LETTER TO THE DIRECTOR FEDERAL BUREAU OF INVESTIGATION RE: REQUEST FOR INVESTIGATION

• Document Type: FOIA
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 06837689
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 15
• Document Creation Date: March 9, 2023
• Document Release Date: October 30, 2020
• Case Number: F-2020-00456
• Publication Date: December 2, 1950

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/ 410 CENTRAL INTRUIGENCE AGEN410
WASHINGTON 25, D. C.
f
The Director.
Federal Bureau of Investigation
Tenth & Pennsylvania Ave., N. W.
Washington 25; D. C.
. Christopher Callan
Re: Request for Investigation
Dear Sir: If
2 DEC 1950
It is r quested that an investigation of the following named person be
conducted iq. order to determine loyalty, character, discretion, trustworthiness,
financial h4bits, foreign connections, and general suitability for Government
employment:
Name
. LYONS, David Robert
The above-named person:
7 -
( ) Is an applicant for employment.
( -) Was employed and has no access to classified information.
( ) Has been a full employee of this Agency since
Xec 't'
y'
Remarks:
STE3TLY COWIDENTIAL
This is C.:1 ;'.�-.7::: a' �(,7,....:,�:,!,-1(i:oTi
f..r. a :3: -.-.. .-..- .:. ,..; _. :. 3,1 s i GIA.
,.r.w ; �i .
11E; raz:4 no ;13 ,-.';.:-.*.o..A to any
.person cu'Es'ala of the em.
Eric. - 1 PUS
mp
Form No.
38-103
Feb 1949
DEC 4 11
93 it
FOR THE CHiEe OF TNSPVellTnN ANTLANYITTPTPV-
TAFFt
Chief, Personnel Security Blidostm
Branch
(b)(3)1
(b)(6)
(b)(3)
(b)(6)
(b)(3-)
(b)(6)
(b)(3)
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PERSONAL HISTORY STATEMENT
Instructions: 1. Answer all questions completely. If question does not apply write "not applic-
able." Write "unknown" only if you do not know the answer and cannot obtain
the answer from personal records. Use the blank pages at the end of this form
for extra details on any question or questions for which you do not have suffi-
cient room.
2. Type, print or write carefully; illegible or incomplete forms will not receive con-
sideration.
HAVE YOU READ AND DO YOU UNDERSTAND THE INSTRUCTIONS?
YLCg� No
SEC. 1. PERSONAL BACKGROUND
Mims
A. FULL NAME Mr. (Use No _....._,Zort. a
1.. � ri4 BeglerX1 M332.---Ext Hoine � Orange 4,2003
-.\\N Initials)
'4
Nk-if
Telephone:
Office* "
PRESENT ADDRESS 1.01._ South Harrison St.) at nrarieft) N.J.. Eq.s ex, USA
St. &.No. City � , State - Country -
PERMANENT ADDRESS 164 South Harrison St , Rant OrWngtai, NJ. USA'
St. & No. City State CaurOry
B. NICKNAME nave"� 31B0b11 WHAT OTHER NAMES HAVE YOU USED? Nonn
C.
D.
� UNDER WHAT CIRCUMSTANCES HAVE YOU EVER USED THESE
NAMES? � blot ,qppli CP-101 a
HOW LONG? IF A LEGAL CHANGE, GIVE PARTICULARS
. No+ Apr,
Where? . 1923 . What Authority
DATE OF BIRTH 17 Aug. 1.923AACE OF BIRTH
PRESENT CITIZENSHIP U.S � BY BIRTH?
Country
Newark
City
Yes
Newstars ay
BY MARRIAGE?
coNg
No
BY NATURALIZATION CERTIFICATE if ISSUED BY
Date Court
AT Hot Applicable
City state Country
HAVE YOU HAD A PREVIOUS NATIONALITY? NO
Yes or No Country
HELD BETWEEN WHAT DATES? TO ANY OTHER NATIONALITY?
Country
GIVE PARTICULARS Not appl
HAVE YOU TAKEN STEPS TO CHANGE PRESENT CITIZENSHIP? GIVE PARTICULARS:
N9t applicable
1"
(b)(6)
FORM NO. qa
SEP 11418 w--
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Not applicable
E. IF BORN OUTSIDE U.S. WHEN DID YOU FIRST ARRIVE IN THIS COUNTRY?
PORT OF ENTRY') ON PASSPORT OF WHAT COUNTRY?
