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Home Telephone No. ------------
Husband's Office Address
Signed
----------------------------.Authorizing Officer
Agency '. ____________________________
----------
Office Telephone No.
Date
· *This 'application, if submitted by an agency other
- telephone me (Ext. 6043) if this date is acceptable.
cc: IRG/ARA - Mr. Broderick
U/SIG
- Mr.· Les h
FIDP Working Group
G/PM:CAFreshman:mj: bpw
11/27/68
SEC~E'f
THE WHITE HOUSE:
WASHINGTON
February 13, · 1964
SECB;a:r
DECLASSIFIED
NATIONAL SECURITY
- requested.
Signature ------------------------Home Telephone No.
Husband's Office Address
--------
Signed --------------------------.Authorizing Officer
Agency "---------------------------
Office Telephone No.
Date
· *This 'a pplication, if submitted