[2]Page : 1
[4]JFK ASSASSINATION SYSTEM
[5]IDENTIFICATION FORM
[7]AGENCY INFORMATION
[9]AGENCY : INSCOM/CSF
[10]RECORD NUMBER : 194-10005-10140 .
[11]RECORDS SERIES : DOD AFFILIATED PERSONNEL AND INCIDENT INVESTIGATIONS
[12]‘AGENCY FILE NUMBER : PAGES 1110-1117
[14]DOCUMENT INFORMATION
[16]ORIGINATOR : USA
[17]FROM :
[18]TO :
[19]TITLE : STATEMENT OF PERSONAL HISTORY
[21]PAGES : 8
[22]SUBJECTS : SCHEER, ROBERT
[24]Io,
[25]| DOCUMENT TYPE : PAPER, TEXTUAL DOCUMENT
[26]| CLASSIFICATION : UNCLASSIFIED
[27]RESTRICTIONS : 3
[28]CURRENT STATUS : RELEASED WITH DELETIONS
[29]DATE OF LAST REVIEW : 03/07/95
[30]OPENING CRITERIA
[31]COMMENTS
[33]NW 60613 Docld:34530159 Page 1
[35]ARMED FORCES SECURITY QUESTIONNAIRE
[37]1.— EXPLANATION
[39]1. The interests of National Security require that all persons
[40]being considered for membership or retention in the Armed
[41]Forces be reliable, trustworthy, of good character, and of com-
[42]plete and unswerving loyalty to the United States. Accordingly,
[43]it is necessary for you to furnish information concerning your
[44]security qualifications. The answers which you give will be used
[45]in determining whether you are eligible for membership in the
[46]Armed Forces, in selection of your duty assignment, and for such
[47]other action as may be appropriate.
[49]2. You are advised that in accordance with the Fifth Amend-
[50]ment of the Constitution of the United States you cannot be
[52]compelled to furnish any statements which you may reasonably
[53]believe may lead to your prosecution for a crime. This is the
[54]only reason for which you may avail yourself of the privilege af-
[55]forded by the Fifth Amendment in refusing to answer questions
[56]under Parc IV below. Claiming the Fifth Amendment will not
[57]by itself constitute sufficient grounds to exempt you from mili-
[58]tary service for reasons of security. You are not required to
[59]answer any questions in this questionnaire, the answer to which
[60]might be incriminating. If you do claim the privilege granted by
[61]the Fifth Amendment in refusing to answer any question, you
[62]should make a statement to chat effect after the question involved.
[64]H.—ORGANIZATIONS OF SECURITY SIGNIFICANCE
[66]1. There is set forth below a list of names of organizations,
[67]groups, and movements, reported by the Attorney General of che
[68]United States as having significance in connection with the
[69]National Security. Please examine the list carefully, and note those
[70]organizations, and organizations of similar names, with which you
[71]are familiar. Then answer the questions set forth in Part IV below.
[73]2. Your statement concerning membership or other association
[74]with one or more of the organizations named may not, of itself,
[75]cause you to be ineligible for acceptance or retention’ in the
[77]Armed Forces. Your age at the time of such association, cir-
[78]cumstances prompting it, and the extent and frequency of
[79]involvement, are all highly pertinent, and will be fully weighed.
[80]Set forth all such factors under ‘Remarks’ below, and continue
[81]on separate attached sheets of paper if necessary.
[83]3. If chere is any doubt in your mind as to whether your name
[84]has been linked with one of the organizations named, or as to
[85]whether a particular association is ‘worth mentioning,’ make a
[87]|
[89]sidiaries and affiliates.
[91]subsidiaries and affiliates, including—
[92]Alabama People’s Educational Assdciation.
[93]Florida Press and Educational League.
[94]Oklahoma League for Political Education.
[96]Virginia League for People’s Education.
[97]Young Communist League.
[98]Abraham Lincoln Brigade.
[99]Abraham Lincoln School, Chicago, Illinois.
[100]Action Commitee to Free Spain Now.
[102]slavia, Inc.
[104]time Unions.
[105]American Christian Nationalist Party.
[107]Birobidjan, Inc.
[108]American Committee for Spanish Freedom.
[109]American Committee for Yugoslav Relief, Inc.
[111]Europe.
[113]American Committee for National Unity.
[114]American Council on Soviet Relations.
[115]American Croatian Congress.
[117]American Jewish Labor Council.
[119]American League Against War and Fascism.
[120]American League for Peace and Democracy.
[121]American National Labor Party.
[122]American National Socialist League.
[123]American National Socialist Party.
[124]American Nationalist Party.
[125]American Patriots, Inc.
[127]American Peace Crusade.
[129]American Peace Mobilization.
[130]American Poles for Peace.
[131]American Polish Labor Council.
[132]American Polish League.
[134]United American Spanish Aid Committee).
[135]American-Russian Fraternal Society.
[137]lations with the Soviet Union).
[138]American Russian Institute, Philadelphia.
[139]American Russian Institute of San Francisco.
[141]Los Angeles.
[144]Nw 88614" Bocid:34530159 Page 2
[146]Communist Political Association, its subdivisions,
[148]People’s Educational and Press Association of Texas.
[150]American Association for Reconstruction in Yugo-
[152]American Branch of the Federation of Greek Mari-
[154]American Committee for European Workers’ Relief.
[155]American Committee for Protection of Foreign Born.
