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araee eyeenneens ; | 3} 1 CASE SEPA LNO. &CSC use one) I 19. HAVE YOU EVER HAD A NERVOUS EREAXDOWN OR HAVE YOU EVER HAD MEDICAL TREATMENT FOR A MENTAL CONDITION? Oyes Gro. C1 your enawer la You,” five details in item 28.) 2), FOREIGN COUNTRIES VISITEO (SINCE 1933. (Exclusive of military service.) COUNTRY DATE LEFT USA. OATE RETURNED USA. PURPOSE None ; 21. ARE YOU NOW, OR HAVE YOU EVER BEEN, A MEMSER OF THE COMMUNIST PARTY, USA, OR ANY COMMUNIST OR FASCIST ORGANIZATION? | Oves Wnro. + 22, ARE YOU xow ioe HAVE YOU EVER BEEN A MERCER OF ANY FOREIGN C OR COMESTIC ORGANIZATION J ASSOCIATION, MOVEMENT. COUR OR comsinaTieNe ra PERSONS W S TOTALITARIAN, FASCIST, COMMUN, OR SUBVERSIVE OR WHICH HAS ADOPTE: SONS. A POLICY OF ADV G OR AFPROVIN COMMISSION eo ACTS OF FORCE OR VIOLENCE TO OENY OTHER PERSONS THORS RIGHTS UNDER TREGONST, UTUTION OF THE UNITES STATES. OR WHICH Sees TO ALTER THE FORM OF GOVERNMENT OF THE UNITES STATES BY UNCONSTITUTIONAL MEANS? (7) YES 23. IF YOUR ANSWER TO QUESTION 21 OR 22 ABOVE IS “YES.™ STATE Ee NAMES OF ALL SUCH ORGANIZATIONS, ASSOCIATIONS, MOVEMENTS, GROUPS, OR COM. EINATIONS OF PERSONS AND DATES OF MEMBERSHIP, IN ITEM 23 OR ON A SEPARATE SHEET TO EE ATTACHED TO AND MADE APART OF THIS FORM, GIVE COM. PLETE DETAILS OF YOUR A ACTIVITIES THEREIN AND MAKE ANY EXPLANATION YOU OESIRE REGAROING YOUR MEMBERSHIP OR ACTIVITIES, NAME IN FULL ADDRESS + FROM ro OFFKEHERO 24 MEMBERSHIP IN OTHER ORGANIZATIONS, (List all orfanisations inwhich you are now a member or hare been a member, except those whith show relitioue or political affiliations.) (Uf none, 00 state.) NAME IN FULL ADDRESS TYPE FROM ro OFFICE HAO b6 Per BOC None 23, RELATIVES, (P. te, 2 1 Chil there, and efaters, I dead. Name of spouse “ghouls include maiden name and oP other ‘ne mes by previous Fh st Racer ee Met a tate dead" after Aen A onship and furnish dnformation for other columne a3 of time (vy COUNTRY OF PRESENT RELATION RAVE IN FULG ‘ERI ADORESS 8IRTH CITIZENSHIP Father Mother : + |~Wite Daughte Daughte Bx-Wife Brother : Sister b6 Per BOC . b7C Per BOC DB Cooper-7194