LAST U.S. VISA
Ap Aie-thle
Number type Place of Issue Date of Issue
SEC. 2. PHYSICAL DESCRIPTION
AGE 27 SEX Male HEIGHT -
6';-" WEIGHT 190 1 bs
EYES (h 5y HAIR Brown COMPLEXION fair SCARS Lft� post shoulde
BUILD large OTHER DISTINGUISHING FEATURES none
SEC. 3. MARITAL STATUS
(b)(6)
A. SINGLE No MARRIED Yee DIVORCED No WIDOWED ND
STATE DATE, PLACE, AND REASON FOR ALL SEPARATIONS, DIVORCES OR ANNULMENTS
none not applicable
(IF YOU HAVE BEEN MARRIED MORE THAN ONCE �INCLUDE ANNUL-
S. WIFE OR HUSBAND MENTS �USE A SEPARATE SHEET FOR FORMER WIFE OR HUSBAND
GIVING DATA REQUIRED BELOW FOR ALL PREVIOUS MARRIAGES.)
NAME OF SPOUSE Miriam none Steinhardt
First Middle Maiden
PLACE AND DATE OF MARRIAGE 3 March 1946 New York Oity
HIS (OR HER) ADDRESS BEFORE MARRIAGE
Last
Lyons
New York (b)(6)
St. & No. City State Country USA
LIVING OR DECEASED living DATE OF DECEASE C.A.UgE
PRESENT, OR LAST. ADDRESS
DATE OF BIRTH
St. & No. City
State
USA
Country
'LACE OF BIRTH _
City State Country
IF BORN OUTSIDE US. INDICATE DATE AND PLACE OF ENTRY not applicable
CITIZENSHIP USA WHEN ACQUIRED 9 Birth WHERE?
OCCUPATION Housewife
USA
City State Country
LAST EMPLOYER N.J. Bell Tele Oo.
South Orange Business Office
EMPLOYER'S OR BUSINESS ADDRESS No aplicable
St. & No. City State Country
MILITARY SERVICE FROM none TO BRANCH OF SERVICE
Date Date
COUNTRY DETAILS OF OTHER GOV'T. SERVICE, U.S. OR FOREIGN
Not Applicable
Mkt)
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SEC. 4.
4.
�
CHILDREN OR DEPENDENTS (Include partial dependents)
(b)(6)
(b)(6)
1. NAME
RELATIONSHIP
Daughter
AG
CITIZENSHIP
US
ADDRESS
2. NAME
St. & No. City
RELATIONSHIP
Stole
country
AGE
CITIZENSHIP
ADDRESS
3. NAME
St. & No. City
RELATIONSHIP
State
Country
AGE
CITIZENSHIP
ADDRESS
St. at No. City State Country
SEC. 5. FATHER (Give the same information for stepfather and/or guardian on a separate sheet)
FULL NAME Mauri oe None Lt Intestinal
Las First Middle
LIVING OR DECEASEIDRnessed DATE OF DECEASE
PRESENT, OR, LAST, ADDRESS
26 Oct
49
ate
USA
SE _____Qiititiriletion
(b)(6)
CounRsex USA
DATE OF BIRTH LACE OF BIRTHBricciltvapprt
State
Cann oFuSrly
IF BORN OUTSIDE U.S. INDICATE DATE AND PLACE OF ENTRY Not applicable
B
CITIZENSHIP WHEN ACQUIRED? WHER.E?
City State Country
8i01 17 r iter
OCCUPATION LAST EMPLOYER
510 Va.shinct.,n St Newark N.J. USA
EMPLOYER'S OR OWN BUSINESS ADDRESS
St. & No. City State Country
none
MILITARY SERVICE FROM TO BRANCH OF SERVICE
Date Date
COUNTRY DETAILS OF 0.air..H. GOV'T SERVICE, U.S. OR FOREIGN.
Not applicable
SEC. 6. MOTHER (Give the same information for stepmother on a separate sheet)
FULL NAME Sophia 1e
Last
112: Lyons
Deoeased 30 Ja1.1942 Hypertension
LIVING OR DECEASED DATE OF DECEASE CAUSE
PRESENT, OR LAST, ADDRESS.