[156]American Committee for the Settlement of Jews in
[158]American Committee to Survey Labor Conditions in
[160]American Council for a Democratic Greece, formerly
[161]known as the Greek American Council; Greek
[163]American Rescue Ship Mission (a project of the
[165]American-Russian Institute, New York (a/so snown
[166]as the American Russian- Institute for Cultural Re-
[168]American Russian Institute of Southern California,
[170]PREVIOUS EDITIONS OF THIS
[172]American Slav Congress.
[174]American Women for Peace.
[176]American Youth Congress.
[178]American Youth for Democracy
[180]Armenian Progressive League of America.
[182]Associated Klans of America.
[184]Association of Georgia Klans.
[186]Association of' German Nationals /Retchsdeutsche
[187]Verernigung ).
[189]Ausland-Organization der NSDAP, Overseas Branch
[190]of Nazi Party.
[192]Baltimore Forum.
[194]Benjamin Davis Freedom Committee.
[196]Black Dragon Society.
[198]Boston School for Marxist Studies, Boston, Massa-
[199]chusetts.
[201]Bridges-Robertson-Schmidt Defense Committee.
[203]Bulgarian American People’s League of the United
[204]States of America.
[206]California Emergency Defense Committee.
[208]California Labor School, Inc., 321 Divisadero Street.
[209]San Francisco, California. *
[211]Carpatho-Russtan People’s Society.
[213]Central Council of American Women of Croatian
[214]Descent (also knoum as Central Council of Amer-
[215]itan Croatian Women, National Council of Croa-
[218]Central Japanese’ Association (Berkoku Chuo Nippon-
[219]jin Kai). .
[221]Central Japanese Association .of Southern California.
[223]Central Organization of the German-American Na-
[224]aonal Alliance ( Deutsche-Amerikanische Einbeits-
[225]front)
[227]Cervantes Fraternal Society.
[229]China Welfare Appeal, Inc.
[231]Chopin Culrural Cencer.
[233]Citizens Committee to Free Earl Browder.
[235]Citizens Committee for Harry Bridges.
[237]Citizens Committee of the Upper West Side (New
[238]York City). :
[240]Citizens Emergency Defense Conference,
[242]Citizens Protective League. . : :
[244]Civil Liberties Sponsoring Committee of Pittsburgh.
[246]Civil Rights Congress and its affiliated organiza-
[247]tions, including Civil Rights Congress for Texas.
[248]Veterans Against Discrimination of Civil Rights
[250]Congress of New York. .
[252]Columbians.
[254]Comite Coordinador Pro Republica Espanola.
[256]Comite Pro Derechos Civiles.
[258]Committee to Abolish Discrimination in Maryland.
[260]Committee to Aid the Fighting South.
[262]Commitee to Defend the Rights and Freedom of
[263]Pittsburgh's Political. Prisoners.
[265]RE OBSOLETE (for Army use).
[267]nm“: Bund (/ Amertkadeutscher Valbs-
[269]full explanation under “Remarks.”
[271]Organizations designated by the Attorney General, pursuant to Executive Order 10450, are listed below:
[272]Communist Party, U. S. A., its subdivisions, sub-
[274]Committee for a Democratic Far Eastern Policy.
[276]Committee for. Constitutional and Political Freedom.
[278]Committee for the Defense of the Pittsburgh Six.
[280]Committee for Nationalist Action.
[282]Committee for the Negro in the Arts.
[284]Committee for Peace and Brotherhood Festival in
[285]Phitadelphia.
[287]Committee for the Protection of the Bill of Rights.
[289]Commitee for World Youth Friendship and Cul-
[290]tural Exchange.
[292]Committee to Defend Marie Richardson.
[294]Committee to Uphold the Bill of Rights.
[296]Commonwealth College, Mena, Arkansas.
[298]Congress Against Discrimination.
[300]Congress of the Unemployed.
[302]Connecticut Committee to Aid Victims of the Smith
[303]Act.
[305]Connecticut State Youth Conference.
[307]Congress of American Revolutionary Writers.
[309]Congress of American Women.
[311]Council on African Affairs.
[313]Council of Greek Americans.
[315]Council for Jobs, Relief, and Housing.
[317]Council for Pan-American Democracy.
[319]Croatian Benevolent Fraternity.
[321]Dai Nippon Butoku Kai / Military Virtwe Society of
[322]Japan ar Military Art Society of Japan).
[324]Daily Worker Press Club.
[326]Daniels Defense Committee.
[328]Dante Alighieri Society -*Betueen 1935 and 1940).
[330]- Dennis Defense Committee.
[332]Detroit Youth Assembly.
[334]East Bay Peace Committee.
[336]Elsinore Progressive League.
[338]Emergency Conference to Save Spanish Refugees
[339](founding body of the North American Spanish Aid
[340]Committee ). .
[342]Everybody's Committee to Outlaw War.
[344]Families of the Baltimore Smith Act Victims.
[346]Families of the Smith Act Victims.
[348]Federation of Italian, War Veterans in the U. S. A.,
[349]Inc. (Associazione Nazionale Combattenti Ltaltani,
[350]Federazione degli Stati Uniti a! America).
[352]Finnish-American Mutual Aid Society.
[354]Florida Press and Educational League.
[356]Frederick Douglass Educational Center.
[358]Freedom Stage, Inc.
[360]Friends of the New Germany / Freunde des Neuen
[361]Deutschlands).
