Part 114, page 33
Document date 11 July 1952
FBI 164-81, Vault Part 114 p. 33 (DB Cooper-10655), Form, dated 11 Jul 1952 — cooper.theunsolved.net/parts/Cooper-Part-114/pages/33
Transcript
The scan is the source; the transcript is machine-generated from it.
51. FORMER SPOUSE NAME OR FORMER SPOUSE (Last or maiden name, first name, middle name): [guess: Cardoner] [guess: Patsy] [illegible] DATE AND PLACE OF MARRIAGE: [illegible] [guess: 1948] [guess: Hattiesburg] [illegible] DATE OF BIRTH: [guess: 1922] PLACE OF BIRTH (City, State, and country): Unknown [X] LIVING [ ] DECEASED DATE OF DIVORCE OR DEATH: 15 JUNE 1943 PLACE: Hattiesburg Mi[guess: ss].
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52. CHILDREN SEX | NAME | AGE | FULL ADDRESS | OCCUPATION NONE b6 per FBI b7C per FBI
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53. DEPENDENTS SEX | NAME | RELATIONSHIP | AGE | DEGREE OF DEPENDENCY NONE
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54. HAVE YOU EVER BEEN ARRESTED, INDICTED, OR CONVICTED FOR ANY VIOLATION OF LAW, OTHER THAN A MINOR TRAFFIC VIOLATION? [ ] YES [X] NO. IF SO, STATE THE NAME AND PLACE OF COURT, NATURE OF OFFENSE, DATE, AND DISPOSITION OF CASE [illegible — response area heavily degraded]
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55. ARE THERE ANY UNFAVORABLE INCIDENTS IN YOUR LIFE NOT MENTIONED ABOVE WHICH YOU BELIEVE MAY REFLECT UPON YOUR LOYALTY TO THE U.S. GOVERNMENT OR UPON YOUR ABILITY TO PERFORM THE DUTIES WHICH YOU WILL BE CALLED UPON TO UNDERTAKE? [ ] YES [X] NO. IF SO, DESCRIBE (If additional space is necessary, use Remarks.) [illegible — response area heavily degraded with significant noise]
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56. NOTIFY IN CASE OF EMERGENCY (Give name, relationship, and address) Ann Catherine Miles [guess: Niso] 242 Covina Ave. Long Beach-3-Calif.
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I CERTIFY THAT THE FOREGOING ANSWERS ARE TRUE, CORRECT, AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF AND IN SIGNING THIS CERTIFICATE I DO SO WITH THE UNDERSTANDING THAT THE VERACITY OF ALL STATEMENTS MADE HEREIN WILL BE INVESTIGATED AND IF FOUND INCORRECT, INCOMPLETE, OR MISLEADING IN ANY PARTICULAR I MAY BE RELIEVED OF MY ASSIGNMENT AND SUCH OTHER DISCIPLINARY ACTION TAKEN AS MAY BE APPROPRIATE.
(DATE): 9 Feb 1949 (SIGNATURE): [illegible handwritten signature — possibly "[guess: Douglas] D. [guess: Duley]"] (WITNESS): [illegible handwritten signature]
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10-52040-1 DB Cooper-10655