Statement of Personal History, Harold Allen Countryman (NPRC copy)

STATEMENT OF PERSONAL HISTORY

INSTRUCTIONS: Read the certification at the end of this questionnaire before entering the required data. Print or type all answers. All questions and statements must be completed. If the answer is "None," so state. Do not misstate or omit material fact since the statements made herein are subject to verification. If more space is needed, use the Remarks section, item 20, and attach additional sheets if necessary. The information entered hereon is for official use only and will be maintained in confidence.

1. (Print) FIRST NAME—MIDDLE NAME—MAIDEN NAME (If any)—LAST NAME [X] MR. Harold Allen Countryman

2. STATUS X CIVILIAN | MILITARY ON ACTIVE DUTY

3. ALIAS(ES), NICKNAME(S), OR CHANGES IN NAME (Other than by marriage) None

4. PERMANENT MAILING ADDRESS 6814 - 30th NE, Seattle, Wash. 98115

5. DATE OF BIRTH (Day, month, year) 5 Dec 33 PLACE OF BIRTH: Yakima, Yakima, Washington PLACE CERTIFICATE RECORDED: Seattle, Washington, 27Dec33

RACE: Cau HEIGHT: 5'10" WEIGHT: 155lbs COLOR OF EYES: Blue COLOR OF HAIR: Blonde SCARS, PHYSICAL DEFECTS, DISTINGUISHING MARKS: ½" Scar right knee cap

6. DO YOU HAVE A HISTORY OF MENTAL OR NERVOUS DISORDERS? YES [X] NO ARE YOU NOW OR HAVE YOU EVER BEEN ADDICTED TO THE USE OF HABIT FORMING DRUGS SUCH AS NARCOTICS OR BARBITURATES? YES [X] NO ARE YOU NOW OR HAVE YOU EVER BE[EN]... USE[R] [IN] EXCESS OF ALCOHOLIC BEVERAGES? YES [X] NO CAUTION: SPECIAL HANDLING REQUIRED

7. U.S. CITIZEN: [X] YES NATIVE: X YES IF NATURALIZED, CERTIFICATE NO.: N/A IF DERIVED, PARENTS' CERTIFICATE NO(S): This material copied from records of National Personnel Records Center, St. Louis, Missouri, for reference only. Do not reproduce or disseminate in its original form outside

ALIEN: N/A REGISTRATION NO: N/A NATIVE COUNTRY: N/A

8. MILITARY SERVICE ARE YOU PRESENTLY ON ACTIVE DUTY IN THE U.S. ARMED FORCES DRAWING FULL PAY? YES [X] NO

GRADE AND SERVICE NO.: 1st Lt - 05 703 722 SERVICE AND COMPONENT: Army-USAR / MPC-USAR ORGANIZATION AND STATION: H/HCo, 2nd Bn, 104th Regt (AIT), Renton, Wash.

HAVE YOU PREVIOUSLY SERVED TOURS OF EXTENDED ACTIVE DUTY: [X] YES COUNTRY: USA SERVICE: Army COMPONENT: MPC FROM (Date): Mar 53 TO (Date): Mar 56 TYPE DISCHARGES OR SEPARATIONS—GRADE AND SERVICE NO.: Hon Cpl E-4 RA 19 469 110

9. EDUCATION Sep40 - Jun46: Garfield Grade School Yakima, Wash - x - 6th Grade Sep46 - May48: Skykomish Jr High Skykomish, Wash - x - 8th Grade Sep48 - May52: Skykomish High School Skykomish, Wash - x - 12th Grade Oct52 - Feb53: University of Washington, Seattle, Wash - x - 2 yrs ACD GED Test US Army

10. FAMILY FATHER: Roswell I. Countryman, 20 Feb 1889, Foley, Minn, 1721 Conger, Olympia, Wash, X MOTHER (Maiden name): Ethel M. Tallman, 15 Jul 1891, Cambridge, Minn, 1721 Conger, Olympia, Wash, X SPOUSE (Maiden name): Floreta F. Warrington, 21 Feb, 1932, Tulsa, Oklahoma, 6814 - 30th NE, Seattle, Wash, X OTHER (Specify) Father-in-Law: Jacob Warrington, 2 Nov 1899, Oklahoma, 4424 Dayton, Sacramento, Calif, X, b6 Per NPRC (Mother-In-Law): Rosalee O'Neal, 11 Oct 1901, Arkansas, 4424 Dayton, Sacramento, Calif, X