[363]Friends of the Soviet Union.
[365]Garibaldi American Fraternal Society.
[367]George Washington Carver School, New York City.
[369]Page !
[374]Germag American Republican League
[376]German American Vocational League ¢ Deurshe
[377]Amerskanishe Berufige-metnsehaft)
[379]Guardian Club,
[381]Harlem Trade Union Council.
[383]Hawau Civil Liberties Commuttec.
[385]Heimuska Kai. also known as Nokube: Hereki,
[386]Gimusha Kai, Zaibel Nihonjin, Heivaku Gimu-
[387]sha Kai and Zaiber Heimusha Kai / Japanese Re-
[388]siding in America Miltary Conseripts Assocration)
[390]Hellenic: American Brotherhood,
[392]Hinode Kai ¢ fenperiatl Japanese Reservists)
[394]Hinomaru Kai (Resing Sun Flag Socuty—a aroup
[395]af Japanese War Veterans)
[397]Hokuber Zaigo Shoke Dan ¢Nerth American Reserve
[398]Officers Asta nation)
[400]Hollywood Writers Mobilization for Defense.
[402]Hungarian-Amernan Council for Democracy.
[404]Hungarian Brotherhood.
[406]idaho Pension Union.
[408]Independent Party / Seutsle. Washington).
[410]Independent People’s Pany
[412]Industrial Workers of the World.
[414]International Labor Defense.
[416]International Workers Order, its subdivisions, sub-
[417]sidiaries and affiliates
[419]Japanese Association of America.
[421]Japanese Overseas Central Society ¢Kuigai Dohn
[422]Chuo Kar}
[424]Japanese Overseas Convention, Tokyo. Japan. 1940.
[426]Japanese Protectave Association / Recruiting Organ-
[427]sation)
[429]Jefferson School of Social Science. New York City.
[431]Jewish Culcure Sociery.
[433]Jewish Penple’s Committee.
[435]Jewish People's Fraternal Order.
[437]Jikyoku Lin Kai ( The Committee for the Criss).
[439]Johnson-Forest Group.
[441]Johnsonutes.
[443]Jome Ant-Fascist Refugee Committee.
[445]Joint Council of Progressive Italian-Americans, Inc.
[447]Joseph Weydemeyer School of Social Science, St.
[448]Louis. Missouri.
[450]Kiber Seinen Kai ¢ Assocration of U.S. estrzens of
[451]Japanese ancestry who have returned to America after
[452]Mudying m Japan}
[454]Knights of the White Camelia.
[456]Ku Klux Klan,
[458]Kyffhaeuser. also known as Kyffhacuser League
[459](Kyffhseuser Bund), Ky ffhacuser Fellowship (Kyf-
[460]hacuser Kameradschaft)
[462]Kyffhaeusee War Relief ( Kiffhacuser Kreegshilfiuerk).
[464]Labor Council for Negro Rights.
[465]Labor Research Association, Inc.
[466]Labor Youth League.
[468]League for Common Sense.
[470]League of American Writers.
[472]Lictor Society (ltahen Black Shirts),
[474]Macedonian-American People’s League.
[476]Mario Morganuni Circle.
[478]Maritime Labor Committee to Defend Al Lannon.
[480]Maryland Congress Against Discrimination.
[482]Massachusetrs Committee for the Bill of Rights.
[484]Massachusetts Minute Women for Peace (not con-
[485]nected with the Minute Women of the U.S. A.
[486]Inc.).
[488]Maurwe Braverman Defense Committee.
[490]Michigan Civil Raghts Federation.
[492]1. Ser forth an explanation for each answer checked “Yes”
[493]under question 2 below under “Remarks.”
[494]extra sheets as necessary for a full explanation, signing or initial-
[496]ing each extra sheet.
[498]2. Title 18, U. S. Code, Section 1001, provides, in pertinent
[499]part: “Whoever . . . falsifies, conceals or covers up . . . a ma-
[500]statements . . . or makes
[501]shall be fined not more than
[502]$10,000 or imprisoned not more than $ years, or both.” Any
[503]false, fraudulent or fictitious response to the questions under Part
[504]IV below may give rise to criminal fiabilicy under Title 18,
[506]terial fact, or makes any false
[507]or uses any false writing .
[509]NW sabia’ poeid-sashorse Page 3
[511]Michigan Council for Peace.
[512]Michigan School of Social Science.
[514]Nanka Teikoku Gunyudan f Impertal Military briends
[515]Group or Southern California War Veterans).
[517]National Association of Mexican Americans (also
[518]bnown as Asocracion Nacional Mexico- Americana }.
[520]National Blue Star Mothers of America (not to be
[521]confused with the Blue Star Mothers of America
[522]organized in February 1942).
[524]National Committee for the Defense of Political
[525]Prisoners.
[527]National Committee for Freedom of the Press.
[529]National Committee to Win Amnesty for Smith
[530]Act Vicums,
[532]National Commuttee to Win the Peace.
[534]National Conference on American Policy in China
[535]and the Far East (2 Conference called by the Com-
[536]mittee for a Demncratre Far Eastern Policy).
[538]National Council of Americans of Croatian Descent.
[540]National Council of American-Sovier Friendship.
[542]National Federation for Constitutional Liberties.
[544]National Labor Conference for Peace.
[546]National Negro Congress.
[548]National Negro Labor Council.
[550]Nationalist Action League.
