PERSONAL HISTORY STATEMENT
Date: July 27, 1964
INSTRUCTIONS:
1. Answer all questions completely or check appropriate box. If question is not applicable, write "N/A." Write "Do not know" if you do not know the answer and it cannot be obtained from personal records. Use blank space at end of form for extra details on any question for which you have insufficient space.
2. Type, print or write carefully; illegible or incomplete forms will not receive consideration.
3. Consider your answers carefully. Your signature at the end of this form will certify to their correctness. Careful completion of all applicable questions will permit review of your qualifications to the best advantage.
SECTION I: GENERAL PERSONAL AND PHYSICAL DATA
Name: [Redacted]
Height: 6'0"
Weight: 195 lbs
Color of Eyes: Blue
Color of Hair: Brown
Complexion: Light
Build: Heavy