DB Cooper 12001

11. OTHER RELATIVES AND ALIEN FRIENDS LIVING IN FOREIGN COUNTRIES (List grandparents, first cousins, aunts, uncles, brothers- and sisters-in-law, and other persons with whom a close relationship existed or exists)

RELATIONSHIP AND NAME | AGE | OCCUPATION | ADDRESS | CITIZENSHIP Mr. & Mrs. Ben Sykes (Aunt & Uncle) | | Retired[guess: n.] | [guess: SPC] Canada SPECIAL HANDLING REQUIRED | Canadian

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This material copied from records of National Personnel Records Center, St. Louis, Missouri, to be used for reference only. Do not recopy or disseminate in its original form outside the Bureau.

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12. FOREIGN TRAVEL (Other than as a direct result of United States military duties)

DATES | COUNTRY VISITED | PURPOSE OF TRAVEL FROM— | TO— Aug 47 | Aug 47 | Canada | Visit Aunt & Uncle

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13. EMPLOYMENT (Show every employment you have had and all periods of unemployment)

MONTH AND YEAR | NAME AND ADDRESS OF EMPLOYER | NAME OF IMMEDIATE SUPERVISOR | REASON FOR LEAVING FROM | TO Dec 49 | Aug 50 | H. H. Princehouse Sr, & Jr Skykomish, Washington | Princehouse | Sold out Aug 50 | Dec 50 | Ted Clarke Skykomish, Washington | Ted Clarke | School Jun 51 | Jul 51 | Addison Miller Co Spokane, Washington | A. Fredrickson | Better Employment Jul 51 | Aug 51 | Funderburk Const Co. Skykomish, Washington | Funderburk | Job Finished Aug 51 | Sep 51 | U. S. Forest Service Skykomish, Washington | John Sarginsen | Return to School Jun 52 | Sep 52 | King County Hospital Seattle, Washington | Mrs. Frew | Better Employment Sep 52 | Oct 52 | Modern Home Builders Seattle, Washington | Ray Steverson | Return to School Dec 52 | Dec 52 | U. S. Post Office Seattle, Washington | Unknown | Xmas Only Jan 53 | Mar 53 | Wilmark Service Seattle, Washington | J. Hadley | Enter US Army Apr 56 | Mar 57 | Tall's Camera Supply Seattle, Washington | Ted Camera | Better Employment

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DID ANY OF THE ABOVE EMPLOYMENTS REQUIRE A SECURITY CLEARANCE? ☐ YES XX NO DO YOU HAVE ANY FOREIGN PROPERTY OR BUSINESS CONNECTIONS, OR HAVE YOU BEEN EMPLOYED BY A FOREIGN GOVERNMENT, FIRM, OR AGENCY? ☐ YES XX NO HAVE YOU EVER BEEN REFUSED BOND? ☐ YES X NO IF THE ANSWER TO ANY OF THE ABOVE IS "YES," EXPLAIN IN ITEM 20

SOCIAL SECURITY NO. 531-30-0336

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14. CREDIT AND CHARACTER REFERENCES (Do not include relatives, former employers, or persons living outside the United States or its Territories.

NAME (List 3 credit and 5 character) | YEARS KNOWN | STREET AND NUMBER (Business address preferred) | CITY | STATE OR TERRITORY Tall's Camera & Supply | 10 | 1421 - 3d Avenue | Seattle | Wash. Marshall's Sptg Goods | 15 | 1st & Madison | Seattle | Wash. Zales Jewelers | 8 | 3rd & Pine | Seattle | Wash. Jerome Lowe | 12 | 2037½ - 13th West | Seattle | Wash. Harold Hudson | 11 | 357 N 57th | Seattle | Wash. Richard Cook | 10 | 1008 NE 16th | Bellevue | Wash. Fred Powell | 10 | 225 Summit East | Seattle | Wash.

