCIAL STATUS
[814]1. ARE YOu ENTIRELY OZ FENOENT Su YOLA SALARY? _.
[815]2.4F YOUR ANS@ER I$ "NO" TO THE S20VE, STATE SOUPCES OF OTHEG IWISME
[817]Investments,
[819]' 3) BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS
[821]WAME DE INSTIT TIO; ADDRESS (Cry, State, Country)
[823]Falls Church Bank Falls Church, Virginia : ‘
[824]‘ Banco Nacio lai Ge f * LEO = NMLEXICO DF :
[825]4. HAVE YOU EVER SEEW IN, OR PETITIONED FOR, BANKRUPTCY. ~~ ves “M?
[827]3. 1F YOUR ANSWER IS “VES TO THE ABOVE, GIVE PARTICULARS, INCLUD 5G couRT AND DATES)
[829]. 6 GIVE THREE CRECIT REFERENCES IS THE UNITED STATES
[831]WAVE 1 ADDRESS (No., Street, City, State)
[833]Fails Chur Bank aLis. ’ ging
[835]7. SO YOU RECEIVE AW ANNUITY FRO THE UNITED STATES on DISTRICT CF COLUMBIA GOVERNWENT UNDER ANY RETIREMENT
[836]ACT. PENSION, OR COMPENSATION 7 OM WILITARY OR NAVAL SERVICE? wo VES yoxe
[838]8. IF YOUR ANSWER 1S “YES TO THE ABOVE QUESTION. GIVE COMPLETE SETA
[840]. DO YOU HAVE ANY FINANCIAL INTEREST iN, OR OFFICIAL “CONNECTIONS WITH NON-U.S. CORPORATIONS OR BUSINESSES; OR in
[841]OR SITH U.S. CORPORATIONS OR BUSINESSES MAVING SUBSTANTIAL FOREIGN INTERESTS?
[843]KS ves CL! wo (If anewes *YES*, turmiah details on sepesare shect.)
[845]e SECTION Xil : MARITAL STATUS
[847]+. PRESENT STATUS (Sigle, Married, Urcfowed, Sepereted, Olvorced, of Anmulled; SPECIFY: h r} ie d 1
[848]2. STATE DATE, PLACE, AND REASGS FCR ALL SEPARATIONS, DIVORCES oR ANNULMENTS
[850]NA,
[852]WIFE, HUSRAND If you have been martied ore than once - including annulments - use a separate sheet for former wife or
[854]. OR FIANCE: busband grvizg data required below foe all previocs marriages. If carriage conterplated, fill in prpropriate
[855]- information for fiance.
[856]3. MAME (First) Neddiey Olasten) (Lest) :
[857]Rachel Esther Williams Wichtrich | 6
[858]4. DATE OF wanahee “Sg CE OF MARRIAGE (City, State. Comrerv) {6
[859]Dec, 23, 1938  _t m._Arizona_~ County é ‘
[860]£. HIS 10% MER) ADDRESS BEFORE WARRIAGE &. Steet, City, . Cowmery)
[862](© /{3300 Hawthorne S:,, Tucson, Ariz, U.S.A
[864]. i, A. .
[865]= 7. Living 18 SATE OF CEAT CAUSE OF DEATH . 5 a
[866]xx | ves ] mr) 5 | 6 ‘ :
[868]any er
[870]4
[871]1G_CURRENT AOGSESS (Guee leat adirens if dvconsed) —* : 3
[872]Toluca Highway, Kim, 19 1/2, ELM tagueyino. Cuajima D. fexico
[873]49, "DATE oF i 92. PLACE OF BIRTH CCuy State, Coanerv: td. CITIZENSHIP
[874]13/191 "OF i fAvoca} Texas, U.S.A, _ U.S.A. i
[875]O SECTION Xf CONTINUED TO PAGE 10 -
[878]8 ee
[880]Meas, 8 ante
[883]14-0000
[885]i
[886]',
[887]n
[888]i
[889]i
[890]i.
[893]Ree
[897]SECTION ZI CONTINLED FROW PAGE $_
[899]1a. 1F BORN OUTSIDE U.S. - DATE =F ENTRY “ISTPLACE OF ENTRY
[901]6. TDOMER CITIZEN Seis) JW. Dare Eg, ciTizensnir [i WHECE ACQUIRED (City. Stove, tanm
[902]Ctl las,
[903]‘ ¥ N.A, | ANTES | NLA.
[904]NA NA et
[906]19. OCCUPATION
[907]j unemployed gree Leet two employers)
[908]t
[910]Housewife . INA.
[911]21. EMPLOYER'S OR BUSINESS ADDRESS "No . Street Cay. State, Country)
[913]NLA. :
[915]22. DATES OF MILITARY SERVICE (From end to - Fy Mo and Yr)
[916]2 , stiscn GF SERVICE
[918]M4
[919]25. DETAILS CF OTHER GOVERNMENT SERVICE, U-S. CR FOREIGN
[920]BN.A,
[922]SECTION XtIt CHILDREN ANO OTHER DEPENDENTS
[923]1, PROVIDE THE FOLLOWING INFOOMATION FOR ALL CHILOREN AND DEPENDENTS
[925]i
[927]24, COUNTRY WITH WHICH MILITARY SERVICE AFFILIATED
[929]NAME 1 PELATIONSWP | CATE AD PLACE OF BIRT | GTizensmP | ADDRESS
[931]i ce a-10' GS, t ” | avy OG
[932]ohn Allen Wichtrich\ 6@ Son Tucson, Arizona | U.S.A Newport, R,1
[934]a ne en
[935], 23. PRESENT EMPLOYER fAleo erve fzener eriployer. ot if spouse decoased or
[937]: F — {Unie Of NN.’ Mex,
[938]Janet Rae Wichtrich |G Danghter /3-5-1943 ( 67 | USA, ituqucgue, Ne Wa
[940]96 Mexico D.F
[942]} .
[943]2% usa. | Mexico, DF
[947]~ wri O39 i
[948]Fuss extol baugher Uae he? | usa | Movco.D-E
[950].
