Part 41, page 74

Transcript

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

19. ARE THERE ANY INCIDENTS IN YOUR LIFE NOT MENTIONED HEREIN WHICH MAY REFLECT UPON YOUR LOYALTY TO THE UNITED STATES OR UPON YOUR SUITABILITY TO PERFORM THE DUTIES WHICH YOU MAY BE CALLED UPON TO TA[KE] WHICH MIGHT REQUIRE FURTHER EXPLANATION? ☐ YES [NO] IF "YES," GIVE DETAILS

---

20. REMARKS

Employment:

Mar 57 - Present Seattle Police Dept Seattle, Washington Capt Green Present Employer

---

"I HEREBY CERTIFY THAT THE ABOVE ENTRIES ARECOMPLETE AND CORRECT TO THE BEST OF MY KNOWL[EDGE] KNOWLEDGE AND INDICATE THAT ANY AND ALL CHANGES THAT HAVE OCCURED SINCE JANUARY 1959"

---

CAUTION: SPECIAL HANDLING REQUIRED

This material copied from records of National Personnel Records Center, St. Louis, Missouri, to be used for reference only. Do not recopy or disseminate in its original form outside the Bureau.

---

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. I UNDERSTAND THAT A KNOWING AND WILLFUL FALSE STATEMENT ON THIS FORM CAN BE PUNISHED BY FINE OR IMPRISONMENT OR BOTH (See U. S. Code, title 18, section 1001)

DATE SIGNATURE OF PERSON COMPLETING FORM 23 Feb 66 [signature] TYPED NAME AND ADDRESS OF WITNESS Tommy A. Mendoza, 11004 Caraway Drive SW, Tacoma, Washington 98499 21. THIS SECTION TO BE COMPLETED BY AUTHORITY REQUESTING INVESTIGATION

---

BRIEF DESCRIPTION OF DUTY ASSIGNMENT AND DEGREE OF CLASSIFIED MATTER (top secret, secret, etc.) TO WHICH APPLICANT WILL REQUIRE ACCESS

Presently Battalion S-1 and Company Commander of HH Co, 2nd Bn, 104th Regiment (AIT), (TOP SECRET - 6A Sep 53)

---

RECORD OF PRIOR CLEARANCES

DATE OF CLEARANCE TYPE OF CLEARANCE AGENCY THAT COMPLETED INVESTIGATION Sep 53 TOP SECRET 6th US Army

REMARKS

---

DB Cooper-12004