FBI Vault, D.B. Cooper Part 86 (263 pages)
Scans: https://vault.fbi.gov/D-B-Cooper%20/D.B.%20Cooper%20Part%2086/view
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==== Part 86 · PDF page 1 ====
FEDERAL BUREAU OF INVESTIGATION
FOU/PA

DELETED PAGE INFORMATION SHEET
FOV/PAH 1:16-cv-G1790-62

Total Deleted Page(s) = 36
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X Deleted Page{s} xX

X No Duplication Fee X

X For this Page X
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==== Part 86 · PDF page 2 ====
FD:340 REV. (6:24-65)

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File No. LOY -EILG,

Date Received

From

(NAME OF CONTRIBUTOR)

(ADDRESS OF CONTRIBUTOR)

(CITY AND STATE)

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To Be Returned ["] Yes Receipt Given [_] Yes
["] No [ ] No

==== Part 86 · PDF page 3 ====
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==== Part 86 · PDF page 4 · Bates DB Cooper-DB Cooper-37843 ====
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==== Part 86 · PDF page 5 · Bates DB Cooper-DB Cooper-37844 ====
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==== Part 86 · PDF page 6 · Bates DB Cooper-DB Cooper-37845 ====
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==== Part 86 · PDF page 7 · Bates DB Cooper-DB Cooper-3 ====
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File No. NORTAK tot—SI- Ja

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(ADDRESS OF CONTRIBUTOR)

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==== Part 86 · PDF page 8 · Bates DB Cooper-DB Cooper-37848 ====
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==== Part 86 · PDF page 9 · Bates DB Cooper-DB Cooper-37849 ====
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==== Part 86 · PDF page 11 · Bates DB Cooper-DB Cooper-37853 ====
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==== Part 86 · PDF page 12 · Bates DB Cooper-DB Cooper-37854 ====
FD-340 REV, (6-24-65)

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File No. LR 164-22 —/Ay"
Date Received 12/13/76
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TADDREOS OF CO

Hope, Arkansas

SA

(NAME OF SPECIAL AGENT)
'

To Be Returned & | Yes Receipt Given [[] Yes
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Description :

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==== Part 86 · PDF page 13 · Bates DB Cooper-DB Cooper-37855 ====
FD-340 REV, (6-24-65)

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==== Part 86 · PDF page 14 ====
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==== Part 86 · PDF page 15 · Bates DB Cooper-DB Cooper-37858 ====
FD-340 REV. (6-24-65)
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Date Received
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==== Part 86 · PDF page 16 · Bates DB Cooper-DB Cooper-37860 ====
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==== Part 86 · PDF page 17 · Bates DB Cooper-DB Cooper-37861 ====
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==== Part 86 · PDF page 18 · Bates DB Cooper-DB Cooper-3 ====
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==== Part 86 · PDF page 19 · Bates DB Cooper-DB Cooper-37863 ====
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==== Part 86 · PDF page 20 · Bates DB Cooper-DB Cooper-37864 ====
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014052 0009 Emp. Nome J COFFELT
Emp. No, a Dapt. : 7 =
Poy Ending O2/ 13/ t2: Emp, No. 014052 Dept. C009
Regutor YO Dvertine S Pay Ending O1l/ 30/72 -
egulor erti 4
Annual Sick ao 50 Overtime / VE
leave eave :
Annvot Sick
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Date IN our TOTAL HOURS Other
mot 01/31/72, VD DATE int out TOTAL HOURS
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| 02/13/72] 1 so. | 01/29/72] 2
FORM. 90 " ;
Authored Signeture — ee we ee _ . Sur. Or/39/7T2 2
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==== Part 86 · PDF page 21 · Bates DB Cooper-DB Cooper-37865 ====
J SOFPFLT

Emp. Name

Emp. No.

myn nt ar Ta:

.Emp No. 91405? Dep. oce9
Pay Ending O3/17/72

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Hours. Hours.

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wleave - Lasve

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J _CCEFELT

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014052

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Pay Ending

D2/27/72

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Other 8
DATE IN out TOTAL HOURS.
. api 3"
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won, | 02/28/72 [Pep

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Fé. | O3/03/72

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wea} O3298/72

the | O3/99/72

ri | O3/10/72

sor. | 03/11/72 | YD

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FORM 90

Authorized Sgnotuec

ASN $2 fuse

Annual . Sick ~ ae
leove leove
- Dilferentiol § . _
On Cail 5.
" thes $ :
DATE . iN Out Tort: HDLRS
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==== Part 86 · PDF page 22 · Bates DB Cooper-DB Cooper-37866 ====
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DATE IN our TOTAL HOURS

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FORM 90 ; ne

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==== Part 86 · PDF page 23 · Bates DB Cooper-DB Cooper-3 ====
G

J COFFELT
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Pov Ending 95/04/ T2
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FORM 70

Authovred Synatyre

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==== Part 86 · PDF page 24 · Bates DB Cooper-DB Cooper-37868 ====
cme None__3 SEE FELT 'emp, Nanos __CCEFELT cs
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Poy Ending LTA S2172 'hor tatua OBJTB IPD. —
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. Other $ Other $s
DATE iN our Total HOURS Dale IN ouT TOTAL HOURS
won| 29/19/72 (929 6 Pg a} nent 06/05/72 (P22 | P Eley a3 |
nunf cel2Cs721F SC 1 SEIS ts, west G6/66/72 [FO° L Ae 5.
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FORM 90 FORM 90 . Zz b6
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==== Part 86 · PDF page 25 ====
6320/0001 /4709/ 0528 |
LTeJACK J COFFELT en
ooOB S$ 12TH RUAD 32206 Emp. Nome
ARLINGTON: VA- €14C052 95096.
Emp. No Deol. :
- 97/16/72, eee
Pay Ending 2230 ~ 7x2 OQ Z Pov Eediog a a ta
Regulor U> neenive / hated $s ' > Soon VA Sas |
Hours ours i
Stek . Anavel Sith ee
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ou - Other 5
ther
= DATE : in OuT IOIAL HOURS
DATE iN our TOTAL HOURS ": fi
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FORM 90 Authoring) Signatwee bé
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==== Part 86 · PDF page 26 · Bates DB Cooper-DB Cooper-37870 ====
" §320/0001/4709/ 0528

COFFELT,JACK
4208 $ 12TH ROAD
ARLINGTONs VAs

AUG 27 1972

22204

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==== Part 86 · PDF page 27 · Bates DB Cooper-DB Cooper-37871 ====
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a SEP 24 1972 ° 4 i
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DATE in , OUT FOTAL HOURS 7 :
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==== Part 86 · PDF page 28 · Bates DB Cooper-DB Cooper-37872 ====
6320/0001 /4709/0528

G28 § 12TH ROAD
ARLINGTON, VAS. 222047
Pay Ending OCT 8 1972

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FORM 90

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==== Part 86 · PDF page 29 · Bates DB Cooper-DB Cooper-37873 ====
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Coffelt, Jack ee
4208 S$. 12th Road ol, '
Arlington, Va. 5 ON TG
"* DATE SALARY DIFF. POSTTION SHIFT
-12-8-71 $410/mo. oT OR Orderly Fr
ee 7 ' ©. | 955330
DATE, TERMINATED: FSAR a #29 72. ne
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DB Cooper-37873

J

==== Part 86 · PDF page 30 · Bates DB Cooper-DB Cooper-37874 ====
DB Cooper-37874

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==== Part 86 · PDF page 31 · Bates DB Cooper-DB Cooper-37875 ====
a
. - |
fok a
| Joe : x , " TERMINATTION- - . . .
er Date: sally 5 -
j 'Employee! s Name Teck a a Co Eeett
_Pirst' Middle Last a
Department Oem , Position Qe neel-t |
Reason for Termination: (Check One) Remarks: (Briefly indicate nature

Voluntary Resignation
_ End Temp. Assignment
Discharge

Other

Employee's Rating:
Performance

'of action.)