[952]32. NUMBER Or UTHER DEPENDENTS (Inching
[953]2 NUMBER OF CHIL DOSEN cictating ere |% numero» wrwen QerenDenTs dnctetng sar
[954]CUMARRIED UNDER 21 Ya. OF Ase | {you Fo8 « 37 50% OF TrZIR SUPPORT, OR
[955]AND NOT SEL F-SUPPORTING. | GHILORES, &. ce 21 V@S. OF ACE WHO ARE NOT
[957]SECTION XIV FATHER (Give same information. tor Stepfather 204 or Guerdion Sepatale sheet}
[958]2. LIVING | TS. DATE OF SEatH 14. CAUSE OF DEATH
[960]ives -X}vo | Feb, 19592 Pneumonia
[962]&. DATE OF BIRTH jy PLACE OF B:RTH (City, State, Country)
[964]1864 Germany
[966]9. 1F BORN OUTSIDE US.- DATE OF ENTRY | 10. PLACE OF ENTRY
[967]Unknown_ Unknowa
[968]wa FeRen L CITIZENSUUPIST 12. rate US. CITIZENSHIP
[970]German 9-15" 35
[971]14, OCCUPATION 1S. PRESENT EMPLOYER ( et employer, sf Father ie deco
[973]Owner, Sheeimetal Shop : N.A.
[976]14-0000
[978]ne SECTION XV MOTHER (Give same ifturcatca tor Stepmetter on separate sheets
[980]1. FULL NAME (LaceF irat-Muddle) 2 Living 7 IORTE OF DEATH @. CAUSE CF DEATH
[981]Z a6 [vas y [no
[983]Esparza Fermina b._195]_ _:_Paeumonia
[985]YRREKT AOCRESS - Giv: ST ADORESS, iF DECEASES (No., Street, Caty, Stste, Country?
[987]vin cox, Arizona) (O__
[989]OF BATA 7 Poace or enba tear tae, County) Ty Chieu tee
[990]: 1874 yChihuahua} Mexico, D.F,. {U.S.A
[992]. S$. 5F BORN OUTSIDE U.S. - DATE MTRY (O pad, 0. PLACE oF ENTAaY
[994]1 ~°| Unknown ' Et Paso, Texa-
[996]Th @nERE AZQUIRED (Guy, State, Country?
[998]‘ \B. FORMER CITIZENSHIPIS) 12. DATE U.S. CITIZENSHIP
[1000]‘Coun . ACQUIRED . . .
[1001]Komeereel 4 exican i Of ____Bisbee, Arizona _
[1002]RESENT £ GYER (Give leat exployer, tt Mother 1¢ deceased of uneoptoyed)
[1004]14. OCCUPATION
[1006]= test .
[1007]16. EMPLOYER'S BUSINESS ALORESS OR MOTHER'S BUSINESS ADDRESS IF SELF EMPLOYED
[1009]|
[1010]4
[1011]i NLA.
[1012]H 17. DATES OF MILITARY SERVICE (From-end-To) 18. SRANCH OF SERVICE 19. COumTay
[1013]Hy '
[1014]NUS : A
[1015]| 2. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN
[1016]f NLA.
[1017]j e SECTION Xvi BROTHERS AND SISTERS (nciueing Halt-, Step- ead Adopted Brothers and Sisters)
[1018]yer PULL MAME (LaerFirer-Middiey a RELATIONSHIP \ “Be Cat eden Soteh (Country
[1019]: Mrs.\Ma rgaret Aaderso7) OG Sister
[1020]- 4, Cur ADDRESS (Nou, Street, City, Zone, State, Country} . S. Living "6, AGE
[1021]‘L037 Olson St,, El Paso, Texas \ (6 x ives | ‘xa 5
[1022]‘ 7 FULL NAME (Laat. irat-Middie; 2. RELATIONSHIP 2. CITIZENSHIP (Country)
[1023]2 Mrs, {Charlette Edelman\OG i
[1024].4. Fa cun ADDRESS (No., Street, 7» Zone, Siete, Camtry} : S. Living 6. AGE
[1025]- "ves & twa |
[1026]{ 2. FULL “AME (LashFirsteMatdies - 2% RELATIONSHIP 2. CITIZENSHIP (Country)
[1027]: Ars Sister U.S.
[1028]i 14. Cul T ADDRESS (No., Street, City, Zone, State, Country) 3. Living ‘6. AGE
[1029]. 28 Nozales, Santa Barbara, California) (6 Xtves | Two f 52
[1030]2. RELATIONSHIP 13. CITIZENSHIP (Comey)
[1031]1
[1032]|
[1033]i 3. Liwas
[1034]'
[1035]“E- CURRENT ADORESS mx, Street, City, Zone, State, Country)
[1036]Los Angeles Area (Address Unknown :
[1037]| iV. FULD NAME (Leet Firatebdsdaic,s 2 RELATIONSHIP 3. CETIZEN $etIP (Country)
[1038]| Wichrrich |_O6 Broch U.S,
[1039]URARENT ADORESS(Ne., Street, City, Zone, State, Country) S. Living 6. AGE
[1040]! ves Xx [40 |
[1041]{ 1. FULA NAME fLa@at-F srat- Middle 2. RELATIONSHIP 2. CITIZENS 41P (Country)
[1042]H 7 _—— -
[1043]: 4. CURRENT ADDRESS (No., Street, City. Zone, Stare, Country) Living
[1046]1. PULL MAME (Laat-Feratiddies
[1048]8. LIVING
[1050]| [ves
[1052]@. CUARENT ADOAESS (No., Street, City, Zone, State, Country)
[1054][he PULL NAME (LootFtret-Maddies
[1056]ry :
[1057]4, CURMENT ADORESS (No.. Street, City, Zone, State, Country)
[1059]. cane
[1060]j
[1062]i
[1066]+ bade
[1068]“anew a
[1071]14-0000
[1073]TAUSE OF DEATH
[1075]Stroke
[1077]Hi
[1079]6, DATE OF BATH
[1081]Unknown
[1083]$.1F @ORN OVTUITE U.S.
