Blank Personal Data Memorandum, Agricultural Adjustment Administration

Form No. A. A. A. 83 Revised June 1935 UNITED STATES DEPARTMENT OF AGRICULTURE AGRICULTURAL ADJUSTMENT ADMINISTRATION WASHINGTON, D. C. PERSONAL DATA MEMORANDUM (Whenever necessary, write additional information on separate sheet. Your own handwriting is preferred; do not use pencil unless it is indelible pencil. The information given in this memorandum will be treated as confidential. The department reserves the right to verify statements made on this form, and report to the Civil Service Commission or other government agency any misstatement or untruth) Date 1. Name 2. Address 3. Telephone no. 4. Date of birth 5. Place of birth If foreign born, state when and how naturalized 6. Legal residence 7. If now residing in the District of Columbia, how long have you been so residing? 8. Indicate sex, marital condition, and race by mark, thus (x) SEX MARITAL CONDITION RACE (if other, state which) MALE FEMALE SINGLE MARRIED DIVORCED WIDOWED WHITE COLORED 9. If a woman who has been married, state maiden name 10. If married, give occupation and salary of spouse 11. Number of persons, other than yourself, wholly dependent on you for support 12. Are you physically defective in any way? 13. What is the present state of your health? 14. Do you use opiates? If so, which, and to what extent? 15. If in the Federal service now, please answer following questions in detail. Your name as shown above should be identical with that written on present appointment. (a) Designation (b) Salary (c) Department (d) Bureau or division (e) Name, title, and address of immediate superior TRUMAN, ARCHIVES& CATIONAL RECORDS DMIN' (f) Will your bureau or department consent to your transfer, complying with all existing regulations COVERAGERY 8-8510