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PLACE OF REPORT
rowM F>":~o DEPARTMENT OF STATE
•':o'ot FORL~ItiN SERVICE OF THE UNITED STATES OF AMERICA !r~ v ~~~ j
REPORT OP dIRTM ABROAD DATE OF REPORT
Of A CITIZEN Of THE UNITED STATES Of AMERICA ~ ~9 ~~a
NAME OF CNILO IN FULL SEX '
r
GATE OF •IRTN ( . ~ PLACE OF OIRTN IN FUL
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THE FOLLOWING ITEMS MUST OE COMPLETED FOR BOTH FATHER ANO IIOTNERt i
ITEM MOTHER
FATHER
BULL NAME
Paul Hanataaod Tltal^ar Jr. (~(pb•~• ~~ ~ J~o~ulaaa
DATE OF sIRTN 1e ~~ ,e~
PLACE OF YIRTN 1'j0A0~9rt• K~1fi,11
5~ ~g PRESENT ADORES: ~4~ Vim 8~iis0
~7 a~~~ ~h ADDRESS IN UNITED STATES
EVIDENCE OF U.S. CITIZENSHIP 8 p~ ~7`~3 1i~d qtr
li ALIEN. SNO7t NATIONALITY `J~
US D3rtb CaYtifioatA (~ ~°~~~ ~'~~'°"O~'~"~"""'~« * Il 1 ~
p,L PRECISE PERIODS OF PHYSICAL
~74~ .. ~~T PRESENCElMUNITEDSTATES 79~ + ~~~
PRECISE PERIODS OF ANY fERViCE /
ABROAD IN THE ARMED FORCES OF R ,
7~T • presQnt THE UNITED STATES _
PLACE OF MARRIAGE DATE OF MARRIAGE ~_
SI
(NNEN REPORTED sY MAn. USE THIS FORM)
Subscribed and axon to ba[oro me this '~-
dap of • 1~-'
at
(SEALI oNhf
ADDRESS
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(rNEN REPORTED IN PERSON. USE TNIf FORM)
Sabscribed and srron to before me tkis
dap of . 19
at
of the United Stites
of America
(SEAL)
A11Ea1CAIi CONSDLATE dE~gsj,
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The iafo~faiiaa WAS lii~i' V -ed Bother. ppoonnee
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br tke docs~aataXsted beYoF. mss. s been
seat of Stet+. Ilalji~~ts.+r.-: ~
Doca~eats s~2)ie{s Nhmsilmmton. W.WM. • ~~..-
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(SEAL) " '- , ~,- ~'~~~ , ,'' v~~•
`~ ~ !d ~ • f ~•~ Ydam ~a1i1 of the Gaited Sates of America.
(No fee prestx~
FORMAPPROVtO ~-•"•_ BOOK PAUL 3W
aY04tT aYRaAU NO. 4T~R1ts:1