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Standard Form 86 AUGUST 1968 - -) DUS, CVE service COMMISSION. : me qures ™ INSTRUCTIONS —Preparein triplicate, using a typewriter. Fill in allitems. . If the answer is ‘‘No”’ or ‘‘None, is neeted for any item, continue under item 28. 0 20- Brags : i. FULL NAME 220 a Ti ke UN. (FURST NAM : a (MIDDLE NAME) adfpitiate and jp “Ehrlichman «| John’ * ~7- Daniel ena ata RTT full name are OTHER NAMES USED. (Maiden name, names by former marriages, former names c! * not acceptable. legally of otherwise, aliases, nicknames, etc. Specily which, and show dat eu If no middie - : Lo ee . name, iat ’ initiale on - show ““(no fiven ‘ or middie ¢ name)” s. COSInGLE 7. IF MARRIED. WIDOWED, OR DIVORCED, Give FULL NAME AND DATE AND PLACE oF BIRTH OF SPOUSE OR FORMER SPOUSE. INCLUDE WIFE'S MAIDEN NAME, GIVE DATE AND PLACE OF MARRIAGE OR DIVORCE. . : . & MARRIED (Give same information regarding all previous marriages and divorces.) ~ x0: oan a - Gwioowen | Jeanne Fisher Ehrlichman (b) Hollywood, California 9/10/27 . Goworceo -| Married: Montecieto, Calif 8. DATES AND PLACES OF RESIDENCE. (If actual places of residence differ from the mailing addr: _and go back to January 1. 1937. ntinue under item 6 on other side at necessary. +) omer co ‘Present = “330 Chesapeake Dr. 1/9/69 .- =: 33820 Hunts Point Rd, © . Bellevue | 1954 - 11536N. E. 24th St. . Bellevue 1951. 2954 - 72nd S. E. - _ Mercer Island 1951. . 786 Live Oak Avenue , Menlo Park 1949 . 202 San Vicente Blvd, - Santa Monica 1945 — Service oe 1943 = 202 San Vicente Blvd. Santa Monica wen. 9. Bey BIRTH (LL NATURALIZED ALIEN REGISTRATION NO, ~ DATE, PLACE, AND COURT . CERT.NO. - -—sPETITIONNO. * ClosaveD Panens CERT.NOG). J REGISTRATION NO. | NATIVE COUNTRY Po i ad 10. EDUCATION. (All echools above cclenentary) oe _-NAME OF SCHOOL se ADDRESS - Santa Monica H. ‘Ss. : Santa Monica ~ ' California. W. Los Angeles Califo rnia ‘Palo Alto California FRANCH OF SERVICE OF mom ane rating | (army, Navy. Ait Force, 0.)