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(When Filled In)
SECTION VI (Continued from PAGE 2)
B. HAVE YOU EVER BEEN, OR, ARE PETITIONED FOR, BANKRUPTCY? ( ) YES (X) NO
If your answer is "YES" to the above question, give particulars, including court and details.
C. DO YOU RECEIVE AN ANNUITY FROM THE UNITED STATES OR DISTRICT OF COLUMBIA GOVERNMENT UNDER AN RETIREMENT ACT, PENSION, OR COMPENSATION FOR MILITARY OR NAVAL SERVICE? ( ) YES (X) NO
If your answer is "YES" to the above question, give complete details.
D. DO YOU HAVE ANY FINANCIAL INTEREST IN, OR OFFICIAL CONNECTION WITH, INDIVIDUALS, CORPORATIONS OR BUSINESSES ON THE LIST OF SUBVERSIVE ORGANIZATIONS OR INDIVIDUALS WHOSE ACTIVITIES ARE CONSIDERED DETRIMENTAL TO THE INTEREST OF THE UNITED STATES? ( ) YES (X) NO
If your answer is "YES," give complete details on a separate sheet and attach in a sealed envelope.
SECTION VII CITIZENSHIP
A. PLACE OF BIRTH (Country) U.S.A. (City) (State)
B. HAVE YOU TAKEN STEPS TO BECOME A CITIZEN OF ANOTHER COUNTRY? ( ) YES (X) NO
If your answer is "YES," give particulars.
C. IF YOU HAVE APPLIED FOR DUAL CITIZENSHIP, INDICATE PRESENT STATUS OF YOUR APPLICATION (Present papers, etc.)
SECTION VIII EDUCATION
A. CHECK OR INDICATE HIGHEST LEVEL OF EDUCATION ATTAINED:
( ) ELEMENTARY SCHOOL ( ) HIGH SCHOOL ( ) COLLEGE OR UNIVERSITY ( ) GRADUATE SCHOOL
B. LIST ALL SCHOOLS, COLLEGES, UNIVERSITIES, SERVICE SCHOOLS, AND OTHER INSTITUTIONS ATTENDED, INCLUDING CORRESPONDENCE COURSES, IN THE ORDER ATTENDED.
NAME AND LOCATION OF COLLEGE OR UNIVERSITY SUBJECT STUDIED DATES ATTENDED DEGREE DATE OF DEGREE
FROM TO RECEIVED RECEIVED
NA NA
NAME OF SCHOOL STUDY OR SPECIALIZATION DATES ATTENDED TOTAL
FROM TO HOURS
Hadlicks Private Accounting NOV-48 APR-49 9 1/4
Business School OCT-46 FEB-50
Other Schools NA
Other Educational Training Not Indicated Above NA
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