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1
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Pro r o or '1hip:
Corpor ion:
Ind· v1du 1:
rinci 1 rop r y
J\dd.r. o. :
T l·phone Numbor:
nvolv d and o o
Adult:
rn.11ori
Hal·:
Fomalo1
C .t:tz .nship:
o!' robl ·m:
'
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Da
0
st n ry in
Unit d Sto.t s;
und r Tr oury ioenn non?:
0
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of
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ri·
@
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rinc
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1
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ant
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h
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ta. to
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n.
Or
of laot ontr
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r
n ·o
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Citiz nsh
D t,
of' 1
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to Unit ,d
A
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Adult:
Addr SS:
(st,reot
ld Nu1.ibor)
I
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falo:
Female;
C iz nship:
no.
n
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l finor t
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dt
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phon
':t'ind
l
11volvotl
H
cop
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of'
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Name:
Adult:
i\ddress:
D . c o 1~ la.'""t ont 'Y nto Uni
~
-t
ru
rinor:
alo : ~
F omal.o:
Oitiz nnhip:
cl '1t tes:
: 3;,~·it.Lng uncior 'Jroo/'Ut'Y ..L.iic noo
'l,J
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tu!
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·.rfoor:
SG:
f
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..... (City)
n ry in o Uni
of las
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or
Busin so:
Pnr n rsh p:
f
Pr01 rl or,,,"hip:
Corr.. or ··· ion:
Indivl. t l:
Princi
1 rro
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(r>tn o)
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Add eeo:
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./
11
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Citizcnnhip:
Dtl'"
of 1 ,ct . . ntry 'n o Unit ..
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n
t
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or
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:
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r ~J.ophom
Adult:
Addre s:
I.Iinor:
Mnl :
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0 -· r
tine under rrro
'1\lr~
Cit
cs£ to)
Lioonn
z n~hi:p#
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110ir?:
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roon in rv ,., d:
'ry o of Buoin on:
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f\ddr
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nd
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Citiz nohip :
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· 1t:u g un 1rr Tr o
Ty
/I.ck
l' OMJ:
T lophon
1fwnl> ·r:
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ct
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.finor :
Addre s:
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(city)
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(8 nto)
n·ry into Unit d Strit
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Typ
of Busin-os:
Pnrtn r.hi~:
Pro r i
or ~hip:
Cor Jor
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l~
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r n i ·l rop r y nvolv d o.nd cope
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ss:
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I
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Citizenship :
D e o. 1 s
0
r
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in
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n · ry ilito Uni
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dor Tron.nury Lie nno now"':
'rypo
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of
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now?:
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Uinor:
?6.nle:
Female:
(Oity)
Citizenships - - - -
(State)
Dn
Date ot last entry into United States:
,.,
O~rating
under Treasury License now?:
Type of Business:
Person intervie,·red:
.Partnership:
Proprietor ship:
Corporation:
Individual:
Principal property involved and scope
Acti
Action
or
problem:
taken: ~r
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onal paaoa
ere
necea$~ry
"\nute 1
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?. al ~
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Citizen hip:
in
- - - -..
und r Trcnau:ry Liccnn
n .rv1 Oil
Addro s :
Tolophon
Prlncl1 1
• t
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0
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t
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,~....._, of the Uni od St
01
0
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llinC\r:
lia.l a
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Ci iz nahip: ~........-..........
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or
lG.st
ntry into Unitod Gt t
Op r tin undor 'l 'r asury Lio n
n ·t?: ..
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0. .. . . -. . . . . .
p
1,
p;
r1.n i
nd eoop ot probl :
~
........
.......
Adul :
Acld.r so:
Uinor:
Malo:
F tnl\lo:
Citiz nohip:
Dt
of l at
ntry into Unit d Stnt o:
ina under Tro oury Lie nn
Ty
of Duoin ~so:
Po.:r ner hip:
Pro :rL orshi
noH1:
p :r · on in.t rvj, ned:
/\ddl
•'
Cor ,,or lion:
Indivi.du l:
P inc pn
or
____
----------------------------....---~
Tel .hon Num or:
nd ocop
---------------·-------
......,.,......_.,...__
.......,
_____.......,
Los . n l o rnneh
nk or 0 n Fr 1 isco
rv
F oal A~ nt of the United Sto.tos
cdaraJ. R
Adult:
Minor:
Ad res
Mnlo:
Female:
Citiz nship:
Dn
n:
or
lo.st ontry -.nto Unit 0c
,.,,,nt. 18 und o "
T1·0 .L8 t:cy
Lio
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l'\tM
t s:
now?: ---~----.....
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pt
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(_D_lt_t_e_)_...--..~.....,.._
Tol phone:
In orviewi
Add ·
(Street
(c!iy)
D to of l ot
0
r tin
'ryp
llumbor}--
Female:
Cith nohip: _.......__.___
(sto.to)
-
ntry into Unit d Sto.t · s:
under
or B\l ::iin
and
Adult:
Uinor:
Hnlec
·r
o oury Lio cm fl · 11ow?:
OS:
--
~
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Par norsh p:
Propri or h p:
Cor por iont
ndividu 1:
:r no
,..