EHCCSS te

"

'Excellent Very Good Good Satisfactory Unsatisfactory

Attendance

Attitude

I uartil Cecenthy

Appearance

ail

ta
Le"
—_*

Personality

,-

Remarks: Wwf, Co€etr han Qesaan Svuvecl me. Ago nue ty oxbeaped

vot she Upcen Te

i

POS TWA. We hus Boon 6Fe Aput oe Suk Luioe oat Ctesasial Busitesns

—
LntytKyo Lath him Ay Shen ev jufi2f42 ay 0 eumisyn ay th ett Be re tee
ve Sequiae coll yz Ne Aes Mov woeced Since. © toi NN to RePeeT Kow ween 70f73 ;
- Las hse wd2us ett WSEK ed: aca ' 4} 24 , 19 92> '
Day Date oy
. ' , "s i7en se
Would you tehixe? — Subject To: See ASae. - Woulp Gtenre
Yes No muvee 92 OA Blems a]
hed = D6 .
NOTED AND APPROVED: ~ . co
Northern Virginia Docté7s al
- Termination rec nn irieh: -
: TINIE OS CEAILOL . . (B te)
REMARKS : Raxn f"ronord file:
— oy
z aL ee a | i "4 ond
we FO wily ee ee Sere wa
Ping cosdfile: VA ©
Resord nard fitar: fv .
NVDH Form # 126 Horpltaligation cancelled: [a .
- Switchboard: WA
(6% fe ' 8 ceemmome

DB Cooper-37875

==== Part 86 · PDF page 32 ====
3 Nol JEBRN VIRGINIA DOCTORS HOSP: \L
'EMPLOYEE EVALUATION: "2 JOB PERFORMANCE REPORT

Date: fo/se/2 ew

Name:_ co CEs! v- awa

Last First Initial 3 Mos. Probationery Period
. ; Annual
' Department: O.k: Texmination_wu—
Station: OR, Position:__0 @pvely
Full Time: Part Time;___ "shite: 9 % sci
Temporary: ___ Permanent: _.-—~

_~,

NOTE: If employee is graded unsat;

isfactory in any category, this

report must be shown, discussed,

and signed by employee as an

acknowledgement of contents.
_Remarks

Grading from left
to right indicates
- lowest to
highest

Attendance

Job Performance

i
i
4
an

Ability. hd
Industry A 1 ;
ae .
t on
Dependability A . : frac \ Reeenttly :
Cooperation le 4 ;
Appearance af i}
ij ft ¥
Personality I po
Health | | i? :
'GENERAL

REMARKS syye. co€ ee ir bal Recceaen svvven Ma, S40 A ve Mecess iT =n herve

anty wou. lwo iweS rir Cen hs6 Oo sites) res Veudwt. thes Agata Pett Ales?

Eee Fy Te waed lusee - Fate BE us tarps Ly eeet Cye pree solrafpr ge
Ne ws Bre AvePlgcro. Nes wer wWeemepn yet.

Employee's Departmen

Signature Signature
Approvea_ >< Remarks, b6
Disapproved . b7C
Date Administr

i

==== Part 86 · PDF page 33 · Bates DB Cooper-DB Cooper-37877 ====
- August 30, 1972 ae

— = oe - an =—-

- wack Coffelt

'In a recent letter from one of our patients,

you were singled out for special commendation.

We wish to let' you know how proud we are to
have an efficient and competent employee such
as ySu on our staff.

Administrator

me

:,
#
%

e ane:
b6
b7C

. L
t

DB Cooper-37877

==== Part 86 · PDF page 34 · Bates DB Cooper-DB Cooper-37878 ====
form VA.—4 (Rey.

Department of Ta. vars
ofpe\*+

Print full name.

11.72}

IRGINA EMPLOYEE'
ys 2X

4a

WITHHOLDING EXEMPTION ERTIFICATE _
is YN £ _dity Nod,

Social

54d af

Vee!

State. "Wrez...:

City.

* Ze ELT

Print home ested Z £3

EMPLOYEE: -
File this exemption certifi- 1.
cate with your employer, 2
EMPLOYER:

Keep exemption certificates
with your records. Certifi-
cates may be on this form,
or a similor form. If the
employee is believed to have

claimed too mony exempt- 4,
fons, notify the Virginio De-
partment of Taxation. 5.

HOW TO CLAIM WITHHOLDING EXEMPTIONS

aeqer
o © © © = © Be ye oe we hw ee

!f SINGLE, and you claim an exemption, weite the figure

. If MARRIED, one exemption each for husband and wife if not claimed on another certificate.

(a) If you claim both of these exemptions, write the figure '2' l i
(b) If you claim cne of these exemptions, write the figure "1% ~
(c) If you claim neither of these exemptions, write "0' - aan

Exemptions for age and blindness (applicable only to you and your wife but not to dependents):

(a) 1f you or your wife will be 65 years of age ar older at the end of the year, and you claim this
exemption, write the figure 'I': if both Are 65 or older; and you claim both af these
exemptions, write the figure "*2"

(b) $f you or your wife ora blind, and you claim this exemption, write the figure 1"; if both
ate blind, and you cloim both of these exemptions, write the figure "2"-.. 0.4. ..45 62

If you claim exemptions for one or more dependents, write the number of such exemptions . . :
Add the number of exemptions which you have claimed obove and write the total .-......
Additionol withhoiding per pay period under agreement with employer...

i oD a © @ © #@ @ @

Oo

whteee meee

t CERTIFY oy the number of withholding ogptions claimed on this ce

{Bate}. f Zh. ' cL

at ied

ificate does net eed the number to which | am entitled.

719 (Signed)

aa

DB Cooper-37878 —

==== Part 86 · PDF page 35 · Bates DB Cooper-DB Cooper-37879 ====
} . cores . +
- »
. . . +
tee ease ee ee . .
rt, a she tha
. ath Coe dep oe Cahig ve . 4 Tae

A: fF YOU FAIL to file this certifi with your employer, he

*. must withhold Virginia income tax '.om your wages without
* exemption, If an employer believes thet an employee is claim-
ing en excessive number of exemptions, he will odvise the

Deportment of Taxation. : . .

. B. NUMBER OF EXEMPTIONS.—Do not claim more thon the
"correct number of exemptions. However, if you expect to owe
more income tax for the taxable yeor thon will be withheld if
you cloim every exemption to which yoy ore entitled, you may
increose the withholding by claiming a smaller number of ex-
emptions or you moy enter inte on ogreement with your em-
ployer to have additional amounts withheld. :

Cc. EMPLOYEES WITH TWO OR MORE EMPLOYERS.—-If you
have more than one employer and wish to increase your with-
hotding to on omount nearer your correct income tax you should
cloim a smotler number or no exemptions on each Form Va.—4
filed with all employers other thon your principal employer.

- BD, CHANGES IN EXEMPTIONS.—-You moy file a new certifi-
cate ot any time if the number of your exemptions INCREASES.

You must file o new certificate within 10 days if the number

'of exemptions previously claimed by you DECREASES for any of
. the following reasons: .

{1} Your wife: [or husband) for whom you have been claiming exemp~
tion is divorced cor legofly seperated, or claims her (or his) own exemp-
lion on o seporote certificote.

~ tesanene€2} The support of a dependent for whom you claimed exemption is

P]

wo
. ey
ue
. .. : ' : '
eo. , ao ' .
- ' '.
. wit. re } ¥ pekoe ae Tones oe
faken over by someone' so that you no longer expect to furnish more
than half the support 4, ne year. tl.

(3) You find that o dependent for whom you claimed exemption will
receive $600 or mare of income of kis own during the toxable year, -

OTHER DECREASES in exemption, such as the death of o wife
or a dependent, do not affect your withholding until the next
yeor, but require the filing of a new certificate by December 1
of the year in which they occur. wt oe te

Ek. DEPENDENTS.—Do not claim ony dependent in Line 4
fon other side) unless he or she meets off four of the follow-
ing tests: (1) He or she is receiving over one-helf of his or her
support from you for the taxoble yeor, and {2) he or she is
"closely related''.to you, ond (3) he or she will not have as much
as $600 gross income of his or her own during the toxable yeor
(if a son, daughter, stepson, or stepdaughter is a full time student
at an educational! institution, this Jimitation does not czgply),. and
(4) if married, her or his exemption is not cloimed by her husband
or his wife. "Closely related" meons your children (including
stepchildren ond legally adopted children) ond grandchildren;
your porents and grondporents; your brothers and sisters; your
immediote "in-laws" (mothes-, father-, son-, doughter-, brother-,
sister-in-law}; your blood related uncles, ounts, nieces, ond
nephews, : ' .