[1085]TS.- DATE OF ENTRY ” a NAY OF ENTRY
[1086]NA.
[1088]Th. FORMER CITIZEMSHIPIS) 12. OATE U.S. CITIZENSHIP ACBURED | 13. WERE ACQUIRED (City, Sater Country)
[1093]3. DATE SOF DEATH
[1095]1918
[1097]4, CAUSE OF DEATH
[1099]“Flu
[1101]it)
[1102]6. DATE OF aint
[1104]nenown b
[1105]$. IF BORN OSTSISE U.S. - DATE OF ENTRY 10. PLACE OF EeTRY
[1107]NA N,A.
[1109]12. DATE US. CITIZENSHIP ACCUIREO
[1110]NUS
[1111]18. PRESENT EWPLOYEN ‘Give lest employes, if NothspmeLaw ie deceased of unemployed) .
[1113]13. WHEPE ACQUIRED (Cay, Stare, Countey)
[1117]e [section xix RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (3) LIVE ASROAD,
[1118]ot ° (2) ARE NOT U.S. CITIZENS OR (3) WORE FOR A FOREIGN GOVERNMENT Ni, A
[1120]+ EMPLOVED BY
[1122]4, ADDRESS OA COUNTRY IN BHICH RELATIVE RESIDES
[1124]6. OATE OF LAST CONTACT
[1126]7. FREQUENCY oF CONTALT wo St ORT AST
[1127]a
[1128]@. ADDRESS OF COUNTRY IN (cn RELATIVE RESISES
[1130]1, FULL NAWE Perey | 2, RELATIONSHIP =
[1132]eee a  AODRESE On counray wm mmicm nesATE NHS | OR COUNTRY IN WHICH RELATIVE RESIDES 5. EMPLOYED BY
[1134]6. CATEZENSHIP ;Countey) eed Of CONTACT 8. DATE OF LAST CONTACT
[1136]4 Pee NAWE (LaateFiratMiddie) 2. RELATIONSHIP aan
[1138]4, ADDRESS OR eee eee in SHICH |“ Aooness on county momen nevarwerssoes | RESIDES §. EMPLOYED BY
[1139]‘. CITIZENSHIP —— + FREQUENCY OF CONTACT 8. DATE OF Last CONTACT
[1141]SFCTION XIX CONTINUED TO PAGE 13
[1143]6. CITIZENSHIP (Country) 7. FREQUENCY SOF CONTACT
[1145]leper nee
[1147]a
[1149]1. Fuce NAME frewecmamecancrimemiay |
[1151]ae eee ea sepecinpeeenn a ney ge —ot a
[1154]3
[1157]14-0000
[1159]Seana URE ARTY REE NEN OEE A HONE BRITS Sentnele
[1161]. cae ae . a -
[1164]SECTION XIX CONTINLED FROM PAGE 12
[1165]& SPECIAL REMARKS, IF ANY, CONCERNING RELAT.VES HOTED IN SECTION XIX ABOVE
[1167]Any relatives I might have in Mexico or Germany are unknown, _
[1169]© section xx RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO ARE IN THE MILITARY OR CIVIL °
[1170]SERVICE OF THE UNITED STATES
[1172]1. NAME (Lest-F iret-Aiddie)
[1174]$. ADDRESS (No., Street, City, State, Country)
[1176]1, NAME (Lactef wetdMiddie)
[1177]{S. ADORESS C¥o.. Street, Coty, State, Country)
[1179]1. NAME (Leet-Firet-Middie) 3. AGE 4 CITIZENSHIP
[1180]. |
[1182]i
[1184]5. ADDRESS (No, Sareer, City, State, Country)
[1186]SECTION XX! ____REFERENCES, ACQUAINTANCES, AND NEIGHBORS _
[1187]t- o65T FIVE CHARACTER REFERLSIES. NOT RELATIVES. IN THE U-5S.. ANG RNOW YOU INTIMATELY
[1189]NAME BUSINESS ADDRESS | RESIDENCE ADDRESS
[1190](Leet-P isat-Middle) . {No., Street, Cate and State) j (Xo Street cur end State)
[1192]SATOMI | dd ealatvadnnatanecerteemateeenenias mmuononemntie names + on!
[1193]e
[1195]1 East 30th Stdis | :
[1197]ucso p Ona .
[1198]° Univ, of Arizona |
[1199]Pistor, Willia LOG (Animal Science i
[1201]2. LIST FivE PEASOKS IN THE U.S. WHO <NCw YOU SOCIALLY - NOT SELATIVES, SUPERYISOO: OF EMPLOYERS
[1203]NAME H BUSINESS ANNRESS ' RESIDENCE ADDRESS
[1204](Laet-F eret-Middte) i {No . Street. Caty and State) (Na Street, Cry and Stare)
[1205]1
[1206]t
[1208]Bechtold, Edward JoyG ! : ston. Tenn ved ( :
[1209]Gra _ mi G ‘cn SOG {Vts
[1210]ven, William\©O (1P. A. aD - Miamt, Florida es estead = = = prorida.
[1212]cott Bil,\ OG Tuanoequs aa df-Xics 2
[1213]24 Carlsbad Wa
[1215]iverside, Califo ia, :
[1216]| Silver Ridze Rdjvo
[1218]3. LIST THREE NEIGHBORS AT YOUR MOST RECENT NORMAL RESIDENCE IN THE U.S.
[1220]MAME BUSINESS ADORESS RESIDENCE ADDRESS
[1221](Leet-F eret-Middle) (Ne., Street, Caty and State) (No . Street. City and State)
[1223]13468 Gunston R Je
[1225]j_Pawley, Ted (CS : Alexandria
[1229]os AN fo wren kena
[1231]SE a eg ae . _ or rs
[1233]Tavemae es
[1235]14-0000
[1237]i
[1239]cememennsreetunrerts one Aine eran ment
[1241]Care
[1243]Rid Nm sen secaie. te PUES RIA
[1245]dob Sg Wat Gal tal inte Meta saat aewediecteencionm sanauannne caiman
[1247]eck Ba A ae ene one!
