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(FORM 1 PAGE 2)
SECTION III (Continued From Page 1)
21. DATES OF MILITARY SERVICE (From - To) (If in both WWI and WWII)
22. BRANCH OF SERVICE 23. COUNTRY WITH WHICH MILITARY SERVICE AFFILIATED
24. DETAILS OF OTHER GOVERNMENT SERVICE, U.S. OR FOREIGN
SECTION IV - RELATIVES BY BLOOD, MARRIAGE OR ADOPTION LIVING ABROAD OR WHO ARE NOT U.S. CITIZENS
FULL NAME (Last-First-Middle) RELATIONSHIP AGE
N/A
ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
CITIZENSHIP (Country) FREQUENCY OF CONTACT DATE OF LAST CONTACT
FULL NAME (Last-First-Middle) RELATIONSHIP AGE
N/A
ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
CITIZENSHIP (Country) FREQUENCY OF CONTACT DATE OF LAST CONTACT
FULL NAME (Last-First-Middle) RELATIONSHIP AGE
N/A
ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
CITIZENSHIP (Country) FREQUENCY OF CONTACT DATE OF LAST CONTACT
FULL NAME (Last-First-Middle) RELATIONSHIP AGE
N/A
ADDRESS OR COUNTRY IN WHICH RELATIVE RESIDES
CITIZENSHIP (Country) FREQUENCY OF CONTACT DATE OF LAST CONTACT
SPECIAL REMARKS, IF ANY, CONCERNING THESE RELATIVES
N/A
SECTION V FINANCIAL STATUS
25. ARE YOU ENTIRELY DEPENDENT UPON YOUR SALARY? [X] YES [ ] NO
IF YOUR ANSWER IS "NO" TO NO. 25 ABOVE, STATE SOURCES OF OTHER INCOME
N/A
26. NAME OF BANKING INSTITUTIONS WITH WHICH YOU HAVE ACCOUNTS
(Include Name of Institution, Address (City, State, Country))
UNION TRUST CO. WASHINGTON, D.C.
SECTION V (Continued to Page 3)
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