F, PENALTIES.—Penalties are imposed for willfully supplying
false information or willful failure to supply informetion which
would reduce the withholding exemption. es ee

Tt a emer SIO?

tae

DB Cooper-37879° |

Es ee A

f=. acl ee Dina Ade 30

aoa Fhe

==== Part 86 · PDF page 36 · Bates DB Cooper-DB Cooper-37880 ====
Goyph. Dab

Pf. /o~ Td

wa "—

NoRTHERN VIRGINIA DocTORs HOSPITAL
_DEPARTMENT OF RADIOLOGY

REQUISITION FOR ROENTEEN EXAMINATION b6

*b7C

Insurance: GHI o 'No GHI O

(Check one)
walk g chair at stretcher. ;

el

Transport to X-ray department by ff a
(Cheek one) ° .. my :

DQ Usshe
(2) £f. WGrtdoby

Part to be examined

Aenea. -

chee Ve aed? 2h woe

Clinical Diagnosis

b6
b7C

Wurses plgnature

Report of Roentgenologist

a, _ Date of Examination

~ Roentgen 'Findings:

Dear

Kay No_ oly 1 fe -

July 10, 1972 —

wropel ott

RE: Jack Coffelt, #66674 9 st

te

"45 . to tee

 "%eray examination of the chest reveals the previously described blunting "of the left

costopnrenic angle secondary to scarring.

Old healed rib fractures are noted on the

'vight. The lung fields are clear.
calcified at the knob and tortuous.

The heart is unremarkable.

The aorta is elongated

The lateral view reveals degenerative changes of

> the thoracic spine.

- be...

x-ray examination of the right shoulder girdle reveals no evidence of fracture or

: subluxation. Minimal degenerative changes are noted. BIC
N. B.—The Radiologist will be pleased to confer with the Attending Physician with respect to all cases
referred to this department.

; . . - . "ey . : ; wad 4. =
rhe " ' nbiiokileet "be

;

Lr

Z q

4

DB Cooper-37880

==== Part 86 · PDF page 37 · Bates DB Cooper-DB Cooper-37881 ====
Sar fF

ap fs

+ 4th Re

Meee + wate
Ped :
4
Foge bee wm Namwevenveremnrs one
¥
¢

. rage . .
~ . . a
. wo ee ve La,
. . . ' . * 7 * -
ny . yo te

Noe tHERN VIRGINIA DOCTORS HOSPITAL:

oo EMPLOYEE ACCIDENT REPORT'
. : _ NOTE: This form to be completed in
duplicate and sent immediately to
- Administeotor,

_ NAME OF EMPLOYEE INJURED 4Ld,

ok :
: CR
DEPARTMENT ——— AM.
we" _ . i . . : YH -
DATE OF INJURY 2 = D-IL _ pny or weex_" Wy nme G2 Fe cu.)

=, WAS EMPLOYEE anced DANGERS OF JOB

WAS EMPLOYEE DO|NG REGULAR WORK?!
BEING DONE? "/ 44 -—~ fers feb, Ke ht line te LO happend

- ' wh *s ' ~f .
BRIEF DESCRIPTION OF INJURY Eo ctacdk ihe brinss FX, baci Ut tne Ls Ladle Jforge. a

fp. an

PHYSICIAN NOTIFIED: (Name)

"4

Lene Os ee. ¢

4

7
HOW DIO INJURY HAPPEN? 2 cl snail Leltenp fo IE. AE oe Late. Zz we a

WHAT DO YOU BELIEVE CAUSED THE ACCIDENT? (DESCRIBED {a} any unsofe act ofthe injured employee or fellow. wae
(b) Ff foulty s machine or equ} sent tle) unsafe copditionysf a area {d) £2) other unset. conditions)" Y fin ke bite, Pref e, ot nS
tN ig a SF Chie Nee CoS feds 1 ee CE: WS Hearn
der ao PLAN hor tat a Sore, aoe Pas ene Lhacwsl oe the. LF oA: wae Lert Souy
Sete thie Tes Pre ref (OOS Tem fhe FOIL LiF CE itp I oie
> he Gack $terh on& Lortm Ara < etbdic Brivedhen. R, ef ke kf hpblbead, he LYAL

th, erp dicteren bierre deny,

*. What should be done to prevent repetition?

ip God Ge Fi ble Sle
GOH Lew
v

HAS THIS BEEN DONE? tp ~ixheacchly NOT, GIVE REASON.

Chenin Ty fit Chet he

2 det C22. aud ohke Meda torr ct be, 2 atluck ton Eb

a a

we FF ara vovid, nw aH aon

a

IK ede Aa Caf vp re Aer, Of bed ote cece. G hey! Ph. (04 Cache
oti a
. Dote this report completed by supervisor — SIGNED F
- ~, . . Seo 24 ee
. Nach Leila ae
PHYSICIAN' s REPORT: (DESCRIBE TREATMENT AND/OR MEDICATIONS) WA : Ze ~
nF. 107 «Ayn + ohiest Aan ne
b7C

SIGNED

| _—__M,D.

. av.
"DATE OF THIS REPORT 7 ? 2 > SIGNE

|

woe thin. . Qack atk efi + eberke

re linn pk + ea *K Rl 'S.

a At folie He A pt o- foo

DB Cooper- 37881 j

==== Part 86 · PDF page 38 · Bates DB Cooper-DB Cooper-37882 ====
PRESENT STATUS .
| POSITION. 68 or an i

'Station_ "GR
7 DEPARTMENT.

Cle

"Part, 'tine

"aro eo 4-12

2Full time .* _ temporary pernanatt

LTH. FOLL( WING 'PERSONNEL, ACTIONS | TO BE APPROVED

rei

eet

{Returning to "aguty. "Resume & on > pays 3

"Position

es

>
he

24-7 2

Current, Pay Period

654 .
ae 3
- 'or tee, '

" .

buco
kh

J
ry

eg "department
2 ful Sime.

'per "asi/nont

"oa!

as Zollows?

, .

g@ovelu _ Dept. ' "O: Re
Albu per day/nonth, Disferential- 0.7

. 7°

_, OTHER ACTION: (Specify) . ee
Disa *
. ; the SG or tate t AQMLULSteatvol - .
ttle eat Sadbtty . "Shs Buatdeea i' 4 'sete tate a Nar hess tet Pt Oh bg Ne eRe tee Bae Soe te ce

DB Cooper-37882

==== Part 86 · PDF page 39 · Bates DB Cooper-DB Cooper-37883 ====
ee er eres

NORTHERN VIRGINIA

| sneer AtNO S:YES

DOCTORS HOSPITAL
' WERE THEPHONE
COFFELT, JACK - 521-4665 eS Log 2: 35pen 7/19/73 3
=poaTs AGE [Sex ; YT RACE=—~—~=*SYSCMARTAL STATUS 3
Batt Ot ORIN | ORTH PLACE RELIGION OCCUPATION ACCOMODATION
2/20/25 | MISSOURI PROT, PHYSICIST rev Osemrren QS casoucD)
[v7 ADMITTING DIAGNOSIS ROOM NO. ROOM RANE
THROMBOPHLEBITIS 3K 3148 66.00
m NCY RELATIONSHIP" _| OFF. PHONE a ae ri}
| 4
"INSURANCE . CONTRACT NO TT CODE NO
GHI 159+1727 1110-B EFR: 6/1/72
INSURED THROUGH EMPLOYER OUS. PKORE b6
SELF IBM CORPE, (UNABLE TO GIVE PHONE#) | b7C
CAUSE FOR ADMISSION, ws
PHYSICAL FINDINGS. 7 / a ° ; ;
LABORATORY FINDINGS. \
A FO KK Leer
cr al —_ Cee
OPERATIVE FINDINGS: :
ROR Conse A za Beek, 2 A 4 }
oN"
t- aa
OA
Lf .
FINAL DIAGNOSIS =e .
. A CODE
COMPLICATIONS ay,
CONSULTATION WITH: . DISCHARGE i
: ia) 72 ~) f- 73_
'TION ON DISCHARGE: RECOVERED (] IMPROVEO [}—— ;
AVEO [] NOT TREATED [] DX. ONLY [J :
utopsy [] COPY TO PHYSICIAN ~ YES [3° NOL] __ L M.D. ;
b6
- b7c ?