[1251]wate pg NUT Maile PMS ae wee VS tate
[1253]- ole
[1254]© | SECTION Xxtt
[1256]NOTE: List nanee and addresses of aii clubs, societies, professional societies, employee groups or organizations of any kind
[1258]Cinctude memberaluip in, o¢ support of, any organization having tradquarters of branch en a foreign country) to which you
[1259]belong or have belonged. .
[1261]es
[1263]DORESS
[1265]a
[1266]- NAME AND CHAPTER (Number, Street, Caty. State, Countes>
[1268]American Club ‘| Mexico, D.F, :
[1270]amber of Commerce|
[1272]RESIDENCES FOR THE PAST 15 YEARS
[1274]Ale ic sa 7 RADE AES-SENCE CIRST
[1275](Number, Street, City, State, Country)
[1277]Méklco, DF., Mexico 5655 Sierra Leona { (© 1949 i
[1279]Mexico, D.F., Mexico ~Toluca Highway, Kim 19 /D 69 Po
[1283]ee BAT wing pris Biche tater
[1285]| |
[1287]Sp,
[1289]14-0000)
[1291]SECTION XXIV
[1293]1. DO YOU ADVOCATE OR HAVE Vu EVEH ADVOCATES OF ARE YOu Son OR HAVE YO. EVER BEEN A MEUEER OF;
[1294]OR HAVE YO. EVER SUPPCATES OF BEEN ASSOCIATED W TH ANS = SAITICAL PRETY INDIVIDUAL OR O8GAN-
[1295]IZATION anit ADVOCATES CS TEACHES Ire Cute inkOw OF SOVERNMENT GF TE UNITED STATES BY
[1297]ENTE OF OTKER SNSTITUTIONA. MEANS GA 3 97 FORCE OF vw SLENCE TO CENT PERSONS
[1299]TREIR AGRI UNOER THE COSsTiTUTION OF Trl UNITED STATES
[1301]2. IF YOU HAVE ANSWERED “YES* TO THE ABOVE CUESTION EXPLAIN
[1303]as T&F 80. TO WHAT EXTENTT
[1304]3. 00 YOU USE OR HAVE You - Rice 1" Niog ves
[1305]EVER USED INTOXICANTS® NO Moderate
[1306]6 IF SO. TO WHAT EXTENT?
[1308]$. DO YOU USE OR HAVE YoU ves
[1309]EVER USED NARCOTICS? Xixo
[1311]1. HAVE YOU EVER BEEN A WEWSER OF, OR SUPPORTED. OR HAD ANY CONNECTIONS atta A FOREIGN INTELLIGENCE ORGAN-
[1312]IZATION OA ITS SCTIVITIES® .
[1313](Eves {no IF BNSWER IS “YES®, GIVE COMPLETE BETAILS. ‘
[1315]'
[1317]i
[1319]6. LIST BELOW THE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO WHICH YOU H PP
[1320]PLOYMENT SINCE 1940 E ENTS, AGENCIES ces c U HAVE APPLIED FOR Eb
[1322]None,
[1324]NOUCTED An INVESTIGATION OF YOU, INDICATE THE NAME OF THE
[1326]NOTE SPECIAL! If your onswer is * TES" to the following Quastions 10, 11 or 12, provide the information tequested for each
[1327]INSTRUCTIONS | question on o tepcrate, signed shee? and attach the sheet to this form in a sealed envelope.
[1328]B OEY, AINED. ARRESTED, INDICTEO OR CON-
[1330]10, MAVE YOU. OR TO YOUR KNOWLZOGE HAS YOUR SPOUSE, EVER BEEK
[1331]WSaER FOR ANY VIOLATION OF THE LAWOTHER THAN A WINCR TR. FIC VIOLATION IM THE UNITED STATES OF
[1333](€ $0, STATE WAME OF COURT. CITY, STATE, COUNTRY, DATE, NATURE OF OFFENSE AND DISPOSITION OF CASE
[1334]IN ACCORDANCE WITH THE SPECIAL INSTRUCTION ADOVE.
[1336]MAVE YOU EVER BEEN ARFESTED. COURT-MARTIALED OR OTHERWISE PUNISHED UNDER MILITARY Law on REG
[1337]USADae IF SO, DESCRIBE UNCIDENTIS) AND PROVIDE DATE(S! OF OCCURRENCE ON SEPARATE SHEET IN AC
[1339]ANCE WITH SPECIAL thSTRUCTIONS ABOVE.
[1341]r
[1342]5
[1343]i
[1344]H
[1345]H
[1346]H
[1348]ARE THERE ANY UNFAVORABLE INCIDENTS IN YOUR LIFE, NOT MENTIONED ABOVE, WHICH MAY BE DISCOVERED
[1349]IN SUBSEQUENT INVESTIGATION, WHETHER YCU WERE DIRECTLY :NVOLVED OR NOT, WHICH MIGHT RESUIRE EX-
[1350]PLANATION!E IF 50. DESTAISE INCIDENTS) AND PROVIDE DATEIS! OF OCCURRENCE ON SEPARATE SHEET IN AC>
[1352]COROENCE WITH SPECIAL INSTRUCTIONS ABOVE-
[1354]PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
[1356]sian) oe
[1358]Street, City, Zone, Siese, Cantry)- INDICATE NAME OF FIRWOR|6. BUSINESS PHONE NO. a “igo
[1360]s. GusiWESS ADDF ADDRESS (No. St
[1361]PLOVER, IF APPLICABLE
[1363]merican Chamber of Commerce In Mexico
[1364]Lucerna #78, Mexico, D.F,
[1366]7. IN CASE CF EMERGENCY. OTHER CLOSE RELATIVES Moines, Failes) MAY ALSO BE NOTIFIED. IF SUGH NOTIFICATION
[1367]1S NOT CESIRAGLE, BECAUSE CF HEALTH CQ OTHER aE ASONS PLEASE STATS G {6
[1369]Mr or Mrs Ellen Claridge » 619-16ch Sc., N.W
[1370]Albuquerque, New Mexico - (Sister ln law)
[1372]5
[1373]F
[1375]seobocs
[1377]' aIS- '
[1379]we tee tao adage aawemaitagt
[1381]x
[1384]14-0000
[1386]Pat PLN SL Se! Wk a RMR Aleta peeencemenintene manamnen wanes te ie mata nen ss
[1388]adie BHD, S
[1392]estas eh Eibadasieis ine oS
[1396]“44. Y
[1398]SECTION YrvI _
[1400]YOU ARE INFORMED THAT THE COHRECTNESS OF srry STATEMENT WADE IN THIS 4FPLICATION
[1401]WILL BE INVESTIGATED.
