HomeMy WebLinkAbout07-20-07
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LAW OFFICES
MARLIN R_ McCALEB
IN RE: ESTATE OF HYUNG JOO
BAIR, LATE OF SILVER
SPRING TOWNSHIP,
CUMBERLAND COUNTY,
PENNSYLVANIA,
DECEASED
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS COURT DIVISION
ESTATE NO. 21-06-0004
REPORT PURSUANT TO ORPHANS' COURT RULE 13.3
The body of Hyung Joo Bair, a 66-year old Korean woman,
was found on the floor of her home at 76 North Old Stonehouse
Road, Silver Spring Township, on December 5, 2005, by her
friend, Soon Hun Kang. The Cumberland County Coroner was
notified and as the result of his investigation, he estimated
that she died on December 2, 2005. His investigation also
failed to uncover any evidence of a will or any evidence to
identify or locate next-of-kin.
Letters of Administration were issued by the Register of
wills of Cumberland County, Pennsylvania, to the undersigned on
January 3, 2006. Thereafter, the undersigned commenced an
investigation to identify and locate the decedent's next-of-
kin. The first step was a thorough search of decedent's
residence, which yielded the following written records:
1. Provisional Family Register dated August 7, 1959
(Exhibit A) i
2. Visa Application Form dated December 11, 1959 (Exhibit
B) i
3. Questionnaire and Application for Quota Registration
dated December 15, 1961 (Exhibit C) i
4. Passport issued by the Republic of Korea on January
14, 1960 (Exhibit D) i
5 .
Certificate of Naturalization dated June 3, 1969
(Exhibit E) i
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Copy of a Complaint in Divorce filed by Clayton W.
Bair, Jr., Plaintiff, against Hyung Joo Bair,
Defendant, in the Court of Common Pleas of Cumberland
County, Pennsylvania, to No. 1066 September Term,
1974, together with Notice of a Master's Hearing on
November 8, 1974, and Notice of the filing of the
Master's Report on November 12, 1974 (collectively,
Exhibit F) .
o
C'
From the foregoing documents, it appears that the decedent
was born on July 13, 1939, in what is now Sinuiju City, North
Korea. All that is known of her father is his surname: MOON.
Her mother was Ssi KIM. In the Family provisional Register
dated August 7, 1959 (Exhibit A), the decedent reported that
both of her parents were deceased. In the Visa Application
Form dated December 11, 1959 (Exhibit B), she repeated that
both her parents were deceased and she stated that she had no
siblings or children.
The decedent married Clayton W. Bair, Jr., on December 11,
1959, in Seoul, Korea. Mr. Bair, a resident of Cumberland
County, was at that time a member of the U. S. Army stationed
in Korea. When he was transferred back to this country, the
decedent came with him; she entered the country through Hawaii
on December 31, 1961. Ultimately, they made their home in
Cumberland County.
On June 3, 1969, the decedent became a naturalized citizen
of the United States (Exhibit E) .
On August 30, 1974, Mr. Bair commenced an action in
divorce against the decedent (Exhibit F). The Notes of
Testimony from the Master's Hearing on November 8, 1974,
reflect that the decedent did not appear, but Mr. Bair appeared
and testified. He confirmed the limited information about the
decedent's parents. He also testified that there were no
children born of his marriage to the decedent. The parties
were divorced by Decree dated December 2, 1974. There is no
evidence that the decedent ever again married. (Note: Mr.
Bair died on August 3, 2002, and except as provided above, he
was not a source of information).
LAW OFFICES
MARLIN R. McCALEB
The undersigned contacted the Korean Consulate in New York
City for assistance in obtaining information about the
decedent's family background. The first contact was a fax
transmission on January 23, 2006 (Exhibit G). That resulted in
telephone calls from Hae Cho, a staff member of the Consulate,
on January 25 and 31, 2006. She explained that in Korea,
hospitals do not issue birth certificates or provide birth
information. It is the responsibility of the family to report
the birth to the Family Census Registry, which compiles and
maintains such information. The reported information could
include the names of parents and siblings; marriages can
subsequently be entered, along with information about the in-
laws. However, the responsibility to report is on the family
and if nothing is reported, nothing is recorded. She further
reported that they searched the Family Census Registry under
the name of "Hyung Joo Moon" and found only the information
shown on Exhibit A, which was entered by the decedent in
August, 1959, apparently in preparation for her marriage and
visa application. A subsequent request, on March 28, 2006,
seeking written confirmation of this information, resulted in a
-2-
letter from the Consul, dated June 19, 2006 (Exhibit H),
reporting that because of "privacy protection regulation", they
cannot provide information on decedent's next-of-kin.
The undersigned contacted the International Commission for
the Accreditation of Professional Genealogists (ICAPGen) and
the Association of Professional Genealogists (APG) for
assistance in locating a genealogist experienced in Korean
genealogy, but neither organization could provide a member with
such experience. The undersigned also spoke by telephone with
the Family History Library sponsored by ICAPGen, but they were
also unable to help.
The undersigned filed a request with the U. S. Citizenship
and Immigration Services of the U. S. Department of Homeland
Security, pursuant to the Freedom of Information Act (FOIA) (5
U. S. Code 552) to obtain copies of the decedent's immigration
records. That request was answered by letter dated May 17,
2007 (Exhibit I).
The undersigned also contacted the decedent's former
employer, Iceland Seafood Corporation, for whom she worked
until 1999, but the company had discarded her personnel
records.
Lastly, the undersigned, through staff, spoke with those
personally acquainted with her, including Soon Hun Kang, her
good friend; Chong Horowitz, an acquaintance; Marsha Johnson,
her former sister-in-law; Kwi-Ae Alexander, of the Korean
American Wives Association; and John Kauffman, her neighbor.
Mrs. Kang said that she and her husband met the decedent
when they came to this country 27 years ago. She introduced
them to the Korean community, helped them obtain jobs and learn
the language. She considered the decedent a very good friend
with whom she visited regularly (every couple of days). The
decedent told them she had no living relatives here or in
Korea.
Marsha Johnson, sister of Clayton W. Bair, Jr., said that
her brother told the family that the decedent was an orphan
with no living relatives. The decedent never spoke of family
or relatives. Mrs. Johnson also said that the decedent never
had any visitors from Korea, nor did she ever return to Korea.
Chong Horowitz met the decedent many years ago but had not
had any recent contact with her. As far as she knows, the
decedent had no living relatives.
Mrs. Alexander knew of the decedent through Mrs. Kang and
LAW OFFICES
MARLIN R. McCALEB
-3-
Mrs. Horowitz but did not have a personal relationship with
her. She always understood from what she was told that the
decedent had no relatives.
Mr. Kauffman said that the decedent never spoke about
family or friends. She lived by herself since she bought her
home in 1977. He described her as rather reclusive; she owned
a car but seldom left the house except to shop for food or
clothing.
From all of the foregoing, the undersigned concludes that
the decedent died intestate without any surviving relatives
within the relationships described in Section 2103(1) through
(5) of the Probate, Estates and Fiduciaries Code (20 Pa.C.S.A.
2103(1) through 2103(5)), so that the Commonwealth of
Pennsylvania becomes the statutory heir pursuant to subsection
(6) thereof.
I understand that false statements herein are made
to the penalties of 18 Pa. ~C.S., Section 4904, relating
unsworn falsification to auth 'ies,~~ .
Date: July 20, 2007 ~ . ~
Marlin R. McCaleb
Administrator
subject
to
LAW OFFICES
MARLIN R. McCALEB
-4-
EXHIBIT A
(English Translation copy of the Korean' Original. Provisional Family Regiater)
WARD OFFICE
CHUIG-KU, SEOUL cm
KOREA
PROVISIONAL FAMn.Y RliJ}ISTER DATED ISSUED: August 7, 1959
Provisional Domic11e: 152 1st St., U1ji-Ro, <hung-Ku, Seoul, Korea
'.
*FORMER HEAD
: MOON, Unknown middle or first name. (Deceased)
:V MOON. Hl'UIlIl J 00
: HOON, UDk. first or middle name (Deceased)
: KIM, 58i (Deceased)
: 1st Daughter
Namp1\1D1
: Ju17 13, 1939
*PRESENT HEAD
Father
Mother
Order 0 f Birth
FEUy Origin
Date of Birth
Description:
Born at #UDknolm No.8ima-Do~, Sin1lft1i-Ju-City.
Headship sucoeeded on the death of former head. MOON, (Unk. first er
middle Name) on April 3, 1942, thereof reg istered.
According to the Ordinance No. 179 (Permanep.t Address Oriana1.:q
registered a8 ot Unknown No. Sunha..-Dong, Sinuiju-C1ty), repoJ't.ed. and
received on Augu,st 7" 1959, thereof registered.
'Ibis is to certify that the above stateDBDI; is a tUll, true and
correct copy to the Korean OriginaJ.Prov1s1ona1 Fami.q' Register Permamntly
filed with this Oftice.
/s./ _ -4 (Q.fficial Sealed)
KIM, INBAE
Chief of Chung-Ku Ward Office,
Special Cit., 0 f Seoul, Korea
~~~Y'-~ ~~.. .' ~~\
"~. .HO E, 00: BkG S&R_' ---. .~
Speci City ot Seoul, Korea ~~
On this 4th day of Newember, 1959.
K ~ ~ .~ ~~-~~.r-
.r-I 0 U S E,_(.w)~tfmG~M71~t52.(lfi$:t~~)
M P jONG BANG SERV I CE
. ARRIAGE 'ROCEDUP,ES '52 H! sr, Ul..CHHiO, SEOUL, KOREA
(OPPOSITE BANDO SLDG.)
EXHIBIT B
t;-2-
c< 1<
Office Use:
1YPe. f/1-1
Date Received: r,.(J Lt -L.--tA--L.JL; I ~ I If' j
PERSONAL INFOlli~TION
AMERICAN ENR\SSY
SEOUL
VISA APPLICATION FORM
.100 (Nee-MOON)5- -$ J~
}tiddle . Hanmtm
~
1. Name in full BAm
Family
Given
a. Other names used:
b. When used:
c. Reasons for use:
lbne .
2.
Place of birth:
Pyungpuk-D(), Korea.
c. Weight: 105 Ibs. d.
Year of birth 'J9
Month Jul1' .dciY
13
He~ght: JLft.M-in.
e. Marks or scars
None.
f. Race Mongolian g. Sex: Fem~le h, Nationality at birth
Korean
i. Any subsequent nationali tj.es
j. Marital status: Ma~ied X
, Sing 10
, Widowed
Divorced
~' ....
4. Present address; (notify Nmbassy promptly by mail of change of address)
English
#90...84 liawo1-kok-Dorlg, Sungpuk..1\u, Seoul, Korea
1-1! Jf\-1~\l T~ \W Yo ~ It[
""
Nanmun
~~Draw a sketch of your present address in the following space:
5. Pennanent home address;
English: U52 1st St., Uljl-Ro, Chung-h, SeQ1l, Korea
Hanmun ~t I~~ D~J~ l?iY S.2~
6. Reasons for going to U.S.A, :
of study.
If student, give name of school and course
To be 'With husband.
7. Intended length of stay in U,S,A.:
Permanently
3472 Green St., Camp IfUl" Pennsylvania, USA
8. Complete address in U.S,A.:
9. Acoompanied by:
10. Passport number
date
is sued by
11. Previous passports number
, issuing author:i..t.w
"
- 2 -
11. Present Occupation:
Houeewife.
a. Employment: Give names and addresses of firm, dates of employment and
posi tl')ns held.
l\f'U1E
ADDRESS
DATE
POSITION HELD
l\hne.
12. .&1ucation: llst mmes .Q'1d places of schools attended and dE!gree obtained
or last highest grade finished.
None.
13. LanL:uages: Spoken, read" or written:
Eng1..t ail
flllir fair
tair
14. Business ar1dress: Ncne.
15. Name in full of sponsor: Cll.syton Will1m BAIRI Jr.
Indicate if you are your ovm sponsor
a. Address:
3472 Gr~Gn St., C9lUp Hill, Paw, USA
b. Date of First a cquaintance of meeting: April 1959
c. Relationship of sponsor to applicant: Husband.
RELATIVES:
1.
Place where family register is kept: 1/52 1st st.., tn.ji-Ro.. Chung-Ku.,Secul,
[orea ..
Father's name in full: (if deceased, name must still be given)
1400N, Unknown
(Deces,sed)
a.
Present address:
2.
b. Date nnd place of bir~h:
c. Occupation:
3. Nother's name in full (if deceased, name must still be given)
a. Present address:
KIH, Sai (Deoeased,)
b. Date and place of birth:
c. Occupation:
4. Brother's names in full, present a~dresses, and nationalities:
NM1E
ADDRESS
NA'IT ONALITY
None.
5. Sister's name in full, present addresses, and nationalities:
NAj\1E
-
.iillDTIESS
--
NATIONiLUTY
-
Bone ..
/
- 3 -
6. Spouse 's nn.":1e in full: Clayton W:Ullam IMIR$ Jr.
a. Place of birth:
b. Year of birth:
c. Present address:
d. Occupation:
8. Business address:
l'4e<:hen1osburg, Pa., USA
1935
177th OS ASA 00. M?O 301, S. F. Calit.
US Army St.P-/+
No~.
7. NC4llcs in full of all previous spouses, elate and place of marriage;
None .
8. NMi.es in full of all chilr'i.ren, present address, date and place of birth,
Sex, and nationality.
NA.JIiJE
DATE OF
BIRTH
NATIONALITY
PLACE OF
BIl1TH-
ADD HESS
S.~X
JoJr.>Ile..
9. Nmm3, nationality, Dnd address of any relatives, in addition to thosls
list83 above, and nationality.
Ibne.
10. Friends in f0~eign countries:
NAb'E
ADDRESS
OCCUPATION
Non,e.
.vHEREABOUTS:
1. List all places of previous residence from birth to the present:
From (date).
To (date)
COMPLETE lJJDRESS
S1ncaBir"th ".}{~rch 1942 Unkn. No, Sonha..Do~i,'S1nu1Ju' O1ty, Korea
March 1942 ()ot;--m9-",... #;2 6th St!,.JJlerir:.Ro, Ohung-Ku, Seoul,Ko:r"a
Oat. 1949 __ 19;$ ~llB ,.l.~t.. ,ehtWI8~ Ie. KeMleR Cith ~.
... 19'~8 "~..,..J. f' "'....~4 Hiil1l-k,~DQlg, Sungpuk-Ku, &011, Korea.
m Q6'D - -
IY)MlI_ " pye'ieNt /-I4-.-~~
~S-I-r. JqS'i H-On<?fJc? lflJtfdtPYrn-1-1J"j,
2. Travel or resLJence in any other country at any time.
-'Jefl-f( /96/) -+t/ /?/"eseA.lt-: /1/1# /lI#~ ~~ ,- Se~ / /~
/' I I A-P
/Y;rK' To 1'11J,€ /?ftJ: fllI/Qdt,e6k-~(JJ/'7.~ F~ ,
79~? -+U:e. /9rr.. Y/l#/Y~#o/-j)~-fJ~, Se~
~)re!f-r -t 0 /?J7,j Ci-IClI9/1/cr 7/C'NG/ I C/;Ur'VJf/ '
f)e{aye 11l?r- r 't .J
, LJ ~~
~~;
- 4 -
HISCELLANEOUS.
1. List aU '~"ganiz'ltions, associcttjJms, societies, clubs or pD_rties of any
poll tir.:<_; soeic.1, cultural, rel:'L..';'ious or other nature of Hl1ich you ha'vo
been .':1 r-;i.l:)Or or officer at C"h'lY time whether active or honorary, from
February 1117 to present:
WAr1E (;'7' ORGliNIZA TIO~J
LOCATION
DATE OF l1EI1BERSHIP
FOS1 'PION HELD
None .
2. List all arrests, detentions and imprisonments, 'lt~any time and place, by
any ay.thori ties, for any reasuns "lhatevor.
;j'f
None.
3. Character referenc8s:
Give the names of four persons, not relatives, who know you lNoll and why
are n-c;t living in U. N. held territory:
PTi:RlOD OF
r\C~I) iT' T1'J'i-'f'N(1E
.:.=-,.:=...~:....::.~
NAHE IN FULL
cc~~a,ETE ADDRESS
2 years
2 years
2 years
2 years
Wi, It''<> Bile 1190 Hawol-kok-Dong,SuD8bulr-Ku,Seall#l{o:rea
AHN, flown sik Sane 88 the above..
RA, Han Kyung SQltte as tha bo
CHONG.. Ran Solt Same as the a hove.
I HEREBY CERTIFY THAT MY TIE'PLIES TO ALL THE FOREGOING QUESTIONS ARE TRUE,
COHRECT AID COl'1PLETE TO THE BEST OF HY KNO'irlLEDGE ANDffiLIEF.
Date of Signature
December 11, 1959
ftyung Joo BAIR (NeG-t-iOON)
Sit':nature of' applicant in EnGlish and
Hanmun
Further answers to questions may be i-ITi tten on the remaining blank space.
Ti'~'
EXHIBIT C
FORM RI-497
a-1-59
DEPARTMENT OF STATE
FOREIGN SERVICE OF TI-lE UNITED STATES OF AMERICA
QUESTIONNAIRE TO DETERMINE QUOTA OR
NONQUOTA STATUS AND APPLICATION FOR
QUOTA REGISTRATION
"1 -=ri'--'3 '8~ .9l.:g.J1J:
~% +-e 111~"'J- :;t141~ ~~~7]
41~ ~T~ ~ ~~%~ ~~~
TO:
THE UNITED STATES CONSUL AT
or: l"l-=r 0.;I.-\} 'il~})
INSTRUCTIONS
a. This form is Ylllld only for yourself, your spouse and your
unmarried children under 21 years of age. Should other rela-
tlyes wish to accompany you or otherwise immigrate to the
United States, they must IiIl out separate forms. ALL questions
must be answered. Please use typewriter or print In ink in
legible block letters.
b. If the quola 10 which you arc chargeable is oversubscribed and
a quota number is not immediately available for you, your
registration priority dale will be indicated in item 22.
r. "'hen iu,nn rmmher 22 and 23 have been completed by the
consulate, Iccep Ihis papcr in a safe place. Il is valuable evi-
dence of your rcgistl"Utioll dale and quota ehargeablllty.
1. NAME l"<l'1J)
(Las,Name) "<l
(First Name) 'll
T\'"(11i;.Tr...
r: r, Ti)
'DATE 1 ~0J.;;r~crrUl1p.r 'j ((,'j
:;tl ;.] .-\} ~J-
i\'. ~ oJ~~ 'il'6]--* 'il'6]-Ei ~~+;;(} ~ "J:=-j--.'1] alaJ:Ei 'il
'6}Ei a]~ ;;(]-"'IoJ]711oJ: ,'}:it ~'-l4. oJ:'ll 711;]-.91 ='J.~01 'il
'6}.9} %"J:'6]-?l '-t ~ 5:3.. ol-=roJ] 01 'tl .5P} ;s]--e 7cl +oJ]-e
%oJ%~ ~7~Ei o,f~ojl 71'Y ~}"'Io]: ~'-lt1-..5'..-e ~ToJ]
"'J- '6]-"'1 0]: ~'-l4 t;.]-;;(}71 ~ .-\}% ~}?l '-t ~71 oil 91-&-
rJ:!..~.3.J;;(} "l].3t oJ.3..3t 710.1 'o-]-"'I-'T-;.l.2..
