Part 17, page 309
FBI 164-81, Vault Part 17 p. 309 (DB Cooper-5139), Form — cooper.theunsolved.net/parts/Cooper-Part-17/pages/309
Transcript
The scan is the source; the transcript is machine-generated from it.
[FOIA exemption markers: b6, b7C]
ADULT [guess: IDENTIFICATION] FORM
Check Only One Please [illegible] Date [illegible] [redacted fields]
[illegible] CAFE [illegible]
[redacted personal information blocks]
How did you learn of this [illegible]: (Check Only One) [checkbox] [illegible] of [illegible] [checkbox] [illegible] Article [checkbox] [guess: Magazine Article] [checkbox] [illegible] [checkbox] [illegible] [checkbox] [illegible] [checkbox] Other [illegible]
[illegible] only [illegible] and individually or otherwise do- [illegible] 4, and [illegible] $ [illegible]
[redacted block]
How did you learn of this [illegible]: (Check Only One) [illegible] [checkbox] "A Sport Is Born" [guess: Article] [checkbox] Magazine Article [checkbox] [guess: Newspaper Show schedule] [checkbox] Review/Report/Ad [checkbox] World Chart/Mailing List [checkbox] Friend (verbal) [illegible] [checkbox] Word of Mouth [checkbox] Other [illegible]
HOW DID YOU TRAVEL TO CONTACT? [checkbox] Phone [checkbox] M Car [checkbox] Bus [checkbox] Other [illegible]
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[FOIA exemption markers: b6, b7C]
PREVIOUSLY CONTRIBUTED CONTACT
ADULT REGISTRATION FORM
Check Only One Please [illegible] [illegible] [checkbox] [illegible] [checkbox] [guess: Printed] [illegible] [checkbox] [illegible] [checkbox] [illegible]
[guess: Country] Club or give name of: [illegible] A[illegible] [checkbox] [illegible] [checkbox] [guess: Enclosed]
Other [illegible] [illegible]
[redacted personal information blocks]
[illegible] [illegible]
How did you learn of this [illegible]: (Check Only One) [illegible] [checkbox] "A Sport Is Born" [guess: Article] [checkbox] Magazine Article [checkbox] [guess: Newspaper Show schedule] [checkbox] Review/Report/Ad [checkbox] World Chart/Mailing List [checkbox] Friend (verbal) [illegible] [checkbox] Word of Mouth [checkbox] Other [illegible]
HOW DID YOU TRAVEL TO CONTACT? [checkbox] Phone [checkbox] M Car [checkbox] Bus [checkbox] Other [illegible]
INADEQUATE PROCESSING TRAINING AND SORTING
[illegible] are asked to [illegible] not under treatment for any physical information or chronic ail- ments [illegible] have normal vision or have corrective lenses, and that I have [illegible] [illegible] [illegible] [illegible] [illegible] [illegible] [illegible] [illegible] [illegible] [illegible]
4.) Nervous disorder 5.) [illegible] 6.) Diabetes 7.) Kidney or related diseases
Date: 3-1-71
[illegible] TURNS THIS SIDE -- TURNS [guess: THIS] OVER -- READ AND COMPLETE ON THIS SIDE
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DB Cooper-5139