[1403]CERTIF ica 7 iON
[1407]ft hove read and uncerstend the instructions. | Certify thot the foregoing onswers ove true and correct fo the best of my
[1408]knowleoze ond belief. L agree that ony misstatement or o:seen at to material fact will const tute graunds for invedate
[1409]dismisses! or rejection of my opplication. | also understand that ony false stotement mode herem moy be punishable by
[1410]faw (U.S. Code, Title 18, tion 1007),
[1412]shee. t
[1414]2. DATE GF MGNATURES
[1416]TEGVEGNATURES SOS NATURE OF ameLicaNT y
[1417]1. Ff Phang G63 NAA Ade A abclodios ZA |e2
[1421]3. SIGNED AY (City ond State) & SIGNATURE OF wITRESS : .
[1423]Wye hce & an Oe ae :
[1425]NOTE: Use cte rollowing apacefor extra details. Reference each continued item by tion Ang ten umber to which st relates.
[1426]S2gn }2ur name at the ead of the added maternal. Mf addinal spece is required us Iza pages the same size ss this
[1427]page and sign each suck pace. .
[1429]Section XI - (9) - Shares in Ron Castillo S.A, - Mexico, D.P. ; :
[1430]Shares in Telefonos de Mexico, S.A. .
[1432]Section XXI (3) Oaly neighbors - remaining in area.
[1435]n
[1436]S
[1437]t
[1438]4
[1440]ab mretecetat pe-anes orca 1986 0-—sreres
[1442]Be tubes tes Bt Fa ee ER be Sate
[1444]14-0000
[1446]: ' PERSONAL HISTORY STATEMENT — (Appendix D ;
[1448]fl
[1450]men an erent oe
[1452]Listed below are names of crganizations identified by the Attorney General, under his responsibility pursuant to
[1454]Executjve Order 10450, dated 27 April 1953, to st the names of each foreign or domestic organization, association,
[1456]movement, gro7p or combination of persons waich he des!g-atss as Totalitarian, Fascist, Communist, or subversive,
[1457]or as hat: 2g adopted or having shown 2 policy of advocatir ¥ or approving the commission of acts of force or vio-
[1458]lence to deny ethers their righ+s under the Constitution of the United States, or as seeking to alter the form of
[1459]government cf the United States by unconstitutional means.
[1461]Each appodecant or employee and spouse (if any) must review the following lst of organizations for certification
[1463]Purposes, end sign on the last page.
[1465]abrehany Lincei®t Brigade
[1467]Abraham Linco School, Chicago, Titncis
[1469]Action Commicas to Pree Spein Now
[1471]alabama Peopivs Educational Association (sco Communist Polliti-
[1472]eal Association)
[1474]American Assucution for Reconstroction in Yugoslavia, Loc.
[1476]American Braow of the Federation of Greek Maritime Unions
[1478]American Chritcaa Nationalist Party
[1480]American Comsctes for Kuropesn Workers’ Ballet (see Socialist
[1481]Workers Party?
[1483]Emrerter es Romotmne Sor Tys's. Sees of coreigm Born
[1485]American Comerctes fur Spanish
[1487]aAcerkan Comn-ncee for the Sestiement of Jews ta Birobidjan, Ine.
[1489]American Comu-tes for Yugosisy Retief. Inc.
[1491]American Coirmotee to Survey Laber Conditions tn Eurcpe
[1493]American Councl far s Democratic Greece, formerly known as the
[1494]Greek Americes: Council; Greek American Committee for Ma-
[1495]ttonal Unity
[1497]americcn Counc cn Soviet Relations
[1499]American Crostaa Congress
[1501]american Jewist Labor Council
[1503]American Natiozal Labor Party
[1504]Ametican Natiousi Socialist League
[1505]aivéinen Natoma, Socialist Party
[1506]Amerkan Matiomcss Party
[1507]American Patriom Inc,
[1509]Amerikan Peace Crome
[1511]Americas, Feace Mobluration
[1512]American Poles ir Peace
[1514]American Polish Leter Council
[1515]‘amerzicen Polish League
[1517]Spanish Aid Cun-—=irtee)
[1519]American-Russian Fraternal Goctlety
[1521]American Rassisz Enstitute, New York, also known as the Ameri-
[1522]ean Russian locicate for Cultural Relations with the Sorist
[1523]Caton
[1525]American Russier Institute, Philadelp=ss
[1527]American Rusniar Tastitute of San Prascisco
[1529]American Russics [ostitute of Southern California, Los Angeles
[1531]American Slav Compress
[1533]American Women for Peace
[1535]American Touth Ccegrees
[1537]American Youth tx Democracy
[1539]aAmmenisn Progreatre League of America
[1541]Associated Kinns cf america
[1543]Association of Grergia Klans
[1545]Amoctation ef Ge=nan Nationale (Reictateutache Vereinigung)
[1547]Ausiaod-Organiveamcn der NGDAP, Overseas Branch of Nast Party
[1549]Baltimore Forum -
[1550]Benjamin Davin Previom Comaiittee
[1551]Bteck Dregon Bocwey
[1553]American Rescue Sip Miaston (a project of the United American”
[1555]TOS" 444d use raxvious mprnoss -1-
[1557]Bown School for Marxist Broties, Boston, Massachusetts
[1558]Bridges Hobertson-Bchmict Defense Committee
[1560]Buigarian American People’s Leagues of the United States of
[1561]Amerva
[1563]Caitfornis Emergency Defense Committee
[1564]Cectornia Labor School, Ine. 121 Divisadero Street, San Francisco,
[1565]California
[1566]Carpetho-Russisn People’s Society
[1567]Curate eid Of Amercam Women of Crostian Descent. also
[1568]known as Central Counce] of American Croatian Women. Xs-
[1569]Tape) Council of Croatien Ween
[1570]Cexteal Japanese Association (Beikoku Chuo Nippenjin Kal)
[1571]Central Japanese Association of Southern Callfornis
[1572]Cexteal Oryanization of the German-American National Alliance
[1573](Ceuteche-Ameriknnische Kinheitsfront)
[1574]Cervantes Fraternal foctety
[1575]Chios Weifare Appeal, Ine.
