[1]14-0000
[3]104-10117-10076
[5]| 2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992 |
[9]PERSONAL HISTORY STATEMENT — (Appendix I)
[11]Listed below are names of organizations identified by the Attorney General, under his responsibility pursuant to
[12]Executive Order 10450, dated. 27 April 1953, to st the names of. each foreign or domestic. arganization, association,
[13]movement, group or combination.of persons which he designates as Totalitarian, Fascist, Communist, or subversive,
[14]or:as baying adopted. or having shown a policy of advocating or: approving the:commission. of acts af force or vio-
[15]lence to deny others their rights under. the Constitution of the United: States, or as seeking to alter the form. of
[16]government. of the United States by unconstitutional means.
[18]Fach applicant or employee.and spouse (if any). must. review the following list of organizations for certification
[19]purposes,.and sign: on: the: last page.
[21]: Boston. School for Marxist. Studies,.Bostan, Massachusetts
[23]yarn revere art cn ; no one oe
[24]Actlan. Committee to Free-Spain Now Bulgarian American: People's. League of the United States of
[25]Alabama. People's. Btucattonal. Association (see Communist Politi- America
[27]= wate tor tm Yugoslavia, Inc.
[28]American Association. Reconstruction : - Callfornt Det Committee
[29]Americam Branch. of: the Federation: of Greek Maritime Unions : brary . me, 381 Divisadero Btreet,.gan
[30]American Christian: Nationalist. California Labar School,.Inc.. Pranciaco,
[32]Party
[33]American. Committee for Buropean: Workers: Relief (sce Socialist
[35]American Comunittes: for Yugosiav: Retief; Inc:
[36]to: G@unreyx Labor Conditions:in Europe .
[37]: . ‘known sa the: |
[39]‘ Citizens Committes: af the Upper West Side (New York City)
[41]! Citisens Committes to Free Karl Browder
[43]Citizens: Protective Leagus
[45]Civil: Laberties Sponsoring Committes of Pitteburgh
[47]‘Civil Rights Congress and. its affiliated organisations, including:
[48]Civil Rights. Congress for Texas
[49]Veterans Agsinst. Discrimination. of Givil’ Rights Cangrres of
[51]New York
[53]Civil Rights Gongress. for Texas (see Civil Rights Congress)
[55]Columbians
[57]Comite Coorlinador Pro: Republica Espanola
[59](Sea: Puerto Rican Comite Pro Libertades Civiles)
[60]Committes-for'a Democratic Par Eastern Policy
[62]American. Russian. Institute; New York, also:known as the Ameri- |’ Committees for Constitutianal and. Polities!. Preedom
[63]can Russian Institute for. Cultural Relations with the Soviet | Committee for: Nationalist. Action -
[65]Cammittee for Peace and Brotherhood Festival in Philadelphia
[67]American Russian Instituts,. Philadelphia . Committees forthe Defenss of the Pittsburgh. Bix
[69]Axsoerican Russian Institute of. San: Francisco Committes-for-the Negm-in the Arts
[70]American: Russian: Institute of Gouthern California, Los Angeles Committee for the-Protection of the Bill of Rights
[71]American Slav. Congress Committee. for. World Youth: Friendship and Cultural Exchange
[72]American Women for Peace Committee to Aboliah Discrimination in Maryland
[73]American. Youth. Congress (Bee. Congress Against. Discrimination; Maryland Congress
[74]American Youth for Democracy Against Discrimination; Provisional Committee to Abolish
[75]Armenian Progressive League of Americs Discrimination in the State of Maryland)
[76]Ansociated Klans of Amertca Committee to: Aid the Pighting- Bouth
[77]Association of Georgia: Klans Committes. to Defend Marie Bichardson
[78]Association of. German Netionals (Reichsdeuteche Vereinigung) Committees to Defend the Rights and Preedom of Pittsburgh's
[79]Aucland-Organiration Ger NSDAP; Overseas Branch of Nari Party ;  Polltical Prisoners:
[80]OComanitres’ to Uphold. the: Bill of Rights
[82]Forum: Commonwealth College; Mena, Arkansas
[83]Benjemin Davis Freedom Committees Communist Party, U. 8. A. its subdivisions, subsidiaries, and
[84]Biack Dragon Goolety amliates
[86]FORM 444d Use PREVIOUS EDITIONS -1- “)
[88]RR ORES Sa aieties EE er es
[91]14-0000
[93]Communist Political Association, tts subdivisions, subaidiaries,
[94]and affiliates, including:
[95]Alabama People’s Educational Associstion
[96]Florida Press and Educational League
[97]Oklahoma League for Political Education
[98]Peopic’s Educational and Press Association of Texas
[99]Virginia League for People’s Education
[100]Congress Against Discrimination
[101](800 Committee to Abolish Discrimination tn Maryiand)
[102]Congress of American Revolutionary Writers
[103]Congres of American Women
[104]Congress cf the Unemployed
[105]Connecticut Committee to Aid Victims of the Bmith Act
[106]Connecticut State Youth Conference
[107]Oouncil for Joba, Relief and Housing
[108]Oouncil for Pan-American Democracy
[109]Council of Greek Americans
[110]Council on African Affairs
[111]Croatian Benevolent Fraternity
[113]Dai Nippon Butoku Kal (Military Virtue Boclety of Japan or Mill-
[114]tary Art Society of Japan)
[116]Dally Worker Press Chub
[118]Daniels Defense Committees
[120]Dante Alighiert Society (between 3635 and 1940)
[122]Dennis Defense Committees
[124]Detroit Youth Assembly
[126]East Bay Peace Committee
[128]Elsinore Progressive League
[130]Emergency Conference to Gave Spanish Refugees (founding body
[131]of the North American Spanish Ald Committee)
[133]Everybody’s Oammittee to Outlaw War
[135]Pamilies of the Baltimore Smith Act Victims
[137]Pamilies of the Smith Act Victims
[139]Pederatian of Italian War Veterans in the U. & A, Inc. (Assocta-
[140]sione RNasionale Combsttenti Italiani, Federarione degli Stati
[141]Uniti d’America)
[143]Finnish-Americen Mutual Aid Society
[145]Florida Press and Educational League (see Communist Politica)
[146]Associstion)
[148]Prederick Dougtass Educational Center
[150]Freedam Stage, Inc. .
[152]Friends of the New Germany (Preundo des Neuen Deutschlands)
[154]Priends of the Soviet Unicon
[156]Qaribaldl American Fraternal Society
[158]George Washington Carver School, New York City
[160]German-American Bund (Amerikadeutecher Volksbund)
[162]German-American Republican League
[164]German-American Vocational League (Deutache-Amerikaniscne
[165]Berufsgemeinschalt)
[167]Guardian Club °
[169]Hariem Trade Union Council
[171]Hlawaill Civil Liberties Committee
[173]Fleimusha Kat, aleo known as Nokubei Heleki Gimusha Kal, Zaibel
[174]Nihonjin, Heiyeku Gimushba Kai, and Zaibel Heimusha Bal (Jap-
[175]nese Residing tn America Military Conscripts Association)
[177]Hlellentc-American Brotherhood
[179]Binode Kal (Imperial Japanese Reservists)
[181]Pincmaru Kal (Rising Sun Flag Society —a group of Japanese
[182]War Veterans) :
[184]Hokubel Zaigo Shoke Dan (North American Reserve Officera Asso-
[185]ciation)
[187]Hollywood Writers Mobilisation for Defense
[189]Hungarian-American Council for Democracy
[191]Hungarian Brotherhood
[193]Idaho Penston Union
[194]Independent Party (Seattle, Washington)
[195]{See Independent People’s Party)
[197]Independent People’s Party
[198](See Independent Party)
[199]Industrial Workers of the World
[200]International Labor Defense
[201]International Workers Order, ite subdivisions, subsidiaries and
[202]amlistes
[203]Japanese Association of America
[204]Japanese Overseas Central Society (Kaigal Dobo Chuo Kat)
[205]Japanese Overseas Convention, Tokyo, Japan, 1940
[206]Japancee Protective Association (Recruiting Organiration)
[207]Jefferson School of Social Acience, New York City
[208]Jewish Culture Society
[209]Jewish People’s Committee
[210]Jewish People’s Praternal Order
[211]Jixyoku linkal (The Committee for the Crisis)
[212]Johneon-Porest Group
[213](See Johnsonites)
[214]Johnasonites .
[215](Bee Johnson-Forest Group)
[216]Joint Anti-Pasclsat Refugee Committee
[217]Joint Council of Progressive Italian-Americans, Inc.
[218]Joseph Wedemeyer Schoo! of Social Sclence, Bt. Louls, Missourt
[220]EKibei Seinen Kai (Association of U. &. Citizens of Japanese An-
[221]ceetry who have returned to America after studying tn Japan)
[223]Enights of the White Camellia
[225]Ku Klux Elan
[227]Kyfflhacuser, also known as Kyffhacuser League (Xyffhaeuser
[228]Bund), Eyffhacuser Pellowahip (Kyfthacuser Kameradachaft)
[230]Kythaeuser War Relief (Kyffhaeuser Eriegahiifswerk)
[232]Labor Council for Negro Rights
[233]Labor Research Association, Inc.
