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Biographical Encyclopedia of America
309-311 Fifth Avenue, New York, N.Y

(THERE IS NO OBLIGATION WHATEVER INVOLVED IN THE SUBMISSION OF MATERIAL IN THIS QUESTIONNAIRE)

Name (in full) _______________________________________________

Position, Title, or Professional Activity ____________________

Office Address _______________________________________________ 
Street 

City _________________________________

State ________________________________ 

Residence ____________________________________________________ 
Street   City 

Date of Birth ________________________

Place ________________________________
City        State

Name of Parents _______________________________________________ 
Father's Name   Mother's Given and Maiden Name  

Genealogy _____________________________________________________
_______________________________________________________________

Education (Given schools, also degrees, and dates when received
_______________________________________________________________
_______________________________________________________________

Married _______________________________________________________
Wife's Maiden Name or Husband's Name 

Date of Marriage _________________________

Children _______________________________________________________________
________________________________________________________________________

CAREER, (list chronologically all positions, including professional activities since commencement of career, and give dates and places showing complete personal history.)
________________________________________________________________________

________________________________________________________________________
(OVER)

Transcription Notes:
The dots (.....) are the lines in the questionnaire ---------- Reopened for Editing 2024-02-11 15:56:53