◆ SpookStack

ane , . os ae CANS ot tet eat wv fie ait ne Ate fs wae at <* ft wart wet ge A e. see wig + gr” . } eae See On a wih * byte, Na ws De if 7 = ci ', INSTRUCTIONS: Five’ (5) copies of ebconplished. fora wilt badubtitted by the Contractot wes anv investigation forclearance by o militsry department is requited, FYPEOR PRINT AL al tmore space Is sequited, “atch BdRtional Sheets, 1eenatyteg by coresyondirg tt oh a Ca-'d 62 “FORM SILL NOTSBE ACCERTED UNLESS COMPEETELY, AND PROPERLY EXECUTED, 0043 6 6 “ier | pts. stidtis which do not apply will bo marked ‘None’ an rit eieg uy hare | ° woof Roe OF TA LRT Dare ou oe oft +; 4, very te ag tea ‘ - re ~ ~ eee ¢ . . _ > — ar) . . r eer _— - 7 TH, 4 REYALTY FOR MISRERR ATION, = Tile 18 Lioltad Stated Ege 1301 Medea st F protect offons i putt aNDLE OFS ihidttnsat St . “Phere* thoi beanie 310,005 Fink ash as euake & falee statement of tedreemidiont6 my Depcrcaeni of Agbi'cy- Sl Ore Uliled Sidtesies (0 any wetter within the fuctadi ction of my Depatment oe Agency of the United Statse, Tale includes any statement knowingly mete by explorer ; er employes Nerein natch te found ta be meorrect, inconglete of wtelédding Way important pecticster = Title 18 United Stasea Code, 921 states Ee ar, tat aely sed wtthatty eepresents himrel! to be @ ettieer of the United States ebatl $6 Lined net mare than $ ® yeere, ord al L9Cor testtsdned not mare 4 7 TO BE COMPLETED BY EMPLOYER ATR FORCE PLANT REPRESENTATIVE MANE ANC AGPRESS OF EMPLOYER Gt n ep! ar Mean THE BOEING COMPANY ” THE BOEING COMPANY AERO : SPACE a7 aN RAL WAY SEATTLE, WASHINGTON FARBER Ge 19@ TITLE AND OFSCAIPTION OF EMPLOYEE'S OUTIES wich REQUIRE ACCESS TO CLASSIFIED INFORMATION SZCUR 5 MATERIALS OR INFORMATION EMPLOYEE WILL HAVE ACCES t CERTIFY THAT THE EW COMPLere TRIES MADE GY UE AGOVE ARE TRU AHS CORA t SELICP AND ARE CORRECT Oo ME Gest OF MY KNOWLEOGE AND - ZOUTATION (Account for all cirtitas wcheete) YEARS Unclude month jf nena) ., . NMATURALIZED CITIZEN ONLY, COMP : TROUGH 14. FORMERLY CITIZEN OF WHAT COUNTRY 1%. DATE AND PLACE OF ENTRY INTO UNITES STATES D 16. CITY, COUNTY, AND STATE WHERE NATURALIZEO ,a DERIVATIVE CITIZENSHIP Ades & RLACE OF NATURALIZATION . , : . ” oom em FR OATR Gm Ite! “% DD ‘ REPLACTS EXITION OF 1 MAR $5, WHiGh 13 OBSOLETE. 0 ee eet ee a 4