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14-Q0000 104-10117-10075] 2025 RELEASE UNDER THE PRESIDENT JOHN F_ KENNEDY ASSASSINATION RECORDS ACT OF 1992
SUPPLEMENTAL PERSONAL HISTORY STATEMENT
instructions SECTION 1
Answer all questions completely: If question does not apply, write "NA. Write "UNKNOWN" only if you do not
Submit in duplicate. be obtained From personal ` records: If additional space is, requircd use extra pages the same size as this
know-the answer and it cannot
each continued item by ^section and item number to which it relates
page and sign each such page. Reference
2 . DATE OF 0 | RTh 3.PLACE 0f 8 / RTh (city State,Country)i SOc SEC No _
FULL NAME (Tast - first middle ) 460-48-6230
Flores Daniel 09 Aug 1935 Gan Marcos Texas
(Sinele, widowed divorced 0r annuHled) SpEcify: Married So
PRESENT STATUS
STATE DATE PLACE AND REASON For ALL D TVORCES or ANNULMENTS
" "NA
SECTION II.
SPOUSE
middle-maiden) DATE B !RTh 3 _ PLACE 0f 0 |RTh (spouse)
NAME OF SPOUSE 183t - first- G91 'Jar 1935
Portland , Oregon Fiores_ Dorothy
Arnett)ob
0f indicate dat e & P lace
DATE AND PLACE 0F MARR |AGE 5 S}"
na
4ZENS#JT
t zation
SRoUsEef{{fea#e?48.;d,
no . )
18 November 1960
(Lima
9
Peru (0 USA
STAtE DA TE PLACE AND REASON For ALL SEPARAT [ ONS D /VORCES OR ANNULMENTS
"NA"
PRESENT EMPLOYER OCcupAtioN Arnold and Porter 06
Legal Secretary
(No . Street city, Stefe & Zip Code Country if not U.5.)
EMPLOYER 5 Or BUS 1NESS ADDRESS
08
(1229 igth)street NW _ Washington , D.C .
RESTDENCE ( Since date 0 f T8s t PHS if oversea5 residence indicate only city and country)
SECTION T
coun incLus VE DATES month & vea0
ADDRESS LAST RES IdENCE F irst (number street,city,state,- ty) pc Up #
fRom . T 0 -
Ecuador (0 Ma y 1969 May 1971
Guayaquil,
Sept _ 197 Feb . 197-
Lima Peru ) (o
Vienna Va_ 8151 Larkin La Feb 1971_
AND OTHER DEPENDENTS_(Provide informat ion for 0 [ [ children and dependent $ )
SECTION V CHILDREN
ADDRESS
RELAT iONsmip DATE 8 PLACE 0f 8 iRTm citizenshiP 06
NAME
3 March 1911 USA
88151 Larking La
06 Kendra)Flores paughter
Yienna Va Washington,_Dcl
06 zola Marie Flores paughter 15 March 1974 USA
Washington , D.C
F Or M 0 B 5 0 L € TE P R E V | 0u $
12 . 70 444e Ed / T | ON $
(lr
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14-00000 RELATIVESBY__BLOOD, MARRLAGE OR AdoPTION WHO EI THER ) LIvE ABROAD ,
SECT ION V (2) ARE NoT U.s: CITIZENS OR (8) WORK FOR A FOREIGY 'GOVERNMENT
(Laoj FTIUt MiadTe) 2 TepKew;" IP 3 DATfRF BiRTH New %oriefis (City. strLa Country) "GUERRERO Richardd Or
ciT)ZenSHIP (Country) ADDRESS OR CouNtRY in Which RE LATiVE RES IDES
USA Ansbach Germany
EMPLOYED Trny "Beusa?ccontacv 9 mBFcB _ DA TE 117 GONTACT
U.S _
NamE ast-F5c87-MddTe) ~RELATiOnsmip 6ATE OF B iRTH PACE "OF BRTH (City, State, Country)
citizenship (Country) ADDRESS OR COuNTR Y iN Whicm RELATiVE RES IDES
(2
EMPLoyEd BY FREOUENcY OF CONTACT DA TE of LAST CONTACT
NAME (ast-First-Middle) RELATionshiP DATE Of 0irth PLACE Of B IRTH (City, State , Cautry)
citizenship (Country) ADDRESS OR countrY in Which RELATiVE RES IDES
(3)
EMPLO YED BY 8 FREouENcy OF CONTACT 9 DATE 0F LAST CONTACT
SECTion Vi_ PERSONAL DECLARAT I ONS
HAVE You BEEN ArRESTEd indicted OR CONV icTEd For AmY V IOLAT ON of LAw (other han for YES ( explain X No