U3A
St. & No. City L !ate Country
18 DATE OF BIRTH March 1889
PLACE OF BIRTH New YOrk City, New York, USA
�
CITIZENSHIP US Birth
WHEN ACQUIRED', WHERE?
City State Country
IF BORN OUTSIDE 'U.S. INDICATE DATE AND PLACE OF ENTRY Not applicaLle
(b)(6)
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OCCUPATION Housewife LAST EMPLOYER Not applicable
EMPLOYER'S OR OWN BUSINESS ADDRESS
St. & No.
Not applicable
City State
Country
MILITARY SERVICE FROM none TO BRANCH OF SERVICE
COUNTRY
-not, rpl i cable DETAILS OF OTHER GOV'T SERVICE, U.S. OR FOREIGN.
not apolicable
�
BROTHERS AND. SISTERS (Including half-, step-, and adopted brothers and sisters)
1. FULL NAME
PRESENT ADDRESS
- AGE (b)(16)
Last
USA US (b)(6)
St. & No.
2. FULL NAM k Step-bryther)
First
PRESENT ADDRESS
S. FULL NAME
PRESENT ADDRESS
4. FULL NAME
PRESENT ADDRESS
5. FULL NAME
PRESENT ADDRESS
City
State
Country Citizenship
Middle
(b)(6)
Last
USA US (b)(6)
St. & No.
City
State
Country Citizenship
First
Middle
AGE
Last
St. & No.
City State Country Citizenship
First
AGE
Middle Last
St. & No.
City State Country Citizenship
First
AGE
MidctIe Last
St. & No.
City State Country Citizenship
SEC. 8. FATHER-IN-LAW
FULL NAME Joseph First
LIVING OR DECEASED living
Henry Steinhardt
Middle Last
DATE OF DECEASE CAUSE
PRESENT, OR LAST, ADDRESS
St. & No.
DATE OF BIRTH 18 Nov � 1890 puicE OF Ram
City
.USA
State
Newark N.J.
(b)(6)
Country
IF BORN OUTSIDE U.S. INDICATE DATE AND PLACE OF ENTRY
Not applicable
CITIZENSHIP US
OCCUPATION lawyer
WREN ACQUIRED? Birth WHERE?
City State Country -
LAST EMPLOYER Fourth Federal Sa wings 80 Loan Assoc.
New York New York
self-employed
1180 Hititd Blvd
Newark .
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SEC. 9. MOTHER-IN-LAW
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Kath rin.e
FULL NAME
First
LIVING OR DECEASED living DATE OF DECEASE
Gertrude
PRESENT, OR LAST, ADDRESS
Middle
St. & No.
DATE OF BIRTH 8 Mar. 1896 pLAcE OF BIRTH
City state
rv'ark I. J. USA
IF BORN OUTSIDE U.S. INDICATE DATE AND PLACE OF ENTRY not app Icable
CITIZENSHIP US WHEN ACQUIRED?
OCCUPATION
birth NinmERE?
City State Country
housewife LAST EMPLOYER not ap_licable
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SEC. 10. RELATIVES BY BLOOD, MARRIAGE OR ADOPTION, WHO EITHER LIVE ABROAD OR
WHO ARE NOT CITIZENS OF THE UNITED STATES:
none-Not applicable
1. NAME RELATIONSHIP AGE
CITIZENSHIP ADDRESS
St. & No. City State Country
2. NAME RELATIONSHIP AGE
CITIZENSHIP ADDRESS
at. dr No. City State Country
3 NAME RELATIONSHIP
CITIZENSHIP ADDRESS
St. dr No. City State Country
SEC. 11. RELATIVES BY BLOOD OR MARRIAGE. IN THE MILITARY OR CIVIL SERVICE OF
THE U.S. OR OF A FOREIGN GOVERNMENT.
1 Nairn" None- Not applicable RELATIONSHIP AGE
CITIZENSHIP ADDRESS
City
TYPE AND LOCATION OF SERVICE (IF KNOWN)
2 NAME
St. ds No.
RELATIONSHIP
CITIZENSHIP ADDRESS
TYPE AND LOCATION OF SERVICE (IF KNOWN)
3. NAME RELATIONSHIP
CITIZENSHIP ADDRESS
St. & No.