'-t. 'il'6}oJl711 :Jlh~;~or ~-e :o:J-"'J-o] -'-J:7J ~3!j-7} 5l71'-t 'il.j
%~ .!f]'6]-"'I ~"'J-lfiI~ ~;.Ij;, "]->a i\'J-or 'iai:- 7cl+oJ];:
%+ oJ.;;(}~ :>ll=-j-=~J-oJJ 7]oJ %]-71] ~'-l4. !
4. 0.;1.-\]-7]- :>l]=-r= ~ ;>J]=--r~~J--~ -'l:!:~ ;']7J"~'>1]i:- ~+*~ I
oJ1i ~ ;.<J-<!::.oJl ~J1J:ol-"'I -?^l.<t.. ,,] ~ '11-sl-S1 .',;.-!l-<>J "'t 'M 1
~"'J- +11-11.91 'ilT~ %?l7} ~'-14. I
-----~--_._.~-_.._~.~
O'i'riEH KAMES. .'_LJ :ES OR TITLES BY 'VHICH YOU HAVE BEEN KNOWN (If married woman, give "a'Lien n~me',
~** ~~~~ ~~ 5l~ ~ ~~Ei 'llEi ~'ll ~~ 'I(~~"'IEi 7cl+~;: ~~1i "<l~% ~'Y~~'
(Middle 1\a ) ".J
,TO(',
3. ADDRESS AND TELEPHONE NUMBER (-'T-<!::.~ =1l~l!1I)
_i.7.!.y.:J....(, .l.i.,~~:"'>"1'-' ":-' i~~-:<_:, -:'~~:_...~""".~0._:'~-:", ~ec; _~_J_, =~OT'e;_:. _____ ___
4. OCCUPATION \.::;J "l:I ) I 5. DATE OF BIRTH (.<lIl(! ~ 'll) I G. PLACE OF BlInH (it.<ll:>.J I
'i( 'IT'~,' '7,~ '-..l..~daY ('\!)1Emonlh(~) -:;0_ year ttd,)I_ City,(),I) Pr,'vinc(" (~)
-7. ;'A:\-II~--(f.i'-i;CA~lUEH' ( +::u.9J "<l 'll ) 18. M!\I~E~ N'~M~ OF l;;~fHER \.2..:tl.9J -'J cJ )
__1'n(~~~_~~,_,1-,:,(" 'n(i'f"'C'''''' "'8(1) i<;J1" ,,!1J '. llP.ce" f~(", .}____
9. PLACES OF IHHTU OF PARENTS (City, Province, Country)
Father:
:If-
TTnl-'1"" 'n
10. NAME Ol< SPOUSE (~~ 4-:>.}.9J
"<l~
(Maiden or Family Name) 'll
T1:\ -TR
I
-----!
i
_Country (.;;-1
-----1
4'-.5'...91 *"'~:::<1 (-=r, 5., ;.J,)
Mother:
.5'..
TT.....J~'1iro,'.rn
!
--(Middle -:,ames) I
, T T'P' T'~ I
1:;' SP0U~'~ 'lM~lICHATING WITH -
YOU? 0] 'tl oj] ~p. +;;(]- %"J- "'I i'- .
CA1Yes 0 :-") !
7} J'f-
--------------- .
(First Name) -'.:l
(:T'
"';/-([1(1-_1
11. UATE 01' 1\11\'1'11 lh' ,sl,J(,), US", \ 1" 1-', LACE 01' BlUTH 01' SPUUSB (~~ +:>.}.9J ~~a;;:] '113'
~+4.9J .<lIl(!~'ll - ,
-=:(cla~'. (".1)..2 month. (-~) _ 3~ ;rcar (td.) __ City, (;.1)._ _ Province. (5., "'l:) Country (-=r)
--- ~-- -- ------- .
14. i'LACE~; OF Blin'H OF SPOUSE'S PARENTS (City, Province, C"untr)') l:lf-Y.9J 71-?;;(J.9} "llo,U lCS:-,
.x.. , /-1,)
Father: (:If-::u) lh1-"nhrt1 Mother: (.5'..::u) ~'n.'~l"l'1
'il%~.2f-%"J:~ oJ-_ --r-.'fJpr..J:SrO]~;<Ff}- ~T I
15. LIST UNMARP:IED CHILDREN UNDER 21 YEARS WHO WILL ACCOMPANY YOU: ;UoJJ 7] q] %}),].<t.. i
---- NAME OF CHILD PLACh 01' ll1RTH (Cit)', Province; LOl:lll':Y)-- - --DATE-tii---Bm'ifl \uay, mon-"" )-earJ I
l,Tm~:HEi "N) ~ .<lI :::<] (-=r, 5., ;'],) ...g~~~oi _--=-~I
16. WERE YOU on YOUR SPOUSE BORN IN A COUNTRY IN WHICH NONE OF yo:.m PARENTS WERE BORN OR HAD ..\ PEHMANEXT
RESIDENCE AT THE TIME OF YOUR (YOUR SPOUSE'S) BffiTH?
.:rl %}'-t 'il %]-.91 ~~+;;(]--e 'il~} !E.i:- -'l1 ~~ +AtEi it.<ll "'J-I'l <>I] 'il '6]-.9J oJ='J .91 ~ ;:'*01 ~I>g 1']-:::<1?i-?l ,+ ~ -'T--11-~ 7}:>'] jL ~:>.J
~1tl -=r7l-<>I]~ *...g %]-9;l.%1.-}'-l7,1]- ? 0 Yes (7}J 0 No (:If-)
17. (a) DO YOU HAVE ANY OF THE FOLLOWING RELATIVES WHO ARE UNITED STATES CITIZENS? (Check app:roprinte box)
7]-. %]-;UoJ] 71:41~ 'il%]-Ei ~~ToJ] "l-=r}.l'll~ ",}~~ ~*1.-},*? (~"'J- ~IoJJ It.;.1 %]-),].2..)
DFather or Mother 0 Spouse U adult Son or Danghter 0 Brother or Sister
:If-~ !E.i:- .5'..~ ~~+:::<l- "'J l(!Ei A}"'I '8jj;ol] !E.-e Al-..~
17. (ll) DO YOU HAVE RELATIVES AS MENTIONED ABOVE WHO HAVE BEEN LAWFULLY ADMITTED TO THE UNITED STATES
FOR PER'MANENT RESIDENCE? IF YES, STATE RELATIONSHIP:
*. -t~,-!r -',1 ~%-olI ~ "rSj ~~ 2..~ ~'\i 7..i 2..~ "1';:-01] oJ';:-~ ....1-~~ ~ %'-l >71-? "JQ,,! ~ 4'li .:z.::tl-.9fSj J1J:;rj]~ 719J '6'}-"].2..
__'0
(c) IF YOUR SPOUSE IS IMMIGRATING WITH YOU AND HAS RELATIVES OF THE CATEGORIES MENTIONED IN (n), STATE HE-
LATIONSHlP AND CHECK WHETHER SUCH RELATIVES ARE
l:j-. "JoJ. .:il%}~ llH-:::t}i\' .:il'6'}91- 7J,-01 0]'tl'6'}3L (4)ifr ;;n"J-Sj -',1~% 7]-:;t].:iL ~2..'li .:z. J1J:;rj]~ 'il-"1'6'}3L 4% 01.=.
1;JoIJ ~"J-B}~ 7l-~ 710~ '6'}-"].2.. O,~r,S.~ITxE:t .;~~ 0 ~~LI~_~ER~:;:rl':~SI~E:~~~____
18. IF YOU on ANY PEHSON l\AMED ABOVE WIlO WILL IMMIGHATE WITH YOU ARE NOW HESIDING IN THE UNITED STATES,
STATE: .:il %} !E.~ .:il '6'}91- -c-H:01 0] 'tl ~ -^J7] 71'il oJ %-61] ifi"n "]';:-61J ?l f- %-o]'li .:z. ....1-11% 710J '6'}-"1.2..
WHEN YOV ('rUBY I i';NTlmEU (Illonth, )~ear)- WHEHE-visA-WA'S 6BTAIl\Elr~".;:-....]-%- "?1 =; :;tJ\WHEN VISA WAS GH'ANTED (month,
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CHECK TYPE OI;'VISA-USEO--:FOH SUCH ENTItY: OJ....}~uoJ~Ojj---....}+~ oJ-f....1-%-Sj-*T~ 7]oJ '6'}.).]T--m
year)
Diplomatic or Government Official 0 Visitor (business) 0 Exchange Visitor 0 Visitor (pleasure)
D.s] .iiZ.J1l- !E. ~ ;;tJ 4'-:e1-ij ff7~ (....1-~;;<}) .iiZ.~7~ 'lH:-7Jl (%7-J)
Tran~it Treaty Trader or Investor 0 Crewman 0 Stu<lent DInternation Organization ofTIcial or Employee
O-'t-.:;ij-o,1 0 a:. o-f-^.)-o,1!E. ~ !f-:::t]-7]- 1l-ij ~..>> .;:-;.n 71 T:e1-ij !E.~ %ql-ij
O TClllporary 'Vorker or Trainee 0 Foreign Press, Radio, other information Dlcdia representative.
~P1.!J:.-l'-:::t} B:.-e- -t-~-ij .s]';:-oJ..e <!}-q.2.. 71E-} -'t-1l7JJ1J:-.1lJE
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19. IF YOV ENTEHED THE UNITED STATES AS AN EXCHANGE VISITOR, GIVE:
.:il'6'}7]- "1';;-011 OJ';:-~ OJ oj ~~~ .:z. ....1-1!%'6'}71 %1:....].2.., ' . .
DATE--Vis-X-WAS Gi\ANTl.-;j) -- ---, -.. D~\'tE (If'-LAST-'EXTENSION llY u:s. IMMlGHATION ' DATE OF DEPARTURE FROM V,S.
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_da).(o,!)_month(~)_ ~'car ('dJ __day (oJ) _______ month (~\______ yeUl' (>;! -, _day (o,! ) ,_month C~~ y"[1" (1ft)
20. LIST BELOW IN DATE O-RDERAi~i -PLACES OFFORMER -RES IDENrn-S-iN-CE REACHINGAGEOF SIXTEE~ OF ,:CuilsELF YOUR
SPOUSE AND YOUR VNMAHlUED CHILDHEN UNDEH 21 YEARS OF AGE NA.l\IEU ON THE OBYERSE SIDE WHO WILL BIlIIIGHATE
TO THE UNITED STATES WITH YOU. (It is not necessary to list the places where you resided less than three months).
.:il'6'} ~ .:il;;-}9-} -c-H-o-J "1';:-61] 01'U~ :tl7] 71'ilSj .:il'6']-Sj ll~-'l-;>:} ~ "J=i"-"Il"lT{}Sj "l~:::tH~ "J:i"~",Ajl
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SA0l11
1)'
ore"
-,
I FHO~t TO
(Illonth, yt'ar) (Illollth, year)
I ;~~(~')'O(,('cl/;) : :::tJ l~);'r~>;!~'
I, '::-'/, I 10&:;fl:
__~::.-... I '-,. r , I C '-,(\
I"''' I,: ?7: ':p(;se:o__t
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Uf.,:JjQt,- C HU~
CITY OR TOWN
-"1 !E. ~ :-: 1fi
eauanp':-f)0nQ, Chlmj
y A nn~TOn O'_nonp'-Donp'
J U~w'lknk~Don'-;' 'i ,C;p
Hannan-Dona ,Spou1
PROVINCE
.:s:..
COUNTRY
.;:-
NAlIIE OF FAMILY ~lE"IBER
7} ~ oJ "(j
1{ orpr'
hOt..(:"...:-
"rnr0
21. 1 llIJlla;;!rlTld that only m!! spollse and my unmarried children UIl der 21 years of a!1,e m~y - b-;-;'~cI!;ded ill my rcgistratio--';'-:-l'i';rtl1c~-
und~rstalld that, if my rcgistratioll is accepted, 1 am responsible for keepillg you IIlformed of allY challgc in my IIddrcss or ill my
famIly status.
~ol.f:- .2..:e1 ~oJ~ ll~-'l-:::t}
~~ ~ !E.~ ~oJSJ *~o]
.=..~ ~ ~ 0] ~ %% 'Y"'-14
~ tlJ:=i"-~] ,,] tlJSj ~ol Sj ,,] ~*'l "J-o] ~ol Sj *.5l.61J ~.,} !OJ. r.1 0 ~ 01-'-14
~ 4- .!<j It! ~'li 0] .:il %}olJ>'Il ~oJ Sj -r.z'-t 7}~~~J-~J ~ -8'}~ 'ii 7cl oj 45.: 4f-~ t;~
DO NOT WRlTE BELOW T-~~~--'''J ~,
01 ~ 71 ~,jt1 11}-"].2..
received and has a priority as of tile 23. The indIvidual whose name is signed above is registered unuer
the:
22. Tllis application was
date stamped below:
ONon- 0 1st 0 2nd D3nl 0 4th Preferellc"
category of the 0 quota 0 suhquotn for
Page No.
I Line No,
Spouse Included
DYes 0 No
Children
DYes ONo
NOTE: When this document is returned to you by this office, KEEP IT. It is your record.
BE SURE TO INFORM THIS OFFICE OF ANY CHANGE IN YOUR ADDRESS OR FAMILY STATUS
\l]:iL ('T-Sj\:~ ....}-l'-.z6l]J.] 01 J.]-1t~ .:il'6loJJ~ 'll-~ ~ u1l,ot]i:- 01~ ~ J!.3'J:%};.l~.oj J.]-1t-e- ;r]B}Sj 7]~
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EXIBIT F
CLAYTON W. BAIR, JR.
vs.
IN THE COURT OF COMMON PLEAS OF
CmmERLAND COUNTY, PENNSYLVANIA
CIVIL DIVISION - lAW
HYUNG JOG BlUR
C-f-
NO. )()(o0 ~(J.f-I..-
IN DIVORCE
TE:RI>iJ, 1974
COMPLAINT
1. The Plaintiff, Clayton W. Bair, Jr., resides at 18 Circle
Drive, Nechanicsburg, Cumberland County, Pennsylvania, and is sui
juris.
2. The Defendant, Hyung Joo Bair, resides at 326 Raven Court,
Mechanicsburg, Cumberland County, Pennsylvania, and is sui juris.
3. '1.'he Plaintiff has resided within the Commomvealth of
Pennsylvania since January of 1961, 13 years and 8 months immediately
preceding the filing of this complaint.
4. The Defendant is a citizen of the United States and has
resided in the Commonwealth of Pennsylvania aince January of 1961, 13
years and 8 months immediately preceding the filing of this complaint.
5. The parties were lawfully joined in marriage on December 11,
1959, at Seoul, Korea.
6. In violation of her marriage vows and of the laws of the
Commonwealth of Pennsylvania, the Defendant has over a period of time
offered such indignities to the person of the Plaintiff as to rlender
his condition intolerable and his life burdensome.
7. '1'llis action is not collusive.
o. No prior action for divorce or annulment of the marriage
between the parties has ever been instituted in this or any other
jurisdiction.
WHEREf.'ORE, the Plaintiff prays that a decree be entered divorcing
Plaintiff from the bonds of matrimony heretofore existing betwec~n
Plaintiff and Defendant.
b~ERS, MYERS, FLOWER & JOHNSON
By
-
STATE OF PENNSYLVANIA)
) 5S:
COUNTY OF CmmERLAND)
CLAYTON W. BAIR, JR., being duly sworn according to law, deposes
and says that the facts set forth in the foregoing complaint are true
and correct.
i
" g'
,., . " (<
12. .~. .~"C. D) t.i 1::':tt.~''1'
--L! :1 ----J.
/clayton ~J. Bur,' r.
Sworn to and s\IDscribed before me
this
day of
.( , 1974.
rmJE COpy FT{OrVl n
u
In re~3lirllu;~!\/ \i'll;c;'-i:~i~' 1 hr;-!/:: UP ~,u1 rn'y' hand
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(~-.d-/~-7-' ProUlui,,-'latj
CT,i\YTON W.. UA. IH, JH.. II ,
.PlalntLf'f I
J
J
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J
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HYUIH} .Jon HAJJ". ~
Defendant t
1 N vQUH'r OF
GUJ''!rl~l~Rt~M,D GOUi4'I'Y, P I~r{N~~:O.NANIA
CIVI!+ DlVISIQN .LAW
. 1066
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, 197/'''
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11 I 00 A.. M. ,
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Clayton W.. t\'S\i.r. f,rr., Plalrr1:1ff
1'3 l.;!.rcl!1;! L'irlv~
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Hill ",'\.m (". hol"lf-t~'h ~H~qui r r.,
,\,;a,f,:'t\91" in Liivoroi! .
CJ~AYTQn W. !:lAIn, .JR., $ IN Tm~ COURT O,F (;Ofl~l;1iON .PLI~AS OF
.Pla,lntl:fr .
. Om~1BEIU"'I\ND OOUNTY, PENNSYLVANIA
.
V~. t (lIVII, IJIVISION - 'LAW
.
. N()' 1. 066 LtF.J?TEMf~EH 'J.'ER~l, :1 '974
HYtJ,NG .;roo nAIf{, i
Defendant I IN DIVORCtE:
~I" ml' Ul"''I'~'l(~ ~"A'~\~' fi'l"cr~Q,-",m
nV.""i;i' A . :;Ji~.LJ:"ir m j,),l.'~ .,1\ ,,,'1' . l:..li; ,n",,I,,'
. . Pi" ~ ... . . ~ J. !...ilI ,4H."," ... ~,I8.... ..fIW*'. . l~",
7(01/ AI.~g It'EfUEBY NOTIF:U:li thR t 't1f:l report flS .Mas'tor 11'1 'the
nhovG....~.mtl tl.d aotion has been filed 1n thf3 Prothono'taI".V' 8 OttleQ,
recommending that the C<:)\U7t f'm,ter a J)~a,rae in !Jivorcfi!' A~ V.lit. as
p:r"y~d for lnthe CQ.m:pla.lnt.
A,n~.r 1!:lJu;l'bptlonm to said report rnu.st '0& :fll!CJd wi thin ten (10)
d.nYi!l from reoei,pt of this no'tl<H?
i i
I,d tl (t:J
\, ,(/ClfAL.~_.,--"._....;~,
November t I"~ , 197J",.
!
~-{,r;-itollat'l~. Es~~uiiti._., .