Sal

DB Cooper-37883 eas be

==== Part 86 · PDF page 40 · Bates DB Cooper-DB Cooper-37884 ====
PARENTS, GUARDIAN OR OTHER RESPONSE OLAION.

et Tat CALE OF MINGH CHEDEEN TES SECTION MUST GE COMPLETED BY THE

NORTHERN VIRGINIA DOCTORS HOSPITAL

Ld

1 (ORXMUD, HERERT AUTHORZE THE PERFORMANCE OF ANY MEDICAL «PROCECUEE WHICH MAY 0€ AOVIRED An GCOmmeD OF
arTenOwS pRYucuN oF__MYSELF, JACK COFFELT

. A PATEMT Al MORNIN VEGans SOCK

MOSPTTAL, FURTHERMORE, 1 BWI RESPECIFULLY REQUEST THE USE OF ANY
wien at ORMANCE
WitNEgs:
pate an
ve
é
b6
RELEASE FORM RESPONSIBILITY FOR ABORTION BTC
LUE UNDERSIGNED, A PATIENT APPLYEIG FOR ADMISUON TO NORTXTIN VIRGHIA DOCIONS HONEA Rare Alot AM Bt A CoE

ARORTION 1 HERESY DECLARE THAT NEITHER THE ATIEMOING PHYSICIAN NOT ANY PERSON EuPLOTED 8Y O8 COMMECTED StH Ra $4 NOOR
HAS KROWINGLT PERFORMED ANY ACT WHICH MAY HAVE CONIRRUIED 10 THE WOUCTION OF THE ABORTION

DASE WITMESS. . ONES

WITNESS

RELEASE FROM RESPONSIBILITY FOR DISCHARGE :

| IME UNDERSIGNED, DEMAND JHE RELEASE OF : . on
NORIHERN VIRGINIA SOCTORS HOSPITAL ANO ASSUMT FULL RESPONSBAITY FOR HIS O8 MER DISCHARGE AGAMSI tHE ADVICE OF we areas
maa:

PHYSICIAN AND OF THE HOSAITAL ADMINISTRATION, 3 ACKHOWLIOGE THAT 1 HAVE SEEM INFORMED OF Ing tte «INVORVED AMD NEDOET
THE ATTEWOWIG PHYSICIAN AND THE HOSTAL FROM ALL REWONSRATY FOR ANY GL EPFECTS WHICH AAT RETULT FROME TUICH OMCKASGE.

x

oatt ~ WIIG $3. SHOWED.

WITNESS

ABSENCE PERMIT

&

A PATENT IN WORTHERS VEORMA BOCIORS HOTA
PMO 11 MECESSARY 10 CEAVE IKE HOMITAL TEMPORARKY, [AM FULLY AWARE THAT WHATEVER RLINESUS AND OO IUESS weetn Mar MF AL
ver DURING MY ABSENCE SKAGL HOT SE THE RESPONSI OF THE PHYSICIAN (1% IN CHARGE, THE HOMITAL = OR ANTONE Comet wet ma
Howital . \

«

| REALIZE FURTHIR THAT EMERGENCY ADMISSIONS SO THE HOMUAL MIDE NECESUPATE DHE USE OF MT HOUTA BGR. - *, s+"

; ' THA
Dal WINES, $Onto % ef

WHE SS

Tet

DB Cooper-37884

==== Part 86 · PDF page 41 · Bates DB Cooper-DB Cooper-37885 ====
fr
y
F
q
t
.
.

ba " NORTHERN VIRGINIA DOCTORS HOSPITAL |
wVEFELT JACK HISTORY
PS aes aga
— yo See
_ INFORMANT DATE afafr3
fo?

CHIEF COMPLAINT yj " focwe fies: wee nh. ley.
waa fi aies, heorsgeer he has

PRESENT ILLNESS

ly LV headed

LEM were. fe t-f
dean. 2° tn Lihat snes :
Labyadl Uh ood Lb hens be
Ldey pif hen, ph lied
has we | hocabered riper Che
Le palit Lvcontt Ko LL
; : shodavi —Tlarlinsicne ecsche «rmmufor

- Fx bartezeeal Korma

PAST MEDICAL ILLNESS

N

Led grscal 4 how Ly Lhirecent
FAMILY HISTORY Wie wa
SOCIAL HISTORY ovctonay - {-2 aA xX Four.

TOM Hiv = lial! (enbadesealedler.
REVIEW OF SYSTEMS AZC

bé "
b7Cc

Signed See 0972,

N.V.0.H. Form No. 23

REV 46

DB Cooper-37885

t
* V
>
+
oo ep ae . ans 2 whee ww eee =~ Sy OR NOR rmernannpes remnant RINE yy gS" ge

A gar - sche copelae A - hyn EAELE -

==== Part 86 · PDF page 42 · Bates DB Cooper-DB Cooper-37886 ====
.
Yj . t
TCFFELT JACK VMERGA DOCTORS MowrTAL |
2EMH Ss BWR FQLCS |

e -~

Pa 4 .

| GENERAL CONDITION: or BE, ZL? LE2 RESP LZ
wT,

ey ufofek yee? Dehn Corll 18 nore
Libs: faldlened dace C. seem thperecrt,

Ger onde, wel veil ee le Les ae Lav ek 4 £0/1's- 4ML
ferr Cle, Craven dord amd Cer

Jose tee
xl, 4 op tw ph brtre . than ;

- ret
Heder q.. ull .
Hick : Aft fut Lode, Pel Ad

Jane USE, llr G1 . allo
Ze BoE S COM: awa

BL Chew " en, (OO Manages, arganerneges alle,

A: eae
COT fon ling WM a
" wre vindsled Canale. Low a GE
4g Hervant Gm. @. ore Loker G

MSs fe Les hile 6 € on ple

} a 7 b7C

EXAMINED BY;|

DB Cooper-37886

==== Part 86 · PDF page 43 ====
.

.
Fete Mipinneinp® § erht oe <p sce ewn- +
Tres ee .

fos

Earn pee
=e

to» THA

Nero pcre 4
Bea art On +

rd
an

==== Part 86 · PDF page 44 · Bates DB Cooper-DB Cooper-37888 ====
OEE EE EE 2, Pee TREN

CG Cath. evo

, PS acmrssion uninacysis

NORTHERN VIRGINIA DOCTORS
DEPARTMENT OF PATER OGY
URINALYSTS
pars, 7/7
oO Sutkownitch
Erythrocytes a
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Sheet 3

LABORATORY REPORT SHEET

DB Cooper-37888

==== Part 86 · PDF page 45 · Bates DB Cooper-DB Cooper-37889 ====
JARS

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QUINIDINE.

MSTORY:

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: PR INTERVAL: 019

QRS INTERVAL: 06

INTERPRETATION:

* WITHIN NORMAL LIMITS.