TYPE AND LOCATION OF SERVICE (IF KNOWN)
5
St. & No.
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SEC. 12. EDUCATION
ELEMENTARY SCHOOL Bergen St. School ADDRESS Newark il. J.U3A �
City State Country
HIGH SCHOOL
DATES ATTENDED 1929-1936 GRADUATE? YES
Weequahic High 3 chool
ADDRESS
Newark N. J. USA city
1936-1940 State Country
DATES ATTENDED GRADUATE 9 YES
COLLEGE The George Washington Univ ADDRESS WashingtonD.O.USA
City State Cmmti7
DATES ATTENDED 10)10 19)13 DEGREE AB
COT.T.RGE The Geo.Washik;ton Univ. ADDRESS Washington D.C. USA
School of Medicine City State Country .
DATES ATTENDED 1943-1946 DEGREE MD
SEC. 13. MILITARY, NAVAL OR OTHER GOV'T SERVICE�U.S. OR FOREIGN
U.S.-�Germariy- Austria Military Captain
1942-46 1947-.
49
(b)(6)
Country
N.Y.P.E. N.Y.
�)�.4 REMARKS
Station
Service
None
lank
Dates of Service
Hono.cabie
Serial No. Type of Discharge
kg el., art;
SELECTIVE SERVICE BOARD NUMBER ADDRESS Essex County New Jersey
IF DEFERRED. GIVE REASON Not. applicable
INDICATE MEMBERSHIP IN MILITARY RESERVE.. ORGANIZATIONS
None
SEC. 14 CHRONOLOGICAL HISTORY OF EMPLOYMENT FOR PAST 15 YEARS. ACCOUNT
FOR ALL PERIODS. INCLUDE CASUAL EMPLOYMENT. INCLUDE ALSO PERIODS
OF UNEMPLOYMENT. GIVE ADDRESSES AND STATE WHAT YOU DID DURING
PERIODS OF UNEMPLOYMENT. LIST LAST POSITION FIRST.
�.\�
1. FROM 1 July 1950 TO present
EMPLOYING FIRM OR AGENCY
St Michael 1s Hospital
ADDRESS 306 Hi rh St.. Newark New Jersey USA
St. & No. City
KIND OF BUSINESS . Pediatric Residen cx,mmE OF stypEronsoR
,,.
TITLE OF JOB Chief Pediatric Resident SALARY $ 1 6-0 pER Month
Attendance on wards and supervisicn of Pediatric residents and
YOUR DUTIES interns. on Watde and out-patients.
REASONS FOR LEAVING Still-empl eyed
2. FROM 1 January 1950 To 30 June 1950
EMPLOYING FIRM OR AGENCY
State
Essex County Isolation Hospital
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(b)(6)
K(t6)
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ADDRESS
�
Belleville N. J.
St. & No. � City State
KIND OF BUSIWS Hosp.for contaAous
L4upluabl NAME OF SUPERVISOR
a -b
USA (b)(6)
nnlinfro,.
TITLE OF JOB 155.
Lonth
Re.A..cleat. in c..m.-4-,a PER,s2ous dieeaNLARY $
YOUR DUTIES and communicable disease
REASONS FOR LEAVING to continue resi trainin:r. praL--,ram.
3. FRold , 1 July 1949
TO
51 Nec.1949
EMPLOYING FIRM OR AGENCY St. Michael I s Hospital
ADDRESS ;0.5 Hiiji St Newark
St. & No. City
Pediatric Residency
KIND OF BUSINESS
N.J.
State
NAME OF SUPERVISOR
USA (b)(6)
Country
TITLE OF JOB Resident in Pediatric& 75. month
PER SALARY $
YOUR DIMES Resident in pediatrics
REASONS FOR LEAVING to Continue redidency program
4. FROM 1 April 1946 TO -;;,0 June 1947
EMI3LOYING FIRM OR AGENCY
Newark City Hospital
ADDRESS Fairmount Ave Newark N� J � USA
St. & No. City State CoAatry,
KIND OF BUSINESS Rotating internship NAME or SUPERVISOR
TITLE OP JOB rotatin.z_ intern
REASONS FOR LEAVIDa
cgetlft-EtuT4Es to eater :Lilitary service-t,Jrnination of internship
(b)(6)
SALARY $ 30. pER month
YOUR DUTIES
REASONS-FeEMEIFFENe4 rotatinc4 intern
5. FROM sptly 1941
TO Aus 1941
EMPLOYING FIRM OR AGENCY At.1 anti c ii,Tanufacturing Co.
