FormCID Interview Worksheet, ROI 967-76-0643, interview of SSG at Sullivan Barracks3 November 19761 page
fbi_formLegibility: medium

Part 41, page 144

DB Cooper-15024Serials 967-76-0643, SE 164-81-7192

Document date 3 November 1976

Open in FBI Vault (Part 41, page 144 of the PDF)

FBI 164-81, Vault Part 41 p. 144 (DB Cooper-15024), Form, dated 3 Nov 1976 — cooper.theunsolved.net/parts/Cooper-Part-41/pages/144

Places

5/68th ArmorSullivan Barracks, APO NY 09086

Dates mentioned

0830//3 Nov 760915//3 Nov 7619 Nov 781967-76-0643Feb 79NOV 24 1976

Transcript

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

INTERVIEW WORKSHEET CID Regulation 195-7 SECTION A - PERSONAL DATA ON PERSON INTERVIEWED

1. NAME (Last, First, Middle): [redacted] 2. ROI/SEQ NO. (Include Primary Offense Code): 967-76-0643 1st Information Report 3. ALIASES/NICKNAMES: None 4. ORGANIZATION/ADDRESS: Co A, 5/68th Armor Sullivan Barracks, APO NY 09086 Tele: MH-823 5. MCAC: E1 6. SEX: M 7. RACE: Cauc 8. GRADE: SSG 9. DOB (Yr, Mo, Day): [redacted] 10. POB (City, State): [redacted] 11. SSN: [redacted] 12. FORMER SERVICE NO.: [redacted] 13. HT: 69 14. WT: 170 15. HAIR: Br 16. EYES: Br 17. IDENTIFYING MARKS: None 18. SECURITY CLEARANCE: SECRET 19. MOS: [redacted] 20. DUTY ASSIGNMENT: Tank Commander 21. ACTION TAKEN: YES [checked] NO [] NA [checked] 22. INTERVIEWEE RELATIONSHIP TO CASE: SUSPECT [] SUBJECT [] VICTIM [] WITNESS [X] 23. OFFENSE CODES RELATING TO INDIVIDUAL ONLY: [redacted]

SECTION B - OPTIONAL 24. PERMANENT HOME ADDRESS: [redacted] 25. TELEPHONE: OTR 26. ETS: 19 Nov 78 27. DEROS/PCS: Feb 79 28. CITIZENSHIP (Req No.): US 29. MARITAL STATUS: Married 30. PASSPORT NUMBER: None 31. EDUCATION LEVEL: HS Grad 32. KNOWN FRIENDS/ACQUAINTANCES: [redacted] 33. VEHICLE DATA: [redacted] 34. OFFENSE(S) UNDER INVESTIGATION: Hijacking 35. DATE, PLACE, TIME INTERVIEW BEGAN: 0830//3 Nov 76//CID Office 36. RIGHTS READ AND EXPLAINED BY: [redacted] 37. COUNSEL REQ/PRESENT (Full Name): [redacted] 38. WRITTEN STATEMENT TAKEN: YES [] NO [X] 39. LINEUP USED: YES [] NO [X] 40. POLYGRAPH REQUESTED: YES [] NO [X] 41. PERSON FINGERPRINTED: YES [] NO [X] 42. CO NOTIFIED (Date and Name): N/A 43. CRD CHECK (If Yes, give Date): YES [] NO [X] 44. INTERVIEW CONDUCTED BY: SA [redacted] 45. TIME AND DATE TERMINATED: 0915//3 Nov 76 46. DISPOSITION OF INTERVIEWEE: Released to duty

REMARKS: [redacted/illegible]

164-81-7192 SEARCHED [checked] INDEXED [checked] SERIALIZED [checked] FILED [checked] NOV 24 1976

CID FORM 14 1 FEB 76 PREVIOUS EDITIONS OF THIS FORM ARE OBSOLETE. DB Cooper-15024