[234]Labor Youth League
[236]League for Common Sense
[238]League of American Writers
[240]Lictor Bociety (Italian Black Shirts)
[242]Macedonian-American People's League
[243]Mario Morgantini Circle
[244]Maritime Labor Committee to Defend Al Lannon
[245]Maryland Congress Against Discrimination
[246](Bee Committee to Abolish Discrimination in Maryland)
[247]Massachusetts Committee for the Bill of Rights
[248]Massachusetts Minute Women for Peace (not connected with the
[249]Minute Women of the U. 8. A. Inc.)
[250]Maurice Braverman Defense Committee
[251]Michigan Civil Rights Federation
[252]Michigan Council for Peace
[253]Michigan School of Social Gclence
[255]Wanka Telkoku Gunyudan (Imperial Military Friends Group or
[256]Southern California War Veterans)
[258]National Association of Mezican Americans (also known as Asccia-
[259]clon Nactonal Mexico- Americans) .
[261]National Blue Star Mothers of America (not to be confused with
[262]the Blue Star Mothers of America organized in February 1942)
[264]National Committes for Freedam of the Press
[266]National Committee for the Defense of Political Prisoners
[268]National Committee to Win Amnesty for Smith Act Victims
[270]National Committee to Win the Peace
[272]National Conference on American Policy in Chins and the Par East
[273](@ Conference calied by the Committee for a Democratic Par
[274]Eastern Policy)
[276]National Council of Americans of Croatian Descent
[278]National Council of American-Soviet Friendship
[280]National Federation for Constitutional Liberties
[282]National Labor Conference for Peace
[284]Nationa! Negro Congress
[286]National Negro Labor Council
[288]Nationalist Action League
[291]14.99000
[293]Nationalist Party of Puerto Rico
[295]Nature Priends of America (since 1935)
[297]Negro Labor, Victory Committees
[299]Kew Committee for Publications
[301]Nichide! Kogyo Kaisha (The Great Fuji Theatre)
[302]North American Committee to Ald Spanish Democracy
[303]North American 6panish Ald Committce
[305]North Philadelphis Forum
[307]Northwest Japanese Association
[309]Ohio School! of Bocial Sciences
[311]Oklahoma Committee to Defend Political Prisoners
[313]Oxiahoma League for Political Education (see Communist Politi-
[314]cal Association)
[316]Original Gouthern Elans, Incorporated
[318]Pactfic Northwest Labor &chool, Beattie, Washington
[320]Palo Alto Peace Club
[322]Partido del Pueblo of Panama {operating in the Canal Zone)
[324]Peace Information Center
[326]Peece Movement of Ethiopia
[328]People’s Drama, Inc.
[330]People’s Educational and Press Association of Texas (see Commu
[331]nist Political Association)
[333]People’s Educational Association (incorperated under name Los
[335]Educational Association, Inc.), also known as People’s
[337]Educational Center, People’s University, People’s School
[339]People’s Institute of Applied Religion
[341]Peoples Programs (Seattle, Washington)
[343]People’s Radio Foundation, Inc.
[345]People’s Rights Party
[347]Philadelphia Labor Committee for Negro Rights
[349]Philadelphia School of Boctal Sclance and Art
[351]Photo League (New York City)
[353]Pittsburgh arts Club
[355]Political Prisoners’ Welfare Committee
[357]Polonia Society of the TWO
[359]Progreastve German-Americans, also known as Progressive Ger-
[360]man-Americans of Chicago
[362]Proietarian Party of America
[364]Protestant War Veterans of the United States, Inc.
[366]Provisional Committee of Citizens for Peace, Bouthweet Aros
[368]Provisional Committee on Latin American Affairs
[370]Provisional Committee to Abolish Discrimination in the State of
[372]Maryland
[373](Bee: Committees to Abolish Discrimination in Maryiend)
[375]Puerto Rican Comite Pro Libertades Civiles (CLC)
[376](See Comite Pro Derechos Civiles)
[378]Puertorriquenos Unidos (Puerto Ricans United)
[380]Quad City Committee for Pesce
[381]Queensbridge Tenants League
[383]Revolutionary Workers League
[384]Romanian-American Fraternal Society
[385]Russian American Society, Inc.
[387]Sakura Kal (Patriotic Goclety, oF Cherry Association — composed
[388]of veterans of Russo-Japanese War)
[389]Bamuel Adams School, Boston, Massachusetts
[393]Banta Barbara Peace Porum
[395]Gcbhappes Defense Committee
[397]Gchnelderman-Darcy Defense Committee
[399]Bchool of Jewish Btudies, New York City
[401]Beattie Labor School, Beattie, Washington
[403]Berdian-American Fraternal Society
[405]Gerdian Vidordan Council .
[407]Shinto Temples (limited to State Shinto abolished in 1945)
[409]Olver Shirt Legion of America ”
[411]@lavie Council of Southern California
[413]Slovak Workers Society
[415]Blovenian-American National Council
[417]Goctalist Workers Party, including American Oommittee for Euro-
[418]pean Workers’ Relief
[420]Gokoku Kal (Fatheriand Society)
[422]Southern Negro Youth Congress
[424]Buiko Sha (Reserve Officers Association, Los Angeles)
[426]Byracuse Women for Pesce
[428]Tom Paine School of Social Science, Philadelphia, Pennsyivanis
[429]Tom Paine School of Westchester, New York
[430]Trade Union Committes for Peace
[431](See Trade Unionists for Peace)
[432]Trade Unionists for Peace
[433](Bee Trade Unionista for Peace)
[434]Tri-State Negro Trade Union Oouncil
[436]Unrainian-American Fraternal Union
[438]Union of American Croatians
[440]Union of New York Veterans
[442]United American Spenish Ald Committes
[444]United Committee of Jewish Gocieties and Landsmanschaft Fed-
[445]erations, also known as Coordination Oommittes of Jewish
[446]Landsmapschaften and Praternal Organizations
[448]United Committee of South Slavic Americans
[450]United Defense Council of Southern California
[452]United Hariem ‘Tenants and Consumers Organization
[454]United May Day Committee
[456]United Negro and Allied Veterans of America
[458]Veterans Against Discrimination of Civil Rights Congress of New
[459]York (see Civil Rights Congress)
[461]Veterans of the Abraham Lincoln Brigade
[463]Virginia League for People’s Education (see Communist Political
[464]Association)
[466]Voice of Freedom Committee
[468]Walt Whitman School of Social Science, Newark, New Jereey
[469]Washington Bookshop Association
[471]Washington Committee for Democratic Action
[473]Washington Committee to Defend the Bul of Rights
[474]Washington Commonwealth Federation
[476]Washington Pension Union
[478]Wisconsin. Conference on Gocial Legislation
[480]Workers Alliance (since April 1934)
[482]Yiddlaher Kultur Parband
[484]Young Communist League
[485]Yugoslay-American Cooperstive Home, Inc.
[486]Yugoelav Seamen's Club, Inc.
[488]ay, we
[490]a . ETM +.
[492]14-0000
[496]al ‘Any phase of communications; administration; or personnel
[498]i le
[500]THIS DATE (Pill In)
[502]September 6, 1961
[504]1. Answer all questions completely or check appropriate box. If question is not applicable, write “NA”. Write “Un-
[505]known” only if you do not know the answer and it cannot be obtained from personal records. Use blank space at
[506]end of form for extra details on any question for which you have insufficient space.
[508]2. Type, print or write carefully; illegible or incomplete forms will not receive consideration.
[510]3. Consider your answers carefully. Your signature at the end of this form will certify to their correctness. Careful
[511]completion of all applicable questions will permit review of your qualifications to the best advantage.
[513]SECTION | GENERAL PERSONAL AND PHYSICAE”DAY
[514]1. FULL NAME (Last+Firet-Middie)
[516]eT ee
[517]FLORES, Daniel PA 6 Pee ree
[519]4, HEIGHT S. WEIGHT . 6. COLOR OF EYES 7. COLOR OF HAIR [APE COMPLEXION 9. TYPE BUILD
[520]5+ 6" 165 pds. Brown Black } Dark
[521]10. SCARS (Type end Location) Right cheek, one-half inch scar; left*upper Zip, one-
[523]both received playing football
[525]a
[526]None
[527]12. CURRENT ADDRESS (No., Street, City, Zone, State and Country)
[529]2828 Connecticut Avenue,N. We, #20 / ; .
[530]2828 Connecticut Avenue, N. W.
[531]ashington 8, D. ©, & #203 - Washington 8, Dc.
[533]- CURRENT PHONE NO. 15. OFFICE PHONE NO. & EXT. 16. LEGAL RESIDENCE (State, Territory or Country)
[534]265-832 & None Washington, District of Columbia
[535]18. OTHER NAMES YOU HAVE USED :
[536]5 None
[538]19. INDICATE CIRCUMSTANCES (Including Length of Time) UNDER WHICH YOU HAVE EVER USED THESE NAMES.