[552]Nationalist Party of Puerto Rico.
[554]Nature Friends cf America ¢ Since 1935)
[556]Negro Labor Victory Committee.
[558]New Committee for Publications,
[560]Nichibes Kogyo Kaisha / The Great Fuyjit Theatre).
[562]North American Committee to Aid Spanish Democracy
[564]North Amertcan Spanish Aid Committee.
[566]North Philadelphia Forum.
[568]Northwest Japanese Association.
[570]Ohio School of Social Sciences.
[572]Oklahoma Comminee to Defend Political Prisoners.
[573]Oklahoma League for Political Education.
[575]Original Southern Klans, Incorporated.
[577]Pacific Northwest Labor School. Seattle, Washing-
[578]ton. 7
[580]Palo Alto Peace Club,
[582]Partido del Pueblo of Panama (operating in the
[583]Canal Zone).
[585]Peace Information Center.
[587]Peace Movement of Ethiopia.
[589]People’s Drama, Inc.
[591]People’s Educational and Press Association of Texas.
[593]People’s Educational Association / Incorporated under
[594]name Los Angeles Educational Association. imc ).
[595]also known as People's Educational Center. Peo-
[596]ple’s University, People’s School.
[598]People's Institute of Applied Religion.
[600]Peoples Programs / Seatrie, Washington ).
[602]People’s Radio Foundation, Inc.
[604]People's Rights Party.
[606]Philadelphia Labor Committee for Negro Rights.
[608]Philadelphia School of Social Science and Art.
[610]Photo League (New York Crty J.
[612]Pittsburgh Arts Club.
[614]Political Prisoners’ Welfare Committee.
[616]Polonia Society of the WO.
[618]Progressive Getman-Americans, also known as Pro-
[619]gressive German-Americans of Chicago.
[621]Proletaritan Party of America.
[623]Protestant War Veterans of the United States, Inc.
[625]Provisional Committee of Citizens for Peace, South.
[626]west Area.
[628]Provisional Committee on Latin American Affairs.
[630]Provisional Committce ‘to Abolish Discrimination
[631]in the State of Maryland.
[633]Puerto Rican Comite Pro Libertades Civiles (CLC).
[635]ll. — INSTRUCTIONS
[637]Attach as many
[639]U.S. C., Section 1001.
[640]will not incur such liability unless you supply inaccurate state-
[641]ments with knowledge of their untruthfulness. You are there-
[643]~sttornquenos Unidos ¢ Puerto Ricans United ).
[645]Quad City Commirtee for Peace.
[646]Queensbridge Tenants League.
[648]Revolutionary Workers League
[649]Romanian-American Fraternal Society.
[650]Russian American Society, Inc.
[652]Sakura Kai (Patriotic Society, or Cherry Association,
[653]composed of veterans of Russo-Japanese War).
[655]Samuel Adams School, Boston, Mass.
[657]Santa Barbara Peace Forum.
[659]Schappes Defense Committee.
[661]Schneiderman-Darcy Defense Committee.
[663]School of Jewish Studies, New York City.
[665]Seattle Labor School, Seattle, Washington.
[667]Serbian American Fraternal Society.
[669]Serbian Vidovdan Council.
[671]Shinto Temples (Limited to State Shinto abolished
[672]in 1945).
[674]Silver Shirt Legion of America.
[676]Slavic Council of Southern California.
[678]Slovak Workers Society. .
[680]Slovenian-American National Council
[682]Socialist Workers Party, including American Com.
[683]mittee for European Workers Relief.
[685]Sokoku Kai (Fatherland Society)
[687]Southern Negro Youth Congress.
[689]Suiko Sha ¢ Reserve Officers Association, Los Angeles)
[691]Syracuse Women for Peace.
[693]Tom Paine School of Social Science, Philadelphia,
[694]Pennsylvania.
[696]Tom Paine School of Westchester, New York,
[698]Trade Union Committee for Peace.
[700]Trade Unionists for Peace.
[702]Tri-State Negro Trade Union Council.
[704]Ukramtan-American Fraternal Union,
[706]Union of American Croatians.
[708]Umon of New York Veterans.
[710]United American Spanish Aid Committee.
[712]Unired Committee of Jewish Societies and Lands.
[713]manschaft Federations, also known as Coordina-
[714]tion Committee of Jewish Landsmanschaften and
[715]Fraternal Organizations.
[717]United Committee of South Slavic Americans.
[719]United Defense Council of Southern Califorma.
[721]United Harlem Tenants and Consumers Organiza-
[722]non.
[724]United May Dav Committee
[726]United Negro and Allied Veterans of America.
[728]Veterans Against Discrimination of Civil Rights
[729]Congress of New York.
[731]Veterans of the Abraham Lincoln Brigade.
[733]Virginia League for People's Education,
[735]Voice of Freedom Commutee
[737]Walt Whiuman School of Social Science. Newark
[738]New Jersey
[740]Washington Bookshop Association
[742]Washington Committee to Defend the Bill of Rights
[744]Washington Commitee for Democratic Action.
[746]Washington Commonwealth Federation.
[748]Washington Pension Union
[750]Wisconsin Conference on Social Legislation.
[752]Workers Alliance (srme April 1936)
[754]Yiddisher Kultur Farband.
[755]Yugoslav-American Cooperative Home. Inc.
[756]Yugoslav Seamen's Club, Inc. .