.t;"~,flt$X" in Lti:voroGl
T'OI
Cla,yton W .0011', tft'!l .rlaint1ff
18 Circlo Drlvfft
M~oht\nlooburg,l Pa. 1. 70S~i
TIyung Joo I~d,r. l)~ren(l~nt
,......t:. "~ n t
. ;:,\,..! 1,a.VJl:,ln vour,'
r. '\. .1: 'h" ";,;t" t".OKr'
,"~(hr.!ln.1.0SvlU't,~, J:a. ,,(-,'),J
Jerry n.Duftie. f~sq.utre
A. ttornay tor Plalntif:f
;.,;yerRl, lviyerfl t Flower ~~J .lohnaon
~rhird a:hd riWarket Stree1a~
LemoynG. Pa. 1704,
nnl1~tl11 1JoFlrd
FrothonottiU:"'Y'G Office
Oourt House
Carl~.ale~ Pa<t 11013
EXHIBIT G
LAW OFFICES
~~~~
FRANKEBERGERPLACE
219 EAST MAIN STREET
P.O. BOX 230
MECHANICSBURG, PENNSYLVANIA 17055
717691-7770
FAX 691-7772
January 23, 2006
By Facsimile Only
ATTN: Consul Hyeran Chun
Republic of Korea Consulate
Re: Estate of Hyung Joo Bair
Date of Death: December 2, 2005
SSN: 521-06-0892
Dear Consul Chun:
Please be advised that I am the Administrator of the Estate
of Hyung Joo Bair, Deceased, who died on December 2, 2005.
Enclosed is a copy of the Certificate of Grant of Letters issued
by the Register of wills of Cumberland County, Pennsylvania,
attesting to my appointment as of January 3, 2006.
Mrs. Bair died in her home and as the result of the
Cumberland County Coroner's investigation, it was determined that
she married Clayton W. Bair, Jr., a u.s. soldier, in Seoul,
Korea, on December 11, 1959. She returned with him to this
country when his tour of duty ended. Mr. and Mrs. Bair were
subsequently divorced in 1974 and she continued to reside in
Cumberland County until her death. No children were born of the
marriage, nor did she ever remarry. There is no evidence that
she has family or next-of-kin living in Korea. The Coroner was
unable to locate a Will for the decedent, nor was he able to
identify or determine existence of any next-of-kin.
We are supplying you with a copy of her passpbrt issued by
the Republic of Korea, and a copy of her Visa Application Form,
in the hopes that you may be able to provide us with any
information regarding possible next-of-kin for Mrs. Bair.
Thank you for your cooperation in this matter.
Very truly yours,
~;P&::~
Marlin R. McCaleb
MRM/eaj
LAW OFFICES
~.~~~
FRANKEBERGERPLACE
219 EAST MAIN STREET
P.O. BOX 230
MECHANICSBURG. PENNSYLVANIA 17055
717 691-7770
FAX 691-7772
FAX: 717 691-7772
FAX COVER SHEET
DATE: January 23, 2006
PLEASE DELIVER THE FOLLOWING PAGES:
TO:
ATTN: Consul Hyeran Chun
Republic of Korea Consulate
FAX: 212-421-3028
FROM: Marlin R. McCaleb, Esquire
Re: Estate of Hyung Joo Bair
Date of Death: December 2, 2005
SSN: 521-06-0892
Request for information on next-of-kin for the above.
WE ARE TRANSMITTING
I~ PAGE(S), INCLUDING THIS COVER LETTER.
IF TRANSMISSION IS NOT COMPLETE, PLEASE CALL
OUR OFFICE (717 691-7770).
IMPORTANT NOTICE
The pages comprising this facsimile transmission contain
confidential information from Marlin R. McCaleb, Esquire. This
information is intended solely for use by the individual entity named
as the recipient hereof. If you are not the intended recipient, .be
aware that any disclosure, copying, distribution or use of the contents
of this transmission is prohibited. If you have received this
transmission in error, please notify us by telephone (collect)
immediately so we may arrange to retrieve this transmission at n.o cost
to you.
TIME 01/23/2006 12:19
r
I
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L..__
DATE. TIME
FAX HJ./NAME
DlJRATION
PAGE(S)
RESULT
t.10~
131/23 12:12
12124213028
00:67:14
16
OK
STANDARD
ECM
I
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EXHIBIT H
~
KOREAN CONSULATE GENERAL
NEW YORK. N.Y.
June 19,2006
:Mr. i'.1arlin R. f..1cCaleb
Frankenberger Place
219 East Main Street
Mechanicsburg, PA 17038
Re: Estate of Ryung Joo Bair
Dear Mr. McCaleb:
I am writing in regards to your query of Ms. Ryung Joo Bair's possible next-of-kin.
After contacting to the police agency and the relevant district office several times, I was
informed that due to a privacy protection regulation, they are unable to provide
information on next-of-kin of the deceased.
Should you have any questions, please do not hesitate to contact me at (646) 674-6070.
Sincerely yours,
Young Roan Lee
Consul
~
HEAD OFFICE: 335 EAST 45TH STREET. NEW YORK. N.Y. 10017 . (646) 674-6000
VISA & PASSPORT SECTION: 460 PARK AVE.. 6TH FLOOR. NEW YORK. N.Y.10022' (646) 674-6000
EXHIBIT I
U.S. Department of Homeland Security
P.O. Box 648010
Lee's Summit, MO 64064-8010
U.S. Citizenship
and Immigration
Services
May 17,2007
NRC2006022062
Marlin R. McCaleb
Attorney at Law
219 E. Main St., Ste. N
Mechanicsburg, PA 17055
Dear Marlin R. McCaleb:
Your request was received in this office on March 20, 2006 for subject: Moon, Hyung Joo.
We have completed our search for records that are responsive to your request. The record consists of 28
pages of material and we have determined to release it in full. The enclosed record consists of the best
reproducible copies available. Old documents/records such as these are maintained on microfilm and the
quality of the image is dependent on the condition of the original document when it was filmed.
The National Records Center does not process petitions, applications or any other type of benefit under
the Immigration and Nationality Act. If you have questions or wish to submit documentation relating to a
pending matter, you must address these issues with your nearest district office.
If you should have any additional questions about your request, please direct your inquiries to
this office at the above address. You may also call us at (816) 350-5570 or fax any
correspondence to (816) 350-5785.
Sincerely,
J)DC~l~
T. Diane Cejka
Director
Enclosure(s)
I ,
j .1
UNITED STATES DEPARTMENT OF JUSTICE
IJnuaaa"oN 41<D NAru&AUZ41'10N Slllm:CIl
, ..
,
Form approved.
B1IdcK Bureau No. tl-R088.10.
DUPUCATE
(To accompany
monthly r_ejtOrt on
Form N-4)
UNITED STATES OF AMERICA
110
PETITION FOR NATURALIZATION
No.
,
To the Honorable
Co.BOQ Pl... Cu~rl.nd County Carlisl.,pa.
The -------------- h__ ------- n_____ ------------ ------------ ~'16-ta)--- _________ _______________ n____ at ------------________n____
"',,,. 1HIlli0ft lor ..........1I_".... IIo..b,. ....... .1lfU~ ~ -aai.r----------------. ,........a... ..~ N.d....U.,. ...... _".1/."." ...._.
(1) My full, true. and correet name il ------.;n-D.eu.-5-r-----------(M;;;;;;.;;:;k~_;.~ftie.bur9' ___________~,---
(2) My ~"'ee is-----------------,i;i:i.-.:-,-----------l'eftft~'Uft4..------------------(c;;;-;;;l;'1().1-~------~~--
------------------J-c..;:;;;;j-----t3'------3g------------- n______,...; a1neri-jtt------------- -----iii;C:;d.i-.-----------------\:.
(8) I Wao born on --,x-;.;;..i------,;,-.yj------ir;;;j'-. in n----n--n----.-----------------n-ca.;;;-;;;;;__KOJ:ea-______.._______________-+.,
-------- ---- -----------,C;.;;;;;:o;;j;...;;;;.~...iO",_----- n___________ ---------- ------------- ------- ------iC;;.k;i---------- __.. -----_________n_. \:
(.) I am ---------- married, and have --------- J.lvl1lS ehlldren. December 31 61 ;
(S) I.... Ia"frlully admitted to the Unlt4d States for permanentt refridenoe On --n------------nu________________n_u_______n_______. 19__~---.,
and bave not abandoned ouch r...idonee. lCore 8 A 12 562 255 '!
(G) My present nationality la ______n__u_______u____________________. ALIEN REGISTRATION NO. ----__________n___..___. \
(7) I have not "'retofore made a I>8tltion for natu...llsa.tion. Hone
(8) I pray th&t my name be changed to -----------------n----------____________hh____________________________.,
(eootlnued ovet)
The following wime..ea, eaeh bel~..,.. :a.'t1:"worn. depOlle and lay:
(1) My name il -----------------a.-It;--.-.5r-JIeCbanic.bl.rg ,-__.....__.-----___________________________________
I reside at - --- ------- ----cih;.O;-;;;1IIInna---..T-.--ti-i:-l:oft----------'cii;-;-;.;;;.i------------------------78;..)""--------------- and
(2) My name la ------------------349-2--81'.." -8i:..--eetap-tIi-ll,--.....---n----------________h____________h
I r..ide at __________.___________________________________________________________________________________________ ______ _________________
(N".""'." --> (CfI,y or .....l (IK.)
I am a eitilen of the United States of Amer!",,; I have personally known and _ve been aequa'lt4d In thftlted States with the' petitioner named
in the petition tor naturalloation of whioh thl. alBdavlt II a part, einea at laaat ----_________________________________: to mYiel'lll>~. Imowle.....
(MOftt.J.l (Da,r) CYMd f l "; .
the petitioner baa I'8Illded. immediately preeedlng the date of ftline this petl,.!: In the UnIted States ""ntlnool18l" 8lnee the~ . t mentlOl\eid: that
the poUtloller .... been J>i>ftieaU" preoent in the United States for at leaat _______ months of thet period: and that the petitioner has been a resident
in the State in which the petition is filed during at leaat the lut 6 months. 1 bave peroonal knowledge that the petitioner i.. and during all luch periods
baa been a pel'8On of good mor&l eharaoter. attaobed to the principl.. ot the Constitution of tbe United States, and well di8JlOMd to thlgood order and
bappine.. of the Unlt4d States. aad in my oplalon the petitioner I. In every way Qualified to be admitted a eltllen of the Uaited Statas.
~' ""'... .......... ~ ... , ..... ... '" ... ....... m.... ...."~ .. _,......~ ... _.ft..." ~.....
::-~~~--- ------:p:-:~-~-~~~----_n___________n__ __ ~Jta._ _ Il.__/d~__________________
(SigtlGt"re of Wit.....) 1"'....t.: ~gUt~~7 Wit.....)
WHEN OATH ADMINISTERED BY CLERK OR DEPUTY WHEN OATH ADMINISTERED BY DJ:SIGNA'I'ED EXAMINER
CLERK OF COURT
AFFIDAVIT OF WITNESSES
ST.4f1'fl..
tlo~:-:~~~t':.:.::i...'U.:' ~;':~dlo':;o~ :iit ~0*,1':~~~ft1~~
and aftldavlt, and filed ~ p1d .Ietltio:ner, la the oJI\ee of the clerk of aaid
CarJ.18L., P..
court at _..._.. ___________...... ______... ____ ..__.._______ ________ ___ ______..___
Sllbaeribed and O"'orn to (aftlnned) before me by above-named peti.
tioner and wltnes.es in the reopeetlve forms of oath shown in aald petition
and aftldavlt at ----------_________________________..__ this _n_____
day of ---------u-n---____u_____u___u_u__u_u_..n. A.D. 19..___
-----uiia-------u-------Apri"I----------------------n-
thI. ---------_____ day of ---__~_:_--~~ A.D. 19____
-~-----------------~---- __n___________
C. . 10.
By _____h__~-----~--- -----ikj;;ei Clork. -
[BeALl
-- -------------- ----- -----------o;.i;.at;,-'i;;.i;;';.::--
I REll8IIY CBIl1'lFY That the fol'e;ll'Olnll' petltlon for Daturallsatlon waa by
petitioner named herein lIied In the oftIee of the .dark of oald court
at __n____________________________________ tbl. _..________ day of
---------------------------------. A.D. 19__.._
------------------------------------.,-------'0;;:;;:-
B" ______________ ___..______ __________________.______
DeJtvtl/ CIeo-lo.
Fonn N-fOl5 (Rev, "'~7)
2
RESULT OF EXAMINATION
Engll.h: Speaks ~" Road. c>'?C Write t,; it' Cia..... "?};::; Govt. V< Date _
G-32Ii In, mw_':2_e.__y______ 0-32S Ree Br,_ ---'"2?-tf?7-;-- 0-32liB __,_________________
D::~i:~::_~~I:~n~ from _n____m___ tD ------------- __:~~~:~_ _____~~_~:::~___ -~~~~:-~--~~~~i_-~-QIT-~:2~--~-l~J!lf~=.
in __n_n_nn___n_ from ________n___ tD ___n_n__n_ n____n____ __n_____________ Examiner ___ -____n___h___________I____.
in _______Uhuu___ from ----------___ tD ---0.-------- __n_nn___ _________________ Cont'd ---f!V~~;B__~i______.
in ___n_____._______ from _n__n__nn to n___________ __no_no_e. __n______________ Cont'd __~_n___ .~:".._------.
C,u.b h.~~o.' ~J>>2t)I...~- ~J"""" '1'11 An":::.-/-' J.l
Wltn... (I) ---___n_____.~u Ciboon.hIP. -lItt.&J_____ ~jl Wltne.. (2) ___n_______~_::I:::!.___;- Cltl.en8hlp -1-"--U.'4 '-f:-I.:J 7
Known petitioner .Inee -J--C:--I__6.J___::::::'5iL-!._C1:J.__ o......~~ . Known petitioner .inee ,t.-'t-(f?-.!1__==fZ~I.-'!?L~_d4_(,_Y.
Abaen~Nitioner ____2_i'.::'-________; Witn... k~;.i_.Af_'.::'_ffl< Absence-Petitioner ____:::>-,_~________; Wltn.... ___~::!::ZnQ_____.
Arresto-Petitloner nn.:27nCr_n____; Wltne.. -_______~:2?_~____ Arrests-PetiUoner ----:1!2..Q-_n_____: Witn... _____.~.:??_'::____,
Subv,-Petltioner -----::-::r-J.&-~}-!'::.---, Wltn... -__.::?:2.a.l::l_ ubv,-Petltloner --n-_.t::J__Q_.t.:7..k?., Wltnea. --::';~~ae....._
......,. ,N
Eligibility 101 (f): O"?(,
Docnr!;J-'/-} Rc
Action or doeuments .tlll required:
lnveotip.tion waived. PetlUoDer and with...... DDder!~ath approved all 8tatements made at the preliminary lnvastleation,
Reoommendation ________ G______ ___~':~:_~~ 4 --1/~~2~. _ -------------------2-~~_!~_~_J~_~q____
~t ~."'~~':;'lI4lMs~'~i-.. (Date)
Reeommendatioo n ------- _____n_ ------,-:---------_____ --------____________l~_________________________________________..____. 19 ____
. V' Py.limiRGP1f g..amin... (Date)
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uI poh.8u. UOIlWlocl.l ,IWV n...pawV U".I0 'ra.rau"I) A:au.IOny am "" qllllll 11' pa$JalIOIla.t q~ 1'> uOJl~Jl"U' .....\.IBDIV .... }O m __S ~JUn
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3
I .
.3
ALIEN REGISTRAnON ~
N Hjil.JlW. 1700 BaiJz.
STATEMENT OF FACTS~ FOR 'GEPARATION OF PETITION N:~~_:::/Lt2~5~i)3.S:~~:~~~~~::~~~~~~~~~~~~~~
SECTION OF LAW ___9.Il!._.__f!A:_-\
(1) My full, true, and correct name is .o____il.U11nD.nJa.O__./1ai.1.J._______u___._n__u____n_____u_____unn_u___~.--___n____n__.__________._.
O-q (Full, true name. without abbreviations)
(2) My present place of residence is 'lJ.!_{l!_!t51___________h_u.i~~f!:.d3:C!!!!::0_~J!!Hl:.J_____[~_~lnooJ'..~_.!~~?::._u.l.2c..J..-'.i,-..
(Number and sind) (City or town)~) (State),,-r
(3) I was born on _.oo_nZ._n__.u/J--m--.____.,J9..__C-._ in _m__J..~~I!d:-::j..f!.n------mn---__--m---.------.----1i9Jl:gg-----:::.
(Month) (Day) (:,Y' (Ciry or town) (County, district, province, or State) (Countty/
(4) I am .__.__~,; or! _m__L~"~nd haveO._~~ving Child, r, . The first name of my husband or~s (<<lK.) n--Clm;tQIJ..-vrJ.:r
(Single;lJlarried~ed; widowed) /
we were married on m_____l1oo_____u._.LL___oo__m59.. 00: at .J~9.~!:oo_____________oo________.moo.___m_.__./!..~__'!:~C!:.._._..__m_______.__;
(Month) (Day) (Year) (City or .awn) (Stare or country)
h. 0< ... wn .... "nm..!1.-<:!!1~;;~f_9---O-L-.l'~:dlmki-p;;;;;;;;:-;;...;--m---..------m<<'(~'iir-~_____
on,--------?,O';thr------m-IJyy-----h.---~r):.------.-; entered the United States at .--~~~~~--~9..~(tiiior-r.;wn")------.oo--n------uoo
._.__.____..._00_____00_..____..___._____.___, on _______..n___._n_______oon____n___________n______oo__for permanent residence in the United States and
(Sta.e) (Month) (Day) (Year)
~ with me .....
now resides 0 apart from me at ,___ u___..______n__ ___'00 _____.____ ._00__._____ ___00.______________..____.. ----____00___ ,----..--f~---....---.-- ..___ .._.;
(Show full address if not living with you) .. -
aod was naruralized on _ _ u _ _. ____ ___ ___ ____ _ __ ____ __. __ _ _ow. u_ ______ __ _ _ at . _. _ n ___ _ __. _ _ __ _ _______ __ 00 _ _ _____ .__________ _ow. _. _ ___ _ _... ______. .___ _. .__.
(Month) (Day) (Year) (Ci.y or town) (S..~,)
Certificate No. ._nn.__n_..____.___..__.____u______n__._n____.__n___.__noo_... or became a citizen by nn___n___._______oo_.__..__n_________.______.
--- - -. -- - - --.... --.. ---. - - - -- - 00 - _._.u - --. -.- .-- __n -. .--- -- - - - -.. .-- ---.-. - --- -- .--. -. -- - -. -oo - - .. --- - -. --- - ow. --. --- -00 -- - - - --7---- - ~-- - n_ --- _00_.
(S) I was lawfully admitted to the United States for perman.~t residence on _m__..!.?__________h_______l!________n.m__.n.,_"~_?..!..~____;
r; . j!" (Month) ~~Vf)-r)O - / (=~)
under the name of ..__.!!:f_W!{}__J.9-9..__f1~____0_______.___m__n_mnmm___ at .!!.q.'!(:!:!.-!-!:.___n__oon_:._n~_~':::____m_______
on the _, _ ___.Ltjg _.~ ~Ym_~___ )~idl~___m .__ m________.____u____ _,_._. _ ___v _ _. ___.______________,.c~___~~~~:____ .______. _n___n~~:~~~___________
(Name of vessel or other means of conveyance) ./
. / 12/1/ "1 ./
. . . . /.' . . 1 (;, . .
