ZACHARIAS, JERROLD REINACH - #49661

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 06764868
• Release Decision: RIFPUB
• Original Classification: U
• Document Page Count: 12
• Document Creation Date: March 9, 2023
• Document Release Date: March 10, 2021
• Case Number: F-2021-01131
• Publication Date: April 15, 1953

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SLCURITT INK:1104AV
CENTRAL INTELLIGENCE AGENCY
WASHINGTON 25, D. C.
15 April 1953
flOMVIO
QSSUU t
k ' t�
'
1'
)1.
The Director
Federal Bureau of Investigation
Tenih Pennsylvania Avenue, N. W.
Washingto 'r,
,
Attention: Er J. Papich
Dear ar:
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3 bject: ACHARIA3, Jerrold Rainach - r;49661
AttAched is a copy of the Personal History Statement
submitted by the Subject person who is employed by this
Agency in a consultant capacity.
In a supplemental statement on file in this office,
Subject stated that he participated in the activities of
the American League Against War and Fascism. He said that
he was interested in opposing Fascism during the early
19301s, but could not remember whether he joined this or-
ganization and, if his name was on their rolls, it was
only for a short time.
In elaborat On of this statement, subject has ad-
vised that in le eerily 19301s he became acquainted with
one Moses C ..SHELESNYAK while attending Hunter College
and, in the company of Mr. S11ELE3NYAK, attended 5 or 6
meetings of the American League Against War and Fascism
which were held in auditoriums at Columbia University.
Subject 'stated he had always opposed communism and dis-
continued attending meetings of the League after a
speaker at one of the meetings was obviously pro-cansun-
ist instead of anti-fascist.
V \O"
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4 4 8
REcoRDED - 1St t
APR ..P1 irms!
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F. B. I.
DEPT oF JUSTICE
lf) 9 irr 151'53
LOY<Y SECTION
� F. B. I..
u. .b DEPT OF JUSTICE
4P 20 4 11 PN '53
v
LOYALTY SECrkm
APR 9
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� SMOLT INFORMATION
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In view of the above information, it would be appre-
ciated if preliminary inquiries could be conducted on the
Subject in order to determine whether further processing
is required under Executive Order 90350
FOR THE DIRECTOR OF CENTRa IHTMLIGENCE:
ffield Edwards ,/i5
Colonel, GSC
Director of �iecurity
p . �
ta. 4 1.
SECRE
-2-
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C. HAVE YOU EVER BEEN IN, OR PETITIONED FOR, BANKRUPTCY?
GIVE PARTICULARS, INCLUDING COURT: ..
No
I). GIVE TH E CREDI MERENCES�IN THE U. S.
I. NAME ADDRESS --- ----- ----- � ---------- ------ -
Harvard 0i:separative Soo. (81411YIKkee. Ave.rthmbridge,"Wits.
2. NAME ......._ ------ ADDRESS . ----- ..... .................... .......... ..... ................... ......
(st. ram .thadot moo. (State)
ADDRESS .. ....
(St. and Number) (City) (State) .
_
1 NAME ard Trust Co.
Snc. 22. RESIDENCES FOR THE PAST 15 YEARS . .
June 1946 52 Minoan St., Belmont, Mass., USA
FROM TO Present
FROM
FROM
FROM
June 1946 To June 1946
July 1945 TO _June
July 1942 To July 1943
Enom .. Pi9To .. 1!942
Maroh FROM . 1939To � Sept. 1940
FROM
Sept. 1937 TO March 1939
(St. and number) (City) (State) (Country)
412 West 110th at., New Iork, Ha., USA
(St. and number) (City) (State) (Country)
227 Haven Ave., New York, N. X., USA
(St. and number) (City) (State) (Country)
150 Tappan St., Brookline, Hass., USA
(St. and number) (City)
305 West 90th St.,
(sutte)
New Xork, N.Y., d
untry)
(St. and number) (City)
600 West 116th St.,
(State)
New York, N. X.,
I;)
(St. and number) (City) (State) (COntrY)
404 or 410 West 120th St., New York, 1401.,USA
(See note'at.end of PersonalstlerstVW StatiliMnt.)