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DB Cooper-1200

STATEMENT OF PERSONAL HISTORY

INSTRUCTIONS: Read the certification at the end of this questionnaire before entering the required data. Print or type all answers. All [illegible] ...

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15. LIST ALL RESIDENCES FROM 1 JANUARY 1937

MONTH AND YEAR STREET AND NUMBER CITY STATE OR COUNTRY FROM - TO Jun 37 Nov 40 Unknown Selah Washington Nov 40 Jul 46 1116 Jefferson Yakima Washington Jul 46 Jun 52 Box 70 Skykomish Washington Jun 52 Sep 52 1314 Minor Seattle Washington Sep 52 Mar 53 4761 - 21st NE Seattle Washington Mar 53 Mar 56 U. S. Army Mar 56 Feb 57 4403 - 24th West Seattle? Washington Feb 57 Apr 58 13000 Aurora Seattle Washington Apr 58 May 58 1503 - 18th Avenue #104 Seattle Washington May 58 Apr 61 9215 - 12th NE Seattle Washington Apr 61 Present 6814 - 30th NE Seattle Washington

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16. PAST AND/OR PRESENT MEMBERSHIP IN ORGANIZATIONS

NAME AND ADDRESS TYPE (Social, fraternal, professional, etc.) OFFICE HELD MEMBERSHIP FROM - TO YMCA Yakima, Wash. Yakima Boys Club - Mar 45 Mar 46 Boys Scout of America Boys Club - Mar 45 Mar 46 Pershing Rifles-Univ of Washington Drill Team - Oct 52 Mar 53 BPOE Elk #92 Seattle Fraternal None Apr 58 - Footprinters Intl Fraternal None Nov 62 Present

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17. YES NO X ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF THE COMMUNIST PARTY U. S. A., OR ANY COMMUNIST ORGANIZATIONS ANYWHERE? X ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF A FASCIST ORGANIZATION?

ARE YOU NOW OR HAVE YOU EVER BEEN A MEMBER OF ANY ORGANIZATION, ASSOCIATION, MOVEMENT, GROUP OR COMBINATION OF PERSONS WHICH ADVOCATES THE OVERTHROW OF OUR CONSTITUTIONAL FORM OF GOVERNMENT, OR WHICH HAS ADOPTED THE POLICY OF ADVOCATING OR APPROVING THE COMMISSION OF ACTS OF FORCE OR VIOLENCE TO DENY OTHER PERSONS THEIR RIGHTS UNDER THE CONSTITUTION OF THE UNITED STATES, OR WHICH SEEKS TO ALTER THE FORM OF GOVERNMENT OF THE UNITED STATES BY UNCONSTITUTIONAL MEANS? X ARE YOU NOW OR HAVE YOU EVER BEEN AFFILIATED OR ASSOCIATED WITH ANY ORGANIZATION OF THE TYPE DESCRIBED ABOVE AS AN AGENT, OFFICIAL, OR EMPLOYEE? X ARE YOU NOW ASSOCIATING WITH, OR HAVE YOU ASSOCIATED WITH ANY INDIVIDUALS, INCLUDING RELATIVES, WHO YOU KNOW OR HAVE REASON TO BELIEVE, ARE OR HAVE BEEN MEMBERS OF ANY OF THE ORGANIZATIONS IDENTIFIED ABOVE? X HAVE YOU EVER ENGAGED IN ANY OF THE FOLLOWING ACTIVITIES OF ANY ORGANIZATION OF THE TYPE DESCRIBED ABOVE: CONTRIBUTION(S) TO, ATTENDANCE AT OR PARTICIPATION IN ANY ORGANIZATIONAL, SOCIAL, OR OTHER ACTIVITIES OF SAID ORGANIZATIONS OR OF ANY PROJECTS SPONSORED BY THEM; THE SALE, GIFT, OR DISTRIBUTION OF ANY WRITTEN, PRINTED, OR OTHER MATTER, PREPARED, REPRODUCED, OR PUBLISHED, BY THEM OR ANY OF THEIR AGENTS OR INSTRUMENTALITIES? X

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IF "YES," DESCRIBE THE CIRCUMSTANCES. ATTACH ADDITIONAL SHEETS FOR A FULL DE[illegible]MENT. [illegible] ORGANIZATIONS, SPECIFY NATURE AND EXTENT OF ASSOCIATION WITH EACH, INCLUDING OFFICE OR POSITION HELD, ALSO INCLUDE DATES, PLACES, AND CREDENTIALS NOW OR FORMERLY HELD. IF ASSOCIATIONS HAVE BEEN WITH INDIVIDUALS WHO ARE MEMBERS OF THE ABOVE ORGANIZATIONS, THEN LIST THE INDIVIDUALS AND THE ORGANIZATIONS WITH WHICH THEY WERE OR ARE AFFILIATED.