(6) [have reSIded continuous 10 the U~ States of AmerIca since _00"______. n_u__n_____n.____n_____n_.nn_.._n_. and coOltlOuously III the
State of m_.__'P.WYJn..__ n____.m_._._n__. where [ now live since ..n-.-JI.151.6.17..d:~--n-----------_-C:;;.,-----.--.. and during the past
5 yeats I have been phy" Iy present in the United States for an aggregate period of ____~.11.~- months. 1.2?
(7) I ~ have previously filed petition f~r naruralization No, ___n__n_n___n____n on .oo__n_U_n__m__m_.______u__.__..______oo_..______
(Month) (Day) (Year)
at__ n_._. ---(Cityj- _n_. - ---00. --- ---.... (stat." j___nn__ -. in the . --__. - __n~____n_ __nn__.__nn..__________n___________..._____n_ Court.
(8) I wish the naturalization court to change my name to _jjJ)./l.2..________._oo_u_.._un___n_____.____._n___.n___._n_nhn_____..__n__n___.____
(Give full name -desired or state "None'.)
(9) Since such lawful admission, I have not been absent from the United States for a period or periods of 6 months or longer ex<:ept as follows
(if none, state "None"): None
DEPARTED FROM THE UNITED STATES RETURNED TO THE UNITED STATES
PoRT DATB VasSEl OR OrHER ME~ ~T DATE VISSEL OR Or..... MEANS
(Monrh, day, year) Of CoNVEVANCE (Month, day, year) Of CONVEY ANCI!:
,.--
._-..-.. ----- -..-. - - --- --- .---- --....-- ---.... ------.- --- --...-- ------.. .....-- - ----.. ------ ___.. __....... R__ --- ------- -- ----.. - - ---- -- - - --- .... ....----.. ..---- -.. -.......--- ---------.
---- --..-- -- -..-.. ---..-..- ----- ------ -.. ---.. - ..-- - --- --.. -_..- - ----- .....-- - ------ ----- --- .-------.--- - -.. --- - -- - --- -- - ---- --- -- ------ -- ---- - -- --... ---... ---.._-- ---.....-...--.
.---.......- -- ----- -----...... ---. ------ - ---.. - ----.. --- ------ ----- - ---- -- ----- ---- -- .-- ------------ -- -- -_.. - - ---- - ---.. - - - ---- ---- -- -..- --- -- - --- -- - _. -- - - ...----- ------.
-------------- -- ---.. --- -- - - -- - - ---- - ----- ----- ---- ---- ------ ------ ----. ..----.- -------..---- -- -.. --. - -- --- .--- -- - --- - -- - --~-- - - -- -- --- -- -- - - ..-- -- -- - -- -------
-----.....-..-..-- - .........-- -_....-- ---..-------.. ---- --.. -.. ...------ -.....-- ----...- ----- ..--- --- ......-----...._-- ---- - - -- - ---- --.. --- - --.....-- .---- --- ---..- ------ - - -..-....- ..---- ---.
If child lives with you, state "with me" in last column; otherwise,
(10) My chIldren now lIVIng are: (Complete all columns as to each child.
give city and state of child's residence. No e
NAME SEX
-.- -- -- ~ - ~ --- -" ----.. - - ..--- - - ----- --- -.".--- - -:;..:.
DATE BoRN
Now LIVING AT-
- - -- - - -- -. - --. - -" - - - - - --. --- -00 - ..4=
-U.1 KW
'- -...._~....... -
.1 J
..
""
--
4
......---- /
(1l) Do you intend to reside permanendy in the United States? n...-------hn-n-.n----..hm________nhmn_____.m__n.h____.~ Yes 0 No
~~ ~ ~o~.ye::~a~~~c~~( f~::; .;~~i~:~;;-~;~~~ ~~:~~~~~~:: ~~~J.~~~~C~~~ ~ ~:~:~~:: :~~ ~~ ~~ ~~~~ ~:: ~ ~~~ ~ ~~~ ~~~~~:: ~:~ ~ ~:~~ 1iif.ii~ :~:::: :.::~: ~~:~:: ::::::
. (City) ./ (Country)
(13) My fa'ther's full name is J!J<!..<!.&----m-.Ld~~~__'}=9..!:_f!=~.f!:!dP;~-{(}; J-g5..-IJ:{i..L.'}!!!'l:.'!:.-::7-''}:.!!g_~_/!..q_I!:f?_~.__.
(14) My mother's ,maiden name was -.SAL.J1i.Jn-h--n..___n.n-___...Z~~nn__h.______...._h.._...__.....n__.__n...______.,.......___.___.
(15) I came to the United States from the port of .mRtf.!tl..5:.eg;td.n------.--m--.m____.mm_____/{qJ1..e.fl..n_.h___u_m.__mm_......
(City) (Country)
( 6) Th . 'th U . d S hI' Cl..au20n tJ Bai..1I. (Ill.
1 e person m e nICe tates to w om was commg wa~. - h.'"'r-h-nu~-h--f.-.rtt-.S--.--.-n..----hr..lOn-..--.-n.__---.-"'n_.
( 17) The place in the United States to which I was going was -L<!.M-j../}/!::1..9..'1J.nJ'../!..1-!?!....'./!..~..L-j../L___~.n.ooo._u___mn_n..
(18) The names of some of the pasTs or o~her p'ersons I traveled with, including members of my own family and their relationship to me,
if 'an y, were ._.____.b --C!.afjtQa.l.... .8.~ -J~!n.___ _ _ _ _ _.. '_00 u __. _ _ _ _ _ _ _ _ __ __ _ _ ..0.__ 00 _..._ __ _... _ 00_ .__. ... _... "'_ ........... n.. .__......
.- - ---- - -- -- --- -- -- -- - ..-... ...--.... ..-----..-- ------- - -- ..--... - ---.. --..-- --.. ---... - - --..... - - -- - -. -- - - -..... - -- --...-.. - --- -......... - - --..... ---- --..- --...- --... -.. - - -... -.. -- --.. -.. - - - - - --- .........-.
Signature of person preparing form, if other than applicant.
I declare that this document was prepared by me at the request of ap.
plicant and is based on all information of which I have any knowledge.
SIGN
SIGNATURE OF ApPLICANT
IC PPLlCANT RIlCBIVf.S MAIL
j1Jedum.i...CA6 J Y)e.tVl.a..
I N B LAN K S BEL 0 W T HIS L I N E.
.]'JOTE CAREFULLY. - This application must he sworn to before an officer of the Immigration and Naturalization Setvice at the time you
appe;u- before such officer for examination on this application.
I do swear that I know the contents of this application comprising.
pages 1 to 4, inclusive, antt tokl .n~ppI8JR"'U4.d IuuusThelclu. l~u\~).
.----.U---.h-..._______.._.hu_n__.n__.h_, subscribed to by me; that
the same are true to the best of my knowledge and belief; that
corrections numbered ( I ) to ( ", >Were made by me Ot at my
tequest; and rhat this apjlication wa~~ed by me with my full, true,
and correct name, SO HELP ME GOD.
/~-~=9a.~~~~f~pplic;..t)"--.------_.---h-
AFFlDA VIT
Subscribed and sworn to before me by applicant at the preliminary
investigation C. . ~-n-----n.._-"'-.-n..n----
"~-______m__ -..~-.t~ W8:-igp----n--.n--....no.._____
thIS Unhn-h__U_U.ft.J 6f. _.n_...__.n_________..___., 19 _"_'.
I certify that before verification the above applicant stated in my pres-
ence that h7~ (heard) read the foregoing application, corrections
~_=~::~~?~7-=.~on=
:' (Naturalization examiner)
l/
~2-:r)?~---f!2.~lL--.I1~?niln6-L!.qd._?4!:_.:~____.__~~_ ~-::-..m-22-_~.eR_19B..9___.._.___
(Por demonstration of applicant's ability to write) _. U".L.-,:,:,:"~
('" 'im~) ---CL""'--L--t-_"'-__':2flB_ r'_L.-::_________________~___n_______"""'"")'\ -----L,-ru-<t-~nS_f;,K-en>:o(e ~ k.
residing at ".-hn....--#.~~m.r.-~,-.r,;.,--b..t;l._ CJ.(~...b..t4..J::':'..~.,..-L':6-:..-----__._.. _ _ ..... "00"'" _ __.__._.____
~ . ') ...... (Street address, city or toWn, and Slljl!)
(2d witness }-----~::--3?..~.~.t?_-.n~T;mmJ)-.t.:.~.b:.Q-~m---:~. Occup~tion ,~J,--~-6LY_....u..L~.Jt'..k ,-
residing at m----.m-------~-~:Z~==-n.C?c.e~~.J:7-..--..s.:f:~~.l,,~-O:-a1.~/;)-./~, : L,-J -rn~-n....__..____...______.___
. "kSSltreet address, City or town, and Sta.,) -,-o}"
- '~j
U.S. .m.______..._____!-:/. ~tate l__n_ooom_6. . Physical presence ----_V/n______ mos. _~-~jl-:...-~ ''''00 n__m.___..._______....
V -:----:{if.-~raIiz n examiner)
ARRIVAL RECORD FOUND
Place 00___00__ .-.---_____0000_00_. 00_ -_._00____00___ __.00__00 _. 00_00__ ___..
Name
- --- -- ~ - --... -- -- --. - -- - -- --- - --- - - -- ---... -- --- ---- - - - --... -- -- - - -... -- ---....
.---.____00_____00__. --------.---n_._nn_._n_ Age -___00__________. __ ___..
Date _n___h..n__.h___.. Marital Status _-n-.-------____.__.n_____._n.
Mannet _00-__00_.00__00. _. -u.____Uh______." --_hU_____n.hn __nh___.
Card index 00---- - ___.__00 _.. ----n_.hn_..nn__. .______ _ _.__ '.'00_',__,
Index books __._0000 _ _hn____ .n.n_._ _. '" U 00_____._____... _00 _... n _ _...
Manifests "_n_. ---.00---00__00__.__00______ __ hnn__ _.00' ..__ '" ___h___..
..------ - - -...------- -- - ------ -..... --.._-- --.. -------...-----------......-----..------...--
. -- -. - - '". - -- -. --- -. - - - (Sig;;-;;;;,;;~fp;~;;;;;~i,;g- ;;;;ch) --..-.-- '''-'- -- m..
N onJiJed ----- - - - ._h.__.. -- - __a ---- __h_n noo n.__ -. __00 00_00_ _.. _ nn _. _. 0000 u_ 00_ _ _ _.. _ __ _ h' _. ___ __ _00. __ _ __.. _ _n _ _ _ _"00 _ _.. _ _ h_.._ __ _.. _ ___ "" _... __
(Pates, reasons, and examiner's initials)
5
,----.----
'-:~l;:;j1r
:--.l.
6
I ,
...
,
< ~"""'I!"li'''''
Form approved. '
Budget Buret" No. H-R079.9
UNITED STATES DEPARTMENT OF JUSTICE
IWMIGRATION AND NATURALIZATION SEIlVICE
ALIEN REGISTRATION
(Show the exact spelliDlJ of your name as it appears on your 'Ili.n registIll'
tion receipt card, aDd the number of your card. If you did not register, '"
state.) 1/ '8'
Name ---'21/:7J--t~~Li2~-n---------m---hm--_..--n.
No. _.11.____ u_5~_._ ___ -..1.:1 _ __n__._ ._h____.. _unn _ - - -- -. ___.
Mail or take to:
\~O\:rMIGRATION AND NATURAUZATION SERVICE
~\~'Y\ 1)\ APPLICATION TO FILE PETITION FOR NATURALIZATION
V\\ \ (See INSTRUCTIONS, page 5_ BE SURE YOU UNDERSTAND EACH QUESTION BE.f.?RE YOU ANSWER IT.)
I desire to file a petition for naturalization in the- Date: .f;ll9.If?.~~___nnnn__..n.__m______n._._____
__n_D~!lQJYJd,g!J.d._D!J!!Jd.-.jf_-..- __m._ __h n. Court at __"uc.~€!-___m n...__ __m___m_._n..._ _ _ _ _ .. J:~!_..... _._ n -- - - - .-_
(Name ofCoutt) (City) (State)
1L (' fJ .
My name is: __...__ -ffUIJ{}.. ;j..Q.Q__...!.-_fLt./J..__ __..__ n.__ _______ .nn_ _ _. .__.. __n nn' ._____.___ .____n.__.___ _ n.__n__.._ _ _' ___n... _'n _. _. n_._____
I Ii~ ." _____________J!..fJ.__ #5-------(-,,;;;-;;;-.;;;-,.;.;;;:;.;~;;;;,;,:;:;~:;-~-,;;;;;;;;;-.;;'i----------------------------------
__hJJlecAan.~~_6_WJ!()__m___.nmn_n _m__ .Cf.!!7!...~'~ntf) ~n____ ._h___._ I?~!km___ (S;;'t;/{z~5cteT- .__._.__.____n
Other names I have used ate: __I..~JL!}f!!:!!_m__nn_________!!J1_~_r!'J:_ ,,~~~__(~~~~_.._._mn.nmm_n._.___...m__mn...n.______mm
(Print or type heR! anyorh r name you'have e-<er used, including maiden name)
HOlUJe W!-~: 0 Male rn Female
My present occupation is Faci.oll.~l- iilOMeIl.,
(Ia) Was your father or mother ~er a United Stares citizen? (If "Yes" explain fully separately) . . . . . . . . . . . . . . , . . . . . . . . . . . . iO Yes ~ No
(lb) Can you read and write English?. . . . . . . . . .. .. - . .. ........... ... . -... ...... . . . . .. . . ... . . -. .. .. .. . . ... . .... . .1~ Yes 0 No
(Ie) Can you spealt' English? . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1[3 Yes D No
( Id) Can you sign your name in English? . . . . . .. . . . .. . - . . .. . . .. .. . .. . . . . .. . . .. . . . . ' .. . .. . .. . .. . . ... .............. '120 Yes 0 No
(2) In what places in the United States have you lived during the last 5 years? List present address FIRST
Faow-
To-
SnutET ADDIlESS
"." < ~f) jf. ch.' y)
(a) __11Jj.1IJ____n_ , 199_0_ ______ PRESENT TIME .~._,....lJ -,-- '5..--.--d.---m.mbl--7r-m---- l"r)m;;;;.g;:g.-r;a7/!!!fjJ...-t'jJ~!-.
(b) ___61.1.8m.__' 19 Q,) _1.01.1/2...m___' 19li6n _Q_~_5Qt+--fJ.~..f!L(Lm~.---g{IJ.-~-.- U?u._~~__.~~Jml~!-.
(c) __hnn__.__._n_ , 19 ____ ______.__un_.__.' 19 ____ __.n.______U______..___________._...n__._.____n_ .__n_n_.U_.n____.__...______________.
(0) n________.n.n._ , 19 .___ ___._n______.nn' 19 "_n n__n._h________n__.nn____nn.__________._______ ____0000 .n.n.__n______..n..__.________..
(e n___n______n__.. 19 n _ nn_...' ______n_' 19 _..h _______n________.__.._____.._.____________.___n.__ _.___nu___.__n___ n_......-n..----__....
(3) What were the names, addresses, and occupations (or types of business) of your employers during the last 5 years?
List present employment FIRST. .
FRO.M-
<:UPATlON OR TvPE
Of BusINESS
(a) ..8 .J .-.-.____n.' 19 ~Z n_n.PRESENT TIM~-.7'--- 7'--- ---/!...--;!J!;,.9:L '!.!mm_ I__f!:.m.~~_!'j___ 1__. n'f!- i/t~.~-~Ji:.-f act.
~1::~1:~::::::::: :: ~~ ::~I:~:::::::: :r:~:"I~~::::~::~~::::-: ~~~?~::t:~::::: ::~~:~::~
(4) Have you been out of the United States since you first arrived? -nmm._nm___._.____m__._____u..__m__.mm._________n. 0 y~ I8i:N~
I( "Yes" fill in the following information for every absence of k11 than 6 ffl/)nths, no matter how short it was.
NAME 0' SHIP, Oil Of AiELlNE, RAILROAD CoMPANV. Bus
s:.oW'ANY, Oil OTHER MEANS USED TO RIlTURN TO THE
UNITED STATES
To-
DATE De'AI<TBD
DATE RETURNED
PUCE Oil Poll.' ENTR
RJrruai!i:> TO TH
> .. ::0
_ _00__.__00 ___ __ __ _ _.... __n _ ___ __ 00_ _ _ _ _ __h _ 00 _ ____. _.__ __._ _ _ _ _ __00... _ _._. __ __ _ _____ _ __ _ 00 00 '.___ ____._._u___ d. n. ___ ."'--: __ _ __. ....,.._. n______
_____.__n ___ ___._ _00_.___.___.__..._ n_ __ n___ n__._ - __ - _. - - ____.00. --- -____.. __.n -- -. ____00 - - -.---- - ___nn - --oe. _. ._.~ .~______ ::.~
~ :=~~ :~~~~:~ ~::~:: : ~~~~~:~::: ~~:~:::: ::: ::: :::::: :::: :::: - :::: ::::::::: ::::: :::: ::: ::::: ::: ::::: ::~: =: :~~~::: :~~lt: ::~~~~::~::: t~::::: :::::
(5-)-H~~ .;;~~-~i~~;-h~~~-;~~b;n- m:-;ri~?~~~1.~~-oo H~~-~~~.h~~. y~.h~-sb~~d o;.~-iE~-~~.~~i~ -~~~-------id:~;~~~-~~
married more than once, fill in the following information for each previous marriage. $l
Ho.... MARlUAGE
ENDED
DATI! MARRIED
DATE MAllIllAGE ENDED
NAWll Of PnsoN TO WHOM MARRIED
SEX
(a) 'hnn._____n.nh_n_____ n_nn___u_________n____. n___._n._n___n__...n._n______nu__nU ______
(b) __oo_._._n____.__n_n__u n7_.______u.n__.oon____. n.u___O________..____nn___.__nn____n_ . _____
r ~) __.__n__n________________ ___nnn_n_.______oo_.____ ___..._____.u..__n_ .___.______.0000_ ___.n _Uh_
(d) noo____n___n.______n._. __n____n__u_n______oo _ __ .___u_n.___ ____.___._.___00____ .___
Form N-4OQ (Rev. 7-1-66) (1)
_____00 0 ...___00_0 .n"'._nn__._oon___
. ______ 0 ...__n_ _ 0 ._._ _h__n_nnn__.
.n____ 0 .._nn__ 0 ____._.n____n._..n
_n.__., D ...______0 .-n-n--n-u-7s-.
