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AUG-31-1994 14:39 FROM r UNIT TO , @ WMFO P.89 ay ty 12 PEOPLE WHO KNOW YOU WELL " b6 List two people who know you wall and live in the United States, bic * Don't fist spouse, other relatives, or former spouses. ty not to fist anyone mentioned in item 9, 10, or 11. Name elephong Number: #1 3) 525-7484 Kastenmeier, Robvext 103 re a Home Address * ie P. Code. 2899 2742 ginest Name #2 wald, Patricia M 2101 Connecticut sve... N.} 13 YOUR OUTSIDE ACTIVITIES List any activities which you may wish to have considered as reftecting favorably on yout reputation for leadership, responsibility, honesty, and integrity in the last 15 years. (Response Optional) City (Counry washington ” SERe U.S.Assjn Former Members of Congress 14 YOUR FOREIGN ACTIVITIES a, Oo-you have any foreign property, business connections, or financial interests? |. . b. Are you now or have you ever been employed by or acted as & consultant for a foreign government, firm, or agency? bs | G.: In the last 15 years, have you had continuing contact with a national of any foreign country designated by the agency instructing you to fill out this form? (NOTE: Hf the agency wants you to answer this question, it will provide you with a list of countries.) ’ ’ . Hf you. answered -“Yes".to a, b, or o, explain in the space below: 15 FOREIGN COUNTRIES YOU HAVE VISITED List foreign countries you have visited, beginning with the most current (#1) and working backward 15 yoars, ' » Do not include countries covered in items 9, 10, and 11. «In the “Code” block, use one of these codes: 1 - Business 2 - Pleasure 3 - Education 4. Other Code Counry : . 4 Bulgaria 16 YOUR MILITARY HISTORY a, Have you served in the United States military? ........... a tae Have you served in the United States Merchant Marine? .. 0... 0.6... eee eee Pde eee eee e cee eeeeee been * If your answer to both questions Is “No,” GO TO QUESTION 17. * ff your answer to either question is “Yes,” GO TO b. b. | Starting with the most current (#1) and working backward, enter information for atl periods of active service inte the table below. * Mark “O" block for Officer or "E* block for Enlisted. «In the "Gode” block, use one of thase codes: 1-Air Force 2-Army 3-Navy 4- Marine Corps 5-Coast Guard 6-Merchant Marine 7 - National Guard Status (Mark “X" in aporopriate blocks « use State Code for National Guard: N Acove Laty | Active Reserve | Nahons ard nachye Retirod (show State) Reserve at _ Enter your Sociat Security Number before going to the next page #4... AUG 31 °94 19:18 © 202 Ge4 1373 PAGE.HBd