Part 25, page 379

Transcript

The scan is the source; the transcript is machine-generated from it.

28. HAVE YOU EVER BEEN ARRESTED, CHARGED, OR HELD BY FEDERAL, STATE, OR OTHER LAW ENFORCEMENT AUTHORITIES, FOR ANY VIOLATION OF ANY FEDERAL LAW, STATE LAW, COUNTY OR MUNICIPAL LAW, REGULATION OR ORDINANCE? INCLUDE ALL COURT MARTIALS, WHILE IN MILITARY SERVICE. DO NOT INCLUDE ANYTHING THAT HAPPENED BEFORE YOUR 16TH BIRTHDAY. DO NOT INCLUDE TRAFFIC VIOLATIONS FOR WHICH THE ONLY PENALTY IMPOSED WAS A FINE OF $25.00 OR LESS. ALL OTHER CHARGES MUST BE INCLUDED EVEN IF THEY WERE DISMISSED. [ ] YES [X] NO IF "YES", GIVE DATE AND PLACE, CHARGE, AND DISPOSITION:

[illegible handwritten or typed entries - mostly blank/redacted]

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30. HAVE YOU EVER BEEN PREVIOUSLY GRANTED OR DENIED A SECURITY CLEARANCE BY THE DEPARTMENT OF THE ARMY, NAVY, OR AIR FORCE, BY THE ATOMIC ENERGY COMMISSION OR OTHER GOVERNMENT AGENCY?

a. GRANTED b. DENIED [ ] YES [X] NO [ ] YES [X] NO

31. IF "YES", INDICATE WHEN GRANTED, WHERE, AND BY WHOM; IF DENIED, WHEN AND BY WHOM 32. WHAT WAS THE LEVEL OF THE CLEARANCE?

DNA DNA

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33. REFERENCES (Give five personal references, stating business address of all references, if known. Do not include relatives, former employers, or persons living outside the United States.)

NAME | YEARS KNOWN | STREET AND NUMBER | CITY | STATE

[All rows redacted/blank - content obscured by b6/b7C exemptions]

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34. LIST ALL FOREIGN OWNED CORPORATIONS OR OTHER BUSINESS ORGANIZATIONS IN WHICH YOU ARE AN OFFICER, DIRECTOR, OWNER, OR ACT IN A REPRESENTATIVE CAPACITY. (If none, so indicate).

NONE

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CERTIFICATION

WARNING: Read every sentence of Certification before signing. 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. [illegible date/signature area]

I certify that I am a citizen of the United States.

I certify that I know that any misrepresentation or false state- ment made by me herein may subject me to prosecution under Section 1001 of the United States Criminal Code, with penalties up to five (5) years imprisonment and $10,000 fine.

I certify that I have read and understood each sentence of this Certification.

[Signature area redacted]

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DB Cooper 8449