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y nix 29+ 4) UNITED STATES ATOMIC ENERGY COMMISSIO P. 0. 80x-- i928 WASHINGTON, O- Cc. $- All sections must be completed - Write none when applicable - Type or print all answérs. Complete answers, attach a supplemental sheet to this form, All addresses must show Street (Check which) YXKware 7 rewace 1) siete CJ ovorceo [oar | vow | year] 1 annie OX wioowtem [29 [8 18767] BIRTHPLACE (City, County, State ond Country) 4, ALL OTHER ADDRESSES FOR PAST 10 YEARS DATE Loudenville, Ohio «CITIZENSHIP: Auten C7 c+ BY NATURALIZATION (CJ None Other PORT OF ENTRY 10. ORAFT BOARD NO. AND ADDRESS WITH WHICH REGISTERED- None Als SOCIAL, SECURITY NO. 364,078.66 12. PERMANENT STATION. AND ADDRESS 1F NOW IN MILITARY SERV. None . : PREVIOUS MILITARY Service: ” SERIAL NUMBER, Faow —_—__—_Brancn To, (vear). County Dist. School Loudonville High Schéo - y, Wooster Ohio Normal ~'|“Wooster, Ohio / ‘Ohio State University | Columbus, Ohio