FROM TO
(St. and Number) (City)
(State)
(Country)
(Stale) (Country)�
SEC. 23. RESIDENCE OR TRAVEL OUTSIDE OF THE UNITED STATES
USA
TOEhglandt France, Germany, Switzerland (1926) Pleasure
A. FROM
FROM
USA TO France, Clersahr(Wi7I � � �
(Country)
?leen:re)
USA England (liggritainess essoattftWS with radalfurPoso
FROM. ...... ........ ...... TO ..... .......
FROM TO ........... ............
FROM TO
(City or section)
(Country) (Ptu:itoso
(City or eection )
(Country) (Purpose)
(City or section)
(Country) (Purpose)
SEC. 24. CLUBS, SOCIETIES, AND OTHER ORGANIZATIONS
LIST NAMES AND ADDRESSES OF ALL CLUBS, SOCIETIES, PROFESSIONAL SOCIETIES, EM-
PLOYEE GROUPS, ORGANIZATIONS OF ANY KIND (INCLUDE MEMBERSHIP IN, OR SUPPORT
OF, ANY ORGANIZATION HAVING HEADQUARTERS OR BRANCH IN A FOREIGN COUNTRY) TO
WHICH YOU BELONG OR HAVE BELONGED:
Amerioan Physioal Society, New York, N. X., USA
2.
3.
Mime nntl Chnptei) (St. and Numb::r) ' (City)
1933 to Present
DATES OF MEMBERSHIP:
Sigma Xi
(State) (Country) �
(Name and Chapter)
(State) (Country)
DATES OF MEMBERSHIP: 1924 to Present
(St. nnd Number) (City)
(Name and Chapter) (St. and Number)
(City)
(State) (Country)
DATES OF MEMBERSHIP:
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SEC. 18. GIVE FIVE CHARACTER REFERENCES�IN THE U. S.--WIIPL9S.i.6,../Z,. tiJ INL
MATELY�(Give residence and business addresses where possible.)
Street and Nu wbc;� City
1. ....... BUS. ....011111bridgikp. State
RES. ADD. 11...ftalge. 1411 Rd, B�.4011t . .. 144g .......
Maas.
2. Dra-P-..- tlio-LOCIlnia �
a� --11*--8-�-� Kellogg....
BUS. ADD.. ..... Cambridge Wise.
RES. ADD. ..l_Berkeley. 41. Gambridge Masa.
BUS. ADD. 2.40.Box..1604. _41.81k40. PI Wax,
RES. ADD.....1111101011/31__
4. BUS. ADD... Jiarrard...tintre Ognbridge Maas .
RES. ADD. ___EL.Wright_ .�t e._ Cambridge__ __Masa ..
BUS. ADD. 310.1.....201.0.,441bils Murray JUU., N
IZE S. ADD. Unk1101/11
5. ----Professor- Fisk
SEC. 19. NAMES OF FIVE PERSONS WHO KNOW you SOCIALLY IN THE UNITED STATES�
NOT REFERENCES, RELATIVES, SUPERVISORS, OR EMPLOYERS�(Give residence
and business addresses where possible.)
1. . _ . ...
BUS.
RES.
Street and N 10121)er City State
...... _.Q4040ge ...
ADD....a_Rutledge Belmont Mass.
2. Profess q � -13. - neener....BUS. ADD. tire Cambridge �Mama
ADD. ...25..BelleYue Rd.. Thaugnt M6.83 �
RES.
3. P1'Of83130.r ILO_F1Flame.eyyJr., Bus.
BE S.
4. .... P.rafeasor__K.a_ . Bainbridge BUS.
..0ambridge. _.. _Masse.- -
__Belmont
ADD. _Bal'ilard..UrAilt� ....Cl/abridge-. -Masa.- --
RES. ADD...MA...Robbins.. Rd . ....eatertown
ADD. _Harvard �Univ.
ADD. _fia_Eloott_Rd....
S. ___1.'inteeaor_Martin..Dentaoh.... BUS. ADD. CambrIdge- -
RES. ADD. -45-Re Bezvoir- at ...-Dambridge. -Maas � -- - -
SEC. 20. GIVE THREE-NEIGHBORS. AT YOUR LAST NORMAL RESIDENCE IN THE U. S.�
(Give residence and business addresses where possible.)
Street and Number City � � S:ate
1.......
BUS. ADD
RES. ADD. .85.-Olifton.-8t.
2. DU S. ADD. ......
RES. ADD.1.08--B1tledge-Rd...Belmont
BUS. ADD.