ELECTROCARDIOGRAPH NUMBER

ELECTRICAL AXIS:
EXG POSITION:
Q. T. INTERVALE

150/90

Seai-Horizoutal

032

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So DB Cooper-37889

==== Part 86 · PDF page 46 · Bates DB Cooper-DB Cooper-37890 ====
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==== Part 86 · PDF page 47 ====
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==== Part 86 · PDF page 48 ====
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==== Part 86 · PDF page 49 ====
NLV.D.H. Form No. 22

PUNY 2

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==== Part 86 · PDF page 50 · Bates DB Cooper-DB Cooper-37894 ====
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DAILY REPORT - NURSES' NOTES
POFFELT Jack NURSES' SIGNATURES: ves |
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Dwika nw aon ia i) Unis
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MEDICATIONS: DATE: P i {8 1? AM to 37 Oa 12.PM he TR Ans
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==== Part 86 · PDF page 51 · Bates DB Cooper-DB Cooper-37895 ====
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SOFFELT JACK
PeXee 14% FaRAS

time:____ 2,30 P ft. DATE: 2115/33

PATIENT ADMITTED: WALKING CHAIR STRETCHER 2
SERVICES OF DOCTOR:
VITAL SIGNS: TEMPERATURE__93 2 pucse..__ (09 RESPIRATION 2 2
HEIGHT WEIGHT. BLOOD PRESSURE .452/9.9 _
ADMISSION DIAGNOSIS:___ Tyo wel phe bi ew
HISTORY OF: DIABETES © iF SO, WHEN?
HEART DISEASE * IF SO, WHEN?
EPILEPSY v IF SO, WHEN?
TUBERCULOSIS. iF SO, WHEN?

atcercies:, _Vb1iKtotm, Sea 1 2el
ysuac pieT__ Boujov

MEDICATIONS PRESENTLY BEING TAKEN:

Name Dosage . Times a Day
MEDICATIONS SENT: HOME — _NURSING OFFICE >
VALUABLES SENT: HOME HOSPITAL SAFE ——
LIST VALUABLES KEPT WITH PATIENT: :

DENTURES: Yes___1-~ NO GLASSES: YES__&<_. NO
URINATION: FREQUENCY. "Ormo| NocTURIA_AO TIMES PER NIGHT
BOWELS: CONSTIPATION? MAD LAXATIVES REQUIRED ___-§_

CONDITION OF PATIENT (BRUISES, RASH, SKIN CONDITION AND/OR ANY OTHER PERTINENT
INFORMATION):

Pt _<£ Housle {le Lis bes SLEULA by bbe us Se eve pot, tas
See @ Leo Coyine, Otel prkinas sous dg for

DB Cooper-37895

==== Part 86 · PDF page 52 · Bates DB Cooper-DB Cooper-37896 ====
DAILY REPORT - NURSES' NOTES

PAFFELT JACK | . tow
Pewee. ray. Fagasg [4 creer
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J, MEDICATIONS: DATE: V0 pete Orly
[ilies Je" aXt)_ 9. Set
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DB Cooper-37896

==== Part 86 · PDF page 53 · Bates DB Cooper-DB Cooper-37897 ====
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DAILY REPORT - NURSES' NOTES
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DB Cooper-37897

==== Part 86 · PDF page 54 ====
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Pe ri FUITUNTEations on Reverse Skis Must be Signed by Patient or Authorized Person r
race . * S:
'dh o# , t EMERGENCY ADOM CHANGES . - ; OTHER SERVICED RENDERED
* $ ' sett ef Nose Nétincude Fes of Attending Fhymclun > ' =
eal aes Satya ores eae pies £57, rr
"3, - Teh : CHANGE STEM - CMARGS - ,
Lyf Rmergency Roem ae" | Sutures, — i X-ray b6
Yel Anethetie tS Tetanus Antitoxin * . —
! + Cantral Suecty " Cae —— ~ : Prvysical TRETOPY .
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DB Cocper-37898

==== Part 86 · PDF page 55 · Bates DB Cooper-DB Cooper-37899 ====
NORTHERN VIRGINIA D

m0. 2799

| AY BOY £

— a,
EMERGENCY ROOM RECORD 74 4 Sarre Ne.
SCE ETerr t
1, Name 4 Firat Name Middle Name Horne Phone Admrtsion Date -@ A&A. j How No.
On tt ede Hy $665 | 2-22 Cee
Addregs , oot . . State Age |Dmect erth[sex, Cet Status | Retigean
E35 ee te uP 4a rr iM Ss WO se.
ayer Address Comoensstion
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N = = 7, Group No. or :_ rere rere F arny
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Orcher hoapitatezation snsurance Nanwe Acidreng T Cert of Poticy No, | Grow Nao € tlectwe Date
Farnly Ogctor Nowtyea Brought By . Type of Service
Ming Ihe at. . _.. ba NS LL} sae Pouce LL be () Reatve OF Sine (xR D9 0 Pt OD) Leb 0 Orne 5
Authorizations on Reverse Side Must be Signed by Patient or Authorized Person
EMERGENCY ROOM CHAAGES.
. . . Does Nor tnctuds Feo of Attending Physician OTHER SEAVICES RENDERED
: Item CHARGE ITEM CHARGE
ee - + - poe —_— 37 O0Ceeeo —_— —
Emergency Rooni aa Sutures X tay: QO
Aneathetic Tatanus Antitonen
| Suppl Catt Laboratory co
Centra ¥ Pryucel Therspy aj
Oresaings EO.U EXG c
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me OL. een "tagaed' BRIEF HISTORY
if accident state where, when and how injured; If tliness describe = .-- —- ---
LL A : at. wd a.
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"7 ' By Whom.
Nurse's Signature ~~ Officers Signatuca Sedge Oretect Time aM
| 1 ALN, : ou
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: . PHYSICIAN'S REPORT
, . CONDITION =~
On ¢ ia G Ora ~ ay "yy fo '
| ADMISSION Gooo O Fer] Poor shock tHemorehege O Come 0 Temp. Rectet 7 RZ oP st
| Treatment: Vetanus Toxgid ec, Tetanus Antltoxin Fest Tetanus Anrttorin anlts
_ . . Li "4 :
Diagnosis: | hy 'Lite. we BT '1 'we 5 '
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Oleposition of Case. _Y. Le fe farts Y Relerred to Or, —_ Deve Ly LE. /2 en
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INSTRUCTIONS TO FATIENT:

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(Patient's Signature!

DB Cooper-37899

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==== Part 86 · PDF page 56 · Bates DB Cooper-DB Cooper-37900 ====
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==== Part 86 · PDF page 57 · Bates DB Cooper-DB Cooper-37901 ====
NORTHERN VIRGINIA DOCTORS HOSPITAL
Pre-Employment Interview .

| NAME Cocte\ Tock - ; DATE 14/4

POSITION APPLIED FOR _g@ove ly

Type of work: Full Time" Pare Tame No.. Days per Week 47

FOR NURSING PERSONNEL: shift: 8-4 "4-E2- 12-8 What days 4 yy - (Rs
. Weekends RovaTi vy .

Other' gst.

OATES. AVAILABLE pital

TRANSPORTATION (gouidxo

HOW REFERRED Mee Smal

PHYSICAL IMPAIRMENTS — Afsuy-

LAST EMPLOYMENT (TYPE OF WORK AND DATS) PLivire Oury

FAMILY: Husband's (or Wife's} Occupation

Children Their ages _ Care Provided —
* IMPRESSIONS s . - 7 ; .
EXCELLENT _ GOOD , FAIR * ~COR

Appearance mo, a = ee , :

Personality tL"
- Health all

Qualifications a

Knowledge of skilis uw _-

Interest La

RECOMMEND FOR EMPLOYMENT _ 4, eS a '

H
QE NVC Cow Nuesirg Degree -heS ECRvBeb ou gueg. TASHST ED
Muth CXKPYKiInce im heseyals - VCE TatKartoe -goua Seteemed

REMARKS : 29 Chores
Employment co Commence } Oui 4 | 7 | . Department 7) .
Aid i - .
shift Gy" — —— @r) PT SALARY $ __ 4/06 6
APPROVAL DIFF. + _osTs b7C

| roams Tractor

NVDH Form #123

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DB Cooper-37901

==== Part 86 · PDF page 58 · Bates DB Cooper-DB Cooper-37902 ====
hel

ERM VIRGINIA DOCTORS HOSH' AL

EMPLOYEE EVALUATION AND JOB PERFORMANCE REPORT " -—
. Pate: 3/1/72
Name: Coleere yu ck == )
Last First initial -3 Mos. Probationery Period _

: , . Annual.
Papartment: OR Terminatione—
Station: Le Position: : ic —! uf
311 Time: -- a Part Time; Shift: q- S
Tamporary:_— Permanent:_*+— - .

