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DEPARTMENT OF STATE
VISA DIVISION
FORM BC--MAY 1944

Form approved. 
Budget Bureau No. 47-R021

PRELIMINARY VISA APPLICATION

Part B. BIOGRAPHICAL DATA CONCERNING VISA APPLICANT

129030 

1. Name of applicant and accompanying relatives.

[[5 columned table]]
| Name | Relationship to (1) | Marital status 1 | Marriage Date Place | Present Address |
|---|---| Date|Place |---|---|
| (1) Regrigues-Pereire Called Pereire | / | D | Jan. 21st 1931 | Paris | Los Madrazo 18 Madrid Spain |
| (2) |   |   |   |   |
| (3) |   |   |   |   |
| (4) |   |   |   |   | 
| (5) Roger Gustave Issac | / | D | D Jan 21st 1941 | Paris | Divorced from Jacqueline SEYMOUR de Ricci
|---|---|---|---|---|
| Date of birth | Place of birth | Citizenship 3 | How acquired 4 | Entry desired | 
| (1) 16th May 1906 | Paris France | French | by birth | [[strikethrough]] Permanent [[/strikethrough]]
| (2) |   |   |   | Temporary Visit ✓ |
| (3) |   |   |   | [[strikethrough]] Transit [[/strikethrough]] | 
| (4) |   |   |   | [[strikethrough]] Student [[/strikethrough]] | 
| (5) |   |   |   |   |

1 S (single) ; M (married) ; W (widowed) ; D (divorced). If previously married, give name of spouse; state whether marriage terminated by death or divorce (give date and place).
2 If applicant is in the United States, give date, place of entry and type of visa. Give file number of any correspondence with Immigration Service ___
3 If stateless, give last citizenship.
4 Birth, marriage, naturalization, derived through parents' naturalization. If citizenship acquired other than by birth give particulars and dates.

2. Consular office at which application is to be made Madrid Spain.
3. Place of previous residence since birth (give approximate dates). If applicant or spouse interned at any time give particulars and dates. If passport used for travel give country of insurance:

[[5 columned table]]
| City | Country | United States street address | Date | Passport | 
|---|---|---|---|---|
| Applicant: Paris | France | [[?]] | 1906-1924 |   | 
| Geneva | [[Switzerland]] |   | 1924-1926 | French
| Paris | France |   | 1926-1942 | French |
| Madrid | Spain |   | 1943-[[?]] | French |
|---|---|---|---|---|
| Spouse: Paris | France |   | from birth to date |   |

4. Close relatives of applicant (including spouse, parents, children, brothers, sisters, if not included in listing at top of Part B. If deceased so indicate. If no close relatives so state. Give close relatives of spouse:
[[4 columned table]]
| Name | Relationship | Address | Citizenship 5 |
|---|---|---|---|---|
|Rogrigues-Pereire   Jacques | Father | 37 Ave. Victor Emmanuel III Paris | French |
| Adele | Mother | 37 Ave. Victor Emmanuel III Paris | F2. |
| Nadine | Daughter | 18 Rue Spontini Paris | F2 |
| Gerard | Brother | U.S. Army | U.S.A. ? | 
| Francois | Brother | French Army | F2 |

5 United States citizen (C). First papers (FP).

5. Occupational experience (list names and addresses of employers, positions held and dates since 1930:
[[2 columned table]]
| Applicant: | Spouse: |
| 1930-1936 Banque de Paris et des [[?]] Paris [[?]] | None | 
| 1934-1940 [[?]] Royale Asturienne des Mines Brussels (B) Commissary  | None | 
| 1936-1942 at my own account | None |
| 1943 - French North African museum near the USA Embassy in Madrid | None |
| 1944 info to date at my own account | None | 

✓ 6. Activities.—Give names of societies and organizations (other than political parties and labor unions in the United States) of which applicant is or has been a member. If no membership state "none." If any applicant is or has been a communist or anarchist give particulars. If not state "none":
| Applicant: | Spouse: | 

7. Has visa applicant ever been convicted of any political or other offense? [[strikethrough]] Yes [[/strikethrough]] No. If answer is yes, give particulars ... ...
8. State in which countries applican has had service or training  in military, naval, or air forces. Give rank and branch (army, navy, etc). If no service or training, state "none." Give United States Selective Service classification: France Military Sargent 
9. Source of foregoing information personal
I declare that the information given above is correct and true to the best of my knowledge and belief.
Date April 5th, 1945 Signature RogerPereire
(SEE ADDITIONAL DECLARATION ON REVERSE SIDE IF PART B IS SIGNED BY PERSON OTHER THAN APPLICANT OR A "C" SPONSOR.)
16—39914—1

Transcription Notes:
A little French on page; I don't feel confident transcribing it