[540]13. PERMANENT ADDRESS (No., Street, City, Zone, State and
[541]Country) AND PHONE NO. x oe 6 3
[543]NA -
[544]SECTION I! POSITION DATA
[546]1. INDICATE THE TYPE OF WORK OR POSITION FOR WHICH YOU ARE APPLYING
[548]work.
[550]2. INDICATE THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL
[551]not be conside: eeny position with a lower
[552]entrence salary).
[554]Pd
[555]ra)
[556]re)
[557]mi
[558]a
[559]4
[560]2
[562]ES
[564]we
[565]ry
[567]in)
[569][o)
[571]io
[573](eo)
[575]or
[576]5
[578]4 INDICATE YOUR WILLINGNESS TO TRAVEL
[580]DATE AVAILABLE FOR EMPLOYMENT
[581]- Immediately
[582]| Joccasronsuuy ] Yewccuentiy [ Jeowstanrey | [orem
[584]5. INDICATE YOUR WILLINGNESS TO ACCEPT ASSIGNMENT IN THE FOLLOWING LOCATIONS (Check (X) each item applicable)
[586]PXoursioe contimenvac uss,
[587]6. INDICATE WHAT RESERVATIONS YOU WOULD PLACE ON ASSIGNMENTS OUTSIDE THE WASHINGTON, D.C. AREA.
[589]I would be willing to travel within the United States provided
[590]said travel would not involve a permanent move whereby my le gal
[591]residence would be changed. However, it is my wish to live overseas
[592]on a permanent Dasis. ;
[594](a
[596]FORM 444 USE PREVIOUS EDITION. DY COONEY ee
[598]14-0000
[600]15. DATE OF ARRIVAL IN U.S. 16. PORT OF ENTRY 17. ON PASSPORT OF WHAT COUNTRY
[601]NA NA NA
[602]NA NA
[603]@ | SECTION IV - EDUCATION
[605]rr er ra
[607]United States of America
[608]af NATURAL- 6. NATURALIZATION CERTIFICATE NO.
[609]"WA NA
[611]7, COURT ISSUING NATURALIZATION CERTIFICATE 8. ISSUED AT (City, State, Country)
[612]NA NA
[613]9. HAVE YOU HELD PREVIOUS NATIONALITY 10. iF YES, GIVE NAME OF COUNTRY
[615]P[res dL X NA
[617]11, GIVE PARTICULARS CONCERNING PREVIOUS NATIONALITY.
[619]NA
[621]13. GIVE PARTICULARS
[622]12. HAVE YOU TAKEN STEPS TO CHANGE [ves | .
[623]PRESENT CITIZENSHIP . ca
[624]f
[626]N
[627]IF YOU HAVE APPLIED FOR U.S. CITIZENSHIP, WHAT IS PRESENT STATUS OF YOUR APPLICATION (First Papere, Etc.)?
[629]NA
[631]14.
[633]1. CHECK (X) HIGHEST LEVEL OF EDUCATION ATTAINED
[635]LESS THAN HIGH SCHOOL GRADUATE OVER TWO YEARS OF COLLEGE - NO DEGREE
[637]IGH SCHOOL GRADUATE || BACHELOR'S RBEGREE
[639]TRADE, BUSINESS, OR COMMERCIAL SCHOOL GRADUATE GRADUATE STUDY LEADING TO HIGHER DEGREE
[640]Two YEARS COLLEGE OR LESS MASTER'S DEGREE a DOCTOR'S DEGREE
[642]2. ELEMENTARY SCHOOL ’
[643]« ADDRESS (City, S: Country)
[645]0
[647]an Marcos,) Texas A
[649],
[651]Pe | |
[653]1. NAME OF BLEMENTAF SCROOL ” tate,
[655]Ban Marcos)Elementary School”
[656]3. DATES ATTENDED (From-end-To)
[658]~» 19h2 - May, 1951 - [xX[ves no
[660]¢2]
[661]o
[662]ct
[664]1. NAME OF HIGH SCHOOL “T 2. ADORESS (City, State, Country)
[666]Gan Marcos) High School ; ~ 6an Marcos,) Texas, U.S.A. ° .
[668]3. DATES AT TENDED (From-and-To) “40 4. GRADUATE
[670]Sept., 1951 - May, 19
[672]1. NAME OF HIGH SCHOOL . ADDRESS (City, State, Country)
[674]iS)
[675]QZ
[676]|
[677]|
[680]RY
[681]|
[685]5 baves ATTENDED Fomana Ta ema
[686]: 4. COLLEGE OR UNIVERSITY STUDY
[688]SUBJECT DATES ATTENDED DATE SEM/QTR
[689][ xo | ReC'O | Grocity
[690][erom [v0 Gomctt)
[692]. SECTION IV CONTINUED TO PAGE 3
[693]. - * . Ey, . =
[696]14.90000
[698]rf sree
[699]SECTION IV CONTINUED FROM PAGE 2
[701]EO IN ITEM 4 WHICH REQUIRED SUBMI '
[702]iTS CONTENT- BMISSION OF A WRITTEN THESIS, INDICATE THE TITLE
[704]6. TRADE, COMMERCIAL AND SPECIALIZED SCHOOLS
[706]8. OTHER EDUCATIONAL TRAINING NOT INDICATED ABOVE.
[708]Weapons Training in Marine Corps. ;
[709]Acted as partisan during cold weather training at Bridgeport,
[710]California (Pickle Meadows = USMC).
[712]a 3
[714]@ | SECTION V FOREIGN LANGUAGE ABILITIES
[716]COMPETENCE - IN ORDER LISTED
[717]1. LANGUAGE _ R-Reed, W-Write, S-Speak
[718](Liat below each language in
[720]which you poesess any degree FLUENT
[722]of competence. Indicate your — BUT
[724]Proficiency to Read, Write or opyiousty
[726]Speak by placing a check (X)
[728]in the appropriate box(es).
[730]2. IF YOU HAVE CHECKED “ACADEMIC STUDY" UNDER *HOW ACQUIRED”, INDICATE LENGTH AND INTENSIVENESS OF STUDY.
[732]NA
[734]YOU HAVE INDICATEO FLUENCY FOR A LANGUAGE HAVING SIGNIFICANT DIFFERENCES IN SPOKEN AND WRITTEN FORM, EX-
[735]AIN YOUR COMPETENCE THEREIN.
[737]NA
[739]4. DESCRIBE YOUR ABILITY TO DO SPECIALIZED LANGUAGE WORK INVOLVING VOCABULARIES AND TERMINOLOGY IN THE SCIEN-
[740]TIFIC, ENGINEERING, TELECOMMUNICATIONS, MILITARY, AND OTHER SPECIALIZED FIELDS.
[742]Could act as literal interpreter at almost any level.
[744]3. IF YOU HAVE NOTED A PROFICIENCY IN LANGUAGE, WOULD YOU BE WILLING TO USE THIS ABILITY IN ANY POSITION FOR WHICH
[745]YOU MIGHT SE SELECTED? .
[748]14.90000
[752]SECTION VI GEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL
[754]1. LIST BELOW ANY FOREIGN REGIONS OR COUNTRIES IN WHICH YOU HAVE TRAVELLED OR GAINED KNOWLEDGE AS A RESULT OF
[755]RESIDENCE, STUDY OR WORK ASSIGNMENT. INDICATE TYPE OF KNOWLEDGE SUCH AS TERRAIN, HARBORS, UTILITIES, RAIL-
[756]ROADS, INDUSTRIES, POLITICAL PARTIES, ETC.
[758]KNOWLEDGE ACQUIRED BY
[760]pd T v T y | ASSIGNe
[761]RAVELIS
[762]ENCE : up MENT
[764]Marine Security Guard - American Embassy - Bolivia and Peru
[765]Vacation - Chile; Argentina; Uruguay; Panama
[767]3. UNITED STATES PASSPORT NUMBER AND EXPIRATION DATE, IF ISSUED.
[769]No. (171850 °%SP-85575)) Passport has been cancelled.
[771]SECTION Vil TYPING AND STENOGRAPHIC SKILLS
[773]1. TYPING (wpm) | 2. SHORTHAND(wpnv 3. SHORTHAND SYSTEM USED - CHECK (X) APPROPRIATE ITEM
[774]5 wpm | None | [ence | [arccownirine | [stenorvee | [owen (pecity)
[775]2. INDICATE OTHER BUSINESS MACHINES WITH WHICH YOU HAVE HAD OPERATING EXPERIENCE OR TRAINING (Comptometer,
[777]Mimeogmph, Card Punch, Etc.).
