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SECTION III CHILDREN AND OTHER DEPENDENTS
1. Number of children (including stepchildren and legally adopted children) and other dependents supported by you: 2
2. Are any of the above married and/or over 21 years of age? (If "Yes," explain in "Additional Comments" section below.) No
3. Provide the following information for all children and dependents:

NAME RELATIONSHIP YEAR OF BIRTH PLACE OF BIRTH CITIZENSHIP ADDRESS
Mira Frances E Burke wife 1906 US 630 St. Charles Ave New Orleans 12, La.
Patricia V Burke daughter 1937 US

ADDITIONAL COMMENTS AND/OR CONTINUATION OF PRECEDING ITEMS

DATE COMPLETED SIGNATURE OF EMPLOYEE

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