47) I 0 - have 0
- have not entered the United States as a crewman after June 30, 1964.
MemberFrom:
(Month, Day. Year)
Name of Organization
Location of Organization
Nature of Organization
48) I
- have 0
- have not been admitted as, or after arrival in the United States acquired the status of, an exchange alien.
Member To:
(Month. Duy. Year)
~
~~
~
49) I 0
- have 0
- have not submitted address reports as required by section 265 of the Immigration and Nationality Act.
50) 1 0 - have [7 - have never (either in the United States or in any foreign country) been arrested, summoned into court as a
defendant, convicted, fined, imprisoned, placed on probation, or forfeited collateral for an act involving a felony, misdemeanor, or
breach of any public law or ordinance (including, but not limited to, traffic violations or dnving incidents involving alcohol). (0
answer is in the affirmative, please give a brief description of each offense including the name and location of the offense, date oj
conviction, any penalty imposed, any sentence imposed, and the time actually served).
5 1) Have you ever served in the Armed Forces of the United States? 0 - Yes 0 - No. If "Yes," please state branch (Army, Navy,
etc.) and service number:
Place of entry on duty: (City and Stute)
Date of entry on duty: (Month. Day, Year)
Type of discharge: (Honorable. Dishonorable, etc.)
I served in active duty status from:
(Month. DUY. Year)
to
(Month. Day, Year)-
. Date of discharge: (Month. Day. Year) -
52) Have you ever left the United States or the jurisdiction of the district where you registered for the draft to avoid being drafted into
.
the military or naval forces of the United States?
D y e s 0 NO
53) Have you ever deserted from the military or naval forces of the United States while the United States was at war?
yes 0 N~
~
54) If male, did you register under the Selective Service (Draft) Law of 19 17,191 8,1948,195 1, or later Draft Laws? 0
Yes 0
N~
If "Yes," please give date, Selective Service num