NOTE: If. employee is graded unsa'

Grading from left
to right indicates

isfactory in any category, this
report must be shown, discussed,

Cees Se!

lowest to and signed by employee as an
highest acknowledgement of contents.
Remarks
Attendance : i ;
| y | a |
Job Performance i A i fed Werk Au &h
ane 4 Wild 4
Ability A |
4 i!
Industry
Dependability i
Cooperation 4 ' a
- Ay,
a 2.pearance i i -
Personality |! A
Health | me!
GENERAL .
PEMARKS A ete Lasgel Li layer lak LUERK Alyy LOM Ever Uae 5.
hawt teem. enplegesT ue" Sune Dear Fern. A Legul
A€emes LLP LE ae culanpen Wy Sep im snls > bbe | fet Tor ME ' Bue te LAVIN Ye,
with Yhe rifleyer ShoeTege 1
Employee's 'Department b6
Signature Signature, bic
fooroved »4 Remarks
Disnpproved
Pate Administrata

DB Cooper-37902

==== Part 86 · PDF page 59 · Bates DB Cooper-DB Cooper-3 ====
-Not.. 1ERN VIRGINIA DOCTORS s nosp(

L
Arlington, Virginia - ;
2 "t b6
- "TERMINATION ii
SF a ee Dates 3-29-13 |

Employee's Name WH ckK Coe eelT _ _

er Te ~ First, _ _ Middle -Last |
Départment Position

Reason. For Terminations

- Voluntary Resignation
'End Temp. Assignment'

-* {Check One)

Remarks: (Briefly indicate nature of

action.) ;
Vf J 2 ft Yn Palo Ay EL.

Aegel paves +n —- Ce AeBChiey

-Discharge De Put -
Other, .

Employees Rating: Excellent Very Good Good Satisfactory Unsatisfactozy;
Performance aie
Attendance U7

"Attitude . u

-Appearance aa ,

'Personality A _

Remarks :__¢np/eyyp atily Sheet. times Sat 20 OLE Lelia

LMC K PE. Te19 Aimest og Fakp TM es Ox google, Rip Lurk
thaterug bl se tt th (AE La. Aes. Meee, tes onl. fepye. lesithegiT

Py ae AeLues ATR KE Lowper Ye Al Ca Peale yu sv7tve.

. 4
Last Day Actually Workde: aan Loan mye 3 5, 19 72
Day Date
Would - you rehire? Le Subject Toe _—
7 "Yes No - ee . 7
|, b6
- KM ere
SUPSrVISOr DKS.

"NOTED AND APP

Northern Virginia Doctors "Hospital

Adminis Termination record received: SY
REMARKS : Fopnins-ss (Dats)
CT ETT St =
L.
Leava slin $!7q4. "LZ
Tae card fils: wa
sOvsrd cavd filed: od _
Horot sys 4
eee OTT CQO S Lad ,
' Form # Switchboard: __ 7 —

DB Cooper-3/7903

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==== Part 86 · PDF page 60 ====
Sr. eee

em eee

This is.to certify that (GIEE: ome et

ev . -S

attended the Orientation Program held on this date.

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==== Part 86 · PDF page 61 · Bates DB Cooper-DB Cooper-3 ====
ud HERN VIRGINIA DOCTORS Hos(: PAL

EMPLOYER EVALUATION AND JOB PERFORMANCE REPORT

Date: dee
Naima: CoFCet rT, +a Che
Ll « . . : "s
Last First Initial 3 Mos, Probationery Period
° , Annual 2 _°
Department: OR, Termination
Station: b. ™ position: penvely
° )
Full Time: L~ Part Time; Shift: ges?
a

- Temporary:

Permanent:

+

Grading from left
to right indicates
lowest to
highest

NOTE: If employee is graded unsat;
isfactory in any category, this
report must be shown, discussed,
and signed by employee as an
acknowledgement of contents.
Remarks

1

Attendance

we
oS

22s of Ove vv tra uly Ar MET tell.

Jon Parformance
\

Ability

Lriustry

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Dependability

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CUNEPRAL

REMARKS _& tri) Cra Play ex ~ hes Patitorial oF Gregan A vere pew ospeely

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DB Cooper-3 | 0

==== Part 86 · PDF page 62 · Bates DB Cooper-DB Cooper-37906 ====
ne tees

COFFELT, JACK

tidae- 4

EMP.

boy

NORTHERN VIRGINIA DOCTOF" HOSPITAL
DEPARTMENT OF PATHOLOUr
SFROLOGY | ys

DATE: 12-13-71

+

—Lincnnn sions > KVUn Ail

i Direct Coombs

a Indirect Coombs

CA 0 Rh Titer

.

<

Cj Pro Marital Serology L_] Monospot ' : - ? .
VDRL Slide Test [_] Heteropnite . .
. - -
[} vpat Quantitative [J Aso-titer oo, : -. a
[J Fra - ass [J]. A. Test itatex} 5
oO Febrile Aggluti nations . Pr) C-Reactive Protein .
\
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* _ NORTHERN VIRGINIA DOCT~™S HOSPITAL
COFFEIT, JACK = EMP. ( . DEPARTMENT OF PATH. JGY
URINALYSIS
whe parE: 12-13-71 _ !
"Bence Jones. :
Q Protein
"SPECIMEN TAKEN BY Cleon Leukocytes ia ee ami
cath 'i fCatch} Erythrocytes (0 Perphobilinogen
C) ADMISSION URINALYSIS Costs: Hyoline r] Phenylpyruvic
{) Repect Urinalysis . Finely Granular. Acid
Appecrance oO Serotonin {SHIAA} .
. Coarsely Granular. | , .
C} Reaction =]
. Cellular 24 HOUR SPECIMENS: °
{3 Specific Gravity =
viibomin.__ Waxy CJ VMA Fa
. LJ Seger. Suger eA a Epithelium £] 17 Ketosteroids .
[F Acetone Crystals ; i
C bDiocetic Acid Mueus {3 Catecholamines
"(2 Bitirubin Miscel: [} t7 Ketogenicsteroids
im) Urobilinogen Occult Blood T
OGtitter Cell D
Nurses Signature 4
(l- /3- 2 Va
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DB Cooper-37906

==== Part 86 · PDF page 63 ====
_—

er

ut

(

- Ref EST FOR BLOOD TEST AND URi ;LYSIS

Employee's Name COFPFLET, JACK

New Employee X

Annual Foliow~up

Semi-Annual Follow~up

ns
ee

ae

Date of Request tp-13-1f

Please send copy of report to the Personnel office to be filed in

employee! S personnel folder.

NVDH Form 4F~201

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7 4

Personnel Office

DB Cooper-

37907

aS .

==== Part 86 · PDF page 64 · Bates DB Cooper-DB Cooper-37908 ====
. ' . (
NORTHERN VIRGINIA DOCTORS HOSPITAL CORP,

601 S. CARYLN SPRINGS ROAD
ARLINGTON, VIRGINIA 22204

.

19/1

Hutchinson, Kansas

To: . December 8,

bé6é
b7C

Regarding: Jack Coffelt

—,

We would great!y appreciate your opinion of the above named applicant for the position of:

O.R. Orderly = in this hospital

Employed by you from: hb CAd A, wales Ly. VL. be

tof 22h Ae Af Step Gra het Yes

No

Student in your hospital from:

Position held:

bree Loz, +f: koi sie, oh AL oA ae

Reason for leaving your employment: ._d-t_- Bll tec Pi nig ale fern D aesied

Would you re-employ? Yes No if no, would you comment under Remarks?

