IDENTIFICATION AND PERSONAL HISTORY
(Nuclear Weapons Test Participant)
Name and address:
Age:
Sex:
Birthdate:
Birthplace:
Places lived since birth:
Education:
Grade School:
12
3
4
High School:
12
3
4
Beyond High School:
1 2
5
3
6
7
8
4 5 or more__
Marital Status:
Single
Widowed
Marr ied
Separated
Divorced
Remarr ied
Ea
fk
gf
by.
~—
me
lume