CURRENT RESIDENCE AND DEPENDENCY REPORT - CARANCI, JOHN C.

• Document Type: FOIA
• Keywords: CARANCI JOHN C
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001496507
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 2
• Document Creation Date: June 22, 2015
• Document Release Date: December 31, 2008
• Case Number: F-2007-00327
• Publication Date: July 2, 1963

(111161
CONFIDEN,XAL [111131
(When FiOeed In)
I icate. The data recorded on this form is essential' in determining travel expenses allowable in connection with leave
at government expense, overseas duty, return to residence upon separation, and for providing current residence and dependency infor-
mation required in the event ofan employee emergency. The original of this form will be filed in the employee's official personnel folder
NAME OF EMPLOYEE (Last) (First) , (Middle) SOCIAL SECURITY NUMBER
I. RESIDENCE DATA
PLACE OF RESIDENCE WHEN INITIALLY APPOINTED
AA
LAST PLACE OF RESIDENCE IN CONTINENTAL U.S. (If appointed
abroad) {l'~ ~J
PLACE IN CONTINENTAL U.S. DESIGNATED AS PERMANENT REST-
DEN 4?E T,
A4s / /?=
HOME LEAVE RESIDENCE
LF f- ,. I)
-A 4
2. MARITAL STATUS (Check one)
SINGLE MARRIED SEPARATED DIVORCED WIDOWED ANNULLED
IF MARRIED, PLACE OF MARRIAGE
DATE OF MARRIAGE
IF DIVORCED, PLACE OF DIVORCE DECREE
DATE OF DECREE
IF WIDOWED, PLACE SPOUSE DIED
DATE SPOUSE DIED
IF PREVIOUSLY MARRIED, INDICATE NAME(S) OF SPOUSE, REASON(S) FOR TERMINATION, AND DATE(S)
APPROVED FOR
RELEASE^DATE:
3. 12-Nov-2008 MEMBERS OF FAMILY
NAME OF SPOUSE
ADDRESS (No., Street, City, Zone, State)
TELEPHONE NO.
NAMES OF CHILDREN
ADDRESS
SEX
DATE OF BIRTH
NAME OF FATHER (Or male guardian)
ADDRESS
TELEPHONE NO.
NAME OF MOTHER (Or female guardian)
ADDRESS
TELEPHONE NO.
WHAT MEMBER(S) OF YOUR FAMILY IF ANY, HAS BEEN TOLD OF YOUR AFFILIATION WITH THE ORGANIZATION IF CONTACT IS RE-
QUIRED IN AN EMERGENCY.
4. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
T
RELATIONSHIP
r r///efr
HOME ADDRESS (N ,:f, Street, City, Zone, tat
HOME TELEPHONE NUMBER
0-111-
BUSINESS TELEPHONE & EXTENSION
IS THE INDIVIDUAL NAMED ABOVE WITTING OF YOUR AGENCY AFFILIATION? (If 'No' give name and address of organiza-
tion he believes you work for.)
YES
NO
IS THIS INDIVID V L AUTHORIZED TO MAKE DECISIONS ON YOUR BEHALF? (If "No' give name and address of person, if
any, who can make such decisions in case of emergency.)
Y'-'`
4-1
NO
DOES THIS INDIVIDUAL KNOW THAT HE HAS BEEN DESIGNATED AS YOUR EMERGENCY ADDRESSEE? (If answer is 'No.
explain why in item 6.)
YES
NO
The persons named in item 3 above may also be notified in case of emergency. If such notification is not desirable because of
health or other reasons, please so state in item 6 on the reverse side of this form.
CONTINUED ON REVERSE SIDE
CURRENT RESIDENCE AND DEPENDENCY REPORT
FORM L1 USE PREVIOUS
4-60 V EDITIONS.
 C?NFlD"TIAL
(When i11ed In)
5. VOLUNTARY ENTRIES
erience in the handling of employee emergencies has shown that the absence of certain personal data often delays and compli-
Ex
p
cates the settlement of estate and financial matters. The information requested in this section may prove very useful to your family`
or attorney in the event of your disability or death and will be disclosed only when circumstances warrant.
INDICATE NAME AND ADDRESS OF ANY BANKING INSTITUTIONS WITH.WHICHYOU HAVE ACCOUNTS AND THE NAMES IN WHICH-THE AC-
COUNTS ARE CARRIED.
- - - -
;y'>
HAVE YOU COMPLETED A LAST WILL AND TESTAMENT? YES NO. (If 'Yes' where is document located?)
ty~
HAVE YOU PREPLANNED AN ARRANGED GUARDIANSHIP OF YOUR CHILDR
YES NO. (If 'Yes' give name(s) and address)
HAVE YOU EXECUTED A POWER OF ATTORNEY? YES NO. (If 'Yes', who possess the power of attorney?)
6. A itTfOIJAY'D fAIAN6 0 OIV INUATION OF PRECEDING ITEMS
SIGNED AT
DATE
SIGNATURE