[758]You are advised, however, that you
[760]fore advised that before you sign this form and turn it in to
[762]US GOVERNMENT PRINTING OFFICE . 1961 O—607912
[764]For Official Use Only
[766]Selective Service or military authorities, you should be sure chat
[767]it is truthful; chat detailed explanations are given for each "Yes"
[768]answer under question 2 of Part IV below, and that details given
[769]are as full and complete as you can make them.
[771]3. In stating details, it is permissible, if your memory is hazy
[772]on particular points, to use such expressions as, ‘I think,” “in
[773]my opinion,"’ “I believe.”’ or “to the best of my recollection.”
[775]Page 2
[777]Page 4
[780]1.
[782]1V.— QUESTIONS
[784]{For each answer checked “Yes” under question 2, se! forth o full explanation under ‘Remarks’ below)
[786]l have tread the list of names of organizations, groups, and move-
[787]menis set forth under Part Il of this form and the explanation which
[788]precedes it.
[790]1. Have you ever cantributed money to any of the organizations,
[791]groups, or movements listed?
[793]. Concerning the list of organizations, groups and movements set forth
[794]under Part H above:
[796]k Have you ever contributed services to any of the organizations,
[797]groups, or movements listed?
[799]Are you now a member of any of the organizations, groups, or
[800]movements listed?
[802]| Have you ever subscribed to any publication of any of the organ-
[803]izations, groups, or movements listed?
[805]. Have you ever been a member of any of the organizations, groups,
[806]or movements listed?
[808]. Are you now employed by any of the organizations, groups, or
[809]movements listed?
[811]Hove you ever been emploved by a foreign government or any
[812]agency thereof?
[814]Are you now a member of the Communist Party of any foreign
[815]country?
[817]Have you ever been employed by any of the organizations,
[818]groups, or movaments listed?
[820]. Hove you ever attended any meeting of any of the organizations, T
[822]groups, or movements listed?
[824]Have you ever been o member of the Communist Party of any
[825]foreign country?
[827]. Have you ever attended any social yathering of any of the argan-
[828]izations, groups, or movements fisted?
[830]. Have you ever attended any gathering of any kind sponsored by
[831]any of the organizations, groups, or movements listed?
[833]. Have you prepared material for publication by any of the organ-
[834]izations, groups, or movements listed?
[836]i. Have you ever corresponded with ony of the organizations, groups,
[837]or movements fisted or with any publication thereof?
[839]Have you ever been the subject of o loyalty of security hearing?
[841]q. Are you now or have you ever been a member of any organiza-
[842]tion, association, movement, group or combination of persons
[843]not on the Attorney General's list which odvocates the overthrow
[844]of our constitutional form of government, or which has adopted
[845]the policy of advocating or approving the commission of acts of
[846]force or violence to deny other persons their rights under the
[847]Constitution of the United States, or which seeks to alter the form
[848]of government of the United States by unconstitutional means?
[850]r. Hove you ever been known by any other jast name than thot used
[851]in signing this questionnaire?
[853]ZL serve CE APS a Sees DP AOOST Pees,
[854]Diu Se Tbe/ tvefese Ie FF 5A Grens: ode
[856]HW ZIP wiper Soe SEES: LESLIE wn
[858]vnfients Armerloorant 26 Ae LIL
[862]REMARKS (Continued)
[864]NW/G0613 Docid:34530159 Page 4
[866]Page 3
[868]REMARKS (Continued) ~
[870]Robert Scheer, born 4 April 1936 in Bronx, New York,
[871]@ registrant under the Universal Military Training
[872]Act, was this date given an opportunity to execute
[873]DD Form 98 and in my presence he refused to do eo.
[875]1/LT, AGC
[877]CERTIFICATION
[879]In regard to any part of this questionnaire concerning which I have had any question as to the meaning, | have requested
[880]and have obtained a complete explanation. I certify that the statements made by me under Part IV above and on any supple-
[881]mental pages hereto attached, are full, true, and correct.
[883]TYPED FULL NAME OF PERSON MAKING CERTIFICATION SERVICE NUMBER (if any) SIGNATURE OF PERSON MAKING CERTIFICATION
[885]TYPED NAME OF WITNESS ‘DATE SIGNATURE OF WITNESS
[887]“4 3
[888]US GOVERNMENT PRINTING OFFICE . 1961 O—607912
[890]nw addr Bet aadsorse Page 5 For Official Use Only:
[892]Page 4
[894]At.
[897]~~ fe
[899]. STATEMENT @#-;,  38PAL HISTORY <omeommmases
[903]INSTRUCTIONS: Read the certification at the end of this questionnaire before entering the required data. Print or type all
[904]answers. All questions and statements must be completed. If the answer is ‘“‘None,”’ so state. Do not misstate or omit material
[905]fact since the statements made herein are subject to verification. If more space is needed, use the Remarks section, item 20, and
[906]attach additional sheets if necessary. The information entered hereon is for official use only and will be maintained in confidence.
[908]1, (Print) FIRST NAME—MIDOLE NAME--MAIDEN NAME (Uf any)—LAST NAME d e b
[909]. nf MR. - - ~ sot 2. STATUS
[910]Clues. ROBERT (NNN) SCHEER ; so.
