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Document Creation Date: 
June 22, 2015
Document Release Date: 
December 31, 2008
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Publication Date: 
January 1, 1957
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(b131 APPROVED FOR RELEASE DATE: 12-Nov-2008 I P'"RSCTT,'EL UP, ,TInrJA ThE I'i1LI, ritl?T- Td [ --~ X11 T, l558' Outsidc.'J, 4'te ,,n1 i r7. o et,t.ry C c cup^ t . ~ -~-k1S'. - aI~A16 on dint' oy, 1,rci rddr(.ss wCtcw.r )OCQ. Qv' ,n .-., _. 1~.._\ m Brot' ,rs art: Ito, (rive n3:nes. eocs' .med 3ddre sirs rl_;zC ant: 1t;i,r tn.^ ' 9rtrCck.i / t~rJ~oQ. ~eo~ y_1 'Citi~ n(U,~, or :thee) Ad.lre::s_y( 1 'r s T''1 Z: datr ^:f. birti>[',/tr ta, v, /-mo o iti. Fn U,G, or oth..r;yad If orn outside U ,, st.. ,.u c_ and *,?.::cc o' entry. -:i-771~/L/ L~'C mric rcr # addrese /___S !.~'~l,'a.. y J t ,'_n1`~~T/rtzletk~ r-foyer. end adore: sl~l 9 VI A u . ' I' 1etlv:.?S 'lv' e:i:rond or who arr' not citi"ens Jf the U.S. :(Give rv s x'ol__ 02:"' addresoes Ste- Roverr c,oe Fd Je3 (Give nges, addresses, and .e rv ce) .11 Ethic;ti on: I?lcm_ ntary school __ Hi.5h School / Coll-gc ~r i,rs nt.t.r. 1cd -- ,.me & addrec , of col? gc Der'rce -_ % jor -- List .any snecia':. or outside courecr ^u2 ,. d r_:` tr t.hin, c,)11; c-? ct.rrjcult ~>a~~y1~~ iL~s/ -Tam/y ~.~cr -eirr e t e A, 41 Y. ____ r.!~i ' / 9~!i - .5'e c' % ? / L i 'III F.etivr ri*littor~, F1`:rvicc:, t1,', or for : _gn(sn,:cify h1'rnch of s::.rvice and de t r: s )-n ~i"~ld~fl~Pr~%h. _ ,mod. / 2 ' -t cam! 4 y3 -corps /9%3 Fad/f1!. Give n:^_.inr ~dcirc s of Selc. c ~1 c , : rvi cc Board r), cor_s c' :-rc d 4 n nssie n i ng Tour aw_ n -f Vf ms r._Pp ? /x'57 2f to aS2`F co. ~I04P33~?~ Li,-,t an'.' spt`c1`1l cunl.t'ic".ti on oL L'-:y he v^ such as 1aneu' -C;., technical or ~`ro C onS. ,-~_ i_.Z! R ~~ l(+i Ii ~~,~y/~/,r C ~~r o i ~P . 11f~?s14 lC=s: ~,tZG2 taL r~oi2 a r~ n < 2lJ O r fl' (rll A.rc you in eond h(.-:1th? 11.a __ xi n en- disah Iitic: that should .7- If dcfcrrr.rl, f'1vc: r-,r son Give chronolorioor1 hi,-,tort' of cn dc,nce, ~. e rc:sz onccs for past 10 years 3.tJona1 sr-ace is nccd?:d, usc rc_v(r. s;: side),,/ jO,5 -1~ Z ro y. Ct=' 9 9t l. y ae; /.5' 5- 1/ __1. 22 / ,5-, #- /,w- ;z r. y tra 1 v Quts ide U . (n Tic ivc da s, places OLA List all clubs,, :.r:d s c.ietir.s you belong to or have vcr be long d te> give names, -SOC111 date;,, end positions held) n Mi, c?: llar. e~_: Dc: you advocate or hall , yeu over advocated, or ore you now or 'oevc *-rou ever hr.en rl-..tuber of, or have you suprorted ern political rx:rty or crgar.i.^ation which ^dvocatcs t' e vcrtnrow of our ccnst;.tuti nel form of Government in the Un_'.tcd. States? _ If "Yes", explain: Have you ever been arrostod, indicted, or convicted for any violation of law other then a minor treffic violation? It so, state name of court, city, state., country, nature of offense, and disposition of ceoc:_ __ If, to your 'hnow!lcdgc, any Govc:rnme:nt agcncy* has conducted an iprvc.sti- c~ tior, of you, ind1 cute below the, name of that , -c-n:y and the a , pm o.:y- mete dot,: of the ,vectigation: *t? :I Pcroc r-mcrg,. ncy: Nar.,.,: V Relationship A&:.ress y (USE OTH p SIDE IF NFCESSARY) :II Ar.. there rn; unf!vorablc incid nts in your life not mcntionrd ''hove l.ri' j ct~ mr,y be di scows' rd in subs..quont invcstig. ti .on, :nether or not, which mipht oo '.ir;. cxpianetion? I.;' ;o, de 'crib: , If not, ancw~;r "Noll. :II T. t'TTTTFY `INAT THE FOP~:CPIN0 AI' 1FR ARF TRUE AND CORP.ECT TO THE Iti KNOWLEDGE' AND BFLIE.F, AND I AGRL'T THAT ANY MI,SSTATFiRnT O'.i OI-IIS`ION AT TO A MATERIAL FACT WILL CONSTITUTE GROUNDS FOR 1'"; 1'IA`I'' I?i ITo!L OR RFJI'CTION OF i?1Y APPLICATION. SiPncca. nt ~.. ~b ?~i~~, Datc S -l r-nnt urc of :r?nlicant: (u,SF OTh%R SIDE I' N""CESSARY) 65,e s2 Qj~-c 1-3