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a _Form ‘ spproved. “17 re a : Budget Bureau No 8-ROOL.7. , , @. cont aed prs Aa none < “ - . . . . . ars avy 4 . oe “UNITED ST TES ae ; Aro ENERGY 0)2MMISSION “WASHINGTON, D. C. _ PERSONGEL ‘SECURITY QUESTIONNAIRE Ly, GIB) yt f9 V9 re § se baad INSTRUCTIONS—All sections must be compl leted. Write “Nong” when a plicable. Type cr rint all wers. If space nok adequate for complete answers, use the BBdigiésial space ‘Provided ente No. 2. Al add fes..yius ¥) how streeb, -f.. nu ger, street, city, and State... ---- : 2: tgs eet : ere =n -" y) fs SeSCRIPTION = Check “ohich). “ MALE fee [vost war [onan sa) amo LER ZPP CD prvorcen: - eat ed 8. BRTHPLACK, (City, comntys. Goose, and country) crTy gor COUNTY OF. ‘BAN ‘FRANCISCO AMENTO.,” ER appressee FOR PAST 15 YEARS DATE ) MAGELLAN AVENUB:.:°°~"*"Pxior’ FRANCISCO, CALIE. 59 i F «| th. SOCIAL “SECURITY NO. “NONE — 7] a2. PERMANENT: ‘STATION. EANK. AND AODRESS IF NOW IN M SERVICE - a ILITARY ADDRES® Ee 1860 HAYES STREET,” SAN | FRANCISCO, Ree es visiteD (Since 1930) (Exclusive of military sefvice) - DATE LEFT DATE RETURNED * — U.S.A. U.S.A. 2 OE