[911]Oo MISS. 7 ; | 4 l CIVILIAN ‘| ~ | turraay on ACTIVE DUTY
[912]3. ALIAS(ES). NICKNAME(S). OR CHANGES IN NAME (Other than by marriage) 4, PERMANENT MAILING ADDRESS °
[913]~~ “'Neone - : wv. .. | 2828 Milvie St., Berkeley, California
[915]{ S. DATE OF BIRTH (Day, month, year)
[917]4 April 1936
[919]PLACE OF BIRTH (City, County, State, and Country) PLACE CERTIFICATE RECCRDED
[920]Bronx,New York,New York,USA Bronx, New York
[921]RACE HEIGHT WEIGHT COLOR OF EYES COLOR OF HAIR SCARS. PHYSICAL DEFECTS, DISTINGUISHING MARKS.
[923]Cauc 70" 180 . Brown Brown None
[925]6. DO YOU HAVE A HISTORY OF MENTAL OR NERVOUS DISORDERS? [_] ves HXKNO ARE YOU NOW OR HAVE YOU EVER BEEN ADDICTED TO THE USE OF HABIT FORMING DRUGS SUCH AS
[926]NARCOTICS OR BARBITURATES? (] YES [Jf NO ARE YOU NOW OR HAVE YOU EVER BEEN A CHRONIC USER TO EXCESS OF ALCOHOLIC BEVERAGES? [_] YES fefhO IF THE
[927]: ANSWER TO ANY OF THE ABOVE IS "YES." EXPLAIN IN ITEM 20, :
[929]i 7,U,S. NATIVE JF NATURALIZED, CERTIFICATE NO. IF DERIVED, PARENTS’ CERTIFICATE NO(S). |. | DATE, PLACE. AND COURT
[931]a kpe 7:
[932]YES . a . ot
[934]gg. 1; ee
[935]NO
[937]eyo wyas. Toa eee _onurs . :
[939]: ALIEN ReGisTRATION NOS 1) 7 FST NATIVE CouNTRY + N14) paTE-AND PORT OF ENTRY a, DO YOU INTEND TO BECOME :
[940]top tase : . - = . AU. S. CITIZEN?
[941]HEF Tce Jo. . - > :
[943][ves To
[945]MILITARY SERVICE
[947]| SERVICE AND COMPONENT — «+ -.- | ORGANIZATION AND STATION. i DATE CURRENT ACTIVE -
[948]rau ra - aos ean : _-.. | / SERVICE STARTED
[954]GRADE AND SERVICE NO SERVICE AND COMPONENT ORGANIZATION AND STATION OR UNIT AND LOCATION
[956]H HAVE YOU PREVIOUSLY SERVED TOURS OF EXTENDED ACTIVE DUTY. ORAWING FULL PAY, FROM WHICH YOU WERE DISCHARGED OR SEPARATED TO CIVILIAN STATUS? o YES i) NO
[957]SE 'YES."’ COMPLETE THE FOLLOWING:
[959]wee ee
[960]COUNTRY SERVICE COMPONENT I ‘[T FROM (Date) | TYPE DISCHARGES OR SEPARATIONS—GRADE AND SERVICE NO.
[961]\ m7 alueistn we ; .
[963]. : aH
[966]9. EDUCATION (Account for all civilian’schools and military academies. Do not include service schools)
[967],
[968]MONTH AND YEARLY HOLA GRADUATE
[969], UEFEOEA DEGREE
[970]\ FROM— ; uot ESE mes NO
[971]| Sep 49
[973]| Sep 53
[974]Sep 55
[975]ep coer ore rst aAguse Unive
[976]i Bp Os pre-e un Gs fUnS Vera £1 Py
[978]10. 7 FAMILY (Lis¢,/nionder ginenn par eras: gpouse guar diansy atépparanits,{fostéy patents, parénts!inz law} formez spouse(s) il divorced give date
[980]. Tey Sedo. puonden sient ea: and sisters, cee hough seosecsat nelude arly’ others you resided with of vith whom a close relationship
[981]existed or exists. If the person is not a U.S. citizen by birth, give date and port of entry, alien registration number, naturalization certificate
[982]number and place of issuance.) . .
[984]U.S. CITIZEN
[986]RELATION AND NAME DATE AND PLACE OF BIRTH PRESENT ADDRESS, IF LIVING YES
[987]FATHER 25 flay 1898
[988]Fred Scheat, co iiss -teleuGermanyerueu* cou iccrs Penesebee Sug Isbeu -  ceTpé
[989]MOTHER (Maiden name) 24 Apr 1900 —C«j 2660 Bronx Park East
[990]Ide KOten Cae iin PR oe Bronx, New York
[991]: SPOUSE (Maiden name Fab. 1942 ‘ 2628 ftilvie Street ‘
[992]Anne Weills Eureka, Calif. Berkeley, Calif. x
[994]OTHER (Specify)
[996]None
[998]Li CUE Sep a
[1000]Exception to Standard Form 86 _
[1001]~ Aaya f the Budget June 1960
[1003]nw sedi) Erteraktth a0 Bake 6 Gener arene ne peony,
[1005]Qe.
[1008]pane
[1009]nn e ne ae i -_
[1010]ea, Lincles, cm |
[1014]: — ENDS Livine IN FORFIGN COUNTRIES (13: srandparents, first cousins, aur
[1016]” 'brothsrs- ena cisters WW, ond cthes porsoms vith wham 92 cless relationship existed or ex::
[1019]RELATIONSHIP AND NAME AGE OCCUPATION ADDRESS / ~ CITIZENSHIP
[1020]‘Wone
[1021]t
[1023]|
[1024]r
[1027]NAME OF IMMEDIATE
[1028]SUPERVISOR
[1030]4 ‘S Ji
[1031]Ue Se Post Office
[1032]New York City, New York
[1033]Syracuse University
[1034]Syracuse
[1036]SOCIAL SECURITY NO.