[779]Thermofax, mimeograph, switchboard
[781]DATES OF
[783]TYPE OF
[784]SPECIALIZED KNOWLEDGE RESIDENCE
[786]otisia oman moana VES P|
[787]Bolivia General knowledge £0
[788]a
[789]fone | Cider
[790]Chile 9
[791]Argentina | 6/30 /59
[792]Uruguay 59
[794]2. INDICATE THE PURPOSE OF VISIT, RESIDENCE, OR TRA
[796]DATES AND
[797]PLACE OF STUDY
[799]NAME OF
[800]REGION OR COUNTRY
[802]General knowledg
[804]SECTION Vil! SPECIAL QUALIFICATIONS 4
[805]1. List ALL HOBBIES AND SPORTS IN WHICH YOU ARE ACTIVE OR HAVE ACTIVELY PARTICIPATED. INDICATE YOUR PROFICIENCY
[807]Foot ball - good
[808]Basketball - fair
[809]Swimming _ > = .good
[810]Reading :- average
[812]Contract.Bridge - very good.
[814]- INDICATE ANY SPECIAL QUALIFICATIONS
[816]RESULTING FROM EXPERIENCE OR TRAINING WHICH MIGHT FIT YOU FOR A
[817]PARTICULAR POSITION OR TYPE OF WORK.
[819]None to my knowledge
[821]+ EXCLUDING BUSINESS EQUIPMENT OR MACHINES WHICH YOU MAY HAVE LISTED IN ITEM 2, SECTION VII, LIST ANY SPECIAL
[822]SKILLS YOU POSSESS RELATING TO OTHER EQUIPMENT AND MACHINES SUCH AS OPERATION OF SHORTWAVE RADIO (Indi-
[823]cate CW epeed, sending and receiving), OF FSET PRESS, TURRET LATHE, SCIENTIFIC AND PROFESSIONAL DEVICES.
[825]None
[827]SECTION VIII CONTINUED TO PAGE 5
[828]7 Ta
[830]14.90000
[832]Seen
[834]SECTION Vill CONTINUED FROM PAGE 4
[836]4. ARE YOU NOW OR HAVE YOU EVER BEEN A LICENSED OR CERTIFIED MEMBER OF ANY TRADE OR PROFESSION, SUCH AS PILOT,
[837]ELECTRICIAN, RADIO OPERATOR, TEACHER, LAWYER, CPA, MEDICAL TECHNICIAN, ETC.? y 00
[839]T es NO
[841]S. IF YOU HAVE ANSWERED *YES® TO ABOVE, INDICATE KIND OF LICENSE AND STATE ISSUING LICENSE (Provide License Registry
[842]Number, tf known).
[844]NA
[846]6. FIRST LICENSE OR CERTIFICATE (Year of Issue) 7. LATEST LICENSE OR CERTIFICATE (Year of Iaaue)
[848]8. LIST ANY SIGNIFICANT PUBLISHED MATERIALS OF WHICH YOU ARE THE AUTHOR (Do NOT eubmit copies unless requested). INDICATE
[849]TRE
[851]z ITE LP UBLICATION DATE, AND TYPE OF WRITING (Non-Fiction of Scientific articles, General Intereat subjects, Novels, Short
[852]tories, Ete). i. oar
[854]None
[856]9. INDICATE ANY DEVICES WHICH YOU HAVE !NVENTED ANO STATE WHETHER OR NOT THEY ARE PATENTED.
[858]None
[860]10. LIST PUBLIC SPEAKING AND PUSLIC RELATIONS EXPERIENCE.
[862]Have spoken in my father's church and other churches approximately
[863]150 times. Met and assisted public in Embassies during my tour of
[864]with the Marine Security Guard
[866]11. LIST ANY PROFESSIONAL, ACADEMIC OR HONORARY ASSOCIATIONS OR SOCIETIES IN WHICH YOU ARE NOW OR WERE FORMERLY
[867]A MEMBER. LIST ACADEMIC HONORS YOU HAVE RECEIVED.
[869]None
[871]SECTION IX 2 EMPLOYMENT HISTORY
[873]NOTE: (LIST LAST POSITION FIRST.) Indicate chronologicdé! history of emptoyment for past 15 years. Account for all periods
[874]including casual employment and ail periods of unemployment. Giveaddress and state what you did during periodsof
[875]unemployment. List all civilian employment by a foreign Govemment, regardless of dates. In completing item 9, “De-
[877]scription of Duties” consider your experience carefully and provide meaningtul, objective statements,
[879]1. INCLUSIVE DATES (From and To - By Mo. and Yr.) 2. NAME OF EMPLOYING FIRM OR AGENCY
[880]\Hiliburn's\Drug Store
[881]0
[883]3S. NAME OF SUPERVISOR 0G
[884]Mr illiam (Hillbu
[886]7. SALARY OR EARNINGS 8. CLASS, GRADE(If Federal Service)
[890]9. DESCRIPTION OF DUTIES
[892]Employee at soda counter
[894]10. REASONS FOR LEAVING .
[896]To participate in school events (football).
[898]SECTION IX CONTINUED TO PAGE 6
[900]-3- SF
[902]14-0000
[904]. : ae SECTION IX CONTINUED FROM PAGE 5
[906]1. INCLUSIVE DATES (From and To - By Mo. and Yr.)
[908]July 195y-dune 1955
[910]2. NAME OF EMPLOYING FIRM OR AGENCY
[911](Diamond)Grocery Store
[914]South Guadalupe St. San Marcos
[916]4. KIND OF BUSINESS 5. NAME OF SUPERVISOR
[918]vir. (Ignacto Gonzales) %6
[920]6. TITLE OF JOB j & CLASS, GRADE (If Federal Service)
[921]Butcher [s3U,00 [ren Week |
[923]9. DESCRIPTION OF DUTIES
[925]Slaughtering and preparing meat for sale as well-as actual selling.
[927]10. REASONS FOR LEAVING
[929]To attend college
[931]1. INCLUSIVE DATES (From and To - By Mo. and Yr.)
[932]ay 9 - September
[933]3. ADDRESS (No., Street, City, State, Country)
[934]San. Marcos)? Texas
[935]Private School Y onn Darkman 9
[936]6. TITLE OF JOB 8. CLASS. GRADE (If Federal Service)
[937]Painter's Assistant Ts 35,00 [FER week |
[939]9. DESCRIPTION OF DUTIES
[941]Painted dormitories in the Academy
[943]10. REASONS FOR LEAVING
[945]To attend school
[947]2. NAME OF EMPLOYING FIRM OR AGENCY
[948]Economy )Department Stores
[950]1. INCLUSIVE DATES (From and To - By Mo. and Yr.)
[951]September, 1956 - July, 1957
[952]3. ADORESS (Nv., Street, City, State, Country)
[953]San Marcos }i0Texas .
[954]s KIND OF BUSINESS 5. NAME OF SUPERVISOR ob
[955]Clothing Store . Mr. (Max Mendlovitz_
[956]6. TITLE OF JOB 8. CLASS. GRADE (If Federal Service)
[957]Sales Clerk s 30,00
[959]9. DESCRIPTION OF DUTIES
[961]Assisted customers in selecting and buying goods.
[963]10. REASONS FOR LEAVING
[965]-To join the Marine Corps.
[967]2. NAME OF EMPLOYING FIRM OR AGENCY
[969]1. INCLUSIVE DATES (From and To - By Mo. and Yr.)
[971]wy 26, 19 - July 2 1961 United States Marine Corps
[972]3. ADDRESS (No., Street, City, State, Country)
[973]Marine Corps Schools, Quantico, Virginia
[974]4. KIND OF BUSINESS 5S. NAME OF SUPERVISOR
[975]Military . - 1Gol. John Magruder
[976]6. TITLE OF JOB ®. CLASS. GRADE (If Fodera! Service)
[977])
[979]Marine Corps Museum Attendant |s 100.00 |rermontH Cpl. (E-
[980]SECTION IX CONTINUED TO PAGE 7
[982]- ot ; SS
[986]14-0000
[988]oa os (
[990]"9. DESCRIPTION OF DUTIES
[991]Acted as guide to all visitors entering Museum, explaining
[992]Marine Corps history, etc. Also on several occasions acted as
[993]interpreter for visiting military personnel from Latin America,
[995]10. REASONS FOR LEAVING
[996]2. NAME OF EMPLOYING FIRM OR AGENCY
[997]06 (Ohio Valley) Engineering Company
[999]Dis charged
[1001]1. INCLUSIVE DATES (From and To - By Mo. and Yr.) .
[1002]July 28, 1961 - August 30, 1961
[1003]3. ADDRESS (No., Street. City, State, Country) . . .
[1005]. Capitbl and I Streets, S. W.), Washington, D. CG.
[1007]Construction Mr.(L. G. Bruce) 0G
[1009]"Laborer. a .
[1010]Service)
[1011]Laborer rer Hour
[1013]9. DESCRIPTION OF DUTIES
[1015]Handyman for Company
[1017]4. KIND OF BUSINESS : 5. NAME OF SUPERVISOR
[1018]6. TITLE OF JOB : 7. SALARY OR EARNINGS
[1020]9. DESCRIPTION OF DUTIES
[1022]8. CLASS. GRADE (If Federal
[1023]Service)
[1025]10. REASONS FOR LEAVING
[1027]8. IF PRIOR SERVICE WITH THE FEDERAL GOVERNMENT 1S NOTED ABOVE, INDICATE THE
[1028]MUMBER OF YEARS CREDITABLE TOWARD U.S. CIVIL SERVICE RETIREMENT, iF KNOWN. 7 1/2 years
[1029].
