Part 36, page 50
Document date 5 April 1954
FBI 164-81, Vault Part 36 p. 50 (DB Cooper-10278), Form, dated 5 Apr 1954 — cooper.theunsolved.net/parts/Cooper-Part-36/pages/50
Transcript
The scan is the source; the transcript is machine-generated from it.
V.A. FORM 3101 MPRO NOV. 1948 REQUEST FOR ARMY INFORMATION WO AGO FORM 53 SERIES RECE[IVED] E[.] NO 214 708 00 [illegible] LOCATION OF REQUESTING OFF[ICE] ORGANIZATION DATE
VAO, Des Moines 9, Iowa Adjudication 40338B 4-5-54
If VA entry is correct, enter "c" in corresponding WD box; if not, make correct entry.
To be completed by Veterans Administration To be completed by War Department 1. LAST NAME - FIRST NAME - MIDDLE INITIAL 1. LAST NAME - FIRST NAME - MIDDLE INITIAL BOOTON, John D 2. ARMY SERIAL NO. 3. C. NO. 2. ARMY SERIAL NO. 3. C. NO. RA 31 292 092 c. 1815 41 43 4. CONVERTED INS. NO. 5. NAT. SER. LIFE INS. NO. 4. CONVERTED INS. NO. 5. NAT. SER. LIFE INS. NO. K. N. K. N. 6. DATE(S) OF ENTRY INTO ACTIVE SERVICE 6. DATE(S) OF ENTRY INTO ACTIVE SERVICE 7. DATE(S) OF DISCHARGE(S) OR RELEASE FROM ACTIVE SERVICE 7. DATE(S) OF DISCHARGE(S) OR RELEASE FROM ACTIVE SERVICE 8. CHARACTER OF DISCHARGE(S) 8. CHARACTER OF DISCHARGE(S) 9. LAST GRADE AND ORGANIZATION 9. LAST GRADE AND ORGANIZATION 10. DATE OF DEATH 11. PLACE OF LAST DISCHARGE 13. DATE OF DEATH 11. PLACE OF LAST DISCHARGE 12. HOME ADDRESS 12. HOME ADDRESS
CAUTION: SPECIAL HANDLING REQUIRED 13. DATE OF BIRTH 14. PLACE OF BIRTH 13. DATE OF BIRTH 14. PLACE OF BIRTH [illegible] from records of [illegible] ALLEGED DISEASE OR INJURY [illegible] reference only. Do not recopy *See below or disseminate in its original form outside the Bureau[illegible] HOSPITAL OR INFIRMARY
ORGANIZATION WITH WHICH SERVING SIGNATURE KENNETH L. MARPLE, Adj. Officer
ADDITIONAL INFORMATION Please furnish entire recordseries.
* Oct-Nov 1951 – Army Hosp, Sapare, Japan – hernia
*(1) USAR, Camp Polk, La., 30 Jan-5 Feb 51 (1) USAR, 8165 AU, APO 309, 8-26 Nov 51 (1) USAR, Ft1 Leavenworth, Kans., 23-29 Dec 52 **(1) USES Gen Pope, 11-15 Apr 51
COPIES ORIGINALS (LOANED) OTHER RECO[RDS] PHYS. EXAM. AT ENTRANCE OTHER [illegible] * 1 Headquarters [illegible] CARDS FIELD MEDICAL M MEDICAL 1 FINAL PHYS. EXAM. TAGS FIELD [illegible] DENTAL M p/s [illegible] ent DATE BY APR 2 2 197[4] Wm. E. F[illegible] CES/Sec I, 74-2 [illegible] USA
DB Cooper-10278