RES. ADD.. - Clifton at �Belmont
3.......
..
SEC. 21. FINANCIAL BACKGROUND
A. ARE YOU ENTIRELY DEPENDENT ON YOUR SALARY? BA. . IF NOT, STATE SOURCES
OF OTHER INCOME
B. NAMES AND ADDRESSES OF BANKS WITH WHICH YOU HAVE ACCOUNTS . ..... .........
__Harrard.Truat..Companyi___Cambridget.:Maaa.
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SEC. 9. MOTHER-IN-LAW
FULL NAME
Edith
(Fired)
Oottfkied Hurivits
(Middle) (1.nat)
LIVING OR DECEASED .. /4744...... DATE OF DECEASE NA CAUSE NA
PRESENT, OR LAST, ADDRESS W, Strqets New Xgrki .. TA, USA
. (St. and Number) (City) (State) (Country)
DATE OF BIRTH .. _.1#PA ......... PLACE OF BIRTH Rumania
IF BORN OUTSIDE U. S. INDICATE DATE AND PLACE OF ENTRY Mgt NEM lorkto..fias.
CITIZENSHIP USA WHEN ACQUIRED? NA WHERE? NA
(City) (State) (Country)
OCCUPATION . ....................... ............ LAST EMPLOYER _A& ............... ....... .......... .......
SEC. 10. RELATIVES BY BLOOD, MARRIAGE OR ADOPTION, WHO EITHER LIVE ABROAD
OR WHO ARE NOT CITIZENS OF THE UNITED STATES:
None
1. NAME RELATIONSHIP AGE
CITIZENSHIP ADDRESS
(St. vial Number) (City) (Stale) (Country)
2. NAME RELATIONSHIP AGE
CITIZENSHIP ADDRESS
(St. and Number) (City)
(State) (Country)
8. NAME ......................... ..... ...... RELATIONSHIP AGE
� CITIZENSHIP ........ ....... ADDRESS
(St. and Number) (City) (State) (Country)
SEC. 11. RELATIVES BY BLOOD OR MARRIAGE IN THE MILITARY OR CIVIL SERVICE OF
THE U. S. OR OF A FOREIGN GOVERNMENT:
1. NAME __Ea:4! At .............. RELATIONSHIP A G
CITIZENSHIP ADDRESS Unk4aV �
(St. and Number) (City) (State) (Country)
TYPE AND LOCATION OF SERVICE (IF KNOWN)
2. NAME Jerrold ed. Zacharias RELATIONSHIP .. ..... AG/000..21
CITIZENSHIP USA
ADDRESS Naval Aisadall7
(St. and 'Number) (City) (State) ... � ........ ---
(Country)
TYPE AND LOCATIOf4 OF SERVICE (IF KNOWN) .......
..
3. NAME RELATIONSHIP ------------------AGE
CITIZENSHIP . ..... ............. ADDRESS � . .......... ......
and Number)* (City) (State) (Country)
I
TYPE AND LOCATION OF SERVICE (IF �
./
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SEC. 12. POSITION DATA
:
A. KIND OF POSITION APPLIED FOR
B. WHAT IS THE LOWEST ANNUAL ENTRANCE SALARY YOU WILL ACCEPT? $
(You Will Not Be Considered For Any Position With A Lower Entrance Salary.)
..........
C. IF YOU ARE WILLING TO TRAVEL, SPECIFY: OCCASIONALLY
FREQUENTLY ............... , CONSTANTLY ..
D. CHECK IF YOU WILL ACCEPT APPOINTMENT, IF OFFERED: IN WASHINGTON, D. C.
ANYWHERE IN THE UNITED STATES .. . , OUTSIDE THE UNITED STATES
E. IF YOU WILL ACCEPT APPOINTMENT IN CERTAIN LOCATIONS ONLY, SPECIFY LOCATIONS:
SEC. 13. EDUCATION
ELEMENTARY SCHOOL
Yes
DATES ATTENDED
Dter
HIGH SCHOOL

ADDRESS Jacksonville, Florida, USA
(City) (Stale)
1915-1918 G No
RADuATE,
al High Sohool ADDRESS Jaokeonville, Florida, USA
DATES ATTENDED
COLLEGE Oolumbia University
(City) (State)
1918-1922 Yes
GRADUATE'
ADDRESS New Iork, New York, USA
(Country)
(Country)
(State) (Country)
MAJOR AND SPECIALTY irkrai" YEARS COMPLETED 4
...... ..........