(0 HR)
· 2
(6) The law provides that you may not be regarded as qualified for naturalization under .certain c~nditions, ~f you knowingly committed c;;(rtain
ottenses or crimes, even though you may not have been arrested therefor. Have you ever, m or outsIde the UnIted States:
(a) Knowingly committed any crime for which you have not been arrested? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes 0
(b) ~:c :=;~~;~~e~,. i.ndicred, convicted, .~~ ,o.r. i.~~~i~~~~ for. ~~ea~~g .o~ ~iOI~~i~~. ~~~ .I~~ o~ .~r~~an~e: ~~c1~.~~ 0 Y es ~ N/
If you answer "Yes" to (a) or (b), give the following intOrmation as to each incident.
WHEN WItEIUl (City) (Slate) (Country)
NA'l"URB OF OFFIl~
OuI:coMB O. CouE, I. ANY
.
(a) .u._n.__u..__. -.u.n---u.n--___._u.__n._____n.u_.___u.____u _. ___.______..__.____.._. _. nuu.____u__ny.u. .----.--------..ri---u..u__..
(b) - --. n__Un_____ .--n.---.---_..n.__nn.n._n_._n____. _ _... u_n____.u_uu... _. ._____.n._ ____ _ __nh_ u'_-I""";"'_ __ __.,..... _ ___ ___"_~_n. _ _ _ _ u...
(c)_ ______.__h__.n n.n_nnn_n_n.nun____. .________n_nn__ ___ _ Unnun._n____.n. __n __ .__..__.___.. __ .~~:..C~n- _ _ :_: . __n.L n .}.___ n _ 'h.
~ :; :~~~~~~~ ~~~~~~~~~~ ~~~~~~~~=~==~~~~~~===~~~~~:~:::::::~:::~~::~:::::::~:::~::~~~::~:~~~~::: :::~: ::::::~~~~:::~:~:~~:~:- n.... .__ n.,. _. ____ ___.
(7) List your present and past membe. rship in every organization, association, fu. nd, foundation, party, club, soC;i' , at s\milar group ill the United
Stiltes and in any other place, and your foreign military service. (If none, write "None:' .. . .
~: ~ ~~~~~~~:~~~:::::~~:::::~~~::~~:~~:~~~:~~~~~~~:~::~~ ::~~~~~~~~~~~~~~:~~~~~~:~:~~ ~~~~~~:~:~: ~~:~~~~~~~::~:~-~::~~:::~~::~: --. , :: ::t:: :: :: :::::::
((j n--.-----.n------.-.-h.--.----.n--.n.__.nn__u__n__n_uu._nn__._U____h---.--.Uh-.__.n..n_.__u________u_____. , 19 _____n' to 19 ___no.
(d) .....--.--.h--n...--.n..--U.U.___n__nnn.nnu__.n_n__.u._._n___.__hnn-___h___._____._nn.n______________n___ , 19 .h'h_.. to 19 __u_..
(On-uu--__.______u.___u_.u___n_______________n_.__________________h____.----h----.-n-----_hn___h__h___nh____u.u , 19 ___h__.. to. 19 ______.
(f) ..------n-..---u--nnn____nn._n_u__.n__._____nn___n_.____.__ -________n_.__h___ __nn_n_n_________________________"' 19 _______" to ~-J _h.n.
(g) .-..n-h--n--h-___.U._________.______n.__.________h_____n________h_.--..----n-n.__..____.___._.n______._____________n ,I? .____'":':'.' to 19 _h__..
(8) (a) Are you now, or have you ever, in the United States or in any other place, been a member of, or in any other way con-
neered or associated with the Communist Party?.. .. .. . .. .. . . . . .. .. . .. _ . . . . . .. . .. .. .. . .. .. . . .. . . . . . . . . .. .. .. . .. . . [J Yes
(b) Have you ever knowingly aided or'supported the Communist Party directly, or indirectly through another organization,
group, or person? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . [I Yes
(c) Do you now or have you ever advocated, taught, believed in, or knowingly supported or furthered the interests of,
Communism? . . . . . .. ... .. .. . . .. .. . . . . . . . . . . .. .. . . . .. _. . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . .. .. .. . . . .. . . . _. . . ,[] Yes
(9) Have you borne any hereditary title or have you been of any order of nobility in any foreign state? . . . . . . . . . . . . . . . . . . . . . . . . CI Yes
(10) Have you ever been a patient in a mental institution, or ha~ you ever been treated for a mental illness?. . .... . ...... _... ..0' Yes
(11) Are deponation proceedings pending against you, or have you ever been deported or ordered deported, or have you ever applied
for suspension of deportation or for preexamination? . ... ..... '" ... ... . . .. " " '/A"" . ...... .. ..... . .. . . '" . . ..... .0 Yes
~~~la~y:;f:;:::rh~O~r~;:e~~~~I.i~~~~~~~~ .;~~~: JrtGr'" .V................. ,....... . .DYes
( 13) Have you ever represented yourself to be a United States citizen? . . . . . . . . . . -. . . . . . . . . . . . _ . . . . . . . . . . . . . . . . , . . . . . . . . . . 0 Yes
(14) (a) Have you ever deserted from the military, air, or naval forces of the United States? . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . .0 Yes
(b) If male, have you ever left the United States to avoid being drafted into the Armed Fotces of the United States? . . . .. .0 Yes
(15) The law provides that you may not be regarded as qualified for naturalization, if, at any time during the period for which you
are required to prove good moral character, you believed in polygamy or have been a polygamist; have received most of your income /
from illegal gambling; have committed adultery; have been a prostitute or have procured anyone for prostitution; or have been a
drug addict or have dealt illegally in drugs. Have you n-e" anywhere, been such a person or committed any of these acts? . . . . .. . .. . . 0' ~o
(16) Do you believe in the.uos. Constitution and form of Governrnenr OfthrUnited Scates'... "'" ........................ .&I~o
(17) Are you willing to take the full oath of allegiance to the United States? (See I uctions).... .. . . . . . _ _ . ..... .. .. '. ....&1 0 No
(18) If the law requires it, are you willing: ~
(a) to bear arms on behalf of the United States? . . .. . .. .. . .. . - .. . .. .. . . . . .. .. . .. . , . . .. . . . .. .. .. . . . . . .. _ .. . .... .. C!lYc!S ~o
(b) to perform noncombatant services in the ArJl!ed Forces of the United States? . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ Y,d""I::;lPo
(r) to perfonn work of national importance under civilian direction?_............... _.............................. .gJYee"!5No
(l9) (a) If male, did you ever register under United States Selective Service laws or dtaft laws? . . . . , ... ... . . . .. _ _. . .. . . . o. . . .. .0 Yes 0 No
If "Yes" give date. .. . .. . . . . . ; Selective Service No.. . .. . . . . . . . . . .. . . ; Local Board No.. . . . . . . . . ; Present classification. . . .. . . . . . . . .
(b) Were you ever exempted from service because of conscientious objections, alienage, or other reasons? . . . . . . . . . . . . .. .0 . 0' Yes &I No
If "Yes," state reasons .................. . .. .. _ . . . . . . . . . . . . . . . . . . . . . . . .. ....... . . . . . . . . . .. . . . . , . . . . . . . . , . . . , . . . . . . . .
(ZO) If serving or ever served in the Armed Forces of the United States, give branch. . . . . . . . . . . . . . . . . . . . . . 0 . . . . , '. . . . . . . . . . . . . . . . . . . . . ;
from. . . . . . . . . . . .. . - . . ., 19 . . .. to .. . . . . . . .. . . , . . " . . ., 19 ...., and from. . . . . _ . . " .. . . . ., 19 .. .. to . . . .. . . . . . ... ..,., 19.. .
o inducted or 0 enlisted at. . . . . . . . . . . . . . , . - . . . . . . . . . . . . . . _ _ . . . _ . . .. _ . . . . . . . , .. . .; Service No. . . . . . . . . . . . . . . . .. . . . . . . . . .. ,
type of discharge. . - . . . . . . . , . . . . .. . . . . . . . . . . . . . . . . . .. . . _ _ . . ..; rank at discharge. . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . , . . . . . ,
(Honoable, Dishonoablc,'etc.)
!l NO/
g] NO/
/
181 No //
Iii No /
IX1 No "I
~No
~No
1iI~
lian;;"
DNo
reason for discharge. .. . .
o Reserve or 0 National Gua~ from. . .
. ..... .................. ....... ..... .-. -,..... ....... '-"'" ..... .....
. (ali"?"8e, conscientlow objector, other)
. . . . . . 19. . - . . to. . . . . . . . . . . . . . . . . . . . . . . . . . .
..
8
I ,
UNITED STA TES DEPAHTMENT OF JUSTICE
Immigration and Naturalizalion Service
To Petitioner:
In connection with the hearing to be held on your pelition before a judge of the nBturallzation court,
answer "Yes" Ot "No" to each question below. In ink or by typewriter, without making a.ny further
explanation at this time. The Cfuestlons refer to what has happened since the dale you appeared with your
witnesses Bnd filed your petition for naturalization. They do not refer to anything that happened before
thai date. When you have answ~red each Cfuestlon. sign your name on the line marked "Sign here" and
fill in your present address. Do not swear to your answers. BRING TIUS LETTER WITH YOU when you
come to the hearing and give it to the naturalization examiner. He will then require you to swear to the.
truthfulness of your answers.
After the date you appeared with your witnesses and paid $10 to file your petition for naturalization:
1. Have you married, or been widowed. separated, or divorced?
(I) Answer NO
(2) Answer No
(3) Answer /'10
(4) Answer ;V6
(5) Answer ,No
(6) Answer Nt)
2. Have you been absent rrom the United Stales?
3. Have you committed any crime or offense, or been arrested. fined, or
charged with tbe violation of any law whatsoever?
4. Have you joined any organization?
5. lIave you become a member or the Communist Party?
6. lIave you claimed exemption from military service?
7. Has there been any change in your willingness to bear arms on behalf or
the United States; to perform non-combatant service in the armed forces
of the United Slales; to perform work oC national importance under civilian /'/0
direction. if the law requires it? (7) Answer
8. The law provides that a petitioner for naturalization shall not be regarded
8S B person oC good moral character who, at any lime aCter his or her
petition Cor n8turaHzotion h08 been filed, has cOIDmlUed adultery; has
been 8 prosUlu.e; has procured any person for the purposes or prostitution:
has been a narcolic drug addict; or has dealt in narcotic drugs illegally in N Cl
an way. Have you committed sucb an act or been such a person? (8; Answer
-2 (;1 .), ((r;7t5 !1Iec'/tdlcs/'IJX 'If /705S
(81 e and ZIP Code)
PETITIONER: DO NOT WRITE BELOW THIS LINE
inne beCo e me at the Cinal heari ng at. c:-
(, . I certHy that beCore being sworn (aerirming) this petitioner stated In my
presence at he she) had signed this Corm; that he (she) understood the contenls: and that hilS (her)
answers therein were t to the be of his (her) knowledge and belier.
(U.s. Naturalizalion Examiner)
GPO 10 I. UI
9
UNITED STATES DEPARTMENT OF JUSTICE
Immigretion and Naturalization Service
P_ A.........
......t ......11 Mo. 41"'".1
{INP
PeUllon No.
710
Hyung Joo Bair
R. D. # 5, Mechanicsburg,Pa.
AR# A12 562 255
Date May 23, 1969
You are hereby notified to appear ror a hearing on your
petill8n ror naturaUzaUoD before a judge of the naturalization
court on June 3, 1969
al Prothonotary I s Office
Court House, Carlisle, Pa.
Please report promptly at 1: 00 P . M. Your wilnes!les need NOT
co.e with )'ou.
It the judge Clnds you quaUned Cor netufaltzatloll, you will be sworn
In 88 a citizen.
YOU MUST BRING WITH YOU THE ITEMS MARKED 0Cl BELOW:
[]] TMs letter, WITH ALL OF THE QUESTIONS ON THE OTHER
SlOE ANSWERED IN INK OR ON A TYPEWRITER.
[!J Alien ReghstratioD Receipt Card.
CBJ Any Immigration documents you may have.
If you cannot come to this bearing, retum this noUee Im...e~
dlalely and state wby you cannot appear. In such case, )'ou will
be sent another notice of hearing at a later date.
Form N-445
(Rev, 1-1-66)
(SEE OTHER SIDE)
10
APPLICANT:
':OMPI.fTE THI~ (f....ily_l
.f;fJ- , fZ-
J
)J,
(. " //. '
't)...f~ .. .
..... ..,/,.-..
(. ,..../
FOIM 0-325
i ,
BE SURE TO PUT YOUR NAME AND ALIEN REGI5TRATlON NUMBER IN THE
BOX OUTlINED BY HEAVY BORDER BELOW.
(G;""",,=,.)
(Aiit1f1 regi"rotiOl'l nUmhl'lr)
;4 I ~ 5,%.2 ;?'S-J-
(INS USE)
(1) ldent.
.
PHI-2'796
Nat z.
~i... ~,' , P/12/68
~------------ ----- -----~ --------- ---
..-...
11
.. __._....._L.;~~~-__.~~.~~ 0 "0 -.:v.~"...,- "'.- "o"J>' :.~--
-~
~r2"~~-" ";-~'"
. "" 'COlM,vNOY'B) I
A 19~fT Su....u NO. ~3--ll~36 ,
1'! OtS :w-> I
~ !'"
. I
.
,01/ol 0-325 (11-1-66)
/; '<)
/')-"-)
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalilation Service
~UG
,. BIOGiAPHK
r'" INfORMATION
I
.. U.s. GOVEANMENT lI'.lt{".~lf4GOffIC,t; "51 or-Z~~5....
FATHER
(Fin' nam.)
H~
I!E"J 7;;'0 BttiA
fAMILY NAMf I RRST NAME ) DA
moO1&. r Un/vwwn.
/(iJR S.di..
NATIONAliTY
Kolteml
(f_ily nam.'
flIoon.
AJ.l. OTHER NAMes~o '.
_L~7J4iA
o MALE IIRTHDATE (_.-!loy-y,.)
~ FfJMlE 711 JI39
AliEN REGISTRATION NO.
(""11 12 562 2
._____0__0__.
SOCIAl. SEC':lJl.I!Y ~(l
(11521 00 VQ
CITY ANPSOU~Y Of RESIDENCE
/VoJd.h. KOIl.e4
NoldA Koltt!.4
MOTHER (Maiden .......)
SPOUSE (If non.,.o _) fAMILY NAME
(fo, wil., give ....iden name)
~ju. I
(1, COUNT~IIITH (II kno....'
~~)
BaiA
-5
71f.
IIRTHDAre
;1'):. -
I C~'f- 7/251 3.f /1l4uA~bUA.9r
fJenruz..
CITY & COUNTRY Of SIITH
DATE OF MARRIAGE ~iiJ/JrIAGE
11/11 / 5.~J!!OA.e4_
fiRST NAME
fORMER SI'OUSES (II none, 10 ....,.! .
FAMll V NAME (Fo< wire, I/i.. moidO<! ......)
FIRST NAME
DATE AND PLACE Of MAKRIAGE
DATE AND PlACE OF TERMlNAnON Of MARRIAGE
fROM, MONtH
ell
,
~
...
APPUCol.NT'S EMPLOYMENT LAST FIVE YEARS. (tf none, to stole.) LIST PRESENT EMPtOYMENT FIRST.
FULL NAME AND ADDRESS Of EMPlOYER
TO
MONTH
. '
LAST FOREIGN RESIDENCE OF MORE THAN ONE YEAR (II no' ohown 01>0....),
CITY COUNTRY FROM TO
. (_I (V..,r) I (MonIIl)
THIS FORM IS SUBMlmO IN CONNECTION WITH APPlICATION fOR,
~ NATUIlAUlATION 0 ADJUSTMENT Of STATUS gOTHER (Specify),
6/1of!ff 41~rd8~OPP~~"
(V-J
LAST OCCUMTION ABROAD (If not rho_ obo..), FRO^\ TO
trOM . =-CMonth) (Y."" I~M...th) (Vear)
City C."".ry
- -
PENALTIES. SEVERE PENALTIES ARE PROVIDED BV LAW FOR
KNOWINGLY AND WIllFULLY fALSifYING OR CON-
CEALING A MATERIAL FACT.
COMPLETE THIS IIOX (Fom;ly _) (GiYM n.....' (MWIe _, (A'.... ~_ion n_,'
( OTHER AGENCY USE) (INS USE)
. f\ e" 1.'1 sed ,t1._'" AII-2796
. "ti..'T'.,nvp. \ v T I \e Nat,z.
f FBI lU\le, .... ^' . . i'n'l \~l' .... "'1':J~ .
Cheek o. ..' ed lo(~a tt;d no \l 1;;' 1 t 'j:l~ r.'~ . ~/12/6B
da.ta suun\\t. ' ur tnf1u\ry. N..
upon . dtlt"lCnt. to yo 'l' cheek _______________ ___ ___h_._ _ __ _ _ _ __ _n _ __ ____
\nforma1,.10n P "dearance. 0 do W
be l."Ousldl:red a,~ a at be subm\tte
to d ,(<u(:st rou. ' ts
attest l'e,~: s :" ~ Division. Fingorprm
FBI Idel1Uf\cat\on 'tive check.
arY for poSl
are necess (2) Ree:. Ir. 1?
fORM G-32S
.... t.::
.,. 15 in
i!:
r- ~ i
~
~ . ::0
I :~ ........
z~
. ~<
,...,.....
0 ~Q
c;;
I \0 :lllI
<
(Ill c:;
... '"
- --".... -.---....--....:.-...._,-....- ".-'~"
- ... '--'~."'-'--"'-"'------'.-~,..-_.._-_....,.._-.
13
. -~ --.~l.".
1 ' .,__
_.....--~ .~.-.._-_..-......u..__.L" '__
' ~'i "fl" D'tr\"
.~J. fotot Amovm
.~.~)('\ Natz. BUGGEr Iv_u No. 43-U36
~I'" r.<' 8/12/68
· ".$ C,OY"::ftNMlHTPFf'i"NGOF'f1Cr: IH6Of'---lS.....!
FORM G-32S 111-1-66)
· BIOGRAPHIC
INFORMATION
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization Service
(F7i:2.}9/~
AU OT)1ER NAMES USED
~ aruiv Bai.A.
(First no_I (Mide/!. n_el 0 tMJ.E
fI g.ung 00 12 FeMAlE
OTY AND COUNT!tY OF IlIIlTH
/I 00 Ba.i.A 5i.n.e.ui-'u , KO/l.e.a ______
fAMILY NAME FtIlsT NAME DATE, CITY AND COUNTRY OF B1~ (H boo....1 CITY AND COUNTRY Of IIfSIDENCE
!1loon (Unhnown) (j)nhn.oWf1.)) /Vo/1..f.h. Ko/l.eJ1.
K1Jn. 54i.. (Unkwwn. /Vo/1..f.h. KO/l.ea
FAMILY NAME fIRST NAME "RTHDATE CITY & COUNTRY Of BIRTH -DATEOiM~
(FIN wH., 8i,.. ....._ _I
rN ~riC:N~~:;ry--""
! Ko/l.ean.
ALlEN RfGISTlATlON NO.
(If''''II 12 562 25
SOCIAL SECURITY NO.
(If.~1 60 0892
fATHER
MOTHER (MaidM _I
SPOUSE (If nono, ... ,'''''''
BtWt.
