DD Form 48 Personnel Security Questionnaire, Boeing Aero-Space Division employee
Title revised to match the document’s own text.
Original title: DD Form 48 Department of Defense Personnel Security Questionnaire, Boeing Aero-Space Division employee
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Id: Cooper-Part-25:376-379
Subject: Cooper Files: Cooper-Part-25:376-379 Document: DD Form 48 Personnel Security Questionnaire, Boeing Aero-Space Division employee Id: Cooper-Part-25:376-379 Page: https://cooper.theunsolved.net/documents/Cooper-Part-25%3A376-379 What is wrong (title, date, type, which pages belong together, copies)? What does the scan show?
A person reads every report. Corrections are made by hand, to the data — titles, dates, names, which pages belong together — never to the scans, and they can take a while to appear.
FBI 164-81, Vault Part 25 pp. 376–379 (DB Cooper-8446–8449), Form — cooper.theunsolved.net/documents/Cooper-Part-25%3A376-379
Form Approved Budget Bureau No. 22-R248
INSTRUCTIONS: Five (5) copies of accomplished form will be submitted by the Contractor when [illegible] investigation for clearance by a military department is required. TYPE OR PRINT ALL ANSWERS. If more space is required, attach additional sheets, identifying by corresponding block number. FORM WILL NOT BE ACCEPTED UNLESS COMPLETELY AND PROPERLY EXECUTED, [illegible] Items which do not apply will be marked "None"
NOTE: A PENALTY FOR MISREPRESENTATION - Title 18 United States Code, 1001 makes it a criminal offense, punishable upon conviction of a fine, imprisonment, $10,000 fine, or both, to make a false statement or representation to any Department or Agency of the United States to any matter within the jurisdiction of any Department or Agency of the United States. This includes any statement knowingly made by employee or employee herein which is found to be incorrect, incomplete or withholding legally important particulars - Title 18 United States Code, 911 states a whoever falsely and willfully represents himself to be a citizen of the United States shall be fined not more than $1,000 or imprisoned not more than three years, or both.
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TO BE COMPLETED BY EMPLOYER
TO: (Cognizant Security Office) AIR FORCE PLANT REPRESENTATIVE THE BOEING COMPANY 7755 E. MARGINAL WAY SEATTLE, WASHINGTON
NAME AND ADDRESS OF EMPLOYER (If a subsidiary, include name of parent company) THE BOEING COMPANY AERO - SPACE DIV[ISION] SEATTLE, WASHINGTON 7755 E. MARGINAL [WAY]
JOB TITLE AND DESCRIPTION OF EMPLOYEE'S DUTIES WHICH REQUIRE ACCESS TO CLASSIFIED INFORMATION [redacted - b6/b7C]
CONTRACT NUMBER, WHEN APPLICABLE [redacted - b7C]
SECURITY CLASSIFICATION OF MATERIALS OR INFORMATION EMPLOYEE WILL HAVE ACCESS TO [redacted - b6/b7C]
I CERTIFY THAT THE ENTRIES MADE BY ME ABOVE ARE TRUE, COMPLETE, AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AND ARE MADE IN GOOD FAITH.
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TO BE COMPLETE[D]
1. LAST NAME - FIRST NAME - MIDDLE NAME [redacted - b6]
[illegible field - ANY OTHER [illegible] NAME(S)] [redacted - b6/b7C]
2. DATE OF BIRTH 4. PLACE OF BIRTH [redacted] [redacted]
5. SOCIAL SECURITY NO. [redacted - b7C]
[MARITAL STATUS] 7. SEX 8. RACE 9. HEIGHT 10. WEIGHT 11. COLOR [eyes] [hair] [redacted] Male White 6'1 195 Blue Black
EDUCATION (Account for all civilian schools) YEARS (Include month if known) GRADUATE [redacted/partially visible: [guess: some text]]
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NATURALIZED CITIZEN ONLY, COMPLETE 14 THROUGH 21
14. FORMERLY CITIZEN OF WHAT COUNTRY 15. DATE AND PLACE OF ENTRY INTO UNITED STATES [blank] D
16. CITY, COUNTY, AND STATE WHERE NATURALIZED 17. COURT [blank] [blank]
18. DATE 19. CERTIFICATE NUMBER 20. FORMER ALIEN REG. NO. [blank] [blank] [blank]
21. DERIVATIVE CITIZENSHIP A. PARENT'S NAME B. CERTIFICATE NUMBER [illegible/blank]
C. PLACE OF NATURALIZATION d. COURT e. DATE(S) [illegible] [illegible/blank] [illegible]
DD FORM 48 REPLACES EDITION OF 1 MAR 55, WHICH IS OBSOLETE.
