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¢ UNITED STAIES ~ / {fFoRw APPRO ATOMIC ENERGY COMMISSION. . qe BUD ‘sup rT. P. 0. BOx.- 5928 bh WASHINGTON, O: C. . PERSONNEL SECURITY-QUESTIONNAIRG HS - All sections must be completed - Write none when applicable - Type or print all answers. ’ for complete answers, attach a supplemental sheet to this form. All addresses must show Street ast, First, Middle) TERING, Charles Franklin tf married woman) 5. DESCRIPT'ON | race _—«|smetcnt | -wercnt = Limite [eron [a7 | ees 6. (Check which) 7. BIRTH DATE. ML Boss Ket CJ siwate CJ orvorceo [oar | wonn | vean | “ARE |-3. PRESENT ADDRESS Fo} wannieo OX wioowier [ 29 | 8 | 1876 8. BIRTHPLACE (City, County, State and Country) Loudenville, Ohio | “aoe Book Cadillac Hotel, Detroit, Mich, 4. ALL OTHER ADDRESSES FOR PAST 10 YEARS DATE 9. CITIZENSHIP: us. 20 None Other ~ a. BY BIRTH D 0:0:§ b. DERIVATIVE CI Date: : Oate . Certificate No. Place } IP ALIBN, INDICATE ALIEN REGISTRATION NUMBER — —_—— A 5 OATE PORT OF ENTRY 10. ORAFT BOARD NO. AND ADDRESS WITH WHICH REGISTERED. None lls SOCIAL, SECURITY NO. 12. PERMANENT STATION AND ADDRESS 1F NOW IN MILITARY SERV. None . . cA. PREVIOUS MILITARY SEavice: SeRtaAL NuMBER arancno From To | (year). oreo memes | 13. 7S EDUCATION (411 schootsaboue 226 “4 = Fa County Dist. School. _.|-,Loudonville, Ohio Loudonville High Schoof-7" 2°" mm ~Woester Ohio Normal ~'|“Wooster » Ohio / Aa - ‘Ohio State University | Columbus, Ohio E is off S Mee