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![handle is hein.jfk/jfkarch61002 and id is 1 raw text is: Mark opposite cash item: te number of the serial nr .seri-tls in whic'h the i ltrr.tinrn appears. d lthmugh the-xe items
are regarded as nonarmeble, rhane-s may be noted by addin; the new seria! number mand ro.str'. out the old. When form is
complete as to all applicable !terns Nee Alent and Field Supe-rvi or should inittaI the f-.r. at tte end.
_Symbo_ Number ' _ - _ _ -_ -'- Office Fii -
Type of Informant: ~ Prob t'Regular ['] Ghetto ( CS Bureau File_ 1 )
SSoit al Number
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1. Name
2. Aliases '
3. Symbol Number assigned and Bureau advised
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4. Cover name assigned and Bureau advised
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5. Background developed
6. Personal history, as required in Sec. 130D, 2c, Vol. IV, M. of I...
7. Description
8. Photograph
9. Credit check
10. Local criminal check
11. Bureau identification Record (FD-9)
12. Selective Service check
I3. Armed Service record check -
14. Informants canvassed
15. Past racial activities t
16. _Racial associates
17. Informant advised of: '-
(a) Not Bureau employee
(b) Activities voluntary i - t1i.-'f
(C) Relationship confidential
(d) FBI jurisdiction
(e) Furnish information only to Bureau - -- -
(f) Payments are income -
(g) Report to be submitted under code name and in third person . -
(h) -Not to contact office personally
(i) Not to retain copies of notes or reports _
* 18. Reliability check
19. Statement of cooperation
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' 20. When removed .rr , probation
' .t C.
21. Informant indices card made --
22. Agent who handles informant -
23. Alternate Agent
24. Flash notice placed ' I - - 1 A.1,... or removed a .
25. Coverage n.. - ° -
Conpictcd -
Ainp-oved . -
- Keep on Top of Other Serialsrin File.
Ni. 94 Docld:32939524 P 1
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