11/11/59
~i::Jr'Gf
Ko/l.etJ.
FOllMER SfIOuses (If _, .. _,
FAMIl.Y NAME (FOf' wH., gMt _idon _mol
fiRST NAME
DATE AND ru.ce OF MARRIAGe
DATE AND PlACE OF I'W.IlNATION OF MAIIlIAGf
fROM: MONIH
Al'PI.lCANT'S EMPLOYMENT LAST FIVE YEARS. (If none, fO state.) UST PRESENT EMPLOYMENT FIRST.
FULL NAME AND ADDllESS Of EMPlOYER OCCUPAnON
i. /fIeCA.
Lema %-~
FROM
MONTH YEAR
TO
YEAI
-----
------~-- -- -- ,--"-- t~--
LAST fOII!lGN RESIDENCE OF MORE THAN ONE YEAR (If nof .hown above), '---rll,ST occurJ\TION ABROAD (IF~ -~--- FROM ~ TO
an """"" ..". ''', , "One. " ,(._' "-, I (._, "_,
(-~__--=:1~':'Ih) (Y-J_~;ry _ COllftlty -L
THIS N)RM IS SlJIMITTEO IN CONNECTION WITH APl'UCA TION N)R, _ __
ua- NATlIRALIZATION 0 ADJUSTMENT OF STATUS 0 OTttER (Specifyl:
'I'CL'i'
PENALTIES, SEVERE PENALTIES ARE P~OVIDfD BY LAW fOR
KNOWINGLY AND WILLFULLY fALSIFYING OR1::oIl-
CEALlNG A I"ATERIAL FACT. I 't
--~
,~ u~~s OF AMiRJ(A
IMMIGRANT VISA AND ALlIN RlGtlTRAtlON' .
. . . . .
",' '.. ';':"', '~. .-' ,'.4".",'" :'--r",:~:. ~:":"':'~'~-~':':'~"':" ""~:".";":'~':'-"""::" .....'.:
'.":hI'YJIOJI~.~!::~ ~l, :oUht;:~.t~: ,",",.' '..','
~~==-~i~~~~7;~:{,~,~..:
-~.__....RQ.k.~-.1.L_W1UD.~--.....__......:"""-,.."",,,___ ~~l:t1:.,on ~J)'rPved .' on. .{Ihr.et.l1.:6, ,:t~Q..... :., ~ ::.
Vice Consul oftfN, Un;ttcUfo_.;~AMeftqd.;. " : '*'lG!MN:r'Vt$a NO.. ~... . " .:~;\ .. . ':. ~ ,. ,_::'
. ....;..J5~(.NO~~A), .:.', ~ '. ,,: .:"::' :,.:
,.:~ O~::::::~":J=~>:t~'.::.:::?F::.'i:~~~
THE VAUDlTT OF THIS ViSA EXPI" :.ill~ .t:',~: >, .~:. ,~.::c
to.,J .' .. . ..(-MoIifA}. ,;.(rifid '.:
oi.'k>NALIiY r~~:.1:::~~~'~~,;
(Fvmil'lllOmc)
(t:In"tamc)
J.G:; Il,i'1:Ulb
HHW~J70
~ certify that the immil'Olrl'. ~ .herfilt Q"i~ in.
the Uni+cd States at.this port on'fhc .....,....".,~....,...
...............77..11.___..2. s.!?_.......................
3'thmc 01 <rcucJ orfli,M No.oI.iicraH) . .
on ...(d;..................(-Li...---._.~(y-6f......
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and was inspected by me and} LIt Jilt'" hI rll.lb..
...ma"'" !tv 'p ui.1 i n ~ . '1' .m,,"'; 1I1tde~ . ,
Symbol ...,4}.~~/................__m
SectiOo/"~~~~. . ..,._1..IIL_ of.... ~."'.' 'an arid.'
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=~.~..2rf'!.'-!.:..::::::::::::::::::::::::~::::::
~Paid $2&'
. l.ocatCycquiv.UWANz67'COO-P..l\iQ,.........__..._,..._._
. ST~T1Si\CS'
",;:.".
(MiMI: 1IGlIfe) .
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TO Mr,s.lJ.yung JO~BAIR ~~",~<<l9!!?:'~'.',i ";:',<~
. ,',. , ~ .,.. " .' . .:-,-..,.' .
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h,., FS-510 !~ & Korean) (8-17'
}IlIlYl1 DEP"'RTM~ OF STATE
FOR~IGN SERVICS; OF THE UNITED STATES OF AM~RICA
APPLICATION FOR IMMIGRANT VISA AND ALIEN
SO REGISTRATION
Ai08 C
BO~ ..f ~"ll $Jl~ ~J>J:
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'UCTIONS: This fonn must be filled out in DUPLICATE by
.'0 writer, or if by hand In legible block letters. ALL questions
musl be answered, If applicable. Questions wblch are not applicable
should be so marked. If Ihere Is insufllclent room on the fonn,
answer on separate sheets, in duplicate using the same numbers as
appear on the form. Attach the sheets to the forms.
DO NOT SIGN this fonn until instructed to do sO by the consular
om""r. The fee for 11IIng tbls application for an Immigrant visa
if $5.00. The fee should be paid in United States dollars or local
currency equivalent or by bank draft, when you appear before the
consular oillcer.
WARNING; AnU fa.be statement or concealment of a matertal fad
may result in I/our permanent exclusion from the United StDlu.
Eoen though you should 11e admitted tl) the United States, a frau-
dulent entry collld be ground for your proseculion and/Or deportation.
:aJ"'1"'}~:* o,}~.g. E}"}71~. -t71("fiC)~ 'ti-?-olHe- 'tl71
oJ! 4H. r !!.~.3. ':<} ~ ~ -f-.!8--i- '*11 ~}"'1..2. $Jl "<l'
....}~ol ~.;::. ~~';toll';::' .5!..!f- "'.I' -&}"'1..2.. o,}~~~ -l-';t
oj Jf-~%}td "fo,}"'-'1.21 'tli -i- ....}~%}of ~%.21 1.;;.1 ell
"'".r~}).l..2.. % '!! :<1';::' * oJ' ~ <>1) ~ of %}8 .2-
* oJ'~..@c "'"J-811 og A}~ ;<1"'J7} ~ ~ol/ *;;.].;::.)~ 'll %};;.]
'C};.1..2.. ~~"'>>elJ qj~ * 11-'J"I~ llII-t- ~o/I .ll.. ~]-
.;::. lll%..@c ~<1J'-1"4 % -r-T=-Jl';::' =flW}7} ogA} ~oJI -t-
~lCol/oll "1~i- s:.-e "tl~ ~i!:- ..@cuR ~01%~~~ :x]
i- ~).1.2...
~ .1!.: 'll-oJ. '11 ~ ~ Ti- ~}~ >+ 11 't aj )\}{l i:- ~ll'll ~kl
=fl~H:- "1~E..~ Jt-c.] og~itl 11~"'1 "<l'lC"l.:s;. .!i!.~l.J'4
1!A} =fl%1-.21 ul~ 'l1~01 ~~ JOlt'J,*.:s;. Jf-lIOJ';;r~ =fl
i!foll qj1l- 7jd:. ~~..@c +'11- AH-7} ~-r ~%'-l4
There'liy apply' for an illimlgrimt visa and alien. reglstrattcitiiltlheUiiile<.l States'-
EmbB8s~ at Seolll, Korea and state the following facts:
4!:-oJ~ :<J-<>ll "'f(II:).~ utr 1:11 A} .'tJ: oJI...q oj'll <1J~~H- ~ ~~<uH-i- -U'" -&-]-1:>1 ~}71.21 ....HIt- ~T ~1.-j4.
-._" ..--- ~----~._--_.
LM.;-familY' n~~I~(~9.j -.:;j)-M:;ar-;-~me Is (*-0.1$4" 'll My middle name Is (4!:-oJ~ 'll)
)
Joo
2. is (4!:-oJ.21 4!:-~ 11 "il (~ "r:<} ol.sj~ ~)
Y-Otber names t"itave used or by which I ha heen now re (If nla ied woman, give maiden name)
. ~oJol ....1-% 1IlI~ s:.~ 4!:-'I.l01 ~~*:<1 'l!eJ~"J. 71'4.21 'll.2l (71~l>l.21' ~-?-oJI-e t1J~).l.2l -'S"cl)"
:HOONLl!~ng ;T<:X?_ . ... ." \ ,'. .
"4.The date of my birth is (-l:-oJ.21) /5. My place of birth is (-t',-oJ9J . i-"lI;;.j) ,
(Day) (Malt/h) (Year) (City or town) ().J. % 'li) (Province) (.:s;..) (Country) (~)
(~JJ JJ1/fJ.) 19)~ ) Sunha~ong, Sinuiju city, No:rea.
6. Myage la . (-t-'I.l.21 'li'i>j7. My present c"Uillg or occupation is" (-l:-'tl.21 ~a])
22 House-Hife
8. My present addresl Is (~'I.l~ ~"'f..t-.)
#740-6, Fannam-dong, Yongsan-Ku, Seoul, Korea.
9. My se"iTS(4!:-'I.l.2l 11 1. ) '110. -M~:~:::l (::~:: :arrie~ :::ie; ~ W;d~~ed 0 Divorced 0 Separated
-&-11 (t1J-!-l :>l.t- vloJ-'tl ol--!- 'fl~
I IInclading my present marrIage. I have bei:n marrIed one Time.
o Male El Female ~'I.l~ ~lllI.21 ~~~ ?l.:~}~}'"l_:tj ;;l~ %}911~.
'It ....
li':'My nationality is (~oJ~ .;:-~) \12. My race is (4!!-oJ~- 'tl~'t!J
Koroun ----_____
14. My personal description is ,~oJ ~l oJ""} I /15.
(a) Color of hair IT",f -'.lj) I (c~" HeiJ(ht (-I:l~) 11 -~
DIu ~1- ~ feet (.'lIj!;!.) ~ inchesC'tl='l.
(b) C01.O r ';;; e. yca oJ'o!j (III!J . '.1. (d) c.omPleXion.. oJ-'~ (~'~I
Dark Broun Medium' Nil
1fi.-MYliurpose In going to theUnhe<.lStates'ls (~oJ:9j --;j~~~~ifT----"--'-
For permanent rcsi1ence.
~e~:i~n~f t~mr:;nt-:.il~ t~r~~j~d';S~~ -:f*ni~~~~j ;j~G;i~J f8. ~~~nd ~f.;J:~er if;] U;}~.i1a~js~~ffi~~~ ~ 4.
~~)~ -'B:z} 'll '-14. Permnontly I Seattle or San Francisco.
19:I'~~_(~0-Not)-'have_,,-~icket to mY!~a:.~estinaUon *oJ~ -<t:!lj~1 ~};ir9.}~~ I~ 7fiJ.:il. ~%-\:l4 (7fiJ.:il.. ~;;.J '?;t%-'14)
o. (a) I alll going to the Umled Slates to Jain the rallowlnl' perRon I 20(b) I am sponsored by the following pet"son and/or or~anization _
I(:!i". 'lame and address and relationship, if any) (7}) *oJ .' mine address if dllTerel't trom (a) h+)4!!-ol ~ '"1-71 gl ~
~ ~71~,j.4 ~~1~71 ~'6}aj t11.;:-oq '\l~t~i<j ~'14 (~E..'tl. ::z. j' ~~~~.2l .!t~-i- ".!-.:il.. ~~'-14. "J:<lf(7r19-} ~eJ.e. ~+".e
AI-;g.9j ':l 'iI f.~ ~ ~oJ.IZj-9j 3'.];:<11 -tr 7] '{j W-~ ) . i>~-i- 71 oJ %}"'].n..
Clayton W. I3air Jr, HusbrU1d,Add: Same us #121. Same as #20.
1. My final address in the Unlled States Is (i'!:-oJ~ ;l~Yl~f--aj<r- ~~)
113472 Green St., C8.r.Jp Hill, Pennsylvania.
o. R FI
*oJ~ -~ "1';:-0;1 ""t71 "JoJl-'1 If- $.3.. "i! %"i=- ~ %'-14
11S. My e::~:~:::o: Is (~oJ4 ,~+,,-;--
I bave the following visible marks of IdentlHcation
~'tl ~ ~:>J
. HE
TA
(bl
Cash
~V
bank deposits
attached affia!l:.~it 0:' SClpport
(cl Real estate (value)
, -1-~~ p~ *11 .
(d) Other. ...................
P e 2!
~-egof!if 71~
23~1~ Rm suhmittlng th. followin~ "ersonal documents in SUPl>Ort of and as part of my application
~oJ~ ~'U$J 1!.~"I~ Jj!IIHI~}o; .9:.-e ::t.. ~.!jl~"I %t-71~ "HH. ~H' lbi4
Birth certificate Mlllblry reeord 0 Promise of employment
f:ljt:.!j"** D.i-^~*.Jj!.71~. .:i1.-R-~)'ll'''I
_POlice "ertillc::te(s) .,...,Evidence ef support or own resources 129 Medical record(s)
k>.l....Jlla:.A~Af 't.!:t1l"ll.li!..-FAf s:..-e ~oJ..9J :lHl--F"I =tl1;fr"l
'-'pIller (d~.cribe)
U)JEJ-\1!'f~?II) Extra copy. of pliot~[;TQ:P}: a Form I-~_9____~__.___.. ___.__
24. NBm. a"<1 present residence of my wiferhus.bapd is Wiv. Inaiden nallle of wife)
~oJ~. ..."l/ if~SJ ~~~ ~ ~ 7J~ .../:iiJBJ tJ)-!-....!. "'8;~ ~J'tI~~) 11 Tj'. ."
_.':'1'\{"'.9n.-,l.._~",1.r u.!"L~dd~...lst']r~n.,. \CarJ~ APO 20_, San .Lranc~sco. CahJ..
2S. The nallles aml uddresses of lll~' cblldrcn under 21 years of aRe arc (.f!:.'dBJ 'fr _ -t'--"l!Dl"J :<}"'l$J ~~ ':ll "t-.&:.)
Hone
..h__"n_n'__h ....u.-..___uh..
26. The names of members Of' my family who are hnmlRratlng wIth me are (~oJ BJ 7l-<?r".r. ~l 'U ~'ll-::t~~ "'8 'll )
None
27. The naIne and adUress of my father Is (If deeeaBed, .0 sl..le, gh'ing dale)
~'U.21 -HIBJ ~~ ~ 'l'.&:. (Al-tlJ-~ ~+olJ-e .:z. ,tHI* A~"if'l!::tH- 71't1 ~~)
HOa N. Si ---,-Ad d: U1"'J:~0"W11
28r'n1~'heOlma..!i!..idenJnOn,~~ar:.1~ ad~cS8( '~~1.':l mother Is (If de"'!a.ed. .0' Btate, giving date)
'":J .., ~ ." 'll llIl .... ~n..r 'lI+oJl ~ .:z. "'HI;;>} ;'l-"t1-~:<H- 71 'tI ~~)
K t', S~ eceased
29. 'l'lle name and addres. of .my next of kin tn my borne country is l~'U~' ~';:->lI.sj .i! -2''ll::ol-~ ~'ll ~ +.&:.l
SONG, Ja.c Man, AcquulnttL'1ce, Add: Same :13 //8.
30. Since mv sbrtoenl" birthday my places of residen"e for~ months or more have been
~oJ~ ;oiJ -r;;\'i:J "lIo,! o]",,~ ;;';:7~~ oJ"J-BJ ::>11'-::tJ
Citll or tOWll Provinec Count"11 TJate.. (Pr'!.In-Io)
....1 -1r-~ tfl ~ ~ ~::o~ ':<}r~J ::tJr~J
..ql~t'J1Ga.'lg::,~ong ,.C11unc:J:1<:t .~~ ~y) ..r.9.1'.et~.....I!.~.r()r.()n;LJ.4.? ~o..:1:1Yi'..
."..... ...:t'-?:'.'':t;p.yror;tl5~ong}Y()tlgd?ngp()~~ll,$<;loul, !Coren. .:19 ?.7nto.. ~95~.n...............
.~.J~M.~:;~~i;~:t;"~~J;~siJ:~t'1~Q,;~::Ul,~?r~]"'i';9f~?~?{~";;e;~~L
Calling or occupation
:!Jill
..........-..".......hn......_n......
...........n....................
31. Sincp m,. sixte""l~ birffittay I am-----orlillv~...._rn.eIl1ber or affiliate of the fOllowin!( pulitical; orofessional. vocation or social orflanization.
~oJ..g. :.n -t';;\'~ "lIOJ. 0]+ .O-}7jBJ ~;l.) :ahl ~* s:..{:- 4~q~.9j ~{lol ~::>1>t ~:t1l .:z. ;j)-1l.9...i!. .srof~~'-1*
Nome an" adrlr"'v Dates (From-To) Type 0' membership and o/1loe held.. if any
'tt~ 'll ~ .&:.;o~ ::<1 ~ ::<1- .::<1- ;t) .tHi BJ * 'J1 :!J ~ ~ 7~=tl ~ wr-oJl.e .:z. -f.4t-
){QPC
'-"..... """'hn... . . ..n.. . ...--... .U-h....__.n._.._.......~.....h......u_. ...... .n.........~.... ......_n_. ...n..............__...
+.. - .n......... n. ...__ ........ .h. ......_ _. '___'h.
. 32~..riipeak;..;:i,.;,({..\;;rHe 'Hi,,' .fOno\ving'f".iiliiiii!(es".nfici',;iie'.;;our:."'.,iiiu"":;ingrro:qel j .......... .
~oJ..g. "b-}71~ oJo-j 2i!.~o-j* N..,-}- ....J7J.~ 1% 'H- "8l..ll il..ll ~* <>,[t-J4
l,angllarye SplU1.k
oJ o-j 'lI:1i~-e ~
.. I~Q:r E3.9:D......um... _ .._ ..(.;.99r].. u... .... ....... ...m..
.. .... n.EngJi.re.lL.... .LitLlg.
....... "n. _..... h.. .........___._._._..
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Read Write
il ~~ Il!:-e:::.t
.......Littl?...............................LiUl.tL.........um.u.._..
...... ..... )!on.e............................ ..... ....None...... .... ..................
......... ...... ........................................................... ................... ...........................................m.
33:-~J~e W;j'i"~i-~ ~ei:D;1'4:~te ~t~~rS~~j ~'r~J~) fhV~~~'4nll ~~~o~s ~G~e4~~~all~~pe ..j'l~a $.**1l.)7{~ n~~:~;o$tale) _
.~~1!- 'lloj atE..'t! .:z. ....Hl-i- 71o,j ~~
None
Uniled Slates Irnmigrntion Jaws require that all prospective imlllii(l.ants answer the following quesllons. T is requirement does not imply
that yoU are suspected of being within any of the classes described in theoe "ueotlons. Your answers will asalst the consular officer to
establish your eligibility to receive a ViS8. If YOU are unable to answer any of these questions please explain your Inability fUlly on
separate sbeet of paper which yoU should attach to this form. Please bear in mind that whatever the nature of your answers to these
stlons, YOll arc not necessarily inellglble to receive a visa. For example, it you were arrested nnd/or convicted for a minor offense,
the consn lar officer is able to establish that such ofTen.e was in fact a miSdemeanor, your arrest andlor conviction would not neccs-
make rou inelll{lhle for a visa.