DATES ATTENDED.. DEGREE A.B. 1922-1928
COLLEGE Columbia University ADDRESS
MAJOR AND SPECIALTY PhYai"
DATES ATTENDED 3.92158
(City)
New Iork, New Xotk, UUL
(City) (State) (Country)
YEARS COMPLETED
DEGREE
Physicsa
CHIEF UNDERGRADUATE COLLEGE SUBJECTS ..... . . Hathematioe..... ............. .....
7
CHIEF GRADUATE COLLEGE SUBJECTS
Pkyaioe
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From Bow. 1940 To May 1941 CLASSIFICATION GRAHQ-121-44578
FROM �Jan....19.42. TO __2un...1946 (IF IN FEDERAL SERpgs. 6-17
EMPLOYING FIRM OR AGENCY ___M&n... inbta of Tech., Radiation Laboratory
ADDRESS ....___11_ Maanacimatta_Ame.....flacOridge, mass .1 mu
(City) (Country)
(St. and Number) (State)
KIND OF BUSINESS ......Exan.cer. NAME OF SUPERVISOR 6_ A. Daridge

TITLE OF JOB ..taff.Menbilr SALARY $ PA � PEn
YOUR DUTIES IA
REASONS FOR LEAVING . .......
CLASSIFICATION GRADE
FROM May 1941 TO Janst . 1942 (IF IN FEDERAL SERVICE)
EMPLOYING FIRM OR AGENCY Dell Telephone Laboratories
ADDRESS 40 Welt Streets. New YogkA.NA XR, USA
(St. and Number) (City) (State) (Country)
KIND OF BUSINESS EPearlftgr NAME OF SUPERVISOR Gordon Thayer
TITLE OF JOB SALARY $ PER
YOUR DUTIES
PA
REASONS FOR LEAVING .... To_return__to_lirt._Racktatunt_laotmum
FROM aes._1933.To 1940 iiingrIVECNPAil, SERVICE)tE
EMPLOYING FIRM OR AGENCY luster. College
ADDRESS ..... filtreat..and.lark_Avennafp__Rem.Xork...N..__X a ....NA
(St. and Number) (City) (State) (Country)
KIND OF BUSINESS Teaching NAME OF SUPERVISOR
TITLE OF JOB krotegfaStr SALARY $ PER .
YOUR DUTIES 114.
.......... � ..... ...........
REASONS FOR LEAVING .....
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SEC. 14. ACTIVE U. S. OR FOREIGN MILITARY SERVICE
DONE
��-__�� --. �
(Country) (Service)
itvok) (Daley of Service)
Lost Slot ion)
(Seriol Number) (Type of Discharge)
REMARKS:
SELECTIVE SERVICE BOARD NUMBER _________ ADDRESS
IF DEFERRED GIVE REASON
INDICATE MEMBERSHIP IN MILITARY RESERVE ORGANIZATIONS
............
SEC. 15. CHRONOLOGICAL HISTORY OF EMPLOYMENT FOR PAST 15 YEARS. ACCOUNT
FOR ALL PERIODS. INCLUDE CASUAL EMPLOYMENT. INCLUDE ALSO PERIODS
OF UNEMPLOYMENT. GIVE ADDRESSES AND STATE WHAT YOU DID DURING
PERIODS OF UNEMPLOYMENT. LIST LAST POSITION FIRST. (List all civilian em-
ployment by a foreign government, regardless of dates.)
CLASSIFICATION GRADE
FROM .....124.5 TO (IF IN FEDERAL SERVICE) ..... _________ ........... .
EMPLOYING FIRM OR AGENCY . ................... Inetitute of Technology
ADDRESS .... 1.7...idaacachusetta..Avenuea.gaNkrisker 1,1408.0.1 U3A
(St. nml N her) (City) (Stote) (Country)
KIND OF BUSINESS ...gollege__. ..... ..... NAME OF SUPERVISOR Professor J. Ot alater
TITLE OF JOB riMfaeflOr SALARY NA PER
YOUR DUTIES ....i.rofesaing..13bynice
REASONS FOR LEAVING IL&
CLASSIFICATION GRADE
FROM July 194B TO November 1945 (IF IN FEDERAL SERVICE)
EMPLOYING FIRM OR AGENCY ...... ..UniveralofGalifornia
ADDRESS ..... .... 40.4_113.4P94,0._!_fIK kegyggh. USA
(SL find Number) (City) (State) (Country)
KIND OF BUSINESS ENAIXeer NAME OF SUPERVISOR ............... ..9PPeOeiner .....
