Record at Time of Reporting for Active Duty (WD AGO Form 163) with acceptance endorsement - Pvt John Emil List
Document date 16 December 1943
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Id: Cooper-Part-45:039-040
Subject: Cooper Files: Cooper-Part-45:039-040 Document: Record at Time of Reporting for Active Duty (WD AGO Form 163) with acceptance endorsement - Pvt John Emil List Id: Cooper-Part-45:039-040 Page: https://cooper.theunsolved.net/documents/Cooper-Part-45%3A039-040 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 45 pp. 39–40 (DB Cooper-4662–4663), Form, dated 16 Dec 1943 — cooper.theunsolved.net/documents/Cooper-Part-45%3A039-040
To be prepared in DUPLICATE [checkmark] to active duty Recalled to active duty [unchecked]
UNASSIGNED PRC 1632.0.S.U. Fort Sheridan. J[illegible] RECORD AT TIME OF REPORTING FOR ACTIVE DUTY 12-27-[illegible] OF MEMBERS OF RESERVE COMPONENTS
Last name: List First name: John Middle name: Emil Army serial No.: 16177034 Grade: Pvt. Unit: [illegible] Home, station of unit: [illegible] Occupation: Student b6 per NPRC b7C Permanent address: Bay City Bay Michigan Urban [X] Rural [ ] Mother tongue: English Birthplace: [redacted] Mich. Birth date: [redacted]
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EXAMINATION
1. Eye abnormalities: None Vision: W.G. Right eye 20/200/20/20 Left eye 20/200/20/20 2. Ear, nose, throat abnormalities: Mastoidectomy scar, behind right ear, well healed Hearing: Right ear: 20/20 Left ear: 20/20 3. Mouth and gum abnormalities: None 4. Teeth: Right (Examinee's) 8 7 6 5 4 3 2 1 Left 1 2 [3] 4 5-6 7 8 16 15 14 13 12 11 10 9 9 10 11 12 13 14 15 16 (Strike out those that are missing; circle those that may be restored) None Missing 5. Skin: Normal Height: 73 in. 6. Varicose veins: None Weight: 154 lb. 7. Hernia: None Girth (at nipples): Inspiration: 39 in. Expiration: 35 in. 8. Hemorrhoids: None Girth (at umbilicus): 29 in. 9. Genitalia: Normal 10. Feet: Normal Posture: good Frame: med. 11. Musculo-skeletal defects: None Color of hair: brown Color of eyes: brown 12. Abdominal viscera: Normal Complexion: fair 13. Cardiovascular system: Normal Pulse: Sitting: [illegible] 14. Lungs, including X-ray, if made: Normal-X-Ray Chest-Negative After exercise: [illegible] 2 min. after exercise: [illegible] 15. Nervous system: reflexes, pupillary Normal, patellar Normal Blood pressure: Systolic: [illegible] Diastolic: [illegible] 16. Endocrine disturbances: None Urinalysis: Sp. g.: 1.025 17. Results of laboratory examinations, when made: 12-16-43 Kahn test-Negative Albumin: neg. Sugar: neg. Microscopic: [illegible] 18. Remarks on defects not sufficiently described above: None Other data: [illegible] 19. Summary of defects in order of importance, impression of physical fitness: Qualified under MR-1-9.
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CAUTION: [partially illegible] [guess: BINDING REQUIRED] [guess: records of National] [guess: -records of Missouri] This [guess: material] [illegible] -St. Louis [guess: repository] Personnel Records [guess: center] [illegible] only. Do not [guess: reissue] [illegible] to be US [illegible] [guess: phys.] for [guess: outside] [illegible] dissemination [illegible]
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Place "X" in box opposite urban if community of 2,500 population or greater; otherwise place "X" in [illegible] Check block applicable.
W.D., A.G.O. Form No. 163 July 23, 1942
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DB Cooper-4662
*I CERTIFY that I have carefully examined the applicant and have correctly recorded the results of the examination; and that, to the best of my judgment and belief, he is mentally and physically qualified for service in the Army of the United States. [redacted/crossed out] XXXXXXXXXX Qualified under MR-1-9.
RECOMMEND: †Acceptance for active duty. [crossed out text]
Place 1632nd.SU.Ft.Sheridan,Ill. Signature [illegible] Date 16, December, 1943. Name typed or stamped M.D. Hartman .............. Capt. Medical Corps. (Grade)
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[SPACE BELOW FOR USE OF COMMANDING OFFICER] 1st Ind. MGR SU Ft. Sheridan DEC 1 5 1943 (Headquarters) (Place) (Date)
To: The Adjutant General. The person named above having reported for active duty under proper orders was- †Accepted for active duty ......DEC 1 5 1943...... (Date) [crossed out] Returned to [illegible] status for ........................for the reasons shown above. (Number of months or days) Discharged ...................................... for the reason shown above. (Date) I acknowledge receipt of copy of this report this date. b6 per NPRC b7C [illegible signature] R. E. WORZELLA, 1st Lt. AUS 1632 SU (Date) (Signature of enlisted man) Adjutant.
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NEAREST RELATIVE AND PERSON TO BE NOTIFIED IN CASE OF EMERGENCY
Nearest relative ................................................Alma List........................(Name in full) (Other than wife or minor child) Relationship ..mother.............. Address | (Number and street or rural route; if none, so state) (City, town, or post office) (State or country) Person to be notified in case of emergency ......mother...... (Name in full)
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DESIGNATION OF BENEFICIARY
The persons eligible to be my beneficiary are designated below: 1. ....none.... (Full name of wife; if no wife, or if she is deceased or divorced, so state) 2. ....none.... (Full name and address of each minor child, and each dependent child over 21 years of age. [illegible due to stamp overlay])
In the event of my leaving no widow or child, or their decease before payment is made [partially obscured by stamp] as my beneficiary the relative whose name, relationship, and address are shown below: 3. ....Alma List (mother) same as above....
In the event of the death or disqualification of the last-named dependent relative before payment is made, I then designate as my beneficiary the relative whose name, relationship, and address are shown below: 4. ....John List (father) same as mother's....
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SPECIAL COPY CAUTION: records obtained from records St. Louis, [guess: Missouri] official Corps Centre only [illegible] outside [illegible] ...records are [illegible] personal use or [illegible] to [illegible] or [guess: disseminate] or [guess: Bureau]...
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Signature of enlisted man ......[illegible first name]...... E. ............[illegible]............ [guess: List] (First name) (Middle initial) (Last name) Witnessed at ....FORT SHERIDAN, ILL..... DEC 1 5 1943 19....
[illegible signature] R. E. WORZELLA, 1st Lt. AUS 1632 SU.................. Recruiting Officer. (Signature of witness attesting) (Name of witness typed) (Grade and organization)
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This form will be prepared in duplicate, the original copy signed and forwarded to The Adjutant General and the carbon copy forwarded to the commanding general of the service command. The copy will be clearly marked "Copy" in large block overprint letters diagonally across the face of the form. U. S. GOVERNMENT PRINTING OFFICE 16-18787-2 DB Cooper-4663
Serials: 16177034