◆ SpookStack

- \ r ae, DATE 7 AT ency CHECK SHEET r | we F255 b Fed 1955 .. Coos: Cocsc FROM: ~ — ° Specify) | Office of The Secretary of Defense LAST ¢ ME - MAIDEN mame (i? ony) ig S€x DATE OF S1RTH PLACE OF BIRTH (City and state) Male 20 November 1925 { Boston, Massachusetts PURPOSE G semest for Record ChectAny investigation subse ent to 9/16/51 LIST OF On. OMS, ASSOCIATIONS, SOCIETIES OR CLUBS WITH Which AFFILIATED: ° ae os ; - LIEN REGISTRATION ISOC IAL SECURITY MBER BER MUMBE 748-77=27 PLACE OF BIRTH (City end state) ” RESIDENCES OURING PAST 15 YEaRS Jan/l3 Boston, Mass, EMPLOYMERT DURING PAST 15 YEARS [June 1, 19s Cambridge, Mass. Charlottesville, Virginia — — — Se , Cs F- —_ L mm Bpiare foeness /o (op 77S 38 7- a o> L ~ Sp. 180 | B aets