SECRET
SECTION IV (Continued from Page 1)
DATES OF MILITARY SERVICE (If none, so state) (Include all periods of active duty for training and inactive duty training)
Sep 1942 - Dec 1946
BRANCH OF U.S. MILITARY SERVICE AFFILIATED
U.S. Marine Corps
DETAILS OF OTHER GOVERNMENT SERVICE (If none, so state)
CIA, New Orleans Field Office, Sept 1947 to date.
SECTION IV RELATIVES BY BLOOD, MARRIAGE OR ADOPTION LIVING ABROAD OR WHO ARE NOT U.S. CITIZENS
1. FULL NAME (Last-First-Middle) RELATIONSHIP AGE
None
2. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
3. CITIZENSHIP (Country) FREQUENCY OF CONTACT DATE OF LAST CONTACT
4. FULL NAME (Last-First-Middle) RELATIONSHIP AGE
5. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
6. CITIZENSHIP (Country) FREQUENCY OF CONTACT DATE OF LAST CONTACT
7. FULL NAME (Last-First-Middle) RELATIONSHIP AGE
8. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
9. CITIZENSHIP (Country) FREQUENCY OF CONTACT DATE OF LAST CONTACT
10. FULL NAME (Last-First-Middle) RELATIONSHIP AGE
11. ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
12. CITIZENSHIP (Country) FREQUENCY OF CONTACT DATE OF LAST CONTACT
13. SPECIAL REMARKS, IF ANY, CONCERNING THESE RELATIVES
SECTION V FINANCIAL STATUS
1. ARE YOU WHOLLY DEPENDENT ON YOUR SALARY? YES [X] NO [ ]
2. DO YOU HAVE ANY FINANCIAL INTEREST IN, OR OFFICIAL CONNECTION WITH, BUSINESS ENTERPRISES OR BUSINESSES ON OR DO YOU RECEIVE COMPENSATION OR INCOME FROM SUCH BUSINESS ENTERPRISES? YES [ ] NO [X] IF YOU HAVE ANSWERED "YES," GIVE COMPLETE DETAILS ON A SEPARATE SHEET AND ATTACH AS A SCHEDULE.
3. DO YOU RECEIVE AN ANNUITY FROM THE UNITED STATES OR DISTRICT OF COLUMBIA GOVERNMENT UNDER ANY RETIREMENT ACT, PENSION, OR COMPENSATION FOR MILITARY OR NAVAL SERVICE? YES [ ] NO [X]
4. IF YOU HAVE ANSWERED "YES" TO THE QUESTION ABOVE, GIVE COMPLETE DETAILS ON A SEPARATE SHEET.
5. WITHOUT REFERENCE TO YOUR SALARY, STATE OTHER SOURCES OF SIGNIFICANT INCOME NOT INDICATED IN PRECEDING ITEMS.
Dividends on stocks, capital gains, interest, rents and an annuity.
SECTION VI (Continued to Page 3)
SECRET