TITLE OF JOB . ..... ---------------SALARY $._ NA, PER _ .........
YOUR DUTIES
578
REASONS FOR LEAVING . ..... Wctof war
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PRESENT ADDRESS
3. FULL NAME AGE
(First) (Middle) (Lnst)
PRESENT ADDRESS
4. FULL NAME
(First) / (middle)
PRESENT ADDRESS ,
(St. nnil Number) (City)
5. FULL NAME
(State)
(Country) (Citizenship)
AGE .....
(LW)
PRESENT ADDRESS
(St. end Number)
(City) (Suite)
(Country) (Citizenship)
SEC. 8. FATHER-IN-LAW
FULL NAME Joseph
(First)
LIVING .OR DECEASED 4.4Y4la
PRESENT, OR LAST, ADDRESS
DATE OF BIRTH 1885
44
5 7 8
OCCUPATION ... ....MP)!!! ...................... LAST,ENPLOYER NCI" � .
EMPLOYER'S OR OWN BUSINESS ADDRESS ___ �.(oe ..........
ancii,iun;Ceri ...
MILITARY SERVICE FROM __IA__ TO --------------------BRANCH OF SERVICE
COUNTRY ....... .......... ---------------DETAILS OF OTHER GOVT., SERVICE, U. S. OR FOREIGN
N4
SEC. 7. BROTHERS AND SISTERS (Including half-, step-, and adopted brothers and sisters) :
1. FULL NAME qaLQ.t....... ................. AGE
(First) (Last)
PRESENT ADDRESS 235 W, 71 Street. NeW Uric, New York? USA
(St. and Number) (City) (State)
(Country) (Citizenship)
2. FULL NAME AGE . . ---
(First) (Middle) (Last)
(St. and Number)
(City)
(State)
(City) (State)
(Country)
(Citizenship)
(Country) (Citlrenshil.)
AGE
(Last)
(First) (Middle)
(Middle)
DATE OF DECEASE
Hurwitz
(Last)
NA CAUSE NA
300 W. 109 St.; New York, New Xork, USA
(St. and Number) (City)
(State) (Country)
New IprIci. Sew
IF BORN OUTSIDE U. S. INDICATE DATE AND PLACE OF ENTRY ..... NA
.....
...
PLACE OF BIRTH
CITIZENSHIP UM WHEN ACQUIRED? ....... ........ WHERE? NA
(City) (State) (Country)
OCCUPATION . ......... ........ .... LAST EMPLOYER New kit at/ Nigh 5011001
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SEC. 4. CHILDREN OR DEPENDENTS (Include partial dependents) :
Johanna Zacharias
1. NAME RELATIONSHIP AGE no.
UNA
CITIZENSHIP ADDRESS
.32 Clifton Stu Belmont, Nasn._.11fil,_
(St. and Number) (City) (State) (Country)
2. NAME Susan Zacharias RELATIONSHIP Dgs.. AGE
Houae,, Radcliffe College)
CITIZENSHIP USA
ADDRESS67 Carden St.,. ...................
(St. and Number) (City) (State) (Country)
3. NAME RELATIONSHIP AGE
CITIZENSHIP . ..... ................. ADDRESS
(St. and Number) (City) (State) (Country)
SEC. 5. FATHER (Give the same information for stepfather and/or guardian on a separate sheet)
FULL NAME Isidor August Zacharias
(Find) (Middle) (Liost)
LIVING OR DECEASED ..P.P95.140_94... DATE OF DECEASE ...P.Ocri9va.n .... __ CAUSE . 9PK9.11..47_...__
PRESENT, OR LAST, ADDRESS
(St. and Number) (City) (State) (Country)
DATE OF BIRTH june 14a)-877PLAcE OF BIRTH Jacksonville,. Florlda,_ VBA
(city) . (State) (country)
IF BORN OUTSIDE U. S. INDICATE DATE AND PLACE OF ENTRY ..........