[1031]8S. HAVE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN FROM ANY POSITION. i YES [ono
[1033]HAVE YOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH YOU DESIRE TO EXPLAIN? (Clves [Ano
[1034]IF YOUR ANSWER TO EITHER OR BOTH QUESTIONS IS “YES®, GIVE DETAILS
[1038]Honorably discharged from United States Marine Corps.
[1041]14.90000
[1043]SECTION Xt MILITARY SERVICE
[1045]1. CURRENT DRAFT STATUS
[1047]1. ARE YOU REGISTERED FOR THE ORAFT UNDER YES | 2. SELECTIVE SERVICE CLASSIFF | 3. SELECTI RVICE NO.
[1048]THE UNIVERSAL MILITARY TRAINING AND | X [ves] CATION VE SERVIC
[1049]SERVICE ACT OF 1948 (As amended) | [wo | IV-A {1-65-35-18 Jb
[1051]4. IF OEFERRED, GIVE REASON S, LOCAL ORAFT BOARD NO. OR DESIGNATION AND ADDRESS
[1052]NA G65 - 101 1/2 BE. San antonio st. ,0%
[1053]2. MILITARY SERVICE RECORD (yp (Lockhart ,) Texas
[1055]1. CURRENT AND/OR PAST ORGANIZATIONAL MEMBERSHIP
[1057]CHECK [X) AS MARINE AIR COAST NATIONALIAIR NAT*L| FOREIGN ORGAN. OR MIL.
[1058]APPROPRIATE ARMY NAVY CORPS FORCE | GUARD SuarD | GuaRD | SERVICE (Specify):
[1060]4. TOTAL LENGTH OF EXTENDED ACTIVE S. ARM,
[1061]FORCES (Poet ond current ENDED ACTIVE DUTY IN U MED
[1062]years :
[1064]CURRENT SERVICE 6. TOTAL LENGTH OF ACTIVE DUTY IN FOREIGN MILITARY OR-
[1065]GANIZATION
[1067]26 July,1957 ~
[1068]7. RANK, GRADE OR | PAST SERVICE CURRENT SERVICE 6. SERVICE, SERIAL OR FILE NUMBER (If now serving, provide cur-
[1069]RATE > Cc 1 E rent number)
[1070]pi. —
[1072]9. PRIMARY MILITARY OCCUPATIONAL PAST SERVICE CURRENT SERVICE
[1073]SPECIALTY (Moe or Deasignator) AND TITLE
[1074]Olyl - Chief Clerk
[1075]10. SECONDARY MIL. OCCUPATIONAL PAST SERVICE CURRENT SERVICE
[1076]SPECIALTY (Moe or Designator) AND
[1077]TITLE ; None
[1079]i. BRIEF DESCRIPTION OF MILITARY DUTIES (Indicate whether applicable to pest of current service)
[1080]Past Service: Clerk - Maintained personnel service records.
[1081]2 years as Security Guard in the American Embassies in
[1082]La Paz, Bolivia and Lima, Peru.
[1084]None
[1086]ersonne AGMINnA § =| OF)
[1087]3. DATE SEPARATEO FROM EXTENDED ACTIVE DUTY (Paat servicg
[1089]5. DATE ENTERED
[1090]ACTIVE DUTY =
[1092]12. CHECK (X) TYPE OF SEPARATION FROM ACTIVE DUTY
[1094]X/ RELEASE TO INACTIVE DUTY |_| RETIREMENT FOR COMBAT DISABILITY |
[1095]Previnewen ronsce | [wermenent ron envatcnconaonny —] [on
[1096]13. CHECK (X) COMPONENT IN WHICH YOU SERVED
[1097]X [Resuian |X] RESERVE (Including the National and Air National Guard) r | OTHER (Including AUS)
[1098]3. MILITARY RESERVE, NATIONAL GUARD AND ROTC STATUS
[1099]1, DO YOU NOW HAVE; 2. ARE YOU NOW A MEMBER OF THE YES 3. ARE YOU NOW A MEMBER OF
[1101]YES
[1102]RESERVE STATUST x NAT'L. GRD. OR AIR NATAL. THE ROTC? | |
[1103][two | Sant X [no x
[1105]4. IF YOU HAVE ANSWERED “YES” TO ITEMS 2,2 OR 3 ABOVE, CHECK COMPONENT MEMBERSHIP BELOW
[1107][pron X ranine conrd — [warvonaccuanq  [coastovano] [wavy ore | WDIcATE move CATEGORY Now
[1108][pavd [am ronce [aim warouana{ [anwy qore | [am ronce nord on
[1110]5. CURRENT RANK, GRADE OR 6 DATE OF APPOINTMENT IN CURRENT |7. EXPIRATION DATE OF CURRENT RESERVE OBLIGA-
[1111]N
[1112]RATE Cpl, (E- May, 1959 January 20, 1962
[1113]8. CHECK (X) CURRENT RESERVE CATEGORY | [READY RESERVE] _ |STANDEY(Active)]| X [STANDBY(Inactive)| | RETIRED
[1115]9. PRIMARY MILITARY OCCUPATIONAL SPECIALTY (Mas or Dosig- |10. SECONDARY MILITARY OCCUPATIONAL SPECIALTY (Moa or Dee-
[1116]netor) AND TITLE . - ignator) AND TITLE * .
[1118]O11 None
[1120]1. BRIEF DESCRIPTION OF MILITARY RESERVE DUTIES
[1122]i
[1123]m
[1126]None
[1128]12. ARE YOU CURRENTLY ASSIGNED OR ATTACHED YES | 13. IF YOU HAVE ANSWERED “YES” TO ITEM 12, GIVE UNIT OR AGENCY
[1129]TO A RESERVE, NAT'L. GUARD OR ROTC TRAIN- AND AODRESS oe
[1130]ING UNIT 3 ix {ro |
[1132]16. HAVE YOU A MILITARY MOBILIZATION Assion- |_| 15. IF YOU HAVE ANSWERED “YES” TD ITEM 14, GIVE UNIT OR AGENCY
[1135]16. iNDICATE- TOTAL MILITARY SERVICE] YEARS MONTHS 17. WHERE ARE YOUR SERVICE RECORDS KEPT?
[1137]-FOR LONGEVITY PURPOSES INCLUD-
[1138]ING ACTIVE AND INACTIVE DUTY 7 Headquarters Mar*ne Corps
[1143]14-0000
[1145]4 rr a ‘
[1146]SECTION XI - FINANCIAL STATUS
[1148]1-ARE YOW ENTIRELY DEPENDENT ON YOUR SALARY? (lves KK]no
[1149]2. IF YOUR ANSWER IS "NO" TO THE ABOVE, STATE SOURCES OF OTHER INCOME
[1151]Wife's income
[1153]3. BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS
[1155]NAME OF INSTITUTION ADDRESS (City, State, Country)
[1157]0 eWe O Avenue,
[1159]4. HAVE YDU EVER SEEN IN, OR PETITIONED FOR, BANKRUPTCY, (] ves [X]no
[1160]5. 1F YOUR ANSWER IS "YES" TO THE ABOVE, GIVE PARTICULARS, INCLUDING COURT AND DATE(S)
[1162]6. GIVE THREE CREDIT REFERENCES IN THE UNITED STATES
[1164]NAME * ADDRESS (No., Street, City, State)
[1165]General Motors Acceptance Corp. Portland 5, Oregon
[1166]P.O. Box 725,
[1167]Gulf Oil Corporation Atlanta 9, Georgia
[1168]917 Caroline Steet,
[1169]Ninde Furniture Company Fredericksburg Virginia
[1170]7. DO YOU RECEIVE AN ANNUITY FROM THE UNITED STATES OR DISTRICT OF COLUMBIA GOVERNMENT UNDER ANY RETIREMENT
[1171]ACT, PENSION, OR COMPENSATION FOR MILITARY OR NAVAL SERVICE? ‘| YES fx] NO
[1173]6. 1F YOUR ANSWER 1S “*YES*’* TO THE ABOVE QUESTION, GIVE COMPLETE DETAILS
[1175]9. DO YOU HAVE ANY FINANCIAL INTEREST IN, OR OFFICIAL CONNECTIONS WITH NON-U.S. CORPORATIONS OR BUSINESSES: OR IN
[1176]OR WITH U.S. CORPORATIONS OR BUSINESSES HAVING SUBSTANTIAL FOREIGN INTERESTS?
[1178]("] ves . NO (If anewer “YES®, fumish details on separate sheet.)
[1180]SECTION XII MARITAL STATUS
[1181]1. PRESENT STATUS (Single, Married, Widowed, Separated, Divorced, or Annulled) SPECIFY: Married
[1182]2. STATE OATE, PLACE, AND REASON FOR ALL SEPARATIONS, DIVORCES OR ANNULMENTS
[1184]NA . °
[1186]WIFE, HUSBAND If you have been married more than once - including annulments - use a separate sheet for former wife or
[1187]OR FIANCE: husband giving data required below for all previous marriages. If marriage contemplated, fill in appropriate
[1188]. information for fiance. .