ADDRESS ,.1,55 BP1rIont kirenne Nevrark.
Country
USA
- � St. & No. City State N. J.
KIND OF BUSINESS Tub,. r:0-41-1-Pq a t.1 MY?' NAME OF SUPERVISOR unknown
unlmown 18.00
TITLE OF JOB _...._
SALARY $ PER ,7eek
YOUR DUILES Presc- 1.T..chine operator
To return to colleL,e for 2a11 tsrr.
REASONS OR LT...AVING
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SEC. 15. HAVE YOU EVER BEEN DISCHARGED OR ASKED TO RESIGN FROM ANY POSITION?
HAVE YOU LEFT A POSITION UNDER CIRCUMSTANCES WHICH YOU DESIRE TO
EXPLAIN? GIVE DETAILS:
SEC. 16. GIVE FIVE CHARACTzati REFERENCES � IN THE U.S. � WHO KNOW YOU INTI-
MATELY � (GIVE RESIDENCE AND BUSINESS ADDRESSES WHERE POSSIBLE.)
SEC. 17. NAMES OF FIVE PERSONS WHO KNOW YOU SOCIALLY IN THE UMTED STATES �
NOT REFERENCES, SUPERVISORS OR EMPLOYERS � (Give residence and business ad-
dresses where possible.)
(b)(6)
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SEC. 18. GIVE THREE NEIGHBORS AT YOUR LAST NORMAL RESIDENCE IN THE U.S. � (Give
residence and business addresses where possible.)
Street and Number
City State
SEC. 19. FINANCIAL BACKGROUND
A. ARE YOU ENTIRELY DEPENDENT ON YOUR SALARY? No re' NOT, STATE SOURCES
OF OTHER INCOME savins
B. NAMES AND ADDRESSES OF BANKS WITH WHICH YOU HAVE ACCOUNTS ______6_01xt,h Orange
-jfintle"O-g�F-i-ele1-i-J65T-4114-1411--Trust Co. E9-1 nrAnzA T
C. HAVE YOU EVER BEEN IN, OR PETITIONED FOR, BANKRUPTCY? No
GIVE PARTICULARS, INCLUDING COURT lant Applioabie
D. GIVE TIEREE CREDIT REFERENCES � IN THE U.S.
1. NAME T,TIFInheresr&Oo. ADDRESS Newark N. J.
St.& No. City State
none
2. NAME ADDRESS
8t..& No.
City State
3. NAME ADDRESS
St. & No. City State
SEC. 20. RESIDENCES FOR THE PAST 15 YEARS
FROM 1949 TO. present 164 So. Harrison St. &tat Orange N.J. USA
St. No. City State Country
....."'
TO 1Y49 US Any USA- Germany- Austria
St. No. City State Country
. FROM 1Y46 To ly41 Li.o liyomiw, Ave. SOU 141 Ora,nge N. J. USA
St. No. City State Country
24.w 2%)3T, NW Washington D.C, USA
St. No. City State Country
FROM 1942 TO 194,5 3501 15th S. N. i7aen D.O. (Pluda..ir) USA
St. No. 1- City State - Country
,,,C)..........FR
OM ,111,11.y1,.!-42.,70 aep r, 142 University of New Ham ,shire Duman' N.11.(Hetze.i. Hs.J..i.)
St. No. City State Country USA
St. No. USA
2014 (?) 110 St., NW 4ashinr,ton D.O.