[1576]Chozta Cultural Center
[1577]Citizens Committee for Harry Bridces
[1578]Citizens Committee of the Tpr *° West Side ‘New York Cisy)
[1579]Citirens Committee to Foe Zor, Browder ~
[1580](Citizens Emergency Defenw Qeatererce .
[1581]Citizens Protective League a
[1582]Cavill Lrverites Sponsoring Committee of Pittsbur. b
[1583]Civa Rights Congress and ics effaced organizations, inciuding:
[1584]Civil Pigt.ts Congress for Texas
[1585]Veterans Against Discrimination of Cir Rights Congress of
[1586]New York
[1587]Civ® Rigste Congress for Texas (ere Cirt! Rights Congress)
[1588]Columbians
[1589]Comite Courdinador Pro Yepublics Espanois
[1590]Comite Pro Derechos Ciriles
[1591](Bee Puerta Hican Comite Pro Libertades Civfles)
[1592]Commictee for a Democratic Pur Eastern Policy *
[1593]Committee for Consututional and Political Freecom .
[1594]Cormitiee for Nationalist Action
[1595]Catnmittes for Peace and Brotherhood Festival in Phitacetphia
[1596]Committee for the Defense of the Pittsburgh fix
[1597]Comautites for the Negro in the Arts
[1598]Committee for the Protection of the Bill of Rigats ’
[1599]Cominitves for World Youth Friendship and Cultural Exchange
[1600]Comamittes to Abolish Discriminauion tn Afarylant
[1601](See Congress, Against Discrirtnaticn: Maryland Congress
[1603]Against Discrinination: Provisional Ccmumittee to Abolish
[1605]Discrimination in the Stace of Maryland)
[1606]Committee to Ald the Fighting South i
[1607]Comsetttes to Defend Marie Richardson .
[1609]Committes to Defend the Righ*s and Freetom of! Pitubarehy -
[1610]Political Prisoners
[1612]Comnmmituss to Conoid the Bill of Rights
[1613]Commanweaith Colege, Mena, Artanss
[1615]Communist Party, U. 6 A, ite subdivisions, subsidiaries, end
[1616]afinates
[1618]4
[1619]A
[1621]nell dit ene
[1623]14-0000
[1625]Cormrritet Political Assocucion, ite subdivisions, subsidiarics, j Wndependent Peeples Party
[1627]and aS tates, Including:
[1628]Astama People’s Educecenal Association
[1629]Fuceice Press and Educaccal League
[1630]Oxahoms League for Puccical Education
[1631]Peceie’s Educational.ant Prees Association of Teras
[1632]Vorgata League for Peszes Zducalion
[1633]Conger Amincst Discrimtmcco
[1634](See Committee to Aboligs Stecrimination im Meryland)
[1635]Congress cf Americar Revalycousry Writers
[1636]Congress of American Wore
[1637]Congrem cf the Unempioses
[1638]Conutecicut Committee to AX Victims of the Brith Act
[1639]Connecucut State Youth Guc“erence
[1640]Conner for Jobs, Relief end Rousing
[1641]Covam fot Pan-American Semocracy
[1642]CouncS of Greek Americans
[1643]Counc= on African Affairs
[1644]Crostisn Benevolent Prateruzy
[1646]Dal ¥:;yoa Butoku Kal Qamreary Virtue Society ef Japan oF MMe
[1647]tary Act Society of Japan)
[1649]Daly Weezer Press Club
[1651]Daniets Defense Committee
[1653]Dante Augiierl Gociety (between 1935 and 2545)
[1655]Dencis Defense Committes
[1657]Detrecz Youth Assembly
[1659]Pas: Esy Peace Committee __
[1661]Eiatoore Progressive League
[1663]Zmerpescy Conference wo Ssve Spanish Refurees (founding boty
[1664]Ge hid fees AMEFcaL spac. 410 Conti)
[1666]Yreryoecy’s Committee to Octiaw War
[1668]Parites of the Baltimore fern Act’ Victims
[1669]Paretiies of the Smith Act Tums
[1670]Pecerauon of Italian War Vrceracs in the U. & A. Inc. (Assocta-
[1672]Florida Presx and Educational League (sce Comsnunis: Political
[1673]Assoxtation)
[1675]Prederix Douglass Educational Center
[1677]Freedom: Stage, Inc.
[1679]Priends cf the New Germany (Freunde des Weien Deutechlands)
[1681]Prients of the Soviet Union ;
[1683]Garttecct Amevican Fratermat Society
[1685]George Washington Carver Echool, New York. Cay
[1686]German-American Bund (Acurrkadeutscher Volkesund}
[1687]Germas-american Republice= League
[1689]Germas-American Vocations. League (Deuteche-Amerikanteche
[1691]Hariem Trace Union Councd
[1693]Hawan Civil Liberties Comxr=tes
[1695]Hetrvahs Kal, also known as Nokubel Helekt Gtrueha Kal, Zatbel
[1696]XNfmen in. Hetyaku Gimusts Kat. and Zaibel He-cushe Kal (Jap-
[1697]onese Residing in Amerios Wilitary Conscripts Association}
[1699]Hellesx-American Brotherhood
[1701]Hisode Sal (imperial Japaoese Reservists)
[1703]Hinomaru Kal (Rising Sun Flag Society —a croup of Japancie
[1704]Wer Veterans)
[1706]Houde? Zaigo Shoke Dan (Hath American Reserve Officers Asso-
[1707]ctauica)
[1709]Holiywood Writers Mobilimarem for Defence
[1711]Hungeriaa-American CouncS for Democracy
[1713]Hungartan Brotherhood
[1715]Idabo Prnsicn Union
[1716]Indepenteat Party (Seattle, Washington)
[1717](See tacepeadent People’s Party)
[1719]|
[1721]|
[1723](3ee Indepextert Party)
[1724]Incustria! Workers of ths World
[1725]Internstional Labor Defense
[1726]International Workers Order, its subcivisions, subsidiaries end
[1727]amtiates .
