EMPLOYEE CONFIDENTIAL STATEMENT OF EMPLOYMENT AND FINANCIAL INTERESTS

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP84-00933R000100110062-3
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 2
• Document Creation Date: December 16, 2016
• Document Release Date: July 22, 2005
• Sequence Number: 62
• Publication Date: January 19, 1982
• Content Type: FORM

Approved For Release 2005/08/03 : CIA-RDP84-00933R000100110062-3
EMPLOYEE CONFIDENTIAL STATEMENT OF EMPLOYMENT/s/ duce T. JohnSOI
STA
AND FINANCIAL INTERESTS
NAME (I ~St first initial
) TITLE OF POSITION DATE OF APP'T IN PRESENT
POSITION
"7~Ci7yr J~If/~Slo G~!/tom ??/uJc~1yL
PART I. EMPLOYMENT AND FINANCIAL INTERESTS
List the names of all corporations, companies, firms, or other business enterprises, partnerships, nonprofit organizations,
and educational or other institutions: (a) with which you are connected as an employee, officer, owner, director, mem-
ber, trustee, partner adviser, or consultant; or (b) in which you, your spouse, minor child, or other blood relative who is a
full-time resident of your household have any continuing financial interests through a pension or retirement plan, shared
income, or other arrangement as a result of any current or prior employment or business or professional association; or
(c) in which you, your spouse, minor child, or other blood relative who is a full-time resident of your household have any
financial interest through the ownership of stock, stock options, bonds, securities, or other arrangements including trusts.
An employee is not required to include any information about his connection with or interest in a professional society or
a charitable, religious, social, fraternal, recreational, public service, civic, or political organization, or a similar organiza-
tion not conducted as a business enterprise. For this purpose, educational and other institutions doing research and de-
velopment or related work involving grants of money from or contracts with the Government are considered business
enterprises. If none, write NONE. AMOUNTS need not be stated. Civil service, social security, and other Government
pensions or annuities are not to be reported. Membership in an investment club is to be reported; holdings of the in-
vestment club need not be reported.
POSITION IN
NATURE OF FINANCIAL
NAME & KIND OF ORGANIZATION
ORGANIZATION
INTEREST. F.G..STOCK.
PRIOR BUSINESS INCOME
(t'se Part I designations
where applicable)
ADDRESS
((use Part I (a),
designations if
(lice Part I (b) & (c)
applicable)
designations if
applicable)
MWiw,U
aXrA.t'* -SANUcS
C0
/~
PW6
YRW AAs, k/1 L' 4
PART II. CREDITORS
List the names of your creditors other than those to whom you may be indebted by reason of a mortgage on property
which you occupy as a personal residence or to whom you may be indebted for current and ordinary household and living
expenses such as household furnishings, automobile, education, vacation, and similar expenses. If none, write NONE.
AMOUNTS need not be stated.
NAME AND ADDRESS OF CREDITOR CHARACTER OF INDEBTEDNESS
(Personal Loan, Note, Security)
PART III. INTERESTS IN REAL PROPERTY
List your, and that of your spouse, minor child, or other blood relative who is a full-time resident of your household, in-
terest in real property or rights in lands, other than property which you occupy as a personal residence. If none, write
NONE. AMOUNTS need not be stated.
NATURE OF INTEREST TYPE OF PROPERTY ADDRESS
(Ownership, Mortgage, Lien, (Residence, hotel, Apartment, (tf rural, give RFD, or
Investment Trust) Farm, undeveloped land) County and State)
FORM 26 2630 OBSOTIONS PREVIOUS
9.79
Approved For Release 2005/08/03 : CIA-RDP84-00933R000100110062-3
 Approved For Release 2005/08/03 : CIA-RDP84-00933R000100110062-3
I CERTIFY that the statements I have made are true, complete, and correct to the best
of my knowledge and belief.
,(/,/9 -
DATE
Approved For Release 2005/08/03 : CIA-RDP84-00933R000100110062-3