MILITARY SERVICE
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DB Cooper-8446
[form number partially legible] REPLACES EDITION OF 8 MAR 55, WHICH IS OBSOLETE.
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MILITARY SERVICE COUNTRY: U.S.A. BRANCH OF SERVICE: Marine Corps SERVICE NUMBER: [redacted b6/b7C] FROM (Date): [redacted b6/b7C] TO (Date): [redacted b6/b7C]
D. TYPE OF DISCHARGE: Honorable 23A. LOCAL DRAFT BOARD (United States) AND ADDRESS: DNA B. ORDER NO.: DNA C. CLASSIFICATION: DNA
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26. RESIDENCE (List all places of residence from 1 Jan 1937, starting with present) STREET, CITY, STATE, OR OTHER POLITICAL SUBDIVISION AND COUNTRY | FROM (Date) | TO (Date) [redacted b6/b7C] | 5-62 | PRESENT [redacted b6/b7C] | 8-61 | 5-62 [redacted b6/b7C] | 6-60 | 8-61 [redacted b6/b7C] | 9-58 | 6-60 [redacted b6/b7C] | 9-57 | 9-58 [redacted b6/b7C] | 6-57 | 9-57 [redacted b6/b7C] | 9-55 | 6-57 [redacted b6/b7C] | 5-55 | 9-55 [redacted b6/b7C] | 1-55 | 5-55 [redacted b6/b7C] | 9-54 | 1-55 [redacted b6/b7C] | 6-54 | 9-54 [redacted b6/b7C] | 3-54 | 6-54 [redacted b6/b7C] | 10-53 | 3-54 [redacted b6/b7C] | 6-53 | 10-53 [redacted b6/b7C] | 2-53 | 6-53 [redacted b6/b7C] | 9-52 | 2-53 [redacted b6/b7C] | 6-52 | 9-52 [redacted b6/b7C] | 9-[guess: 51] | 6-[guess: 52]
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LIST ALL ORGANIZATIONS EXCEPT LABOR UNIONS AND EXCEPT ORGANIZATIONS LISTED ON DD FORM 48.A IN WHICH YOU HOLD OR HAVE HELD MEMBERSHIP NAME AND ADDRESS | TYPE | OFFICE HELD | FROM (Date) | TO (Date) [redacted b6/b7C] | [redacted] | Publicity Drctr. | 6-58 | 6-59 [redacted b6/b7C] | [redacted] | None | 9-57 | 6-58 [redacted b6/b7C] | [redacted] | Vice President | 6-62 | PRESENT [redacted b6/b7C] | [redacted] | None | 9-55 | 6-56 [redacted b6/b7C] | [redacted] | None | 9-55 | 6-60 [redacted b6/b7C] | [redacted] | None | 9-55 | 6-60 [redacted b6/b7C] | [redacted] | None | 2-50 | 2-52 [redacted b6/b7C] | [guess: None/631050 in] | [redacted] | 6-58 | PRESENT
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DB Cooper-8447
FOREIGN COUNTRIES VISITED OR RESIDED IN
DATE LEFT U.S. | DATE RETURNED U.S. | PURPOSE [redacted] | [guess: 14] 6-52 | [guess: Nov] 6-52 | Tourist [illegible entries below, mostly redacted] [illegible] | [illegible] | [illegible] [illegible] | [illegible] | [illegible] [illegible] | [illegible] | [illegible] [illegible] | [illegible] | [illegible] | [illegible] | [illegible]
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27. RELATIVES A. LIST PARENTS, SPOUSE, (including maiden name) CHILDREN, BROTHERS, AND SISTERS (16 years and older). LIST EVEN THOUGH DECEASED
RELATION | NAME | ADDRESS (Enter "deceased" if no longer living) | PLACE & DATE OF BIRTH | PRESENT CITIZENSHIP [redacted - b6, b7C] [redacted - b6, b7C] [redacted - b6, b7C] [redacted - b6, b7C] [redacted - b6, b7C] [redacted - b6, b7C]
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A. LIST OTHER LIVING RELATIVES AND RELATIVES OF SPOUSE KNOWN TO BE RESIDING OUTSIDE THE UNITED STATES
NONE
