FOIA
SUPPLEMENTAL PERSONAL HISTORY STATEMENT - DEBELIUS, JOHN W.
Document Type:
Keywords:
Collection:
Document Number (FOIA) /ESDN (CREST):
0001467755
Release Decision:
RIPPUB
Original Classification:
U
Document Page Count:
2
Document Creation Date:
June 22, 2015
Document Release Date:
November 14, 2008
Sequence Number:
Case Number:
F-2007-01251
Publication Date:
May 11, 1984
File:
| Attachment | Size |
|---|---|
 DOC_0001467755.pdf | 189.83 KB |
Body:
APPROVED FOR RELEASE -
DATE: 03-Sep-2008
(b)(3)
(b)(6)
SUPPLEMENTAL PERSONAL HISTORY STATEMENT
SECTION!. INSTRUCTIONS
Answer all qutstions completely. If question does not apply, write "NA.' Write "UNKNOWN" only if you do not know the answer and it cannot be ob.
tamed from personal records. If additional space is required use extra pages, some size as this and sign each page. Reference continued item by related
section and item number.
The Privacy Act, Public Law 93-579, requires that Federal agencies inform individuals when they ore asked to provide their Social Security Account Num.
ber (SSN) whether the disclosure is mandatory or voluntary, by what authority such number is solicited and what uses will be mode of the SSN. Disclosures
by you of your SSN on this form is voluntary. The authority for this solicitation is Executive Order 9397. The number is used as o means to confirm your
identity. Failure to provide your SSN may delay the processing of this reinvestigation.
I. F L NAME (Last-First-Middle-Maiden)
2 DE F'BIRTH
S. PLACE OF BIRTH (City, State, Country; (4.SOC SEC NO.
JO hi", 1I7
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71'44.7-fipc4,-;:.
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