'tH BJi"}~ ~-e- oj'?) ojl....J-::OI--i::- S}71..9J ~~oJl "'.I' oIIo~4J'-14 01 ..Vail:- -1'l"'~7} 01 'iHPI-".} -F$J <>J.:.. 31011 <lit} -oJBJ-t
:€- ~~ ~.r}-e 310) o}';j'-14 -1'/%t-BJ "'J-.g. "'J-oII~Al-i 'il"l-<>l-s- -1'l~l-~ OJ~AI7 ?ir::<}Z'j-t- ~1i""]~olj .:'r.:&,01 -'<J ~'tI
-1'l<l-}7!- <>J-"=. ~-ltoJ) "'.r 1{-9- lIi.7J-e- ::z. ....l-*~ '1::<)""4 i-~~l 1!'1l6}.:il ::t..31% -i'!- oJ~Oll 1i-t'- %}.>U.. 01 ~~cj) '<ll
1'J-% 1i}~ ::z.~~ -1'l47} "J.s.....) 'tI~Al--F% ~-i- ::o}~o] ~.4-i::- ~% ~%t-i=.- ~.g. o}Yc}-e 31~ *.2j 1iH71 "'~'lf'-14
>:l,#~jL ~JL;J.:;.c. ~~ *.ifj.lft~% >t!-9k'4..ll 7!-11 4.:i1. .:z.~~ ~+.>l] -':;!j~,t}7} ::z.3101 +i!"J- >:l'#")~'4..ll
~ -1'l4~ Jfj~ ~ ~~...-A'lJ:sfr~ -^Mlil:- -1'l"'}i 1i}~v 'l!-.s.-'l 'tI~A}-F "1 '-::<}~::<~.st "J.E.-e~..g. 0}'ll'-14
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K1.rt'nu ~(1R-1i-!)~I) J'
er to he oj 'JWiil~ l ,. ('jr(,'Hl~ . Y(~s" or h 0 ."
..:II.. .,.!f-" ,;!-O\l . G, .... -s-l_oiI 1l,*~ "J-~ *"i f-).1..2-. ~
~;P;f"':~ilct~ti~I~'I~gC'~~l~ i~~t:} 1;~X::tiC~~~4tic"r~_ ''-~~9.nr~17;-;'--- \ 'le~ %\ Gh
eVf'r ht~~lI confined in a civiliaTl prh;on or jail"' I L)
1H!-'] >}, 1-+ 'H~ 'N<l ~ 'I . <->l"f , I y~ -% <:J'f
you ever .~flnP.dTnaIilTljfarv 'prhoion 'or jati',! . _0---- ~
it~"8"J_ol'-'l_ 7JJ\-<>l1 Tii-~ o,!ol "9.l.-i-y17!-? ------ Yes-% ~
e you evPt' b('en en~ag,ed j,:..jiTTIcTi "bnyin!il. serlin~ or handlill~ of narco1.ic dru-gs? I
~ "1_0-1' -t:'i!"~"" ~-e- ~V~ o,!.ol ~%'117!-? Yes -~r :;..
:lQ!e you ever been. thf' hflneflt'if't"~. of a fwrdon anlnf'SlJ l'ehobilitatio11 dcrec. other act of demenc:y or similar ~-I W'tJ
~~c~o-i~~}~{~(<Plam) "ll'oi--e- *~~ o;J"lA'~ *+~ .l1l:%--'f.."lSJ 1Il>Jl% ~~ o,!o] 9.l.%'117l<9.l.~'t! Yes %, t:7
nl-"Hve ~'-m'~er-h{'eu pJnct~drn an almshouse (poorl1ou3e or charitable inltitution)? ----- --I~
"ll*-? T"J~ ~'V.'tlT>ll~_ ~~ :>:}1l~\<>11 ~C>j 9.l."J. o;Jol 9.l.-%-'1,jj.y Yea %1 ~
(b) Are you a pauper, professional be~Br or va~'Rllt1 -- -~-----'---~
.:jf~}-c .It T-':..'tl~l>f ~'tl~ ~~J !r.-c 'If-'ll-:>:~ 'll'117}? , Yes % Jf
(c) ~r::.. yon now al1llctf.d with a phYlilca' defect. di9{".a!'e or dha....ilitv which may Affect your abiHtv to earn B living~ll----
.;oJo}-.:: 'ti:>ll "ll'ii}SJ-.11-'t.~~:;t'J'8\1 ~",l-% A.l>'1l,*~ .:iL;1'}oH ~'tl !l:.-c -'f-:!g-O!lAJ-i-llOll 9.l.-%-'-"1J?j-? I Yes % -
(d) Will you he ahle to mpport yourself financlI.J1y in the Lnite<l-States?-- ---- -~- - Ll
"ll*-i:- "1';:-0I1"'l -1'l o-J-~ ~~~* *;<1~~ 9.l.%'177J.? I Yes % u,> ~
(3) (a) Have y~u ever h~~_ onc_~r_~~e~s~.":.nity1 .:r1~I--e ~~o],* ;og-~~ 'll. o~ 'll.o] ~-%-'17}'}-i-' Ves-%- ~
(b) ~re you now or havc ,'nll ever been afmeled will, psychopathic personality, epilepsy, mental defeet. fits, faint- I
In!{ Bpells~ convulsions or a np.r\'Ol'S bre.a.lcdown? Yes 0 .I. l:I
__ -1f~H;-~-,,1.'lI.1l~_,* 7,}-~_'lI,.:',t'J--3ft_~,},* ?l:~L~3l..:!f..-E: ll~.lo\<lf~:1~?l~~31.tl.u..'-37}'}-.L--.__._1 -0 -
(c) Are you noW' or have you ever been :.l m:trcotif" Of' rlrng ;i( rlif':t or chronic alcoholic? 1---- ~
"lltl_-e- 1t1>1l "I_'lf:!f..{:, ol_lll~* ~~ ~~ **,,} ol71'-'r .::z.il-i~ ~~,,~ ol~~ o,!ol 9.l.-i-'117!-? Yes % ~:tt-
(d) Have you ever been treated In a hospital, institution or c.scwhere lor insanity or other mental disorder 01' tor 1'-- ~-
"ruK or narcotic addiction or alcholism? Yes % .If-
"fla-}-c 'll-~ :<JAJ,*ifr oI_Jll.9'..-e- "1_'lfT~ 1[~~~ *~~ 'tl~ ..a.o.f~ 714~ "Il-&::<>ll-'l "ljl"J:~ olo,! ~%'1171_?'
..--,",-.~''''.'''_"'' _ '"'-"n, ~-'-" "",,"',,, - 'fl-*" if,I'< oJ =- -'I ~ ,,<I '!l'1 II %~ -I I>' -:0;- ,;
(A) Tuberculosis in any forn,' . ---~~-(<>1lt"~ +-\fSJ' 3{ofif.-x.- 7}~)-- ,-- - - -=-_=-"I'~::""'% . -'f-
(E) Leprosy? '*"d Yell % -'f-
(C) Any other dangerous--conta~ou. ,hseatie--T--- - -~fi+-"':i8-~~~-' - -,'Yei:-::g:.l -i
(4) (8) Are YOU-A TloJyg;nllst: do you or>>ctice pOlV~80'V. or do von 'ld"oeate the pract~oroo,y.gamYV~~-._----"--I' -
"ll0'1_-e- o,!.!f-q.o>J '-lj:>:l oJ....14+-i-~;;.l oJ'117} "ll'iil_,,= o,!.!f-4:>l '-lj:>:t oJ.:>l:t+'r9.J~ ~'ll*.:iL 9.l.%'117} : Ye" % ..If-
~';;}.e- % -i-~~ ~~% >1]% %'-171} 1 I
- {hlA!'e~)u-or h-i\ve-~rOl1 ever-been a-prostitute~proc-urel'. or supported \yholly or in part frOIlt the proceed8 of pro~ 1-- ([l
shtntlon? .. '. . Yes 0 ~
~6}-i::- ~>l1 'H.-1j!->f JLf- :x.*-~ .;;-}.:iL ~71"r %o,!ol ~:>\'1- "'- ilJ.'~ 'H-~.l/-l.5'.. -'l!7].e- "i'-oJ~~ ~~}~ -'lI;zjj~1 0'
,,__ ;U ~ !r..e-, .!f-~*12.!'l._ *:>:1 ~}71 '-f *"1 s}~ cj, o,! 01 9.l. %>1 171_ ? '1-- -
(CJ Ar(~ fOll going to the United States toengagC'iii"IUi--jullUOr.lt.1 - sexual Bct, in prQstitutiou, or other unJawful com.. (J
merclollzed vice' ~e" % ...
__~~I--e- "1::r..-q~ 'll~~ pfl%tlJ-'l-l !l:.-e- 71E.J-.Q) i:'\i7.rl AJ'II7.rlqJ ~">>% ~1_7] ~'t}"i 'Cl~<>11 7ril'J.:iL ~>17.1l-? ~
(5) (a) Have you previously applied for a visa to enter the Lm ed States eith~r'u'animmigrant or as a noniJnmi- --~...
grant? (If answr is Yes, slate where and when, whether '/ou applied for a nonimmigrant or an Immigrant visa I ..
and wheil..r the visa was !osued) - Ye" % T
~~}.e- 471,011 ol'tlAt ~~ "lol'i1:>:}.5'.. "].;:-011 'i1~tI_71 ~bi-"i 'll';;-A}H 1l:>,l~ 0,),01 9.l.%y77J. (~o,! 9.l.4'li I
1l:;1~ :>J-~ Al~] '3l tllolttl ~~ ol'i1'i1~Al-~.1d.~ ~oiI.!f- ~ 0 ~A}~ ~it "iH 71i(! '81--,].2..) ----
(h) Have .yolI .been refused admission to the nlted States durin" the last twelve months? (If the answer is Yes i
.."hro.t eVidence that the Attornell General h(l" eon...ented 10 gOllr reap"Il!lng lor adrol.9Sl0n, Into the United Siates I'
oTj-o-}.e- S1t71 T=1\j~:{}-o!l "l~ oJ~~ 71.!f-....J-tJ: oJ"1 9.l.%'-"1"} "J'lJ. 9J.q-~ '\i.1f-"J-'l:1:"1 "lls}2J "1~ 'i1~ "fl.1d. '
:>,loll ~SJ~} %71 ~ >I],;.] '6H..2-
(c) Have you ever been "ll~l_otl;;>j1 ~1_71 ';'r~ol ~%Y71} . ' ._- -. e' '~4?
(A) anested ami deporte.! from ,the Untted Statcs ~JL 19<>1 "1';:-<>11-"1 +'If- -.::J-~ oJ Ves-%-_
(B) voluntarily rentovcd frtlm tht':" 1111itf'd States at Unttpd Statt>,8 Governnu,,:nt e,xnense as a person who feU into -- ~
distress? ~T<>ll ""1-:>1 n1';;-1l.!f-SJ ~lt~~ ;x}~.!'l. o1.3"~~:>L ~__~J.__ Yes % o.!f-
(C) removed from the United States as an alien enemy', ~-rl\~ ';:-'ll~~-"1 +'If-''J-% oJ. ~ ' .....;"
(D) removed---rro"ii1"'the United States at Government expeLS' in lieu uf deportallon? -:-- A)
:>J~SJ tll%~~ +'1l-'~.1d. 3171 ....J-~O'! 'ie,s % V -+
(If the an.swer to a~nyof tile above queslion.$ is Ye.s~ submit evidence that UJt~ Aiiol'negGeneral has cOIlSeiited '0 your re- - -- --. -
applr/{n!i for admi<sion into the Un-fled State...) --::::::;;:::-
_ (".l-o~_ A~71 ^l-~T o1=-'~j-3~~9.L?j~ 'll4'-"Il-"J:ol ~TI"}SJ "l.;r'l.l';:- "Hl:>,loll ~~% ~71~~.1....~1...2-~___ - ~
(6) (al Have you ever attempted to obtain by fraud or willful mtsrepresentatlOn a v,sa or other doeumentatlOu to enter
the Un ited States? y"s
~%H= ~}71'1- .:iL.Qj~ ~~~T.5'..~"'';:-'i1';:-* ~~ oJ~^}~'I>+ 71E.J-~ "l-iT-i- OZ.:il. :>:HHJ,ol 9.l.-i-'117}-?
-~ve-youevir<>iitained bVTriilli or willfulffij'srenresent.tion a visa or other -toeumentation to enter the Un ted ,'Ie",
States" ~%}.e- ';'}7J.'::L:tr.!J~ '.Hl~~.5'..~ "'';;-'ll~* -'l-l~ 'i1~^J:Iol"'} 71!-l-~~~~ oJ~ oJ.ol ~%>1"H
(7) (Q) ,. r~ you now or have vou ever heen ineligible for United States citizenshin?
.;oJ%I_-i:- ilJ.:olI "1';:- ,;.]ttl~-i- OZ{- :>.}7.:jol ~71'-'1- 3lt71oJ! ~i!j~ "I_~o] ~~-e 0,),01 ~%'1*1
(b) Have you' ever departed from or remained outside 01' the United States to avoid or evade miliiary service In
time of war or national emerj!ency? Yes
~ -S- -E: ~ A] ",--i:- ~7}"1 AJ-Al 011 'll Cl!j ~ ;1 Jtj '*1 ~ 'ii'}"i " ~{- ""1 '-"1-:>1 ,,} ,,].;r ~.9-lcll v1-1til-i ~ 'd ~ 01 ~ %>17.1} ?
(e) Have you evpr registered with a draft board unrfer the selective service laws of the United States'? ~
~t}-i:- "1';:- .Qj~~Cl!j'\l<>11 SJii}"i ;1J~~<>11 %'*i!- 'lJ,01 9.l-%-'171~? y". t ~..!f-
(8) -caiiYou, jf you are over sixteen, read and understanti some lanFtnaR:e or dialect' l~
",l-'ll ~'81-7r ",H-:k-'ll olAJ-o]c.]-'ll. o1.!:.'~ -+"Pl o.!<>1'1- "J-<>1~ ~.:iL oJ~ ~~ 9.l.%'-117}1 ~ % No ~
(9) Have you for gain ever assisled anoth"r alien to enter the United ;'.ales' or try to enter the United States in violation I - &
of the laws of the United States' Yo's .5L. .!f-
;A~}~ .!t9-~ "J:.:iL"l 4.e sj,;:-oJo] nl';;-'\i~oll 4l"Jii]."i "1';:-011 oJ~t}71"r 'll';;-TI"r<'4.:iL ~}-c~% 2i.~~ 0,!019.l.%'117}- "
(to) Are you ~ fM'ller ex"ban!le visitor who bas not resided abro..<t for two years following your departnre from the United
States' -'?! ii}-i:- '\l ~ .;;i~ '1l--i- >ll 0.5'..-'l "1';:-it 1liI 'd:~ - -.;i,.J 91';:-011 ~HI-*;<l I'.N:"~'ll '-"1 ,,} ?
(11) Are you now' or have you e:ver been ~'6H='Il!~fl %}ifr 71.~oJ~oll 06\\"J- -6};:4>+ JJl-71<>11 ~"cl' ~ ~01 :ll%Y'*
(a) an anarehiaU (-'f-:>J.!f- 4'-S1 "I_ 1
(b) an advocate of opposition to all organized I!overnment? (.l2.-e -'f..:o17.rl :>J+01! "l~ "J'<ll~;<})
(c) a'l advocate of Communism? (.:g-AJ4'-~ -i-%j} \
Yes % ~ -+
Yu
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DO NOT WRITE BELOW THE FOLLOWING LINE
he consular officer will aSBiBI you in answering the following parts 86 and 37
36. I claitn to be exempt fl"om
37. 1 Claim to be a
o preference quota immigrant under 111"...
QlNoiiquotii."jiiiiii'igrii'iiC.u.h .
My ell,im is based on the following laet.:
----................--.----......--..........
quola.
r am the wife of an American citizen. Petition approved by Orricor rnCherge,
INS, Americn.n Elnbas,sJ, Tokyo, Japan, March 16, 1960.
I U"~'M' ..., I .m """,'re' ,. ~_.., m, ... " ~. U...., S~... Imm,,,,... ""= .. ~. pl're .h_ I ,>>,, " rem
.. U""", s~"'. .... ~., ... .....-,~ .f · .;,. ,- '" ~,i". "'. " ~'" ~. U"i.' S",~ U .. ..., ..... I _ f.oo' " .. ...
admissible under the illUl1igralion laws.
I 00.......' ,.., .", .mfoll, ,... .. m",redO., '.~"-" ...illf" ""........ oJ .. m'.,;,1 h", m." by m, homi. m"""
'""ire' m, " ,,-~, ucl..,.. f"m ... U.i", s..... "'. U I.m ....in.. " "" U.I"' S,,,... m., "'ire, ~ " "'m'"" p".
secution and/or deportation.
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... _<auum .... 're. """,, '" m< - "" '"'"'Ii.. '1 i....... "'" 34. mol m, .... .., '~pk" ,. d, be., ., my komo-.
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",,",,' " .. ,,"'..,'" ,,",", S"riM 7 'I ,.. S""~"iou A "'Wi" C~rol A" ., I95/). 1 ...,,""'" ... ... I"........ ........
having asked for the obtained an expla1lQ.tion on every [loint ,vhich was not clear to me. ,
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11 31" oj $. <!<l.J 'II '" 'I!" 1H 01 ~.oJ" "-31'] U '*'" "" 11 31 ~ ic "I~ ~ ~ ".oj ,,,,,,.oj '111N of. -I!1l" $.11
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~.] "'i~ .....,>+ 'Jof 'I">foJ<l1 ~'*~ "'""" 4-1.'1>+ '1'I"'l1H ~1I '"" of 'I-~ 'f~ "''' 'J'f ~<l>l ~'ll~ -'111
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~~~J ~-e ~-e~.q t1f~of 0191 ~'lli- T~.Jl:!l:. .:z.~.. 'It-i-~J:..~ rt 01~%}.Jl SH''-lrt
y~~t..........................
before Qte 1~._15tlL.__.._.__ day .'?!:..h...h...D.e.c.em.b.er.................. . 19 61
leribed and eworn to
O. Af#!>6/
No.20
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AMERICAf\ EMB~.SSY
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For;' approved.
Budget BurealJ No. 43-R401.