[1038]DID ANY OF THE ABOVE EMPLOYMENTS REQUIRE A SECURITY CLEARANCE? $[] YES MR NO DO YOU HAVE
[1039]ANY FOREIGN PROPERTY OR BUSINESS CONNECTIONS, OR HAVE YOU EVER BEEN EMPLOYED BY A FOREIGN
[1040]GOVERNMENT, FIRM, OR AGENCY? ([] YES (No HAVE YOU EVER BEEN REFUSED BOND? [7] Yes
[1041]XX] NOs IF THE ANSWER TO ANY OF THE ABOVE IS “YES,"" EXPLAIN IN ITEM 20.
[1043]112-268-1134
[1045]CREOIT AND CHARACTER REFERENCES (Do not include relatives, former employers, or persons living outside the
[1047]United States or its Territories.
[1048]; 1 “state or
[1049]* ': TERRITORY
[1051]ire
[1053]Tel ER
[1055]“ STREET AND NUMBER ht
[1056]Jr oeLise 3 cregiis rand § character ye
[1058]| (Basinesscuddress preferred z]
[1061]fips]
[1063]|
[1065]NW 60613 Docid:34530159 Page f
[1068]19. ARE THERE ANY INCIDENTS IN YOUR LIFE NOT MENTIONED HEREIN WHICH MAY REFUECT UPON YOUR LOYALTY TO THE UNITED STATES O1
[1070]R UPON YOUR SUITABILITY TO PERFORM
[1071]THE OUTIES WHICH YOU MAY BE CALLED UPON To TAKE OR WHICH MIGHT REQUIRE/FURTHER EXPLANATION? oO YES O NO
[1073](F *YES,"" GIVE DETAILS
[1075]See Remarks
[1077]Fic
[1078]20. REMARKS
[1080]MIG Kory ye CAbsec® sores seh) sayy x
[1082]go ooply
[1084]Bae Path moe v
[1085]ITEM gf12) FOREIGN TRAVEL Continued ) hen
[1087]FOE ya, Leh SB GGK BER goes
[1088]. rod @b..1966 to Mar 196605: "Vietnam, Combodia,Thailend and Japan - Write «
[1090]x
[1091]i Sar ad
[1092]a >
[1095]errs Sa
[1097]AOLE
[1099]“yy
[1103]I refuse to answer questions 16, 17, and 19 on the grounds that they violate my
[1104]‘constitutional: rights under: :the:-let, Sth 2 14th: Amendnents ‘to the United Statee
[1105]Gonstitutionsiv 5. HABMOMNCS he Vue te agengs tice Age a
[1107]eeh op GH Be Loe CYeaA 57, wh JOM AGES ca pose eee nee
[1109]iehose ow aD AseBe Papy mesure ® os hose v
[1111]Bou ta aRobert Scheer}: a: registiant under the Military Thaining © INR Gaye
[1112]and Service Act, refused to complete DD Form 398 in its
[1114]entirety.
[1116]MYRON K. HAYASHIDA
[1117]1/LT, AGC
[1119]1 CERTIFY THAT THE ENTRIES MADE BY ME ABOVE ARE TRUE. COMPLETE. AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND ARE MADE IN
[1120]GOOD FAITH. | UNDERSTAND THAT A KNOWING AND WILLFUL FALSE STATEMENT ON THIS FORM CAN BE PUNISHED BY FINE OR IMPRISONMENT OR BOTH
[1121](See U. S. Code, title 18, section 1001)
[1123]ye
[1124]a
[1126]‘DATE
[1128]5 Oct 1966
[1130]SIGNATURE OF PERSON COMPLETING FOR
[1132]ANDSADDAE SE FS SIGNATURE OF WITNESS
[1133]~ HAVASHYBA, 1/LT, acc () * :
[1134]g 7% Jac ian > Pornia ZelVL7 HAY aye
[1135]THIS SECTION TO BE COMPLETED BY AUTHORITY REQUESTING INVESTIGATION
[1136]SIGNMENT AND DEGREE OF CLASSIFIED MATTER (top secret, secret, etc.) TO WHICH APPLICANT WILL REQUIRE ACCESS
[1138]“
[1140]ne.
[1144]Peae rs)
[1146]et
[1147]DATE OF CLEARANCE
[1149]REMARKS.
[1151]U.S, GOVERNMENT PRINTING OFFICE : 1960 0—573450_
[1153]NW 88613 Docid:34530159 Page 8
[1157]tT: STREET. AND, NUMBER, Boeds
[1159]a _ _ " "sTaTE on cour?
[1160]1949":") ‘1958 |
[1162]. 1968 |" ¥559 7 Spracuse N.Y. Married Student Housing i fae for
[1164]California
[1166]| 2961 | 1963 [ 2157 Mason Street | | ~—s (|| San Francisco | California |
[1168][1964 | 1965 | 332 Castro St. & 2870 Geery || San Francisco | California |
[1170]| 2965 |
[1172]2628 Milvia Street California
[1174]TYPE
[1176](Social, fraternal, profeasional, etc.)
