SECRET
PERIODIC SUPPLEMENT
PERSONAL HISTORY STATEMENT
This form provides for periodic updating of the information previously furnished on your Personal History Statement. Each item should be answered fully and accurately. If additional space is required, use a separate sheet of paper and identify the item number to which the information applies. If the answer is "None" or "Not Applicable," so state. If you have previously furnished the information requested, so indicate. If you have any doubt about the meaning or interpretation of any question, consult your supervisor. The furnishing of this information is voluntary; however, failure to do so may result in your being unable to continue in your present capacity. The information furnished will be used to determine your suitability for continued employment or association with the Agency. It will be reviewed by authorized personnel only and will not be disclosed to anyone outside the Agency without your consent.
SECTION I
NAME (Last, First, Middle)
WOODS, JAMES SYLVIE
CURRENT ADDRESS (No., Street, City, Zone, State)
2214 F. ST. N.W., WASH. D.C.
PERMANENT ADDRESS (No., Street, City, Zone, State)
FOREST RIVER, NORTH DAKOTA
DATE OF BIRTH
4/9/1911
PLACE OF BIRTH (City, State, Country)
U.S.A.
SECTION II
PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
NAME (Last, First, Middle)
MR. ROSS W. WOODS
RELATIONSHIP
FATHER
HOME ADDRESS (No., Street, City, Zone, State, Country)
FOREST RIVER, NORTH DAKOTA
BUSINESS ADDRESS (No., Street, City, Zone, State, Country)
NA
HOME TELEPHONE NUMBER
NA
BUSINESS TELEPHONE NUMBER
NA
IN CASE OF EMERGENCY, CHECK ONE RELATIVE TO BE NOTIFIED. IF BOTH ARE TO BE NOTIFIED, SO INDICATE. IF SUCH NOTIFICATION IS NOT DESIRABLE BECAUSE OF HEALTH OR OTHER REASONS, PLEASE SO STATE.
SECTION III
MARITAL STATUS
CIRCLE ONE
SINGLE
MARRIED
DIVORCED
WIDOWED
SEPARATED
IF MARRIED, GIVE DATE, PLACE AND REASON FOR ALL SEPARATIONS, DIVORCES OR ANNULMENTS
DATE
PLACE
REASON
NA
SECRET