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104-10073-10081 JFK Assassination Records Archives 1 (7/7/1959)

handle is hein.jfk/jfkarch08764 and id is 1 raw text is: 104-10073.10081


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1. SUBJECT .(NAME. IN ROMAN LWtERS A'.D IN NORMAL
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z. 'Ai iASES1 VARIANT 5fCLLI Gs, CTCINUMBERS, ETC.

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3. BIRTH DATE                    u
                  2  arch. 192!
4. BIRTH PLACE

.  C ITIZENSHIP
                -    Dpliwig


6. PESENT ACTIVITY AND LOCATION
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7;. OCCUPATIONAL SPECIAL tt S  EDUCAT ION


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ORDER)


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       RESPONSE   TO  GREEN'IStr
          REQUEST9


DATE OF REQUEST   JL

REQUEST FROM

          NAME C


OFFICE DESIGNATOR
ROOM, HIuL iNG
EXTENSION


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14. WAS CONTINUING SEARCn REQUET      -

15. TYPE.OF REQUEST.,
A-FIRST  T~IMnE SUI MITTEO     '~   '
    ADDITIONAL DATA
-.COVER-        .
16. INTEREST IN SUBJECT
    ESPIONAGE OR CE ACTIVITT
 SOPERATIONAL  CLEARANCE
    OTHER
17. INFORMATION REQUIRED A  int
or  Caia        aotivity


THIS B.ANK FOR IS CLASSIF'i


   8. MILITARY SERVICE
            SEVICE ARM, COU                     SPECIALTY                LOCAtION              D



   9. PAST OCCUPATIONS
                             ACTIVITY V                                  LOCATI            1   DATES













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     1 s-PU  (IF WIFE, GVE-,MAIDEN NAME)O

     o2    HE M a~fS Or  rF IM AE'FAMILY, AND ASSOCIATES
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   1  OTHER SIGIFICANT DATA       APOLTCS, RELIGION, ETC                    ATTACH  TRA SHEETS     EEDD
                                                  Catholic




INSTRUCTIONS                     INSERT   CARBON;  F ILL OUT  FORMS  COMPLETELY.
                                 SEND  BOTH  SHEETS  TO  FI/D.                   SEE CSI-10-7


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