PERSONAL DATA SHEET - VORHAUS, BERNARD

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0005587563
• Release Decision: RIFPUB
• Original Classification: U
• Document Page Count: 4
• Document Creation Date: June 24, 2015
• Document Release Date: February 10, 2011
• Case Number: F-2010-01904
• Publication Date: January 24, 1967

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.:.:' P PRINT CLEARLY T PE .A ALL. questions; =stating No?~ !'' one
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1. Name NA. I_\ ,h Y lam' N V L
2. Date of Birth -:22S p r L. Cf.~. C 3. Place of Birth
Day Month .Year City Province 0ouritrl
include Aliases, Maiden. Name, previoua'Married Name, etc.
4. Present Address 'L ~,~ \V L .N (n Tel.No.?1(i'ra
5. Distinguishing Marks,of Identification
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10. Passport No, 1 C4 Type of Passport 5F) S
Mother's Name (including Maiden, Name) y - N ,`) /A- =s L_\]-[ ?R)t't~'uS
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T1. Father
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9. Nationality (including farmer, "if any) g~ ~S.I~. ~r~ U ~~ ~'(, , 1 -N(
Spouse's Name (including Maiden Name)-=5~-~\
12. Residences of Six Months or moire since reaching-?age of-16 (dates; street adddres-se's-,
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13. Relatives in U.S. (NasRelationshig treat Addresses, Cities, States).
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14'.Purpose of Proposed Trip to U.So ~V JA S I y -\\c '!i \.J,.S
15. Travel Plans:_ ?
Anticipated Exact Date and Fort of Arrival
Mode of Transportation (Air,' Sea,. .or Land)
Ler.gth of Proposed Stay in .U:S.
D"dstinatibn or Itinerary in U.S.
cities, countries) If',you have aIwaya lived in?this-.country, you may
answer -simply by stating "U.K. . ? Birth to .Present"
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 164 . Accompanying Persons,*' (give 'Name.; Date' and Plece' of Birth: 'Nationality and-,
17. Have you been to the United Stat' s1b59X6 ? When?
Relu ' reship )-
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18...- If you have ever previously applied for a visa., washe`visa issued.?
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Have you applied for any type of United ates?visa before?
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Where?
'If your answer is "No".., 'expla'in why visa was not. issued.
.20.. If you have made any trips to or through countries with O.ommufiist,'governments
190 ' Have you ever consulted' a doctor., or' received treatment, for a? mental or.,
nervous disorder?
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convicted of,,,a crime or other offense?. If so, give full details including
date, place and nature of offense. Exclude only minor traffic. offense's.
23.. Affiliations. (List, names of aU-clubs, parties-, organizations, associations,
political groups, social groups,'societies, etc. to which you belong, or
~. have belonged. Give dates of membership and 'any positions held in e$ch...
22. Have you ever been deported from any country? IV U
I r?art; ?fv that. 'to' the b;iat of inv knowledge: and' recollection my answers to the
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