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28. EMPLOYMENT (Show every employment you have had since 1 Jan 1957 and account for all periods of unemployment)
POSITION HELD | EMPLOYER AND IMMEDIATE SUPERVISOR | ADDRESS | FROM (Date) | TO (Date) [redacted] | [redacted] | [redacted] | 5-62 | PRESENT [redacted] | [redacted] | [redacted] | 2-62 | 5-62 [redacted] | [redacted] | [redacted] | 8-61 | 2-62 [redacted] | [redacted] | [redacted] | 6-61 | 8-61 [redacted] | [redacted] | [redacted] | 9-60 | 6-61 [redacted] | [redacted] | [redacted] | 6-60 | 9-60 [redacted] | [redacted] | [redacted] | 9-58 | 6-60 [redacted] | [redacted] | [redacted] | 6-58 | 9-58 [redacted] | [redacted] | [redacted] | 9-57 | 6-58 [redacted] | [redacted] | [redacted] | 8-57 | 9-57
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DB Cooper-8448
28. HAVE YOU EVER BEEN ARRESTED, CHARGED, OR HELD BY FEDERAL, STATE, OR OTHER LAW ENFORCEMENT AUTHORITIES, FOR ANY VIOLATION OF ANY FEDERAL LAW, STATE LAW, COUNTY OR MUNICIPAL LAW, REGULATION OR ORDINANCE? INCLUDE ALL COURT MARTIALS, WHILE IN MILITARY SERVICE. DO NOT INCLUDE ANYTHING THAT HAPPENED BEFORE YOUR 16TH BIRTHDAY. DO NOT INCLUDE TRAFFIC VIOLATIONS FOR WHICH THE ONLY PENALTY IMPOSED WAS A FINE OF $25.00 OR LESS. ALL OTHER CHARGES MUST BE INCLUDED EVEN IF THEY WERE DISMISSED. [ ] YES [X] NO IF "YES", GIVE DATE AND PLACE, CHARGE, AND DISPOSITION:
[illegible handwritten or typed entries - mostly blank/redacted]
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30. HAVE YOU EVER BEEN PREVIOUSLY GRANTED OR DENIED A SECURITY CLEARANCE BY THE DEPARTMENT OF THE ARMY, NAVY, OR AIR FORCE, BY THE ATOMIC ENERGY COMMISSION OR OTHER GOVERNMENT AGENCY?
a. GRANTED b. DENIED [ ] YES [X] NO [ ] YES [X] NO
31. IF "YES", INDICATE WHEN GRANTED, WHERE, AND BY WHOM; IF DENIED, WHEN AND BY WHOM 32. WHAT WAS THE LEVEL OF THE CLEARANCE?
DNA DNA
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33. REFERENCES (Give five personal references, stating business address of all references, if known. Do not include relatives, former employers, or persons living outside the United States.)
NAME | YEARS KNOWN | STREET AND NUMBER | CITY | STATE
[All rows redacted/blank - content obscured by b6/b7C exemptions]
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34. LIST ALL FOREIGN OWNED CORPORATIONS OR OTHER BUSINESS ORGANIZATIONS IN WHICH YOU ARE AN OFFICER, DIRECTOR, OWNER, OR ACT IN A REPRESENTATIVE CAPACITY. (If none, so indicate).
NONE
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CERTIFICATION
WARNING: Read every sentence of Certification before signing. I certify that the entries made by me above are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. [illegible date/signature area]
I certify that I am a citizen of the United States.
I certify that I know that any misrepresentation or false state- ment made by me herein may subject me to prosecution under Section 1001 of the United States Criminal Code, with penalties up to five (5) years imprisonment and $10,000 fine.
I certify that I have read and understood each sentence of this Certification.
[Signature area redacted]
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DB Cooper 8449