[1728]Japanese Assuctasion of America -
[1729]Japanese Orereas Central Society (Ea‘gai Dodo Chuo Katt
[1730]Japanese Orerens Conrention, Tokyo Japas. 1940 :
[1731]Jepantet Prouctive Association (Recr=ttizg Organization)
[1732]Jefervon Schoel of Social Science. New Fork Cuy
[1733]Jewish Culture Society
[1734]Jewish People’s Commltiwe
[1735]Jewish People’s Fraternal Oréer .
[1736]dixypoku Inka: (The Committee for the Crome)
[1738](See Johnace tes}
[1739]dohnsonites
[1740](See Johusce-Forest Group! ,
[1741]Jommt Anti-Pusct Refugee C * amizzee
[1742]Joint Council of Progressive Itallan-A-ericans, Inc. .
[1743]dooeph Wedemutyer School of Social Science. St. Louis, Misocrt
[1745]EXlbet Setnen Fal (Association of U. &. Cittrens of Japanne An-
[1746]eestry who tare returned to America after studying in cea)
[1747]Enighta of the White Cametiits
[1748]Xe Eu Ds
[1749]. S80 known as Kyfhacuser League .(Kyfsewer
[1750]Bund), Ky=taeuser Fellowship (Erftsecser Eameracects%t}
[1751]Kythaeuser War Eelief (Hyfhacuser Kr:eguniifewerk) .
[1752]3 :
[1754]Labor Council for Negro Rights
[1755]Labor Researcy Association, Inc.
[1756]Labor Youth Lesgue
[1758]Leegue for Com=0n Sense
[1759]League of Amectcan Writers
[1761]Lictor Society «Icalian *'ack Ghirts)
[1763]Macedonian-ametican Peopie’s League
[1764]Marto Morgentct Circle
[1765]Maritime Labce Committee to Defend Al Lana
[1766]Maryland Congress Against Diseriminarxa
[1767]{See Commitee to Abolish Dtsctimisetion in Maryland)
[1768]Massschusetts Committee for the Bol of Eights
[1769]RMewechusctt: Shouts Weenen for Peese (net connected vem the
[1770]MMnute Womex of the U.S. A. Inc) ‘
[1771]Msurice Braverman Defenss Communes .
[1772]Michigan Civa Rights Feceration
[1773]MOchigan Council fcr Peace .
[1774]SOchigan Bebo of Social Science 1
[1776]Nenka Teikor2 Gunvrudan (imperial Mitiary Friends Grp of
[1777]Southern Ceufornia War Veterans)
[1779]National Assocss:icn of Mezican Amesicuns (also known as Asocts-
[1780]eon Nacions. Mexico-Americana)
[1782]Sasional Blue S:ar Mothers of Americe (not to be confumt with
[1783]the Biue Star Mothers of America cxyantred in February 26a)
[1785]National Coremittee for Preedom of tha Pres
[1787]National Commi:tee for the Defense cf Pcivcal Prisoners
[1789]National Com= ites to Win Amnesy for Sith Act Victims
[1791]Natlonal Comouttee to Win the Prace
[1793]Nestonal Conference on American Pocicy “2 China snd the Per Baas
[1794](& Conference called by the Comamntee for a Democratic far
[1795]Eastern Polis)
[1797]National Council of Americans of Croatian Descent
[1799]Rational Couns of American-Soviet Friescship
[1801]National Federation for Consusutionel Livertics
[1803]Rational Later Conference for Peace
[1805]National Negro Congress
[1807]National Negro Labor Council
[1809]toe,
[1811]14-0000
[1813]Netiensiust Party of Puerto Riso
[1815]Xuture Friends of America since 1983).
[1817]Negro Labor Viewory Comimities
[1819]Few Committee for Publications
[1821]Nihibea Kogyo Kaisha (The Greet Pujil Theatre)
[1822]Korth American Committee to Aid Spanish Democracy
[1823]North American Spanith Aid Commistes
[1825]North Palladelphia Porum
[1827]Northwest Japanese Associacion
[1829]Ohio Beboal cf Social Ectences
[1831]OklsLoma Committee to Defex4 Poiltical Prisacers
[1833]Oxisnhoma League for Poliural Education (see Communist Politi.
[1834]cal Aspoctstion)
[1836]Originas Gouthern Elans, incorporated
[1838]Pacific Necthwest Labor School, Sesztle, Washingtos
[1840]Palo Aito Peace Clud
[1842]Partie cel Puedio of Panama (operating.in the Cacst Zone)
[1844]Peace Information Center
[1846]Peace Morenent of Ethiopia
[1848]Peopie'’s Drama, Inc,
[1850]People’s Etucaticnal aud Press Association of Texas (see Commu-
[1851]mint Political Association)
[1853]Peopie’s Ecucational Assoctztim (tneorporated unger name Los
[1854]Angties Educational Associscien. Inc}, also known as Peopis's
[1855]Boducaw.ca: Center, rée wt é CGCTALY, Scopes Ot
[1857]Peop.e's Institute of Applied Begin
[1859]Peoples Programs (Seattie, Washington)
[1861]Peozie's Radio Pouncatior, Inc.
[1863], People’s Rights Party
[1865]Phoaceiphia Labor Commitee ter Negro Rights
[1867]Phitadelphca School of Social Gctence and Ar:
[1869]Photo Leagze (New York City)
[1871]Pittsbargh Arts Club
[1873]Potltical Prisoners’ Welfare Cacmittes
[1875]Polonia Soctety of the INO
[1877]Progressive Germin-Americans, slag known as Progresstre Ger
[1878]it -Ameriesra of Chicaco-
[1880]Preit wlan Party of America .