[1190]3. NAME (First) : (Middle) {Maiden) —~(Last) + 4
[1192]Dorothy anne _ 96 _arnett
[1194]4. STATE ANY OTHER NAMES EVER USED INDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH ANY
[1195]OF THESE NAMES WERE USED. IF LEGAL CHANGE GIVE PARTICULARS
[1196](Where and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 16
[1197]OF THIS FORM TO RECORD THIS INFORMATION.
[1199]Dorothy A, Moran
[1201]N.W. j 24
[1202]12. DATE OF BIRTH 18. PLACE OF BIRTH (City, State, aan 14, CITIZENSHIP
[1203]January 31, 1935 Portland, Oregon United States of
[1205]SECTION XII CONTINUED TO PAGE 10
[1207]9. 597
[1209]14.99000
[1213]SECTION XU CONTINUED FROM PAGE 9 .
[1215]14. IF BORN OUTSIDE U.S. - DATE OF ENTRY 15. PLACE OF ENTRY
[1216]NA -* : ay NA . oo.
[1218]16. FORMER CITIZENSHIP(S) Country(iee)7 17, DATE U.S. CITIZENSHIP 78. WHERE ACQUIRED (City, State, Country)
[1220]NA NA NA
[1221]19. OCCUPATION 20. PRESENT EMPLOYER (Also give former employer, or if spouse deceased or
[1222]7 . employed give last two employers) S
[1223]Legal Secretary* (Boykin and De Francis) d 0
[1224]Former: epartment of State
[1225]1. EMPLOYER'S OR BUSINESS ADDRESS (No., Street, City, State, Country)
[1227]1.000 16th St., NoW., Suite 603) Washington 6, D.C
[1229]22. DATES OF MILITARY SERVICE (From and to - Sy Mo. and Yr.)
[1231]None
[1233]23. BRANCH OF SERVICE - ~ 24. COUNTRY WITH WHICH MILITARY SERVICE AFFILIATED
[1235]25. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN Pope ign Service - Jan., 1958 - Oct.,
[1236]1960: Civil Service - April] 196) - June 1961
[1237]SECTION XIII CHILOREN AND OTHER DEPENDENTS e
[1239]1. PROVIDE THE FOLLOWING INFORMATION FOR ALL CHILDREN AND DEPENDENTS
[1241][”~”~C~SNAME RELATIONSHIP | DATE AND PLACE OF BIRTH | CITIZENSHIP ADDRESS
[1243]3. NUMBER OF OTHER DEPENDENTS (inctuding epous
[1244]parents, step-perents, alster, etc.) WHO OEPEND ON
[1245]YOu FOR AT LEAST 50% OF THEIR SUPPORT, OR
[1246]CHILOREN OVER 21 YRS. QF AGE WHO ARE NOT
[1247]SEL F-SUPPORTING. .
[1249]2. NUMBER OF CHILDREN (Including ate,
[1250]children and doce e
[1252]edopted children) WHO ARE
[1253]UNMARRIED, UNDER 2! YRS. OF AGE,
[1254]ANO NOT SELF-SUPPORTING.
[1256]SECTION XIV FATHER (Give same information, for Stepfather and/or Guardian on @ separate sheet) e
[1257]Jose S, Flores x [ves F
[1259]TAG TER NAMES HE HAS USED INDICATE CIRCUMSTANCES (Including length of time) UNDER WHICH HE HAS
[1260]EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where
[1261]and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS
[1263]FORM TO RECORD THIS INFORMATION.
[1265]=. FUN OL. ES AC
[1266]10. IF BORN OUTSIDE U.S. - DATE OF ENTRY 1%. PLACE OF ENTRY . . .
[1267]May 2h, 1918 Unknown a
[1268]12. FORMER CITIZENSHIP(S) (Country(ies)7 |,19., DATE U.S. CITIZENSHIP 14. WHERE ACQUIRED (City, State, Country)
[1269]ACQUIRED
[1270]Mexican : 9 . +» Austin AXAS
[1271]15. OCCUPATION 16. PRESENT EMPLOYER (Givo last employer, if Father is deceased or unemplayod)
[1272]Baptist Minister Mexican Baptist Church
[1273]17. EMPLOYER'S BUSINESS ADORESS OR FAT *S SUSINESS ADDRESS IF SELF-EMPLOYEO
[1275]ILITARY, SERVICE (From-and-To,
[1277]CATES OF M
[1278]my know edge never
[1280]21, DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN
[1282]= | SY
[1284]14.90000
[1285]iseohy
[1287]» ‘| SECTION XV
[1288]1. FULL NAME (Laet-Piret-Middle)
[1290]__Flores,(agustina )a
[1292]8. STATE OTHER NAMES SHE HAS USED
[1294]None to knowledge
[1296]3. DATE OF DEATH 4. CAUSE OF DEATH
[1298]June 1939 Unknown
[1299]DMST ANCES (incliding length of time) UNDER WHICH SHE HAS
[1300]SE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where
[1301]thority). USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS
[1303]6. CURRENT ADDRESS - GIVE LAST ADORESS, IF DECEASED (No., Street,
[1305]S. Austin and Lee Streets
[1306]ATE OF BIRTH
[1308]San Marcos
[1310]: 7 OD 8. PLACE OF BIRTH (City, State, Country) ee a
[1311]September 20, 19034 Mier y Noriega, Nuevo Leon, Mexico VMiexican \ |
[1313]10. IF BORN OUTSIDE V.5.~ DATE OF ENTRY 11, PLACE OF ENTRY
[1315]Unknown
[1316]12, FORMER CITIZENSHIP(S) /Country(iee)7
[1317]NA
[1318]15. OCCUPATION
[1319]Housewife
[1321]ACQUIRED
[1323]Unknown
[1325]15. DATE U.S. CITIZENSHIP | 14. WHERE ACQUIRED (City, State, Couha
[1326]NA NA
[1328]16. PRESENT EMPLOYER (Give last employer, if Mother ia deceased or unemployed,
[1330]N.
[1332]17, EMPLOYER’S BUSINESS ADDRESS OR MOTHER'S BUSINESS ADDRESS IF SELF EMPLOYEO
[1334]NA
[1336]18, DATES OF MILITARY SERVICE (Fronrend-To) 19. BRANCH OF SERVICE 20. COUNTRY
[1338]NA
[1340]21, DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN
[1342]> | SECTION XVI
[1344]1. FULL NAME (Last-F iret-Middlo)
[1346](Patlan, Francés Dob
[1348]Renteria Rachel)o&
[1350]4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
[1352]11 Lambert St.$°San Antonio
[1354]I FULL NAME (Lact-F iret-Middie)
[1356]Black, Rebecca Mary)?6
[1358]4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
[1359]San Marcos,) Texas
[1361]01 S. Guadalupe st
[1363]1 FULL NAME (Laat-Firat-Middile,
[1365]Flores ,/Samue1\0
[1369]Wo., Street, City, Zone, State, Country)
[1370]i | Texas
[1372]g
[1373]Route 2, Box 320, San Marcos
[1374]FULL NAME, (Last-Firat-Middle) °
[1376]Bruce, Esther
[1377]. " oe City, Zone, State, Country)
[1379]7 FULL NAME (Last-F irat-Middle)
[1380]Flores, (Eleazar, 0G |
[1382]Texas
[1384]NA NA
[1386]BROTHERS AND SISTERS (Including Half-, Step- and Adopted Brothers and Sisters)
[1388]2. RELATIONSHIP 3. CITIZENSHIP (Country)
[1389]Sister U.S. of America
[1390]3. LIVING
[1392]3. CITIZENSHIP (Country)
[1393]U.S. of America
[1395]6. AGE
[1397]: K [ves | [xo | 39
[1398]2. RELATIONSHIP 3. CITIZENSHIP (Country)
[1399]Sister U.S. of America
[1400]K[res | [xo |
[1401]Brother U.S. of America
[1402]S. LIVING 6. AGE
[1404]X[rves | [xo | 32
[1406]3. CITIZENSHIP (Country)
[1408]U.S. of America
[1410]PXives | [xo | 2g
[1412]2. RELATIONSHIP 3. CITIZENSHIP (Country)
[1413]Sister U.S. of america
[1414]3S. LIVING 6. AGE
[1416]iX[ves| jo] 2
[1418]3. CITIZENSHIP (Country)
[1420]U.S. of America
[1422]2. RELATIONSHIP
[1423]Sister
[1425]2. RELATIONSHIP
[1427]-Brother
[1429]2. RELATIONSHIP
[1431]Brother
[1433]4. CURRENT AODRESS (No., Street, City, Zone, State, Country)
[1435]Dec eased
[1436]1. FULL NAME (Last-Firat-AMiddle)
[1437]Flores, (Juan)o6
[1438]4. CURRENT ADDRESS (No., Street, City, Zone, State, Country)
[1440]De Ceased
[1442]ee] 7 |
[1443]2. RELATIONSHIP 3. CITIZENSHIP (Country)
[1444]U.S. of America
[1445]3. LIVING 6. AGE
[1447]PD Tves [XT xo | NA
[1450]14.90000
[1452]SECTION XVII FATHER-IN-LAW e
[1453]¥, FULL NAME (Last-Firet-Middle) 2. LIVING 3. DATE OF DEATH 4. CAUSE OF DEATH
[1455]‘Arnett, Carl Raymond) 74 XT | [so]
[1457]$3. STATE OTHER NAMES HE HAS USED INDICATE CIRCUMSTANCES (Including tength of time) UNDER WHICH HE HAS
[1458]EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where
[1459]and by what authority). USE EXTRA SPACE PROVIDED ON PAGE 16 OF THIS
[1460]FORM TO RECORD THIS INFORMATION.