*GooD *SATISFACTOAY : - NEEDS IMPROVEMENT

Attendance:

Job Performance:

Ability:

industry:

Dependability: . '

Cooperation:

Appearance:

. Personality: '

Health: °

REMARKS; e

_ Sign

7

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Titt Bo

Operating Room Supervisor
"(Please Check {X} or commant if indicated.}

N,V.D0.H, Form 57

DB Cooper-37908 |

==== Part 86 · PDF page 65 · Bates DB Cooper-DB Cooper-37909 ====
a pea

net

NORTHERN VIRGINIA DOCTORS HOSPITAL CORP. '

&01 S. CARLYN SPRINGS ROAD
ARLINGTON, VIRGINIA .

APPLICATION FOR APPOINTM , = -.

NAME: -(isseihtes., Mr.) . Aghghiach? vensatsnne Telephone Zin... tO LE.
ADDRESS: (Permanent) wi 01. LL he. Bliocal) . Gor Callen rey lo sees
Date of Birth. Ziad tf... Nene. Weight... 9.5. Date of last iysieal exeminat Ge ciacee 2. ZI.

Date and diagnosis .
of any recent iflness:....02.2.€2 Marital Status - M...... SAC Other...... No. of Dependents..22.....

Position for which Minimum Salary
Application is made: a Date Aveilable:..2tceces!... Expected:

REGISTRATION:

ination « . . Certificate
in which shate: Ss Year: Number: ace

X\ , Certificate
Virginia: Year:....... Number:
Other States: S : Nic ccecieeeeesseaee "eeveee

MEMBERSHIP: Alumnae ANA. aw L.N.E

ACADEMIC AND PROFESSIONAL QUALIFICATIONS:

Name City and State . _ Dates Diploma - Course
. Degree '
Credits

rrr Titre teeter iit ee ieee ee ee ere ttt rr)

High on ' ; - -
Schools... A ee, occcecececccvescecocesrercesseeaceees 2 "eseses ;

Schoo! of : - '
Nursing: 224%, sees ; sseaceesesevsterqearssscessuceessesereesseasensansoates

Coll J - ote
University: a Us wet hI EN AEF ose ceeee ans seeneseee as as peeeecetesaseases .
-f) "le a, . . .

Clinical
Post-grad. .
Courses: : ewes seseesanerenscnerecte ss

EMPLOYMENT EXPERIENCE: .
Position title: Institution or Agency: Address: Dates: (Duties describe briefly}

chapel fl, ennne oP: ee > See evreeetes bIC
: ree aa ey eRe : oc 3 oe er" Necro

vtovoebinosasoces ie eat Laa2 "Tr Co. & 1360. ( Syme)

are tan
1 ane

PROFESSION REFERE Name . Position : wat

6 i .

1.
NN 2 {p A rene eussueracassenesusavssssvecvasssestieautsacsatsesuceearsaseneeaseass
SNe Measaua ) seseeastacperscssssessonrerseres

. J
Datei... cecsceccsescceecrvesecccoseteses : Signature... Lek! ME... —Lipiitt Po avanvsenenaees
NAV.0.H. 2854 REV. 10/63 , mA

A isle HE AMG fof

Sphere
e

DB Cooper-37909

-

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2 ates

f
cA

==== Part 86 · PDF page 66 ====
ese
'-
J
Please Attach . (Please use this space for additional information
Recent Photograph regarding eductation, experience, etc.)
In case of emergency .
Person'to be notifieq 2 aac eeecteneee Relationship
. 'fa . . [FL '
Address Cakens beeing Phone.4
. (Please do not write below this. ta '
b6
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Date application received:........... Lpeeetene References receiveds.:.......eccesercereres
Date of employment: esnacene, Position title:
initia! Salary:
\ CHANGES IN POSITION STATUS , .. SALARY INCREASE
Date: Change: Date: - New Salary:
RESIGNATION; Date: Letter of notification received:
Summary of Professional progress submitted:.......cscecsrensee
DISMISSAL FROM HOSPITAL EMPLOYMENT:
Date:
REMarkS:....csorevesccsneveaceessnesscssssssscersssenevencsecerssaseureestssensnupeasseeserssunacensrassasaseueesacueceres seeetacesssngeeasscessagensnenenrs eneee
Signeds.... ccs. csceseccesersteceseeeenee
Titles eect eeeeserresneeesecnsscssersenerenses
Doles... tcereerceneneeteceerernsetarturenseenenre nieces
. ate"
<. #
DB Cooper 37210 Fi

==== Part 86 · PDF page 67 · Bates DB Cooper-DB Cooper-37911 ====
ye =r
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wer " f
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a . | Popavenrt 6
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- é
J $ ' 4% —- - ae ard . Nate Se ratte gM TSM teers . ayer
es - i
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C Cap SD ans os ag
4 .f * *.
+ . . . . Pa . . rs * -* a . . a a . . . ns
. . . . ae . t .°* *.
' | REQUEST FOR CHEST X-RAY a wee tee

ey
ray "
ele?

Employee's Name COFFLET, JACK. pate of Request: 7 S3-7;

Date of Last Chest X-Ray ' , New Employee 1e x Tet DF:
Te, ce "At Bollow-up
cae De po Co : ae e . Semi-Annual a i
pe ) wens a 2 "7." Bollow-up ee te

- Please send copy of report to the Personnel Office to be filed in 2a

employee's personnel folder. co SoM Pot.
. : . Y Fu ate . vs wy
: | . - . v 5 . "
WNVDH FH#200 , ; c :
se ne SO . = en one a
aa hea, i a? . ' aa aan + ~ oF * .t : ows eptets 1 ead - eon a ae '
we ReBeae be ath a nee BRS 8 me de ARTS Fire te Neb abate Se gk dete oe Sothtne Co ek! Megclechec3S A ehidbactey Lee ESR Rot aS cee
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DB Cooper-37911 iss t
$c

==== Part 86 · PDF page 68 · Bates DB Cooper-DB Cooper-37912 ====
December
S are clear.

*) $5955

Chest shows pleurai scarring
mediastinum, and bo

"4

ny thorax app

at the left 'base. 'Otherwise
normal, ©: 7

"4 eat yt
DP twee Se ret Fetes

2

CAE Bh eel cal a be alee Det
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Pee eT Renee