City State Country
01-Aj-,1,-ton D.C. USA
FRom1.947
Om 1943
To .1y46
FROM 1941 TO 1942
14
\r/ FROM 1940 TO 1941
����.�
SEC. 21. RESIDENCE OR TRAVEL OUTSIDE OF THE UNITED STATES
A. FROM
1947 TO 1948 Heid.elbcrgi.Ger=4.7.- Vienna, Auetr.o. Lalitary .
City or Section Country Purpose
FROM TO
City or Section Country purpose
FROM TO
City or Section
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FROM TO
City or Section Country Purpose
FROM TO
City or Section Country Purpose
FROM TO
City or Section
Country Purpose
B. LAST US. PASSPORT NUMBER, DATE, AND PLACE OF ISSUE'
Not ApplicartIA
HOW MANY OTHER U.S. PASSPORTS HAVE YOU HAD GIVE APPROXIMATE
DATES Not Applicamue
PASSPORTS OF OTHER NATIONS*
SEC. 22. CLUBS, SOCIETIES AND OTHER ORGANIZATIONS
LIST NAMES AND ADDRESSES OF ALL CLUBS, SOCIETIES, PROFESSIONAL SOCIETIES,
EMPLOYEE GROUPS, ORGANIZATIONS OF ANY KIND (INCLUDE MEMBERSHIP IN, OR SUP-
PORT OF, ANY ORGANIZATION HAVING HEADQUARTERS OR BRANCH IN A FOREIGN COUN-
TRY) TO WHICH YOU BELONG OR HAVE BELONGED:
Aesculapean Society The Geo. Wash Univ. Wash D.O. USA
Name and Chapter
St. & No. city . state country
DATES OF MEMBERSHIP* 1941-1943
2 Alpho Rho Physiolocical Society The Geo Wash Univ School of Lediclue
Name and Chapter St. & No. City State Country
DATES OF MEMBERSHIP. 194- 1y46
3 A.F.A. King Obstetrical Society, The Geo i:Ash MANY, School Of LediciLle
Name and Chapter St. & No. City State Countr7USA
DATES OF MEMBERSHIPS 1y40
4 Sratil- Reed- &well Medical Honor Society- The Geo.T7ash6Entwe Scheel of
5
Name and Chapter St. & No. City State Country
DATES OF MEM:BERSHIP: 1945,4946
� Med USA
.The Geo Wash Univ. Med, Society And Genets-1 Alumni Assoc.
Name and Chapter 1 St. & No. City State Country
DATES OF MEMBERSHIP' i946 to present
6 As..oc. of Military Sureons pf the United States Wash D.O. USA
Name and Chapter St. & No. '� City 'State Conntey
DATES OF MEMBERSHIP' 1949 to"prseat
Phi Delta Epsilon The Geo. 74h Univ School Of Med. Wash D.O.
Name and Chapter �
DATES OF MEMBERSHIP'
St. & No. City State Country
1943� 1946
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SEC. 23. GENERAL QUALIFICATIONS
�
A. FOREIGN LANGUAGES (STATE DEGREE OR PROFICIENCY AS "SLIGHT" "FAIR" OR
"FLUENT")
German fair slight slijit
LANGUAGE SPEAK READ WRITE
French slight Ai,ht slight
LANGUAGE SPEAK READ WRITE
LANGUAGE SPEAK READ WRITE
B. LIST ALL SPORTS AND HOBBIES WHICH INTEREST YOU: INDICATE DEGREE OF PROFI-
CIENCY IN EACH:
haRketbali Main� � ( active participant )
photography Raiz
C. HAVE YOU ANY QUALIFICATIONS, AS A RESULT OF TRAINING OR EXPERIENCE, WHICH
MIGHT FIT YOU FOR A PARTICULAR POSITION?
Qualiried Phy iician
D. LIST BELOW THE NAMES OF GOVERNMENT DEPARTMENTS, AGENCIES OR OFFICES TO
WHICH YOU HAVE APPLIED FOR EMPLOYMENT SINCE 1939:
()antral Intellience Acency 1950
E. IF, TO YOUR KNOWLEDGE, ANY OF THE ABOVE HAS CONDUCTED AN INVESTIGATION OF
YOU, INDICATE BELOW THE NAME OF THAT AGENCY AND THE APPROXIMATE DATE OF
THE INVESTIGATION:
None, t. iav kaowledg
11
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SEC. 24. MISCELLANEOUS
A. DO YOU ADVOCATE OR HAVE YOU EVER ADVOCATED; OR ARE YOU NOW OR HAVE YOU
EVER. BEEN A MEMBER OR, OR HAVE YOU SUPPORTED ANY POLITICAL PARTY OR ORGANI-
ZATION WHICH ADVOCATES THE OVERTHROW OF OUR CONSTITUTIONAL FORM OF GOV-
ERNMENT IN THE UNITED STATES?
