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104-10514-10035 JFK Assassination Records Archives 1 (9/2/1964)

handle is hein.jfk/jfkarch48828 and id is 1 raw text is: 













CIA   10M' Ca.IN PROGRM


£41 ,ssr nr -r-zf -SAVVXDO
    CONV3*-':tAi SECTIO~N


  PLEASE PRINT nR T        o     an U.  .      *GISTR  No.

    VISA OR TOURIST CARD .OPPLTTr. a TRVL TO<FL S:IlDR>

  FULL NAME                                 CzTIzENSHifP    4

  PLACE AND DATE OF BIRTH

  PROFESSION   taRITALSTATriUsamle

  RELIGION             RACE -:hile         SEX   nil1a

  PURPOSE OF TRIP a              LLNGTH OF DESIRED STAY-4am   -

  DATE OF. EXPECTED ..RRIVAL IN SL SALV.'jOR  A    m- 6a

  PRESENT ADDRESS

  NAME OF MINORS TRAVELING WITH APPLICANT     ao

  NAME, KINSHIP AND ADDRESS OF NEAREST RELATIVE IN THE U.S.A.

      none.

 IF APPLICANT GOES ON BUSINESS GIVE KA'IIE OF FIRM SPONSORING THE

 TRIP

 REQUIRED DOCUMENTS:

 PASSPORT No            ISSED  -1                   ,DATE 7 Feb 63

 POLICE CERTIFICATE ISSUED BY                  .    D.TE

 HEALTH CERTIFICATE- ISSUED BY                      DATE_20_oV$M62

 VACCINATION CERTIFICATE ISSUED B                   DATE 29 Nam 62-

TOURISTS MAY SHOW ANY OTHER DOCUIENT .S PROOF OF CITI ZENSHIP:


    I DECLARE. UNDER OATH THAT THE ABOVE INFORMATION IS TRUE AND CORRECT,
    THAT MY ACTIVITIES WILL NOT TEND TO VIOLATE .NY SALV.iDOREAN LAWS,
    THAT I VILL NOT SEEK TO CHANGE MY VISA. STATUS, AND TIAT I AM IN
    POSSESSION OF $250.oo OR ROUND TRIP TICKET.
    District OL.9aia, $5:
      On thia 2nd day.
-   before me appeared                      .   .C.   ..w..1L4. 196    .
    personally .known to aw  ac.sovi, PLACE AND DATE /
    the above instrunant and              PLAnE am
    in a7 presance.
  .;;g     2   ?      M          __________,______________.________
       ~r  V IMT~ Tr n:)~ .iI.4 (' T ~ , 1LN  ,~I            1fO


14-1514-10035


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