[1]14-9000
[3]104-10117-
[4]( 7-10075) | 2025 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992 |
[6]a
[8]SECTION 1.
[10]Submit in duplicate. Answer all questions completely. If question does not apply, write “NA.” Write “UNKNOWN?” only if you do not
[11]know-the answer and it cannot be obtained from personal records. If additional space is required use extra pages the same size as this
[12]page and sign each such page. Reference each continued item by “section and item number to which it relates.
[14]. FULL NAME (Last-first-middle ) 2-DATE OF BIRTH] 3.PLACE OF BIRTH (City,State,Country)
[15]Flores, Daniel :
[16]. PRESENT STATUS (Single, widowed, divorced, or annulled) SPECIFY: Married 12
[17]S. STATE DATE, PLACE. AND REASON FOR ALL DIVORCES OR ANNULMENTS
[21]SECTION 11. SPOUSE
[22]1. NAME OF SPOUSE (last- first-middle-maiden) + DATE QF BIRTH 3. PLACE OF BIRTH (spouse)
[24]Flores, (Dorothy Arnettyob 0481 Jan 1935 Portland, Oregon
[26]4. DATE AND PLACE OF MARRIAGE . C\TIZENSHIP OF SPOUSE (Tf naturalized. indicate date & place
[27]18 November 1960 . reaneegee e-
[28]USA
[30]6. STATE DATE, PLACE. AND REASON FOR ALL SEPARATIONS. DIVORCES OR ANNULMENTS
[34]7. OCCUPATION 8. PRESENT EMPLOYER
[35]Legal Secretary (Arnold and Porter) 0%
[37]9. EMPLOYER'S OR BUSINESS ADORESS (No., Street, City, State & Zip Code - Country if not U.S.)
[39]: (0)
[40](229 19th)Street NW, Washington, D.C.
[42]SECTION Lil. RESIDENCE (Since date of last PHS, if overseas residence indicate only city and country)
[43]ADDRESS - LAST RESIDENCE FIRST (number, street, city,state,country) Jngl, oh + INCLUSIVE DATES (month & year)
[45](Guayaquil, Ecuador | (0 May 1969 |May 1971
[47]Feb. 1974
[49](
[50]"7
[52]yo]
[55]we
[56]c
[57]i
[59]Sept. 197
[61]+3 .
[62]ienna, va (8151 Larkin La.) | gen. 1974
[64]SECTION IV. CHELDREN AND OTHER DEPENDENTS (Provide information for all children and dependents )
[65]ob (Kendra) Flores 3 March 1971 F usa | $151 Larking La
[66]= . Washington D Vienna a
[67]o6 (Zola Marie)Flores 15 March 1974 USA fe
[68]San ons
[69](4)
[71]FORM OBSOLETE PREVIOUS
[73]12-70 ute EDITIONS
[75]“tal
[77]14.90000
[79], RELATIVES BY BLOOD, MARRIAGE OR ADOPTION WHO EITHER (1) LIVE A
[80]SECTION V. °° + (2) ARE NOT U.S. CITIZENS OR (3) WORK FOR A FOREIGN ‘GOVERNMENT 7 ..
[81]: "y- "(Last-First-Middle) . . 2. : 7 City, State, Country)
[82]"GUERRERO || Richard, Nephew” 3 “i BIRTH “ew “orleans ; La y,
[83]5. CITIZENSHIP (Country) 6- ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES —— :
[84]1) USA Ansbach, Germany
[86]+ EMPLOYED BY
[87]Army
[89]NAME (Last-First-Middle) A
[91]ote ey - .
[93]FREQUENCY QF CONTACT
[94]‘Periodic
[98]2. -RELAT S}ONSHIP 3. DATE OF BIRTH [4
[100]5. CITIZENSHIP (Country) ; ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
[101](2) ; .