[1178]NAME AND ADDRESS
[1180]See Remarks
[1182]ARE YOU NOW OR HAVE YOU EV! EN'A MEMBER OF THE COMMUNIST PARTY U. S. A.. OR ANY COMMUNIST ORGANIZATIONS ANYWHERE?
[1184]ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF/A FASCIST ORGANIZATION? tht
[1186]2 a OR
[1187]ARE YOY NOW OR HAVE YOU EVER BEEN A MEMBER OF ANY PRGANIZATION, ASSOCIATION, MOVEMENT. GROUP OR COMBINATION OF PERSONS WHICH ADVOCATES THE
[1188]OvERT Hon OF OUR CONSTITUTIONAL FORM OF GOVERNMENT, OR WHICH HAS ADOPTED THE POLICY OF ADVOCATING OR APPROVING THE COMMISSION OF ACTS OF FORCE
[1189]OR VIOLENCE TO DENY OTHER PERSONS THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES, OR WHICH SEEKS TO ALTER THE FORM OF GOVERNMENT OF
[1191]eee Tea TUT aah MEANS? <3 Luby (que tcwy ayeey
[1192]ce om ee ¥ 18
[1194]ARE YOU:NQW.OR HAVE you EVER BEEN AFFILIATED OR ASSOCIATED WITH ANY, ORGANIZATION OF THE TYPELDESCRIBED ABOVE AS AN AGENT. OFFICIAL, OR, EMPLOYEE? ;
[1195]set Pee mk : oo , . ‘ we Do, we
[1198]ARE YOU NOW ASSOCIATING WITH, OR’ HAVE YOU ASSOCIATED WITH ANY INDIVIDUALS, INCLUDING RELATIVES, WHO YOU KNOW OR HAVE REASON TO BELIEVE. ARE OR
[1199]HAVE BEEN MEMBERS OF ANY OF THE ORGANIZATIONS IDENTIFIED ABOVE?
[1201]HAVE YOU EVER ENGAGED IN ANY OF THE FOLLOWING ACTIVITIES OF ANY ORGANIZATION OF THE TYPE DESCRIBED ABOVE: CONTRIBUTION(S) TO, ATTENDANCE AT OR
[1202]PARTICIPATION IN ANY ORGANIZATI NAL. hen OR OTHER ACTIVITIES OF SAID ORGANIZATIONS OR OF ANY PROJECTS SPONSORED BY THEM: THE SALE. GIFT. OR DIS-
[1203])
[1206]{TRIBUTION:OF ANY-WRITTEN, P(RIN: ED. Ra BER MAT EES PREPARED: REPROQUCED, OR PUBLISHED. BY THEM OR ANY OF THEIR AGENTS OR iINSTRUMENTALITIES?
[1208]IF “YES,” DESCRIBE THE CIRCUMSTANCES... ATTACH ADDITIONAL-SHEETS FOR A FULL DETAILED STATEMENT. IF ASSOCIATED WITH ANY OF THE ABOVE ORGANIZATIONS. SPECIFY NATURE
[1210]AND EXTENT OF ASSOCIATION WITH EACH, INGUUDING PRFICE;OR;POS|TION HELO; ALSO INCLUDE DATES. PLACES. AND CREDENTIALS NOW OR FORMERLY HELD. IF ASSOCIATIONS HAVE
[1211]i acpetetcan :
[1213]BEEN WITH INDIVIDUALS WHO ARE MEMBERS OF, THE ABOVE ORGANIZATIONS. THEN LIST THE INDIVIDUALS AND THE ORGANIZATIONS WITH WHICH THEY WERE OR ARE AFFILIATEO.
[1215]yeu Gr: eh Mg Se : wf oke “EYE:
[1217]Me Pe ty Ede] opaere
[1221]Joos &
[1223]See Remarks
[1225]16. HAVE YOU EVER BEEN DETAINED, HELD, ARRESTED, INDICTED OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING. OR CONVICTED. FINED. OR IMPRISONED OR
[1226]PLACED ON PROBATION, OR HAVE YOU EVER BEEN ORDERED TO DEPOSIT BAIL OR COLLATERAL FOR THE VIOLATION OF ANY LAW, POLICE REGULATION OR ORDINANCE (excluding
[1227]minor trafic violations for which a fine or forfeiture of $25, or less was imposed)! INCLUDE ALL COURT MARTIALS WHILE IN MILITARY SERVICE. oO YES iF | NO
[1228]IF “‘YES,"’ LIST THE DATE, THE NATURE OF THE OFFENSE OR VIOLATION, THE NAMZ AND LOCATION OF THE COURT OR PLACE OF HEARING, AND THE PENALTY IMPOSED OR OTHER
[1229]DISPOSITION OF EACH CASE.
[1231]wits RELATE. et rn
[1232]4 - b : . tr
[1234]“1
[1236]19. ARE THERE ANY INCIDENTS IN
[1237]YOUR LIFE NOT MENTIONED HEREIN WHICH MAY REFLECT UPON YOUR LOYALTY TO THE UNITED STATES OR UPON YOUR
[1238]RE URTHER EXPLANATION? [) Yes oO NO IF “YES.” GIVE DETAILS ne enone
[1240]THE DUTIES WHICH YOU MAY BE CALLED UPON To TAKE OR WHICH MIGHT REQUI
[1242]613 Docld:34530159 Page 9 Sea Remarks