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104-10164-10091 JFK Assassination Records Archives 1 (08/26/1963)

handle is hein.jfk/jfkarch73835 and id is 1 raw text is: 104-10164-10091
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1. SUBJE.CT TJYPE hAMI IN ROMAN ,.IILHS - SURNAME IN UPPER CAS[)

       MIN,  -   .ie  d


2. ALIASS  VARIANT SPELLING, CTC NUMB1ERS5, ETC.


REQUES.  FOR  GRFEN.I.IST
  NA14E CHECK  NO 143977

          DATE  3 ~Al10.1196.1


                                                                   TO    CHIEF, FI/S 0    ~    ~
3. DATE AND PLACE Of BIRTH                                                   ORIGINATING OFFICER
        t-jA- 191,C                                                NAE     Ja r  ~fia
 4CITIZENSHIP                                                      NAME      NIO       SA3AOSngn11~n
     UAOFI                D  1Mt0   SS   0 PRESENT ACTIVITY AND LOCATION Ros uLIGq   4   Do
                                                                   EKTENSION
                                                                   17. TYPE Of EUS   CHKON
                                     .              . .         ~     FIRST TIME SUIMITTEO
                                                                   Q  ADIIlONAL DATA
                                                                   Q  RTCIIECK FOR CURRENT______
  .OCCUPATIONAL SPECIALTIES. EDUCATION
                                                                   1N. INTEREST IN SUBJECT (CNECN ONE)
                                                                   O  ESPIONAGE OR CE ACTIVITY
                                                                   O   OPERATIONAL CLEARANCE
                                                                     OT QtIP
 7. PAST. ACTIVITIES INCLUDOING MILITARY 59WVICE                 ___________                   ___________
                            ACTIVITY    _________                              LOCATION            DATES

        Subj.  alaia   to  be aaboo.  with  Aamrsto
        Detective   Lraboratorie..u    Qiioag.                                                               1    o.6
        Bubj.  *lai ausoc. with 64 nlipew, and
        LIFE   ems.  for %tonhe Pays he  going into
        Culbe for  Zmsmbry stot on PRD there.

 I. OTNtR 5IGNI1FICAWT DATA (POLITICs. RELIIN) - ADD EXTRA SIIEETS WMCN NiEED


 9. pEICIIP ID          (JIOM?        i,.  (WIGT            (EES           TAIN         RAT'        01N


 0. SPOUSE (I WIFE, GIV   whmAI NAME


 I.  0 IR      01IU P  MMEDIATE PAILY ANIO AIIOCIAtES


 II. INFOR10IION RIQUIRED (ofFINg BflCIP (CALL NltRAL TEEN SUCH AS ODERUGAOY? MAY REsuLT IN A S-&AWCN MlAT DOES
                        NOt FuelY wEit REijUIREMENTI.


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1041014-1091 2022 RELEASE UNDER THE PRESIDENT JOHN  F. KENNEDY ASSASSINATION RECORDS ACT OF 1992

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