[103]7. EMPLOYED BY 8. FREQUENCY OF CONTACT 9. DATE OF LAST CONTACT
[105]1. NAME (Last-First-Middle ) 2. RELATIONSHIP 3. DATE OF BIRTH] 4-PLACE OF BIRTH (City, State ,Coumtry)
[107]5. CITIZENSHIP (Country) 6. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
[109](3)
[111]SECTION VI. PERSONAL DECLARATIONS
[113]1. HAVE YOU BEEN ARRESTED. INDICTED, OR CONVICTED FOR ANY VIOLATION OF LAW (Other than for YES (explain X -
[114]minor traffic, yiolation) SINCE THE .DATE OF YOUR LAST PHS below)
[115]ei? 49) E.! : R . tow)
[117]2. SINCE THE DATE OF YOUR LAST PHS, HAVE THERE BEEN ANY UNFAVORABLE INCIDENTS IN YOUR wire) | (explain
[119]WHICH MIGHT REQUIRE EXPLANATION. below)
[123]3. NAME OF YOUR PRESENT IMMEDLATE SUPERVISOR (include Room Number and Extension) Mr. Nestor “Sanchez Vw
[124]. : X—74 RM 3.0 _
[125]SECTION Vil. PERSONS TO BE NOTIFIED IN CASE OF EMERGENCY =~ <P
[127]1. NAME (Last-First-Middle) as previous PHS 2. RELATIONSHIP
[129]3. HOME ADDRESS (Number, Street, City, gtate, zip Code) \ tous 4. HOME TELEPHONE NUMBER
[131]5S. BUSINESS ADDRESS (Number, Street, City, State, ZIP Code)-1NDICATE NAME OF FIRM| 6. BUSINESS TELEPHONE NUMBER & EXT.
[132]OR EMPLOYER, |F APPLICABLE
[134]we, : ota
[136]7. IN CASE OF EMERGENCY, OTHER CLOSE RELATIVES (spouse, mother, father ...) MAY ALSO BE NOTIFIED. IF SUCH NOTIFICATION
[137]1S NOT DESIRABLE BECAUSE OF HEALTH OR OTHER REASONS, PLEASE IDENTIFY THE PERSONS NOT TO BE NOTIFIED AND THE REASON.
[139]ISECTION VIII. > ADDITIONAL REMARKS .
[141]DATE SIGNATURE OF EMPLOYEE
[143]“pal .
[145]14.90000
[147]1. NAME (Pirest-middle-last )
[149]Pau (rem) a
[151]th oF vember
[153]CITY AND STATE .
[155]DATE TO DATE “NUM Pa . CITY. AND STATE
[157]Se “HAVE YOU BEEN -ARRESTED.. IND IGTED /7OR “CONVICTED FOR -ANY-VIOLATION OF LAW (Other than for .- Explai
[158]_sinor ‘traffic violation). -SANCE ‘THE DATE .OF YOUR -LAST. PHS . | Beis) P "
[160]6. SINCE THE “DATE OF YOUR LAST. PHS, HAVE THERE BEEN ANY. UNFAVORABLE INCIDENTS | iN YOUR LIFE YES (Explai /
[161]WHICH MIGHT REQUIRE EXPLANATION . ~ : . below)
[162]: inst
[164]H 7 Piery OF Be" Nahoney’ ‘IMMEDIATE SUPERVISOR
[166]8. ADDITIONAL REMARKS (USE reverse if necessary)
[168]29 Joisk 967
[170]as tte
[172]tected me ot . We te ee ee ee ee
[174]14.90000
[176]1. NAME (First-middle- last )
[177]Daniel (nm) Flores
[178]3..:1F MARRIED
[180]PLACE OF MARRIAGE
[181]ima, Peru to
[183]SINCE (Date). _| NUMBER AND STREET.
[186]August 1961. 828 Connecticut ive., NAW,
[188]DATE TO DATE NUMBER AND STREET
[190]DATE TO DATE... NUMBER AND STREET
[192]HAVE YOU BEEN ARRESTED. -INDICTED, -
[193]minor traffic violation) SINCE THE DATE OF YOUR LAST PHS
[195]WHICH MIGHT REQUIRE EXPLANATION
[196]NAME OF YOUR PRESENT IMMEDIATE SUPERVISOR
[198]Harry T, Mahoney
[200]ADDITIONAL REMARKS (Use reverse if necessary)
[202]-CTURN PHS:
[203]“12 @ HEADQUARTERS.”
[205]Cy EMPLOYEE
[207]Form!
[208]ron uttte (4)