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STATEMENT OF PERSONAL HISTORY INSTRUCTIONS: Read the certification at the end of this questionnaire before entering the required data. Print or type all answers. All questions and statements must be completed. If the answer is "none," so state. Do not misstate or omit material fact since the statements made herein are subject to verification. If more space is needed, use the Remarks section, item 20, and attach additional sheets if necessary. The information entered hereon is for official use only and will be maintained in confidence. 1. (Print) FIRST NAME-MIDDLE NAME-MAIDEN NAME (If any)-LAST NAME  MR.  MRS.  MISS ^[[Benjamin Oliver Davis, Jr.]] 2. STATUS  CIVILIAN [X] MILITARY ON ACTIVE DUTY 3. ALIAS(ES), NICKNAME(S), OR CHANGES IN NAME (Other than by marriage) ^[[Ben]] 4. PERMANENT MAILING ADDRESS ^[[Hq USAF, Washington, D. C.]] 5. DATE OF BIRTH (Day, month, year) ^[[18 December 1912]] PLACE OF BIRTH (City, County, State, and Country) ^[[D. C.]] PLACE CERTIFICATE RECORDED ^[[D. C.]] RACE ^[[Negro]] HEIGHT ^[[6' 2"]] WEIGHT ^[] COLOR OF EYES ^[[Brown]] COLOR OF HAIR ^[[ Brown]] SCARS, PHYSICAL DEFECTS, DISTINGUISHING MARKS ^[[Scar on forehead]] 6. DO YOU HAVE A HISTORY OF MENTAL OR NERVOUS DISORDERS?  YES [X] NO ARE YOU NOW OR HAVE YOU EVER BEEN ADDICTED TO THE USE OF HABIT FORMING DRUGS SUCH AS NARCOTICS OR BARBITURATES?  YES [X] NO ARE YOU NOW OR HAVE YOU EVER BEEN A CHRONIC USER TO EXCESS OF ALCOHOLIC BEVERAGES?  YES [X] NO IF THE ANSWER TO ANY OF THE ABOVE IS "YES," EXPLAIN IN ITEM 20. 7. U. S. CITIZEN [X] NATIVE [X] YES  NO IF NATURALIZED, CERTIFICATE NO. IF DERIVED, PARENTS' CERTIFICATE NO(S). DATE, PLACE, AND COURT  ALIEN REGISTRATION NO. NATIVE COUNTRY DATE AND PORT OF ENTRY DO YOU INTEND TO BECOME A U. S. CITIZEN?  YES  NO 8. MILITARY SERVICE ARE YOU PRESENTLY ON ACTIVE DUTY IN THE U. S. ARMED FORCES DRAWING FULL PAY? [X] YES  NO IF "YES," COMPLETE THE FOLLOWING: GRADE AND SERVICE NO. ^[[Major General 1206A]] SERVICE AND COMPONENT ^[[USAF]] ORGANIZATION AND STATION ^[[Hq USAF Pentagon]] DATE CURRENT ACTIVE SERVICE STARTED ^[[June 1936]] ARE YOU PRESENTLY A MEMBER OF A U. S. RESERVE OR NATIONAL GUARD ORGANIZATION?  YES [X] NO IF "YES," COMPLETE THE FOLLOWING: GRADE AND SERVICE NO. SERVICE AND COMPONENT ORGANIZATION AND STATION HAVE YOU PREVIOUSLY SERVED TOURS OF EXTENDED ACTIVE DUTY, DRAWING FULL PAY, FROM WHICH YOU WERE DISCHARGED OR SEPARATED TO CIVILIAN STATUS?  YES [X] NO IF "YES," COMPLETE THE FOLLOWING: COUNTRY | SERVICE | COMPONENT | FROM (Date) | TO (Date) | TYPE DISCHARGES OR SEPARATIONS–GRADE AND SERVICE NO. 9. EDUCATION (Account for all civilian schools and military academies. Do not include service schools) MONTH AND YEAR FROM– | MONTH AND YEAR TO– | NAME AND LOCATION OF SCHOOL | GRADUATE YES | GRADUATE NO | DEGREE Sep 1929 | June 1930 | Western Reserve University Cleveland, O. | - | X | - Jun '29 | Aug '29 | Fisk Univ, Nashville, Tenn. | - | X | - Sep 1930 | Dec 1931 | U. of Chicago, Chicago, Ill. | - | X | - July 1932 | June 1936 | U.S. Mil. Academy, West Point, N.Y. | X | - | - June 1931 | Aug 1931 | Ohio State University, Columbus, O. | - | X | B.S. 10. FAMILY (List in order given, parents, spouse, guardians, stepparents, foster parents, parents-in-law, former spouse(s) (if divorced give date and place), children, brothers and sisters, even though deceased. Include any others you resided with or with whom a close relationship existed or exists. If the person is not a U. S. citizen by birth, give date and port of entry, alien registration number, naturalization certificate number and place of issuance.) RELATION AND NAME | DATE AND PLACE OF BIRTH | PRESENT ADDRESS, IF LIVING | U.S. CITIZEN YES | U.S. CITIZEN NO FATHER Benjamin O. Davis | 1 July 1877 D.C. | 1721 S St NW, D.C. | X | - MOTHER Sadie O. Davis | c.1886 Greenville, Miss. | 1721 S St NW, D.C. | X | - SPOUSE (Maiden name) Agatha Scott | 1908 New Haven, Conn. | Qtrs 61B Bolling AFB, D.C. | X | - OTHER (Specify) Sister Olive Streator | April 1906 D.C. | 70 LaSalle Street New York City, N.Y. | X | - Sister Elnora McLendon | 1 Feb 1916 Wilberforce, Ohio | 1015 E. Hyde Park Blvd., Chicago, Ill. | X | - Father-in-law Herman A. Scott | 1873 New England | 97 Carmel Street New Haven, Conn. | X | - Mother-in-law Josephine Scott | c. 1885 Savannah, Ga. | 97 Carmel Street New Haven, Conn. | X | - DD FORM 398 1 MAR 64 REPLACES EDITION OF 1 MAY 55 WHICH MAY BE USED. Exception to Standard Form 86 Approved by Bureau of the Budget June 1960
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