..-...-...---..... ~'-
TO
ATUS OF
ISSUANCE
GRANT VISA
1"
Date Filed I Li
ie. stuh.-j) U~
/:10 -
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(Read this form and the attached instructions carefu
To THE SECRETARY OF STATE,: 101 r')--)(~)
~=~tii:i~~::~:P:~~:~:section _ __ __ ____~\~n._ _n f:_____ __ ./
Approval expires (in first preference ~se~ ~l~l",v.n_m_____mu________m_______~_~_
Remarks: - -' - _ _..,;;,. ;.. - ........ ERNESTO O.
f"tw.... ...tAl et _14_e' . m---nm-------n---------.oFi=ICIWit- _
.~.rt1o.. ..f".. f ~....~J.n -,-,--", (District Di e
\ .,~ .....f'lo\~I\..,.....,.
a....T"WtI(..MCI'.... ."""...~......~ ~l(;jRAT~C'N At-U) '\lOJfl.f.';'\.'f'_~,,, ",s.::-..;.r';.:;f
:,"t ::;. =: >: >r.;'~ nnm..._mu_:_.-__m___j\};;~>;\~~ ~~l~:rr;------:_:-m"'-'----h-
II
- ---- --- - n --u----uh--MAR --l--fi;;S6(1---- - ___u _____ -___._ ____n___ -- ---
(PETITIONER IS NOT TO WRITE ABOVE THIS LINE)
1. Petition is hereby made to classify the status of the alien beneficiary for issuance of an immigrant visa as: (Check one)
~
o
o
c.,
o
o
The spouse, child (regardless of age), parent, brother, or sister of a United States citizen. '5"
tl)
The spouse or child (under 21 years of age) of an alien lawfully admitted to the United States for perma-<>>-
nent residence. ~
A highly skilled person, or as a minister. '-'
Block I.-Information Pertaining to Petitioner
2. Name Clayton William BUR, Jr.
-- - - --- - - - - - - -.-- -- - -- - - ~----(Gi;;- i~il-;'-~; -;i ;;;~~-;'~-;;;'g~;l ~ii~~-: -';;';;;;.;d -;~~~ - m~~i- ;i~ - gi;; - m;ici;;; ~~;; j. _h - - - n_ - - -- - U - n ..-- -- - - - ---
3. Address ------}!:!7~n~~~__~~.._!_._9-~p.__~~_~!L~~_~~!.~_~_~_ __~~___.nn__nmn____nm__._._.__..___u____.. __________
(Number Bnd .treet) (Clt,.) (Statel
(The rest of this block is to be filled in only by an individual per80n filing a petition 1m' a relative)
4. I was born ____m_ -- -~~!--~!. __ ~~~~,u__h___m____ ____ __ __._ _ __ __~_ ~_~~_~_~_~~!_$_~n!'~_~~__~__ mn _On nm___u_.m ___ ____
(DBte) (City) (Co\ln~_
5. If you are a citizen of the United States, give the following:
Was your citizenship acquired throufih birth in the United States, through naturalization, through parentage, or
through marriage? --- m__~l__!?~~u~m__m_______mm_________ nm_ _ _m _m__ m_____u____m _ ____hn______ ___ _ no m ._un_____ __n_
If acquired through naturalization, give number of natural~tion certificate and date and place of naturaliza.tion:
---- -- - - -- - - - - - - -- - - - -- -- ~- - - -- -- -~ --- - ---- - - - - -- _____ _ _____ __ _ _ _ __~__ Jr_ _._ ~ _ _ __. _ ___ ___ _ _ _ ~ ___ _ _ __ _~___ _ _ ____ _ _ __ ___ ___ _____ __ __ _ __ _ __ _ ___ ______ _ _ _ __________
If acquired through parentage or marriage, have you obtained a certificate of citizenship in your own name based on
such acquisition? ______.nuu __n__ ___ ____h__ _u_n___.._n_..____ ___.._ _ u_ ___ _.. n____ ________nu__ _ _u______ _ _____ ___ ___ _.___ n__._n_____ _n _ ___
If so, give number of certificate: ------n----------h______n___u__uu____u_______nu_u.____n_____n___nn--_________u_____nh___
If not, submit evidence of citizenship in accordance with instruction 3a (2).
Have you or any person through whom you claim eitizenship ever lost United States citizenship?__um__u_n___________
If so, attach detailed explanation on separate sheet.
6. If you are a lawful permanent reside:1t alien 1 the United States, give the following:
Alien Registration Number: A-m--_____~__~_________n_______h___
Date, place. and means of admission for lawful permanent residence ------nu_m____u_m___n____u_u_________m____m______
-- -- - - - -------- - ---- -_ __ --_ _ _ __ __ ____ _ _ _ _ _ ___ v ______ ~ _ __ __ ___ _ _ _ ___ _ _. __ _____ __ _ _ __. ~ __ _ _ _~ _ _~ _ _ _ _ __ __ _ __ __ ___ _ _ _ _ ____ __ _ ___ _ _ _ __ ___ ___ _ __ _ _ _ _ __ _ _ _ _ ,__ ..__ __ __
Have you ever lost status as a lawful permanent resident alien? --m_______m___muu.m__________n__n___________m____m__.
If 80, explain: _hh___n.n______n______n______u______________ ___ ___________n__ _________ _ --------______________________n___________________ \
Form I-1M
(2-1/Hll)
~, 17,
fff~
K -,
/9 - 1J-alI7S, 13",.
?
Oll
Block II.-Information Pertaining to Alien Beneficiary
Hyung Joo BAIR (Nee-MOON)
7 . Name of alien ---- --nn--nn--__n______nn____n_n___n_________h__ hnn _ h_n __nn _ __n_h_n_____ ______n_ _h__n_n_ h_ _ ___ ___ _ __ __ _ _ h___n_____
(Firae name) (Middle initial) (Laot name)
8. Date, city, and country of birth of alien ,--------J:':t;!-.Y.n;:2-~--~~2?---__h_m__mhnm_~~:~~_h~~~mh_______
9. Relationship of alien to petitioner -n---!~-~~__________h________h ----nnh--mn--u---m_h______m_h____mn___m____h___. __________ __
10. If this petition is for a spouse, give the foUowinlJi
~:~::: :;i~; ::r:~:: :: :~:b~_~_~~~~~~~~~~~~~~~~:~:~:-:::~:::~:~:::~:::::::::::::::~~~::::~::::~~~:::::::::~:::::~:::::::::::::~::
11. If this petition is for a child, is the child married? ------~n---n..-U-nmh----------______h__m________NO-----n---n--______nm"____
12. If this petition is for a brother or siSter, are your parents the same as the alien's parents? h--------___hhh___nh________.u__
If not, submit a separate statement giving full details llIl to parentage, dates of marriage of parents, and the number of
previous marriages of each parent.
13. If separate petitions are also being submitted for other relatives, give names of each and relationship to petitioner: hm_
,J
:~~::: ~~:: ~ ~~~:::::~: ::::::~::: ~~: ~:::::: ~ :~~ ~:-: :~~:~::~:: ~:: ::::~ :::::: ::~:::::~ ~ :::: ::::: ::~ ::: :~::~: ::~~:::::: ~::: ::: ::: :::::: :~::::::: ::: :~: ~:: ~::~:~ ~~~:
-. ~- --- ----~ ~ -- -- ----. --.-. -. _. -- - -. ----- -. -- --- -. ---- -- ------ - ------.-. --.. -- - - ---- - -. ----- - -- -------- ---.- -- --- - - --- ------ ---.-. - ----- - --.. - - ---. ------ --- --- -. --
- --- -- --. -- ------ - --- ------ - -- -- ---------~----- ---- --~----- -- -- -- ------ -- -- - - -- - --- --.. ------- - -- -. --- - ---- --- - - - a____ -________ ___ _ _a ___ ____ _a_. _ __..____.__ ___ _ ____
14. If this petition is for a highly skilled person or a minister, give the following:
Alien's occupation -n_-n----h------n___________hh____h__n_____m_; full address in the United States where services will
be performed _u -- - - n - - u_ --- __-W"'-_ _nn_ -- U ___n__ n Un -___ _ u__ _ _ __ h_ _ _ __on _ _ __ _ _ _ _0. __ __ _ _ n__ n_ __ _ _ _ _ __ Uh _ __ _ __ _ ____ ___ 0. _ __ n _u ___ _ ___
Name of alien's spouse --- __h_h_ u___ _n_ - - --- n - u__ n --. ___ _u__n__n__ ___ n__nn __ _00_ n n_ _ __ __ _ n _ __ _ _h __ _ ___ _n __ _ n _ __ _ ___._. _b._. __n
N ames and birthdates of children __n 0. ------______________ __n____ ____h___ __ n___ _ _ __ n__ ---__h.__________u_ __mh__n_n_ ___h_____n_____
- -- -- ---- -- -- -- ------ -- --. ------ - -- --.- -- ---- ---- -----. .---- -- --- -- - ---- - --- --- -- -. -- -- -- -- -- -- ---- -- - ------- -- ---- - -_. --. ----. ------- -------- - ---. ---- ----...
--. - -- -- -. ------ --- -- -- -------- - -- -- ----.- ----------. - -. --- ---. - -- --._- - --- --. -- ----- - -. - ---- -. -- ----. ---- ----.. -------. ----------- ---- --- ---------..---------
-- ----- --______a_ _______... __________________________________. ____________________ ______ _ _ __ _____.__ ________ _ ______ ______ ___.._____~__________._~__"._~___ _____
FuJI address of spouse and children ----h-mn-n-h----u___n___u___h_____nnn_______________________uu_hmm_mh_____nu__u____
. - - - -- .-- - - - ~ - -- - --- - -- -- - - - - - --~ - --- - ---- - _.. ------- -- - ------ -- --.. - - - -- ~ '--.. ~ - - --.-. -- ~ - --- - - - - - - ---- - - - - --- - - - - --- - -- - --. - - - ------ -. - ~ - -- - - --- -.- - - -- -- - - ---
If they are abroad, will spouSe and children accompany or follow alien to the United States? .n_____n____m_____________
15. Have you ever filed a petition for this alien before? _ 'n_ ----n~-------------u---m--------__n____m______h____________nm________
If so, give place and date of filing and result: ------m-----------n--nm--n-----n_______m____________m_____h__u_mn_________mh___
--------~ - - --- -- -. -- --~._---- --- - ----------------...-------------- - - ------------ ---, -. --- ..-- -- - ---- - - - - --..- - ---------- -- - - ------------...- ----. -- ~ ----. -~-- -- -..----.....-
16. Has this alien ever been deported from the United States? _____lla._h_____ If so, give alien registration number, reason
for deportation. and place where deportation hearing was held: nun----um-um-_n__________hm____m_nhm___m____.____u__
- - --- ~ -- ~ -- - - - -- -- - --.. ~- --- -- -- -- - - - --- - ---- ---- -- --- - --- -- - - ------- - ---- -- -- - - - - - - ~ - - - - ~_.. - -- - -.. - - -- - -- - - - - - - - -- - - ----- ------ - - - - ---~.. ---- -- - - - -- - - -- - - -. - .. ---- ---
17. ~dd;~~-;~--~~~-u~i~~d-S~~~~-~h~~~~~j~~-:iii. ~~~jd~-j~7~:: ~~n:: ~~~:~::: g~::Hill~:::~~~:~:::~~:::::::::::::::::::
18. Present address of alien n--n#9.Q:':'~~Jj~J~!:':'~~~::_J:;>_'?!.l8.t__~~g!?~~~::~L~~~~___~~;".~~h_____--___U_h_m_ _____
19. Location of American consulate where application for visa will be made ---~f1I-:r-t.<?~__~!?~_~~Y..._3?_~~J;.__~~~___
- ------- --- - -- -- --- 0. -- '''-(cit,.-i;'- - i';;;ig;'- ;.;~;.t;;:i-------- m___ -.- ---- no. --. ----- ----- - _m - --- 0.__ -h---(F;;;.;,lp-~;.;t.:;.i-n---n- _00 n_u_____ _______..
I swear (affirm) that I know the contents of this petition signed by me and that the statements herein are true and COJrrect.
aepublic of' Korea
Specie.l City- of' Seoul
--~~~cif;.<i.d.~~"=N;.ii---m-------
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WARD OP.PlOlS
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PiOVnU.)IAL j'~~.y Ii't~.a D,'\'J:gl) ltiSUi1Ja AuB'lat 7, 1959
ProviS:1Dl1U Dosie1.t.' "'2lat. _.. V.1..ji-)")~ Qt';l'lIJ-i~~, S@Ol.ll, r.or~~
*FOR.1i:1t HitAD
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: iOOit.~. tint 01" ~u. 11_. (Deo.aMld)
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I -'",l..- 1', 1939
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ll_o1' ~t1olU
;';orn a~ ptl.~ ,..,.~~l)Q., S1n~t1~-C1t~..
Htt~*1p. ~fOIIe:.:tId CD the cl..th of tOl'frior nelld ,L'ili.. tUnic. fil"t.lt. ...
4d.cldl.. )iSla.) o.n 4prU.), 1942. t.n&reot l"Ol ltrt.ered..
Aooer411c \0 \be o..tintft_ 10. l.~ ,.......t. AtidretH vripllq
Ns1et.eNJ U o..t. ~ lb. Su.ab~UCUI8. Silluiju-ott.;r), repo~4d ..
No.lwei OIl ~~.t, '7, 1959. t.hel"OOf "'i~t...-d.
Dda U toart117 th.'~ t.be I!lJova lllr.Le,tlnL iI's tt;.L., to.n,.,} ..
oorren OOPl to the Aoreaa 'JrilinalPJoovi81onal ~nll,y R.,bter P"-1lIIullnt.l7
.tUM wlt.Ia tbi.O.tll.-.
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0. Ud.. 4_ u)" 01 ~r. 1959.
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M A DONG BANG SERV ICE '
ARRIAqC ROCEDURES ._1J.T 511 UI.CHI-RO, SE'OUl, KDR&A
(OPPOSITE BANDO BLDG.)
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HEAIiQ.U ik"lTERS
NATIONAL POLICE I REPUBLIC OF KOREA
Sa ouI, Korea
Date December 11 ~ 1961
SUBJECT: Police Certificate
TO Consular Section
American F~1bassy
Seoul
This is to certify that the following information has been
obtained as a result of an investigation conductad by the Nationa.l
Police on tIle below naood person..
a..
Name in full :Bair (Nee I Moon). Hyung Joo
Date of birth : July 1), 1939
Sex ,Female
Nationality :Korean
~omicile :152 1ka, Ulchi-Ro, Chung-Ku. Seoul, Korea.
Present address: 1740-6. Hannam-Dong, Yongsan-Ku. Seoul. Korea.
b.
c.
d.
e.
f.
(1) Political Background None
(2) Criminal Conviction H.ecord, None
(3) Other heference
None
For the Director:
Soo Kyun PARK ~';?
Buperinte::d~~)I~;f~,-', '~
2nd. Sect:l.Oly,r"
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TY OF SEOUL ) S8:
AI1ERICAN CONSULAR SERVICE)
(Original and 1 copy)
AFFIDAVIT CF SUPPORT
I, Clayton William BArR,Jr. , resident of 3472 Green st., Camp Hill,
No. Street
Pennsylvania, USA
being duly sworn depose ani sa;v:
That I was born a c1 tizen of the United States on July 115. 1935
nate of Birth
at Mechan1csbur~ Pa., {.SA
Place of Birth
That it is my intention and desire to have my wife,
( Nee-MOON)
of w.i.fe
Hyung Joo BAIR
Full Name
who is at present resident at 1190-84 Hawol-kok-Dong,
Complete Address
Songbook-Ku, Seoul, Korea , come to the United States.
of wife
That I am and for the past 2i years have been employed by the
United States AnDy
and derive a net annual income of $!,lQ.O.OO-
that I have the following financial assets (List bank deposits, stocks,
bonds, insurance policies real estate holdings, etc.)
Bank Account #600.00 -
Lii'e Insurance $5,000 .00 -
Class "QII allotment will be initiated.
That my wife,
Hyung J 00 BArR
is wholly
age ~': 2IJ
dependent 01). lJIe for support and that I have the following dependents;
None.
That I am willing a,d able to receive, lr.aintain, and support the
prospective immigrant listed above; that I am ready and willing to
deposit a bond, if necessary with the United States immigration authori-
ties to guarantee that such person will not become a public oharge
during her st~y in the United States.
That this affidavit is made by me for the purpose of assisting the
American Consul and the Immigration and Naturalization Service in deter-
mining that the above named person is not a person who will become a
public charge in the event that she is admitted to the United States.
~[~-h~A.
~__ _d_____/
SURSCmH1!:J) AND SWOJlN 10 J:>"-f.n,,., = tlt:is 11th day of December, A.D., 1959,
AT SEOUL, KOHi<:A
IIl't1C4'-Jcf~- - -! '2.
TArilt 1t._ 110.
,._ Paid.: U,S.'
Local 0' ..~\11V'.
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At the request of the American Comul at
CITY
Sl!X)\lL
PlJ.Ssorn. JaLn-i ioaPUAl.
OAi'7OAUgUit'1~
COUNTRkO!FA
FOREIGN SERVICE
UNITED STATES OF AMERICA
MEDICAL EXAMINATION OF VISA APPLICANTS
,I
1 examined specifically for evidenu of any of the following conditio7l.8: P&aspart;
CLASS A:
TUBERCULOSIS (in any form)
LEPROSY (Hansen's Disease)
DANGEROUS CONTACIOUS DISEASES:
Actinomycosis Granuloma'Inguinale
Amebiasis Keratoconjunctivitis infections
Blastomycosis Leishmaniasis
Chancroid Lymphogranuloma Venereum
Favus Mycetoma
Filariasis Paragonimiasis
Gonorrhea
MENTAL CONDITIONS:
Feeble-mindednells
{mental deficiency)
Insanity
1203
"
1 certifiy that on the above dal:4l1 examined
KAME
BAIR, H)'Olmg .....
Ringworm of scalp
Schistosomiasis
Syphilis, infectious stage
Trachoma
Trypanosomiasis
Yaws
Previous occurrence of one or more
attacks of insanity
Psychopathic personality
Epilepsy (Idiopathic)
Mental defect
Narcotic drug addiction
Chronic alcoholism
(See proviso, sec. 34.7, USPHS Regs.)
CLASS B:
Physical Defect, Disease, or Disability Serious in Degree or t>errnanent in Nature Amounting to a Substantial Departure
from Normal Physical Well-Being.
CLASS C:
Minor Conditions.
(Check ,mmber (1) below or complete number (2))
My examination, including the X--ray and other reports below, revealed:
(1) No defect, disease, or disability 0
(2) Defect, disease, or disability, or previous occun"ence of one or more att6ck8 of insanity. as follows (give class-A. B, or
C-diagnosis, and pertinent details.) :
CLASS C: Tri'chocephalus in stool
Trichostrongyloidtasis in stool.
Both parasites being treated by this hospital.
Chest X-ray report
Normal
from Dr.
DATE. OF FfNAL NOTlFICATION
Blood serological report
Negative
from Dr.
Urinalysis repc-rt.
from Dr.
SIGN
USA Me
.Cm.ti..". Oft T"~V""U "ide if ft4!JC'NaG,..
Army-Admin Cen-.Japan
28
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National Records Center
P.O. Box 648010
Lee's Summit, MO 64064-8010
Official Business
Penalty For Private Use, $300
Marlin R. McCaleb
Attorney at Law
219 E. Main St., Ste. N
Mechanicsburg, PA 17055