[1462]Ray
[1464]6. CURRENT OR LAST ADORESS (No., Street, City, State, Country) OO
[1466]505 Washington St., Milwaukie, 22,) Oregon
[1468]4S" DATE OF BIRTH 8 PLACE OF BIRTH (City, State, Country)
[1470]9. CITIZENSHIP
[1472]‘January 2, 1909 -j{ Minot, North Dakota U.S. of america
[1473]10, 1F BORN OUTSIDE U.S.- DATE OF ENTRY 11. PLACE OF ENTRY
[1474]WA NA .
[1475]12. FORMER CITIZENSHIPIS) LCountry(ies)) 13. DATE U.S. CITIZENSHIP 14. WHERE ACQUIRED (City, State, Country)
[1476]NA . ACQUIRED NA NA
[1478]16. PRESENT EMPLOYER (Give last employer, if Father-in-Law is deceased or unemployed)
[1480]Wilhelm Inc), Portland, Oregon
[1482]18. OCCUPATION .
[1483]| Warehouse -Foreman
[1484]‘SECTION XVID - OD MOTHER-IN-LAW
[1486]e
[1487]| fompkins alma. Des
[1488]| fompkins, Alma Dean)oG Ke po
[1490]5. STATE OTHER NAMES SHE HAS USED INDICATE CIRCUMSTANCES (Including length of time} UNDER WHICH SHE HAS
[1491]EVER USED THESE NAMES. IF LEGAL CHANGE, GIVE PARTICULARS (Where
[1493]ob and by what authority). USE EXTRA SPACE PROVIDED ON PAGE !6 OF THIS
[1494]Alma Dean Arnett 03 FORM TO RECORD THIS INFORMATION.
[1497]6. CURRENT OR LAST ADDRESS (No., Street, City, State, Country) rere,
[1499](13920 8.E. Portland View Place, Portland 36, Oregon
[1500]7. DATE OF BIRTH 8. PLACE OF BIRTH (City, State, Country)
[1501]May 1910 -+ Portland, Oregon U.S. of Americg
[1502]10. IF BORN OUTSIDE U.S. - DATE OF ENTRY We PLACE OF ENTS
[1503]| WA
[1505]12. FORMER CITIZENSHIP(S) LCountryfies}7 13. DATE U.S. CITIZENSHIP 14, WHERE ACQUIRED (City, State, Country)
[1507]RA .: _ AeauinED NA Na
[1509]OCCUPATION 16. PRESENT EMPLOYER (Give last employer, tf Mother-in-Law is deceased or unemployed)
[1511]SECTION XIX RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (1) LIVE ABROAD,
[1512]. (2) ARE NOT U.S. CITIZENS OR (3) WORK FOR A FOREIGN GOVERNMENT
[1514]FULL NAME (Last-Firat-Middle) .
[1515]None to my. knowledge
[1517]3. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES S. EMPLOYED BY
[1518]6. CITIZENSHIP (Country) . «77 FREQUENCY OF CONTACT PATE OF SAS omen
[1519]° .
[1521]8. DATE OF LAST CONTACT
[1523]1. FULL NAME (Laest-First-Middle) 2. RELATIONSHIP Pace |
[1525]4, ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES 8. EMPLOYED BY
[1527]6. CITIZENSHIP (Country) 7. FREQUENCY OF CONTACT 8. DATE OF LAST CONTACT
[1529]1, FULL NAME (Last-First-Middie) 2. RELATIONSHIP
[1531]@. ADDRESS OR COUNTRY IN WHICH “ELATIVE RESIDES 5. EMPLOYED BY
[1533]6. CITIZENSHIP (Country) 7. FREQUENCY OF CONTACT 8. DATE OF LAST CONTACT
[1535]1. FULL NAME (Last-First-Middle) . 2. RELATIONSHIP
[1536]4. ADORESS OR COUNTRY IN WHICH RELATIVE RESIDES 5S. EMPLOYED BY
[1537]ry :
[1538]6. ‘CITIZENSHIP (Country 7. FREQUENCY OF CONTACT 8. DATE OF LAST CONTACT
[1539]5 ee
[1541]SECTION XIX CONTINUED TO PAGE 13
[1544]oO
[1546]old
[1548]14-0000
[1551]SECTION XIX CONTINUED FROM PAGE 12
[1552]6. SPECIAL REMARKS, IF ANY, CONCERNING RELATIVES NOTED IN SECTION XIX ABOVE
[1554]NA
[1556]. RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO ARE IN THE MILITARY OR CIVIL
[1557]© | SECTION Xx . SERVICE OF THE UNITED STATES °
[1559]1. NAME (Lest-First-Middie) 2. RELATIONSHIP . 4. CITIZENSHIP
[1561]Arnett, Raymond Wesley 9G * | Bro-in-law |U.S. of America
[1563]ODRESS (No., Street, City, State, Country)
[1565]U.S. Army Depot, Pueblo, Colorado
[1567]1. NAME (Leat-Firat-Middle) 2. RELATIONSHIP 4. CITIZENSHIP
[1568]- = 2 °
[1569]2nd Cousin U.S. of America
[1571]6. TYPE AND LOCATION OF SERVICE (If known)
[1573]Air Station, ¢ : _ Aviation - lst Sgt., USMC
[1575]1. NAME (Laat-Pirat-Middle) 2. RELATIONSHIP pee CITIZENSHIP
[1576]5. ADDRESS (No., Streat, City, State, Country) 6. TYPE ANO LOCATION OF SERVICE (If known)
[1578]@ | SECTION XXI REFERENCES, ACQUAINTANCES, AND NEIGHBORS e
[1579]1. LIST FIVE CHARACTER REFERENCES, NOT RELATIVES, IN THE U.S., WHO KNOW YOU INTIMATELY
[1581](Last-Firat-Middle) (No., Street, City and State) ae ({No., Street, City and State) .
[1582]Mr. .and Mrs. (Jose Esp{nog a)\ San Marcos, Texas (San Marcos,) Texas
[1583]. 6
[1584]Mr, (Thaxter Goodell) N\Washington, D.C, : Alexandria irginia
[1585]>— 1711 Massachutes Ave.|,)o%
[1586]Mr, (Alfred Beaty Dept. of Agriculture | Washington, D.C
[1587]Cpl, (Michael Hennessy Lima, Peru tMiraflores, Lima, Per
[1589]2. LIST FIVE PERSONS, IN THE U.S. WHO KNOW YOU SOCIALLY - NOT RELATIVES, SUPERVISORS OR EMPLOYERS
[1591](Last-First-Middte) (No., Stgeet, City and State) (No., Street, City and State)
[1592]’s) Departme Hilitop House} o& |
[1593]ickland Jr washing 2 J pc Li d fash DG
[1594]i D ovat: 6 Ohio
[1596]fl73 Bartolome Herrera
[1597]ores img Per
[1599]“BUSINESS ADDRESS : RESIDENCE ADORESS i
[1600](Laast-Firat-Middie) (No., Street, City and State) (No., Street, City and State)
[1602]Ga oo
[1604]14.90000
[1606]SECTION XXII CLUBS, SOCIETIES, AND OTHER ORGANIZATIONS
[1608]NOTE: List names and eddresses of all clubs, societies, professional societies, employee groups or organizations of any kind -
[1609](Include membership in, or support of, any organization having headquarters or branch in a foreign country) to which you
[1611]* belong or have belonged.
[1612](Number, Street, City, State, Country) [From | To
[1613]oo
[1614](San Marcos) Texas sep 195h
[1616]G Ge High School, Sept.,.
[1617]o3s)J0 Texas _ 19
[1619]} y ex G
[1621]2? . .
[1623]NAME AND CHAPTER
[1625]i
[1626]rs)
[1627]ed
[1629]19
[1634]f
[1635]<4
[1637]SECTION XXHI . RESIDENCES FOR THE PAST 15 YEARS
[1638](Mamber, reat City State, Coun) [row [ed
[1640]#20
[1642]ALGAAS
[1644]Le 96
[1646]1 : '€: . 2 O| Ms 9
[1647]5 ;
[1649]USIS Building ra _& ith Floors, La Paz, Bolivia
[1650]‘eT Company, Headquarters Marine Gorps, Henderson
[1652]Hall, Washington 2 D.C, Sept.,1958 Nov. ,199
[1653]Cold Weather Training Battalion, Pickle Meadows, . Laue 198
[1654]Bridgeport, California ~ Jan 1953 Aug 9G
[1655]Marine Corps Base 9 Palms, California Dec. 195} Janes 14
[1656]Martne Corps Recruit Depot, San Diego California
[1657]Marine Corps Base cage Pendleton California De q
[1659]re)
[1661]S01 S. Guadalupe St., San Marcos, Texas
[1662](Howard Payne Co11 Se Brownwood,) Texas
[1663]Sol Ss. Guadalue St., San Marcos, Texas | sone | sent...
