PERSONAL HISTORY STATEMENT
Instructions: 1. Answer all questions completely. If questions do not apply write "not applicable." Write "unknown" only if you do not know the answer and cannot obtain the answer from personal records. Use the blank space at the end of the form for more details on any question or question for which you do not have enough space. Type or print. Forms not carefully, illegible or incomplete forms will not receive consideration.
HAVE YOU READ AND DO YOU UNDERSTAND THE INSTRUCTIONS: YES
SEC. 1. PERSONAL BACKGROUND
A. FULL NAME: CASASIN
Telephone: NOT APPLICABLE
Home: HO-1945
PRESENT ADDRESS: 899 ST. PAUL ST., BALTIMORE, MD, USA
PERMANENT ADDRESS: 899 ST. PAUL ST., BALTIMORE, MD, USA
B. NICKNAME: NONE
WHAT OTHER NAMES HAVE YOU USED: NONE
UNDER WHAT CIRCUMSTANCES HAVE YOU EVER USED THESE NAMES: NOT APPLICABLE
HOW LONG: NOT APPLICABLE
IF A LEGAL CHANGE, GIVE PARTICULARS: NOT APPLICABLE
C. DATE OF BIRTH: 20 JAN 1924
PLACE OF BIRTH: BALTIMORE, MD, USA
D. PRESENT CITIZENSHIP: USA
BY BIRTH: YES
BY MARRIAGE: NOT APPLICABLE
BY NATURALIZATION CERTIFICATE #: NOT APPLICABLE
ISSUED: NOT APPLICABLE
AT: NOT APPLICABLE
HAVE YOU HAD A PREVIOUS NATIONALITY: NO
IF YES, WHEN WAS IT CHANGED TO PRESENT NATIONALITY: NOT APPLICABLE
GIVE PARTICULARS: NOT APPLICABLE
HAVE YOU TAKEN STEPS TO CHANGE PRESENT CITIZENSHIP: NO
GIVE PARTICULARS: NOT APPLICABLE