IF "YES", EXPLAIN* No.
Not applicable
Yes
B. DO YOU USE, OR HAVE YOU USED, INTOXICANTS? IF SO, TO WHAT
social dr1nkin:2;
EXTENT?
C. HAVE YOU EVER BEEN ARRESTED, INDICTED OR CONVICTED FOR ANY VIOLATION OF
LAW OTHER THAN A MINOR TRAFFIC VIOLATION? IF SO, STATE NAME OF COURT,
CITY, STATE, COUNTRY, NATURE OF OFFENSE AND DISPOSITION OF CASE*
No
D. HAVE YOU EVER BEEN COURT-MARTIALED WHILE A MEMBER OF THE ARMED FORCES?
IF ANSWER IS "YES," GIVE DETAILS BELOW:
SEC. 25. PERSON TO BE NOTIFIED IN CASE OF EMERGENCY:
NvadE Mrs. Miriam S. Lyons
RELATIONSHIP
ADDRESS _
USA
Lit. az No. City State Country
SEC. 26. YOU ARE INFORMED THAT THE CORRECTNESS OF ALL STATEMENTS MADE HERE-
IN WILL BE INVESTIGATED.
ARE THERE ANY UNFAVORABLE INCIDENTS IN YOUR LIFE NOT MENTIONED ABOVE WHICH
MAY BE DISCOVERED IN SUBSEQUENT INVESTIGATION, WHETHER YOU WERE DIRECTLY
INVOLVED OR NOT, WHICH MIGHT REQUIRE EXPLANATION? IF SO, DESCRIBE. IF NOT, AN-
SWER "NO."
No.
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41)
SEC. 27. I CERTIFY THAT THE FOREGOING ANSWERS ARE TRUE AND CORRECT TO THE
BEST OF MY KNOWLEDGE AND BET.Trp, AND I AGREE THAT ANY MISSTATEMENT
OR OMISSION AS TO A MATERIAL FACT WILL CONSTITUTE GROUNDS FOR IM-
MEDIATE DISMISSAL OR RESECTION OF MY APPLICATION.
DATE 8 ,Octobars 1950
AlLze 4.44 *Ka)
Signature of Applicant
USE THE FOLLOWING PAGES FOR EXTRA DETAILS. NUMBER ACCORDING TO THE NUMBER
OF THE QUESTION TO WHICH THEY RELATE. SIGN YOUR NAME AT THE END OF THE ADDED
MATERIAL. IF ADDITIONAL SPACE IS REQUIRED USE EXTRA PAGES THE SAME SIZE AS
THESE AND SIGN EACH SUCH PAGE.
SEQ. 6
Additional information on Step-Mother
Fu11 Name: Emily Fischer Richeimer
Living or Deceased: Living
Present Address:
Date of Birth:
15 April 1879
Citizenship: U.S.
Place of Birth: Newark, N. J. , USA
Acquired: Birth
Occupation: Housewife
Last Employer: Not applicable
Military or Government Service: None- Not aiplicable
SEC. 12
Additional Education
College: The University of New Hampshire
Address: Durham, New Hampshire
Dates Attended: July 1942 to Sept. 1942 ( Summer Session
Degree: None
13
U. S. GOVERNMENT PRINTING OFFICE :1950 0- 807893
Approved for Release: 2020/10/23 C06837689
(b)(6)
Approved for Release: 2020/10/23 C06837689
SEC. 18 .
Explanation:
Because of the nature of my present dwell, (apartment house) and length of
residence there, I am unacquainted with three neighbors at my present address;
therefore one close neighbor is given for the present address, and one each
for my last two addresses in the U.S.
SEC. 20
Additional Residences During the Past 15 Years
July 1941 to Sept. 1941- 670 Clinton Ave., Newark, N.J., USA
1938 to 1940 2 Osborne Terrace, Newark, N.J., USA
1928 to 1938 24 Yates Ave., Newark, N.J., USA
SEC. 22
Additional Organizations Belonged to During College
The George Washington University "Hatchet" . 1940-1942
Phi Epsilon Pi �� (Alpha Mu Chapter) 1940-1942
( The George Washington University)
Approved for Release: 2020/10/23 C06837689.�ft.
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