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a AUG-31-1994 14:36 FROM : TO ia WMFO P.66 ‘9 © WHERE YOU HAVE LIVED Fill In your full addrass fer every place you have lived beginning with the present (#1) and working backward 15 years. - If you attended schoo! away Irom your permanent residence, list the address you lived at while attending school, _ © For any address in the past 3 years: + List a person who knew you at that address, preferably someone who still lives in that afea, + If address fisted is “General Delivery.” a Rural Route, or Star Route, Phineas directions for locati g the rasiderce og an attached continuation sheet, and show the bieck #. gq. MontvYear “Month/Vear | Street Address Present..6/80,, present Name of Person Who Knows You 7s 09/79. 6/80. 52 Quesada, N.We Name of Person W ee er ee tra " MPL Montn’Year Monty Year | Streat Address ode 6473. To. g 1015 Sheridan Road Eb:| 60626 1. ETS’ Parson Who Knows You [SveetAddress ss “ass Apt Gity (Count State leit tode | Telegl fa Number Names oF Parson Who Knows You beet Address City (Country) “ fg , ” oe 7 - Mentvy sar Monthy Year, Sreer Address S wiiss - Name of Berson Who Knows You treat Address Te vy (Country) e i“ i” a“ | | WHERE YOU WENT TO SCHOOL Fill in information about schools you have attended, beyond Junior High School, beginning with the most recent (#1) and working backward 15 years. Aiso list College or University degrees received beyond 75 years. * For schools you attended in the past 3 years, list a person who knew you at school (such as an instructor or a student). « For correspondence schools and extension classes, list records location address. * In the “Code” block, use one of these codes: 7 - High School 2- cokegel university : 3- Vocationat/Trade School Steet Address and City (Coun) of School 500 Sherman Boulevard, Milwaukee Name of Person Who Knew You treet Address and City (Country) a] bea ral elephone Number «Mont ear Month/Year Name of Schoo! Sa fs bach degree . MOnIVY @ar 9/4. 6/5) 2 University of Chicago = | “er Comd) Srect Address and Gly T eT] Of School _ me iP Code ; 1111 Bast 60th Street Chicag a res (2; «FA 401-3, A Name of Person Who Knew You ee J [State | ZIP Code Tolophone Number b6é onthy’ ear MentnYear Code | Name of School Degree/Dipioma/Otha (show each cegree / Monin’y gar bic ee Soe and date received if Code 2) State Sree Aaaress and diy (Ge GRAYS aI School ZIP Gode tit Name of Perton Who Knew You Street Address and City (Country) State ZF Code elephone Number | Pepi te) | Enter your Social Security Number before going to the next page | > Isoa |-116/-152 14 4 Page 2 ~ = —_— AUG 31 °94 19:15 202 324 1373 PAGE. aa6