[1665]. .
[1667]_ ener: a a OE
[1669]ee enamel
[1671]14-0000
[1673]tate
[1674]. x moe
[1676]-1 SECTION XXIV
[1678]ADDITIONAL INFORMATION
[1680]- .
[1682]1. DO YOU ADVOCATE OR HAVE YOU EVER ADVOCATED; OR ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF;
[1683]OR HAVE YOU EVER SUPPORTED OR BEEN ASSOCIATED WITH ANY POLITICAL PARTY, INDIVIDUAL OR ORGAN -
[1684]IZATION WHICH ADVOCATES OR TEACHES THE OVERTHROW OF THE GOVERNMENT OF THE UNITED STATES BY
[1685]FORCE, VIOLENCE OR OTHER UNCONSTITUTIONAL MEANS, OR SEEKS BY FORCE OR VIOLENCE TO OENY PERSONS
[1686]THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES?
[1688]2. IF YOU HAVE ANSWERED °YES® TO THE AGOVE QUESTION, EXPLAIN
[1690][ fves | 4. IF SO, TO WHAT EXTENT? f
[1691]3. DO YOU USE OR HAVE YOU
[1692]EVER USED INTOXICANTS? X[xo |
[1693]. IF 50, TO ?
[1694]5. DO YOU USE OR HAVE You | [ves [& IF s WHAT EXTENT
[1695]EVER USED NARCOTICS? x[xo |
[1697]J. HAVE YOU EVER BEEN A MEMBER OF, OR SUPPORTED, OR HAD ANY CONNECTIONS WITH A FOREIGN INTELLIGENCE ORGAN-
[1698]IZATION OR ITS ACTIVITIES? Coy
[1699]Es
[1701][xno IF ANSWER IS "YES®, GIVE COMPLETE DETAILS.
[1703]8. LIST BELOW THE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO WHICH YOU HAVE APPLIED°?FOR EM-
[1704]PLOYMENT SINCE 1940
[1706]I served years in the United States Marine Corps. a
[1708]KNOWLEDGE, ANY OF THE ABOVE HAVE CONDUCTED AN INVESTIGATION OF YOU, INDICATE THE NAME OF THE
[1709]D THE APPROXIMATE DATE OF THE INVESTIGATION.
[1711]An investigation ( I do not know by whom) was conducted prior
[1712]to my departure for Bolivia where I was attached to the American
[1713]or ges. This investigation took place during August and September
[1714]of 1958.
[1716]NOTE SPECIAL| If your answor is "YES* to the following Questions 10, 11 er 12, provide the Information requested for each
[1717]INSTRUCTIONS | question on a seporate, signed sheet and attach the sheet to this form in a sealed envelope.
[1719]10. HAVE YOU, OR TO YOUR KNOWLEDGE HAS YOUR SPOUSE, EVER BEEN DETAINED, ARRESTED, INDICTED OR CON-
[1720]VICTED FOR ANY VIOLATION OF THE LAW OTHER THAN A MINOR TRAFFIC VIOLATION IN THE UNITED STATES OR
[1722]IF SO, STATE NAME OF COURT, CITY, STATE, COUNTRY, DATE, MATURE OF OFFENSE AND DISPOSITION OF CASE
[1723]IN ACCORDANCE WITH THE SPECIAL INSTRUCTION ABOVE.
[1725]11. HAVE YOU EVER BEEN ARRESTED, COURT-MARTIALED OR OTHERWISE PUNISHED UNDER MILITARY LAW OR REG-
[1726]ULATION? IF SO, DESCRIBE INCIDENT(S) AND PROVIDE DATE(S) OF OCCURRENCE ON SEPARATE SHEET IN AC~
[1727]CORDANCE WITH SPECIAL INSTRUCTIONS ABOVE.
[1729]RE ANY UNFAVORABLE INCIDENTS IN YOUR LIFE, NOT MENTIONED ABOVE, WHICH MAY BE OISCOVERED
[1730]QUENT INVESTIGATION, WHETHER YOU WERE DIRECTLY INVOLVED OR NOT, WHICH MIGHT REQUIRE EX-
[1731]PLANATION? IF SO, DESCRIBE INCIDENT(S) AND PROVIDE DATE(S) OF OCCURRENCE ON SEPARATE SHEET IN AC-
[1732]CORDANCE WITH SPECIAL INSTRUCTIONS ABOVE.
[1734]SECTION XXV PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
[1735]1. NAME (Firat-Middle-Last) 2. RELATIONSHIP
[1737]Mrs. Daniel Flores Wife
[1738]3. HOME ADDRESS (No., Street, City, Zone, State, Country) 4. HOME PHONE VS
[1739]Washington 8, D.C 265-8322 0”
[1741]Ss ‘BUSINESS ADDRESS (N: , Zone, State, Comtry) - INDICATE NAME OF FIRM OR
[1743]EMPLOYER, IF FSS (Wo. Steet
[1744]oykin and De Francis »°5
[1745]1000 16th St., Suite 603} Washington 6, D.C.
[1747]7. IN CASE OF EMERGENCY, OTHER CLOSE RELATIVES (Spouse, Mother, Father) MAY ALSO BE NOTIFIED. 1F SUCH NOTIFICATION
[1749]IS NOT DESIRABLE, BECAUSE OF HEALTH OR OTHER REASONS, PLEASE SO STATE.
[1751]0,
[1752]In all cases wife: Relative, Mrs. Vicente Patién) 631 S. River St.}°%
[1753]lo (Seguin, Texas Telephone (Fp 9~1087 \ a5
[1755]ad
[1757]14.90000
[1759]. gal ag 9
[1761]SECTION XXVI CERTIFICATION
[1763]YOU ARE INFORMED THAT THE CORRECTNESS OF ANY STATEMENT MADE
[1764]: WILL BE INVESTIGATED. IN THIS APPLICATION
[1766]1 have read and understand the instructions. | Certify thet the foregoing answers ore true and correct to the best of m
[1767]knowledge and belief. {| agree that ony misstatement or omission os to material fact will constitute grounds for immediate
[1768]dismissal or rejection-of my application. { also understand that any false statement made herein may be punishable by
[1769]low (U.S. Code, Title 18, Section 1001). .
[1771]we, ana
[1772]x (Cit
[1774]Yl.
[1775]Lh fh Abt een A A :
[1776]3. sigMeEp at (City and State) 7
[1777]Washington, District of Columbia
[1779]NOTE: Use the following space for extra details. Reference each continued item by sectio v7 id item number to which it relates,
[1780]sign your name at the end of the added material. If additional space is required us# extra pages the same size as this
[1781]page and sign each such page. ‘
[1783]MARITAL STATUS: Item #), Section XII . o&
[1785]September 1, 1956 to October 6, 1956. Married to(Lt. Col. Joseph G,
[1786]Moran\in Portland, Oregon, by Circuit Court Judge. Used name of (Moran)
[1787]until November 1,, 1960, when changed to Flores. _ o6
[1789]FATHER-IN-IAW: Item #5, Section XVII
[1790]Short name for Raymond
[1792]GEOGRAPHIC AREA KNOWLEDGE AND FOREIGN TRAVEL: Item #1, Section VI
[1793]Argentina 2 July 1959 to 3 July 1959 Travel
[1795]Panama 10 November 1958 to 13 November 1958 Travel -
[1797]SEE ATTACHED SHEET FOR PERTINENT INFORMATION RELATIVE TO STEP-MOTHER.
[1799]Signed at Washington, D. C., this j “~day of September,
[1801]1961.
[1803]Daniel Flores
[1805]14-0000
[1807]3
[1809]Ip
[1811]ATTACHMENT TO FORM NO. lhl - PERSONAL HISTORY STATEMENT
[1813]Section XV - nia
[1815]Full name: (oneepeton R,) Flores
[1817]Living: Yes
[1819]Other Names She Hag Used: None to my knowledge
[1821]Current Address: Ol S. Guadalupe Street, San Marcos,\ Texas
[1822]Date of Birth: Detember 8, 191) O
[1824]Place of Birth: Mexico
[1826]Citizenship: Mexican
[1828]If Born Outside U.S. - Date of Entry: December 8, 1922
[1829]Place of Entry: Unknown
[1831]Former Citizenships: None
[1833]Occupation: Homemaker and Missionary
[1835]Present Employer: (Mexican Baptist Church, SanMarcos, Texas
[1836]Never served in Military or other Government service to my knowledge,
[1838]This paper is attached to and hereby made a part of Form No. bbb.
[1840]cs