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104-10121-10213 JFK Assassination Records Archives 1 (10/19/1972)

handle is hein.jfk/jfkarch72760 and id is 1 raw text is: 104-10121-10213 2022 RELEASE UNDER THE PRESIDENT JOHN F. KENNEDY ASSASSINATION RECORDS ACT OF 1992
  Case Io.-,                                                       .           Date: 19  Oct  72
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                          U.S.   DOCUMENT REQUEST FORM


Requesting Office:


                Regis


Backstopped address, if


REQUESTS   FOR  U.S. ALIAS  DOCUMENTS FOR USE IN U.S.
     REQUIRE   APPROV      OF OFFICE  OF  SECURITY

 FR/SG             E.      4       Date  ocuments are required: ASAP

tered Alias:  iguel Perez COS
                            I .Write  out middle name, if any)

any:


If address is to be selected by TSD, list state and cities with which you are familiar in order of preference:

   First choice:                   filarland Driver's License

             S,                                                           Ii


Third choice:


0     -


Height:   5' 11 Weight: 198  Hair: Brown   Eyes: Brown    Blood Type: A    Married? Yes

Glasses while driving? No -  Birth date:. 26 August  1925  Place: Phoenix29 Arizona


Occupation:
           (Engineer, Intelligence Officer, Government Official, etc.)


Mexca


(White, Negro, Yellow)


Specify country where documentation will be used:                      _

Documentation requested: aryland   License and      ocial   Securit    Card.
                          tter   pertinent to               Clubs
                                                     4Clubs




As a guide for issuance of appropriate documents, list hobbies, i.e., photography, bowling, shooting, stamps, etc.,

special interests, social clubs, athletic and cultural associations, or professional societies or institutions with which

you are familiar:


Signature exemplar in alias:
(Write name three times)


Supply proper photo or negative for identity document request if required.


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e:


Mexican


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