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J\ddr
P.·
<1
ro
SS:
Tolophon Nwnbor:
l prop r y involv d nd ooopo
Act on I I lU }
............._,....................,.
or
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1:.1
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Los An les B anch
F d r ~ R serve D nk of
· ra.11Ci. co
Fl cal Agent of the Unitod tato
(Dato)
Tole honoi
Intorviow:
J\du1ti{
Hin or
Mti.lo:
Femc.J t
Citiz nship:
Ad r ss:
( t1treot and Nur ibor)
Dn
0£ lo.ot ontry into Unitod Stat s: _,.
________
OJ r t :Lng un or Troa ury Lioenov now'?;
'l ;vpt
1
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Propx j · or,.;h p;
Coi"po r·t ion:
Jt dlvidual:
i
son
/\ · dr
T lophon Numbnr:
Prine pn.l px opot.. ty :Lnvol v d nd sco
.r problom :
l';y
c
0 t')
t
/N ..1.rn
(./)
~
I dult.:
1
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Hol : ~
Fonw.lo:
C t.iz nship:
Dn ' of 1st n·ry in o Un
undor Tro aury
Or: ra. ln
ic nno nov1?:
l · ri on in
' y o of 13 10:\.n. n:.i t
P r 11 r hi :
rop1 i. or .. hi
Co ror ·1. ion:
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)
.-i·
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1
1
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::i
1
Tolophon rlumb r:
(
Pr iM 1. nJ. pro c:r
n
•' I
00
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ddr·
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Citi.zenohip:
n tc of
1
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t
n ry into Uni
under 'I1ro
ttr,
I conn
------
no ·1?:
r
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en
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so:
trinor 1
tn.lo:
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of lact nt,
! '1,t.\,lt
'I'
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r lo:
c.;
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'I'y
0
l r •"on
Addros
T l · hone Numb r:
Princl al
~ro
r ·y
ll
Le An elos Bran h
• d ra1 Ro -rv B nk of 8 n Francioco
Piso l Aa n of the Un ed s o
Du
J
Tolaphono:
In erview:
Adult:
L11.nor:
Addreao i ........._..___(_S_r__e_t__
~-n-d--I-lum
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Mnl :
Fomala:
Citiz nship:
__...,i:_y_i----·--cf-:;t-a.-t'O_) _
D to of las
ntry into Uni
-
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now?:
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" ·d:
·--
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TolGphon Number:
rinc
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al ro r y .nvolvod nd scopo of probl m:
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----
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........
now! :
Pm.·. on Int or vi ) rod:
Tolophon · Numb i:t s
............................
....,__
----
F
Adult:
I.rinor:
l r.l :
Fos nlet
Citizenship :
D e
or. ro.
or
ntry int..o
l st
Unit.~d
ina under 1rro miry Lie nn
Ty a of Bunin
00 1
Par n rohip:
Pro lo ·or h pi
S t s:
110\I?:
or · on
,,.
J\ddroo
.(J~
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Cor porn ti on~
Indlvidull:
opcr y invo v,,
c.)
Tolo hono
nd ocopo
or
tJ
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f.10()
No.m
Adul :
Adcir
llinor:
Ut.l :
Fem le:
OS:
r)
Ci izenr. htp.
(City)
Da , of lao
0
~r
ntry in
Uni ed Stat a;
ting und r Tronour Licenne now?:
r1 ·on int rvj. rred:
I\
dr s
Tole phon Numb or:
P:rinci 1 ro · rty .nv lV' d nnd scope of' robl m:
Lo t nl?Ol o ranch •
ral. R- s rv B nk 0£ n 1• nci~oo
F seal A nt o the Unit~d States
Adult: ..{
Mil or :
Address:
t lo:
:*'
Femal
Ci iz nohip:
nn. t
0
r 1.. ot
(;.,n ry into Un t od fta.t
undo
B'
"n
'fro,. ury Lioenoo now1 t
Por~on
I
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Fis c J. Al' nt1 of the Uni cl ~:itn tc
{Date1
T laphono:
Intorviowc
Nm r
Adult:
I.1inor:
Addr os:
l clo:
Fomalo:
C tizenaM.p~
D1. c of lf\st.
n ry in n United St t s:
or ra . in
I ,r,·on in
'ry
I
c
1,
Oil
ddr or- :
l xoper·y involv d and sco
1
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----...................................................--...--Tol phon Nmnbcr:
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p:
Prin~ip
rv
lU
n
or
ro 101:
Adult;
Addr s
Uinor:
(s ro t and N'Ult-tb-or_)__ _
Ht\lo:
Fomale:
Ci izenohip:
(Sta o)
Do. o of l o
n ry into Unit. d S n
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Typo of
er · n
Bu~ineoo:
hips
roprloto
l
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A t
1
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tld.1.
1t rvl u · d:
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on:
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ndivl.dual1
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pe of pro J••rn:
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co
Adult :
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