Part 114, page 41
Document date 1 August 1945
FBI 164-81, Vault Part 114 p. 41 (DB Cooper-10663), Form, dated 1 Aug 1945 — cooper.theunsolved.net/parts/Cooper-Part-114/pages/41
Transcript
The scan is the source; the transcript is machine-generated from it.
52. REMARKS ON ITEMS NOT SUFFICIENTLY DESCRIBED:
(12) Cont'd---No hospitalization required:
(C)T and A 1940.
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SUMMARY
53. CORRECTIVE MEASURES OR OTHER ACTION RECOMMENDED Repair of cavious teeth
54. IS INDIVIDUAL PERMANENTLY INCAPACITATED FOR GENERAL SERVICE? YES [ ] NO [X] LIMITED SERVICE? YES [ ] NO [ ]
55. IF INCAPACITATED FOR GENERAL OR LIMITED SERVICE STATE REASON [blank]
56. APPOINTMENT IS RECOMMENDED [X] RECOMMENDED WITH MINOR DEFECTS [ ] NOT RECOMMENDED [ ]
57. IF APPOINTMENT IS NOT RECOMMENDED, STATE REASON [blank]
58. ACCORDING TO EXAMINEE'S STATEMENT IS (S)HE DRAWING A PENSION, DISABILITY ALLOWANCE, OR OTHER COMPENSATION OR RETIRED PAY FROM THE U.S. GOVERNMENT? YES [ ] NO [X]
59. IF ANSWER TO 58 IS YES, STATE DISABILITY [blank]
60. ACCORDING TO EXAMINEE'S STATEMENT HAS (S)HE EVER BEEN DISQUALIFIED FOR MILITARY SERVICE OR SEPARATED THEREFROM FOR PHYSICAL DISABILITY, OR BEEN REFUSED LIFE INSURANCE? YES [ ] NO [X]
61. IF ANSWER TO 60 IS YES, STATE REASON [blank]
62. DATE OF EXAMINATION 6 Aug 1946
63. TYPED NAME AND GRADE W N [guess: JENSEN], CAPT. M.C.
64. SIGNATURE (SIGN ORIGINAL ONLY) [signature present]
65. PLACE OF EXAMINATION Ft. Lewis, Wn.
66. TYPED NAME AND GRADE K T [guess: AITCHELL], CAPT. M.C.
67. SIGNATURE (SIGN ORIGINAL ONLY) [signature present]
68. TYPED NAME AND GRADE J H [guess: MCCOY] 1st LT M.C.
69. SIGNATURE (SIGN ALL COPIES) [signature present]
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1st INDORSEMENT
70. DATE [blank]
71. REMARKS [blank]
72. FROM [blank]
73. TO [blank]
74. ORGANIZATION AND ARM OR SERVICE [blank]
75. GRADE [blank]
76. SIGNATURE [partially visible, mostly blank]
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DB Cooper-10663
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State action taken on recommendation of board. [illegible] incapacitated for active service state whether action by retiring board is recommended. 16-43000-1 ☆ GPO