N/A

This material copied from records of National Personnel Records Center, St. Louis, Missouri, to be used for reference only. Do not recopy or disseminate in its original form outside the Bureau.

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18. HAVE YOU EVER BEEN DETAINED, HELD, ARRESTED, INDICTED OR SUMMONED INTO COURT AS A DEFENDANT IN A CRIMINAL PROCEEDING, OR CONVICTED, FINED, OR IMPRISONED OR PLACED ON PROBATION; OR HAVE YOU EVER BEEN ORDERED TO DEPOSIT BAIL OR COLLATERAL FOR THE VIOLATION OF ANY LAW, POLICE REGULATION OR ORDINANCE (excluding minor traffic violations for which a fine or forfeiture of $25, or less was imposed)? INCLUDE ALL COURT MARTIALS WHILE IN MILITARY SERVICE. [] YES [X] NO IF "YES," LIST THE DATE, THE NATURE OF THE OFFENSE OR VIOLATION, THE NAME AND LOCATION OF THE COURT OR PLACE OF HEARING, AND THE PENALTY IMPOSED OR OTHER DISPOSITION OF EACH CASE.

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DB-Cooper-12003

19. ARE THERE ANY INCIDENTS IN YOUR LIFE NOT MENTIONED HEREIN WHICH MAY REFLECT UPON YOUR LOYALTY TO THE UNITED STATES OR UPON YOUR SUITABILITY TO PERFORM THE DUTIES WHICH YOU MAY BE CALLED UPON TO TA[KE] WHICH MIGHT REQUIRE FURTHER EXPLANATION? ☐ YES [NO] IF "YES," GIVE DETAILS

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20. REMARKS

Employment:

Mar 57 - Present Seattle Police Dept Seattle, Washington Capt Green Present Employer

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"I HEREBY CERTIFY THAT THE ABOVE ENTRIES ARECOMPLETE AND CORRECT TO THE BEST OF MY KNOWL[EDGE] KNOWLEDGE AND INDICATE THAT ANY AND ALL CHANGES THAT HAVE OCCURED SINCE JANUARY 1959"

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CAUTION: SPECIAL HANDLING REQUIRED

This material copied from records of National Personnel Records Center, St. Louis, Missouri, to be used for reference only. Do not recopy or disseminate in its original form outside the Bureau.

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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. I UNDERSTAND THAT A KNOWING AND WILLFUL FALSE STATEMENT ON THIS FORM CAN BE PUNISHED BY FINE OR IMPRISONMENT OR BOTH (See U. S. Code, title 18, section 1001)

DATE SIGNATURE OF PERSON COMPLETING FORM 23 Feb 66 [signature] TYPED NAME AND ADDRESS OF WITNESS Tommy A. Mendoza, 11004 Caraway Drive SW, Tacoma, Washington 98499 21. THIS SECTION TO BE COMPLETED BY AUTHORITY REQUESTING INVESTIGATION

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BRIEF DESCRIPTION OF DUTY ASSIGNMENT AND DEGREE OF CLASSIFIED MATTER (top secret, secret, etc.) TO WHICH APPLICANT WILL REQUIRE ACCESS

Presently Battalion S-1 and Company Commander of HH Co, 2nd Bn, 104th Regiment (AIT), (TOP SECRET - 6A Sep 53)

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RECORD OF PRIOR CLEARANCES

DATE OF CLEARANCE TYPE OF CLEARANCE AGENCY THAT COMPLETED INVESTIGATION Sep 53 TOP SECRET 6th US Army

REMARKS

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DB Cooper-12004