Part 26, page 39
Document date 17 December 1970
FBI 164-81, Vault Part 26 p. 39 (DB Cooper-7192), Form, dated 17 Dec 1970 — cooper.theunsolved.net/parts/Cooper-Part-26/pages/39
Transcript
The scan is the source; the transcript is machine-generated from it.
Standard Form 86 AUGUST 1964 U.S. CIVIL SERVICE COMMISSION (F.P.M. CHAPTER 7X) 86-76
SECURITY INVESTIGATION DATA FOR SENSITIVE POSITION
CASE SERIAL NO. (CSC use only)
INSTRUCTIONS.--Prepare in triplicate, using a typewriter. Fill in all items. If the answer is "No" or "None," so state. If more space is needed for any item, continue under item 28.
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1. FULL NAME LAST NAME FIRST NAME MIDDLE NAME [redacted - b6 Per BOC]
(Initials and abbreviations of full name are not acceptable. If no middle name, show "(NMN)"; if initials only, show "(io given, or middle name)")
OTHER NAMES USED. (Maiden name, names by former marriages, former names changed legally or otherwise, aliases, nicknames, etc. Specify which, and show dates used) [redacted - b7C Per BOC]
2. DATE OF BIRTH [redacted - b6 Per BOC]
3. PLACE OF BIRTH [redacted - b7C Per BOC]
4. [X] MALE [ ] FEMALE
5. HEIGHT: 70" WEIGHT: 200 COLOR EYES: Bl COLOR HAIR: Br
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6. [ ] SINGLE [X] MARRIED [ ] WIDOW(ER) [ ] DIVORCED
7. IF MARRIED, WIDOWED, OR DIVORCED, GIVE FULL NAME AND DATE AND PLACE OF BIRTH OF SPOUSE OR FORMER SPOU[SE] WIFE'S MAIDEN NAME. GIVE DATE AND PLACE OF MARRIAGE OR DIVORCE. [redacted - b6 Per BOC] [redacted - b7C Per BOC]
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8. DATES AND PLACES OF RESIDENCE. (If actual places of residence differ from the mailing addresses, furnish and identify both and go back to January 1, 1937. Continue under item 28 on other side if necessary.)
Begin with present
FROM TO NUMBER AND STREET CITY STAT[E] 11/01/70 Present b6 Per BOC 07/68 10/70 05/68 07/68 09/67 04/68 11/66 09/67 04/66 11/66 04/65 04/66 03/65 04/65 01/64 03/65 11/63 01/64 11/60 11/63 10/60 11/60
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9. [X] BY BIRTH [ ] NATURALIZED ALIEN REGISTRATION NO. DATE, PLACE, AND COURT [X] U.S. CITIZEN CERT. NO. PETITION NO. [ ] DERIVED-PARENTS CERT. NO(S). [ ] ALIEN REGISTRATION NO. NATIVE COUNTRY DATE AND PORT OF ENTRY
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10. EDUCATION. (All schools above elementary.) NAME OF SCHOOL ADDRESS FROM (Year) TO (Year) DEGREES [redacted - b6 Per BOC] [redacted - b7C Per BOC]
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11. THIS SPACE FOR FBI USE. (See also item 29.)
12. SOCIAL SECURITY NUMBER [redacted - b6 Per BOC]
13. MILITARY SERVICE (Past or present) SERIAL NO. BRANCH OF SERVICE (If none, give grade or rating (Army, Navy, Air Force, etc.) FROM (Yr.) TO (Yr.) at separation) [redacted] Marine Corps 1951 1970 b6 Per BOC
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DB Cooper-7192