minor trffic atjon) S INCE THE; .DATE OF Your LAST PhS
2 S INCE THE DATE of Your LAST PhS HAVE ThEre BEEN Any UNFAVORABLE incideNts iN Your LIFE YES (explain X No
which MiGHT REouirE EXPLANAT | ON be[07)
3 NAME 0f Your PRESENT MMED |A TE SUPERV isor (inc lude Room Numbe r and Extens ion) Mr Nestor Sanchez
X745L BM3D30
SECTION VI . PERSONS To BE NOTIFIED In CASE OF EMERGENCY
NAME (Last-First-Mi 2 RELAT iOnship aaame
as previous PHS
3 HOME AddrESs (Number Street city, State , ZIP Code ) HOME TELEPHONE NumBER
Bus NESS ADDRESS (Numbe r , Street _ city, Stete , ZIP Code)- ND ICATE NAME 0F FiRM 6 BuS NESS TELEPHONE NUMBER 8 ExT
or EMPLOYER IF APPLICABLE
IN CASE 0F EMERGENCY OthER CLOSE RELATiVeS (Bpouse mot her , father ) MAY ALSO BE notifiED _ IF such notificATioN
IS NOT DeS iRABLE 8ECAUSE 0F HEALTH OR OtheR REASONS PLEASE DENTiFY THE PERSONS not To BE NotifiED AND THE REASON
SECTion VIi ADDI TIONAL REMARKS
DATE 5 GNATURE 0f EMPLOYEE
'INv
be Jon) %iov
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14-00000
SUPPLEMENTAL PERSONAL HISTORY STATEMENT
NAME (Firef-@iddle- Last ) 2 MaR iTAL Status
JinGL { 0Te R Dantel (nr) 'Floroo
MarRied
3 . Mp Marr i ed 0
~SPOUSE, (First-biddle(5a1don)a4et- 7@oror;
L Moran)loren
0F MARR | Age P7{4e ; OF MARR | AGe
PXs %fovARREAGE 1985-
Por (0
REs DENCE ( Since date 0 f Yes t PBS , JI ovot8800 rebidence indicate onty city country)
SincE (Date) NumBER AND STREET city AND 'StATE
PRESENT' jngust 1961 (2828 Conootiout E.%s Walalngton;. DC,420008
DATE To DATE NumBER AND STrEEt city AND "STATE
~FROM
DATE To DATE NUMBEa.-AnD :StreEt city AND :STATE
FRom
You BEEN ARRESTED ; NdiCTED Sor CONVICTED :For Any; violation 0F Law (other than for YES (Exp ain 5 ~HAVE NO
ninor treffic violat ion) :S1NCE The DATE Of Your .Last PhS be1o5)
Since THE 'DATE OF Your Last PhS HAVE THERE BEEN ANY UNF AVORABLE JNc ! DENTS In Your LIFE Ixsios,xplaid No
Vhich might REouire EXPLANAT ION
0f MMED IATE SUPERV ISOR 0x%s YuR NR5eNGY Ex47276
Add | T | ONAL REmARKS (UBe Tevcr0g 'f necebbary)
DATE GnA7UrE 0F EMPLOYEE
2G Iue /967
ani
Form
4-6 1
444e
JIw
Aoe
RM.osl
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14-00000
SUPPLEMENTAL PERSONAL HISTORY STATEMENT
NAME (Firbt-biddlo-Iast) 2 MaritaL StATUS
JI#OLI OTmiR Daniol (nm) Floree
Mirbued
3.-f MARR | Ed
OF SpouSE (FIrst-blddle( mbiden)- [abt ) OuQorotose <" 'toran)riores
PLacF OF Marr | AGE DaTE Of #MaRr i-AGE
Peru lo 18 Novembor "1960
RES | DENCE Since date 0f Jest PBS if Ovcr8688 rejidonce indicate only.elty.& countfy)
SINCE ( Date) numbER AND STREET_ 05 city^ANd_state
PRESENT August '1961 (2828 Connocticut N.W) Wabhington;. D;C: 20008
DAtE To DATE NumBER AND StrEEt city AND STaTE
FROM
DATE To DatE NUMBER AND Street crty ANd state
From
5 HAVE You BEEN ARrESTED _ AIndicted OR ConviCTED For AnY VIOLATION 0f LaC (other than f0r YES (Explain] No
minor treffic violetion) SINCE Txe DATE OF YoUr Last Phs lbeio8) I
SiNCE THE DATE 0F Your LAST PhS HAVE ThERE BEEN AnY UNFAVORABLE JNcidENTS_ in {OUR @FE '(Explaid io
Which might REquire EXPLANATION
X
NAME 0f PRESENT MMed | ATE SUPERV ISOR Yarzy %uR MaEzonoy EXT-7176 RM.#3051;
Add iT |ONAL REMARKS reveroe nece8barY )
PHS
ATTACHMENTS
Ie
DATE GNsKur E 0F EMPLOYEE
2Mmch [G62 'Lul_
FoRm
4 - 6) 444e
Dhpi
Tina,
Ave . ,
lsis5)
if (Use
AND
LETURN
HEADQUARTERS