CITIZENSHIP ____. . PA ..... ..._ WHEN ACQUIRED? riA WHERE? NA
(City) (State) (Country)
OCCUPATION Larger LAST EMPLOYER ..... 7snii_......... ..... .______ ..... .. .......... .____ .......
EMPLOYER'S OR OWN BUSINESS ADDRESS NA
(St. and Number) (City) (State) (Country)
MILITARY SERVICE FROM NA
TO BRANCH OF SERVICE ...... __________ .......
(Date) r � i. A (Drat) � �
NA
COUNTRY DETAILS OF OTHER GOVT. SERVICE, U. S. OR FOREIGN
NA
SEC. 6. MOTHER (Give the same information for stepmother on a separate sheet)
FULL NAME ....... ..... ;1.. Ruth Imp= Zacharias
........... (Middle) (Last)
LIVING OR DECEASED .4Y.414.. ..... . DATE OF DECEASE NA CAUSE ....4 ............ ....
PRESENT, OR LAST, ADDRESS 245 Ws net St.' New Xorki New Xorki USA
(St. and Number) (Mr) . (State) (Country)
PATE OF BIRTH .. YIP PLACE OF BIRTH ...!!!!._9-11.4.�A.�P.
CITIZENSHIP . ..... ..... WHEN ACQUIRED? . . . WHERE? NA
.......
(City) (State) (Country)
IF BORN OUTSIDE U. S. INDICATE DATE:ipleD kLA.C11,0kE44 .....
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E. IF BORN OUTSIDE U. S. WHEN DID YOU:FIRST ARRIVE IN THIS COUNP.P.Sx:16.-17.Avi
PORT OF ENTRY? . ..... AUL� ON PASSPORT OF WHAT COUNTRY?)....MA... ..... .... .. ......
LAST U. S. VISA . .....
(Number) (Type) (Place of Wee) (Date of Insue)
- � .
SEC. 2. PHYSICAL DESCRIPTION
46 Male
AGE SEX .................. HEIGHT ....... WEIGHT 175.... .......
EYES ..................... HAIR Black-A/ray_ COMPLEXION SCARS--------None.........
BUILD OTHER DISTINGUISHING FEATURES Lone
� �
SEC. 3. MARITAL STATUS
A. SINGLE
i� � . g -
� � .�
� MARRIED X ... . .....
...........
STATE DATE, PLACE, AND REASON FOR ALL SEPARATIONS, DIVORCES OR ANNULMENTS ........... . ............
B. WIFE OR HUSBAND (IF YOU HAVE BEEN MARRIED MORE THAN ONCE�INCLUDING ANNUL-
MENTS�USE A SEPARATE SHEET FOR FORMER WIFE OR HUSBAND GIVING DATA REQUIRED
BELOW FOR ALL PREVIOUS MARRIAGES.)
Hurwitz NAME OF SPOUSE lama _Ruth Zacharias
(Fire() (Malden) (Mighllet (1.nnt)
,
PLACE AND DATE Or MARRIAGE ...... _June..23,..1927 � Nest York,
HIS (OR HER) ADDRESS BEFORE MARRIAGE ...1......14.2..Atree.t, New. Xo.r.k
nut) Number) (CRY) -(Stale (Country)
g � �' �� � .'� , . . � �
LIVING OR DECEASED _living__ DATE OF DECEASE fl CAUSE
PRESENT, OR LAST, ADDRESS
32 Mitten Street Belmont& Mase&p_ USA
(St. and Number) (City) (State) (Country)
' � �
DATE OF BIRTH 2/6/01.7 PLACE OF BIRTH New Xcrks New Xco..110.A (City) (State) (Country)
IF BORN OUTSIDE U. S. INDICATE DATE AND PLACE OF ENTRY '""'"
CITIZENSHIP UNA WHEN ACQUIRED? Birth. WHERE? ...NO.W.5 .254.._NALIsauflA
(City) � .(Stitte) (Country)
OCCUPATION . ..... . ...... LAST EMPLOYER ..Malles_41.0_41..rar
EMPLOYER'S OR BUSINESS ADDRESS ___.2,44.2terles..fit.....agatorstAlagia. UA
(St. 'Ind Number) (C)tY) (State) (Country)
MILITARY SERVICE FROM
TO " BRANCH OF SERVICE - � � �
(Date) (Date)
COUNTRY DETAILS OF OTHER GOVT. SERVICE, U. S. OR FOREIGN
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