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![handle is hein.jfk/jfkarch72477 and id is 1 raw text is: 2022 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992
SECTION III. RESIDENCE (Since date of last PHS, if overseas residence indicate only city and country)
ADDRESS . LAST RESIDENCE FIRST (-number,street,city,statecountry) JU. AA INCLUSIVE DATES (month & year)
FROM. TO-
May 1969 May 1971
Lima, Peru (0 Sept. 197 Feb. 197
Vienna a Feb. 1974
SECTION IV. CHILDREN AND OTHER DEPENDENTS (Provide information for all children and dependents)
NAME RELATIONSHIP DATE & PLACE OF BIRTH CITIZENSHIP Q ADDRESS
Flores aughter 3 March 1971 USA
iWenhig-t- , Da,
J06 Flores aughter 15 March 1974 USA
- WashingLou, D.u.
I _______ I I I
FORM OBSOLETE PREVIOUS
12.70 EDITIONS
____ ___ ___ ____ ___ ___ ____ ___ ___ .1 ___ ___ ___ __ ___ ____ ___ ___ ___ _ 1 _ ___ ____ _ . 4)
1104-10117-10076]
SUPPLEMENTAL PERSONAL HISTORY STATEMENT
SECTION I. INSTRUCTIONS
Submit in duplicate. Answer all questions completely. If question does not apply, write NA. Write UNKNOWN only if you do not
know-the answer and it cannot be obtained from personal records. If additional space is required use extra pages the same size as this
page and sign each such page. Reference each continued item by section and item number to which it relates.
. FULL NAME (last-first middle) DATE OF BIRTH LACE OF BIRTH (City.State,Country) 4. SOC SEC NO.
Flores, Daniel Au-1 3 a Marcos) Texas I60-48-623¶
5. PRESENT STATUS (Single, widowed, divorced, or annulled) SPECIFY: Marr-e10
6. STATE DATE. PLACE. AND REASON FOR ALL DIVORCES OR ANNULMENTS
NA'
SECTION II. SPOUSE
I. NAME OF SPOUSE (last-first-middle-maiden) . DATE F BIRTH 3. PLACE OF BIRTH (spouse)
Flores, 06 0 1935 Portland, Oregon
4. DATE AND PLACE OF MARRIAGE 5. C TIZENSHP OFSPOUSE (If aturalized, indicate date & place
4. DTE ND PACEOF MRRIGE0 natura isatiOn & certificate no.)
18 November 1960
CLima, Peru) (0 USA
6. STATE DATE. PLACE. AND REASON FOR ALL SEPARATIONS, DIVORCES OR ANNULMENTS
1NAt
7. OCCUPATION 8. PRESENT EMPLOYER
Legal Secretary o°6
9. EMPLOYER'S OR BUSINESS ADDRESS (No., Street, City, State & Zip Code - Country if not U.S.)
Street NW, Washington, D.C.](ViewImageLocal?handle=hein.jfk/jfkarch72477&div=1&collection=&method=preview&ext=.png&size=3)