[1882]Protestant War Veternos of the Caited Btates, Inc
[1884]Provisona: Committee of Ciitvens for Peace, Southwest Area
[1886](See Committee to Abols® Discrimination in Masyiand)
[1887]Puerto Rican Comiie Pro Libertaces Citiles (CLO)
[1888](See Cemite Pro Derechos CurLes}
[1889]Fucorriquens Unidus (Pcie Aitans Utlted)
[1891]Quad Cry Committee for Peace
[1892]Queersbeidge Tenants League
[1894]Sakura Kal (Patriotic Society, o¢ Cherry Asociatica — composed
[1895]Of veterans cf Rusco-Js;exese War)
[1896]Ssmoel Adams School, Boston, Masmachusetts
[1898]co te meen
[1900]Santa Berbera Peace Porum
[1902]Schappes Defense Commitee
[1904]Cexaeiserman-Derry Defense Conwatee .
[1906]School of Jewish Studies. New York Cry
[1908]Seaitie Labor School, Seattle, Wastoaen
[1910]Sexbian-American Fraternal Society
[1912]Serbian Vidordan Council
[1914]St-nto Tempies-«itatted to State Btixs. aboltzhed in 1645)
[1916]Brrer Shirt Legucn of Americas.
[1918]Savile Councti of Southern Califorcts
[1920]Gowak Workers Sactety
[1922]Sorvenian-American National Coured
[1924]Seciaust Workers Party, including arrericsn Committee foe Euro-
[1925]pean Workers’ Bevef
[1927]Schon Kal (Pacheriand Boctety)
[1929]Seuthem Negro Youth Congress
[1931]Butko Eha (Reserve Otcers Assoccazia. Les Angrics)
[1933]Syracuse Women for Peace
[1935]Tea Paine Schon of Social Science, Pailacelphis, Pennsyivanis
[1936]Tom Paine Scheel of Wesiches:er, Sew Yoru
[1938]‘Teace Tnlon Cocmmitiee for Feace
[1939](See Trade Uncsontscs for Pesce)
[1940]Trace Union‘s:s for Peace
[1941]idee Trace Ursontsts for Peace)
[1942]‘Ist-State Negro Trade Taion Counc®
[1944]Ukrainian-Amerian Pratezsal Unicm
[1946]Union of American Croatians
[1948]Un‘on of Kew York Veverans
[1950]Usited American Spanish Aid Coxe
[1952]Trited Comcalttee cc Jewish Societes and Lan¢smanscham Fed-
[1953]erations, aso Known as Coatmacen Committee of Jewish
[1956]CUxited Committee cf South americans
[1958]United Defense Council of thesa CAS‘ornia
[1960]United Hartem Tenancs and Coxs—ners Orpanizstion
[1962]Unived May Day Comauittee
[1964]UCauited Negro and Aled Veterans ef Ameria
[1966]Tetersns Acsinet Dterrtminatian of Covd Rights Censress of New
[1967]York (see Civ Rights Congress} ‘
[1969]Yeverans of the Abraham Lincon Erigadce
[1971]Virginta League tor Peopte’s Ecacascn (ace Comrauntst Political
[1972]Assoc tation) ‘
[1974]Votce of Freedom Corumittee
[1976]Walt Whitmsn Schooi of Eocial S-ommet, Newark, New Jersey
[1977]Washizston Bookshop Associatioa
[1979]Washington Committees for Democmse Action
[1981]‘Washington Commitvee to Defend ste BL of Rights
[1982]Washington Commonwealth Pedesacun -
[1984]‘Washington Pecsion Unicon .
[1986]Wisconsia Conference on Social Leyatation
[1988]Workers Alliance (since April 1536)
[1990]Yiddisher Kultur Pasbend
[1992]Young Communtst League .
[1993]Yugosisr-Americag Cooperatire Homa, Inc.
[1994]Tugoalev Seamen's Ciud. Inc.
[1996]j
[1999]| : |
[2000]|
[2001]i
[2004]14-0000
[2006]CERTIFICATION :
[2008]I certify that I have read the names of the above Usted organizziws . :
[2010]To the best of my knowledge and belief, I am not, nor have [ been z member of, coxtribated to, received liter-
[2011]ature from, dgned pections of or in bebzf of, or acterced meet:cz: of any orframizes:on listed above, or any
[2012]organization outside the United States espousing Communist, Pascict, Tcealitarian or Nix catses, except as noted
[2013]below.
[2015]To the best of my knowledge and belttef, none of my close reletiver are, nor have ever teen members of, con-
[2016]tributed to, received Lterature from, signed petitions of or in behalf of, cr attended meetixgs of any such organiza-
[2017]tions, except as noted below. .
[2019]INSTRUCTIONS
[2021]For the purpose of this certification, if an cpplicant or employee 4s completing this ferm, the term “eloze rela-
[2022]tive” will include spouse, children, perents, brothers, sisters, uncles, oud cunts, “Close re-atices” of the spouse, for
[2023]this purpose, will include children, parents. brothers, sisters, uncles, cr-¢ aunts.
[2025]Uf there are exceptions to this certificction, set forth below under 22marks all pert=ent information concern-
[2026]ing the neture and extent of your activizes or those of your ciose re-ct:zes in such crzcz-zations, including the
[2027]names of the organizctions, dates of me=bership, meetings attende4, =2les of positions hed, amounts end dates
[2028]of coutributions, rature of petilions signed failing within the meaning c7 the above certitection end circumstances |
[2029]thereof, tities and authors of literature receczed, ane dctes on which rece:czed.
[2031]In exceptions concerzing relatives, include only such information presently known to you or avaliable from
[2032]your own records. ‘
[2034]If necesscry, vse additional sheets and sign each skeet. Write no-we if there are no exceptions.
[2036]REMARKS: To be completed by Spouse | REMARKS: To ke completed by Applicant or Employee
[2038]—City ‘and State
[2040]Le PP IL er
[2041]Witness
[2043]Address — City and State Acdress -—- Czy and Gtate
[2045]Prine we D FO