DB Cooper-37912

==== Part 86 · PDF page 69 · Bates DB Cooper-DB Cooper-3791 ====
saps cpt

- bt i
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. !
£ / :
. 1
' us ' ' , . -
. . Fr
poiva tee. EMP' AYEE'S WITHHOLDING EXEMPTION PFRTIFICATE | =,
Teal Rerence Service THe FFEL ria : al Securlty Number S L ¥ fl £2. T > 5",
Type or print full name —t4 £7 C ix = = Tt led 2iP coe em SF ¥
ome eddie LL OL So 2 te eel. Cy Ap biiw Gul guma.. Shite af
. ~ :
EMPLOVEE: HOW TO CLAIM YOUR WITHHOLDING EXEMPTIONS ne
vile this fom + married and wish withholding as single person), write "1." If you faim no exemptions, write "0". « « 2.
with your employ | 1. If SINGLE (or if married an fe if not claimed on another certificate.
er, Otherwise, he | 2, 1f MARRIED, one exemption each Is allowable for husband and wife if not ¢ i mations, write 1"; (¢) if you
must withhold U.S. (a) If you claim both of these exemptions, write °2"; tb) 1f you claim one of these ex ; nt BS, WAG Es i.
Income tax from claim neither of thesa exemptions, write wa twee ee ees de . dents):
es with . licable only to you and your wife but not to dependents): +4 sey tty
But exemption, | 2 meat ear gour wife wil fo os years of age. of older at the end of the year, and you ci this exemption, wile °2"5
. . ' Ider, and you claim hoth of these exemptions, write _ er ;
eieep this cere {b} it you te your wae ate Bing end you claim this exemption, write "2"; if both ara bite, and you claim both
Hficata with your mptions, write "2?. - 6 + ee ee ee ee ee es . °
Biicate i tf vine 4. If you aed 'cremptions far one of more dependents, write the number ef such exemptions. (Bo net claim exemption __.
employes is be] " ay, dependent unless you are qualified under lastruction 4on other side). . . - i i eA éForm WW-4), and enter
Hleved to have f Jaim additlonal withholding allowances for Itemized deductions fill out and attach Schedu: t __
claimed hag me * the number of allowances claimed (if claimed file new Form W-4 each year} «2 ee ee ee ee ee ee Oe
FADES. . res ee wa eee
Distict Director 6, Add the exemptions and allowances (if any) which you have claimed above and write total ; $
. aaivised. es 7, Additional withholding per pay period under agreement with employer. (See Instruction 1.) _- roan —
= holding exemptions claimed on this cortifiate does not exceed the number ta ybich 1 am entitled, ieth i
t CERTIFY. thet the number of withholding P FY (Signed) oe tn gh, [cara . - i
Wate) Laie ZL, WL, aw 4 }
Form VA~—4 (Rev, 1-13-68) y EMPLOYEE: File this
Department of 'Taxation VIRGINIA EMPLOYEE'S WITHHOLDING EXEMPTION CERTIFICATE form with your emplowe:
"al Securit
Print full name...01.2) <a CON OED ol 10 PO ; (ats Namber.. 023.20 G2 LEO
Print home address in ful! detail....42.69...26 A Me : Yl a oe 4a det. Sa, .
HOW TO CLAIM YOUR WITHHOLDING EXEMPTIONS
1. If you are neither 65 nor blind, enter $1,000 for yourself; if either 65 or blind, enter $1,600; if both 65 and
' blind, enter $2,200 : $ O
2. If you are married and your wife {or husband) has no gross income, or if you and your wife (or husband)
intend to file a joint return, and if your wife (or husband) is neither 65 nor blind, enter $1,000 for her (or
him); if either 65 or blind, enter $1,600; if both 65 and blind, enter $2,200. If your wife (or husband) has in-
peas aera to yizeinia income. tax withholding and claims own exemption on own withholding exemption
certificate, do not make any entry here * ¢
3. If for the year you will provide more than one-half of the support of a dependent relative (see Instruction 5
on back}, enter the number here » multiply the number by $300, and enter result here $
4. If you are an UNMARRIED person, and among the dependents claimed in Line 3 above, there is your father,
mother, son, daughter, sister or brother, enter here $700 for only one such dependent $ i
5. Add the amounts of exemptions which you have claimed above and enter the total here. ates ese: $. a '
I CERTIFY that the amount of withholding exemptions claimed on this certificate does not exceed the amount to which I am
entitled. : ;
(Date) Dee el , 19.27 (Signed)... cto... tag ghetle. ;
: ; :
'
a
DB Cooper-3791

attire

==== Part 86 · PDF page 70 · Bates DB Cooper-DB Cooper-37914 ====
/

1, NUMBER OF EXEMPTIONS.—Do not claim more than the
correct number of exemptions, However, if? + expect to owe more
income tax than will be withheld, a smaller. ser of exemptions may
be claimed or you may enter into an agreement with your employer to

have additional amounts withheld, 'Note this if you have more th

one employer, or if both husband and wife are employed.

2, ITEMIZED DEDUCTIONS.—See Schedule A. (Form W-4) for
instructions on claiming additional allowances based on large itemized

deductions,

2, CHANGES IN EXEMPTIONS.—You may file 2 new certificate

at any time if the number of your exemptions INCREASES.

You must Ale a new certificate within 10 days if the number of ex-

' emptions previously claimed by you DECREASES because:

(a) Your wife (or husbzad) for whom
+ separate certificate,

over by someone else, so that you no longer expect ta furaish more
sopport for the year,

th pendent for whom you claimed exemption will receive
$6 or qi hat 2. oF his own during the year (except your child who is

a student or who is under 19 years of age}.

The death of a wife or 2 dependent, does not affect your withholding
untif the next year, but requires the filing of a new certificate. If pos-

D.8. GOVERKMCHT PARTING OFFICE

oad

1. IF YOU FAIL to file this certificate with your employer, he
must withhold Virginia income tax from your wages without
exemption, If an employer believes that an--mployee is claim-
ing an excessive amount of exemptions, will advise the
Department of Taxation. \

2. AMOUNT OF EXEMPTIONS.—-Do not claim more than the
correct amount of exemptions. However, if you expect to owe
more income tax for the taxable year than will be withheld if
you claim every exemption to which you are entitled, you may
increase the withholding by claiming a smaller amount of ex-
emptions or you may enter into an agreement with your em-
ployer to have additional amounts withheld.

3. EMPLOYEES WITH TWO OR MORE EMPLOYERS.—If you
have more than one employer and wish to increase your with-
holding to an antount nearer your correct income tax you
should claim a smalier amount or no exemptions on each Form
Vao~4 filed with all employers other than your principal em-
ployer.

4. CHANGES IN EXEMPTIONS,—You may file a new certif-
eate at any time if the amount of your exemptions IN-
CREASES.

You must file a new certificate within 10 days if the amount
of exemptions previously claimed by you DECREASES for
any of the folowing reasons:

(8) Your wife for husband} for whom you have been claiming exemp-
tion is divorced or lexally separated, or claims her {or his} own exemyp-

tion on & separate certificate. .
{b} The support of a dependent for whom you claimed exemption is

u have been claiming exemption is
divotced of legally separated, or claims her (or bis) own exemption on a

(} The support of a dependent for whom you cisimed exenaption =

- my
eo

sible, Ble a new certificate by.December 1 of the year.in which the
th occurs, . . .

a further information AS alt your local District Director of In-

ternal Revenue or your employer.

4. DEPENDENTS.—To qualify as your dependent {line 4 on other
side}, a person {a} must receive more than one-half of his or her
support from you for the year, and {b) must have less than $600 gross
income during the year (except your child who is 2 student or who is
under 19 years of age}, and {c} must not be claimed as an exemption
by such person's husband or wife, and {d) must be a citizen or resident
of the United States or a resident of Canada, Mexico, the Republic of
Panama or the Canal Zone (this does not apply to an alien child legally
adopted by and living with a United States citizen abroad), and {e}
must (1) have your home as his principal residence and be a member
of your household for the entire year, or (2) be related to you as

follows: or daughter (including Ie ally adopted children), grandchild, step-
Your' ist Be Oe anront, Replather, stepmother, father-in-law, of
Yous brother, sister, stepbrother, stepsister, half brother, half sister, brother-
ya Fsterio ae or niece (but only if related by blood).

5. PENALTIES.—Penalties are imposed for willfully supplying false
information or willful failure to supply information which would re-
duce the withholding exemptions.
oAB—16—T8081-2 o

>

taken over by someone else, so that you no longer expect to furnish more
than half the aupport for the year,

(c} You find that a depender* for whom you cJnimed exemption will
receive $600 or more of inco: his own during the taxable year.

OTHER DECREASES \_ -xemption, such as the death of
a wife or a dependent, do not affect your withholding until the
next year, but require the filing of a new certificate by Decem-
ber 1 of the year in which they occur.

5. DEPENDENTS.—Do not claim any dependent in Line 3
{on other side) unless he or she meets all four of the follow-
ing tests: (a) He or she is receiving over one-half of his or
her support from you for the taxable year, and (b) he or she
is "closely related" to you, and {c} he or she will not have as
much as $600 gross income of his or her own during the tax-
able year {if a son, daughter, stepson, or stepdaughter is 2
full time student at an educational institution, this Imitation
does not apply}, and (d) if married, her or his exemption is
not claimed by her husband or his wife. "Closely related"
means your children {including stepchildren and legally adopt-
ed children) and grandchildren; your parents and grandpar-
ents; your brothers and sisters; your immediate "in-laws"
{mother-, father-, son-, daughter-, brother-, sister-in-law);
your blood related uncles, aunts, nieces, and nephews. .

If you are a married person, do not make any entry what-
soever in Line 4 {on other side}. .

6. PENALTIES.—-Penalties are imposed for willfully supply-
ing false information or willful failure to supply information
which would reduce the withholding exemption,

EMPLOYER,—KEEP THIS CERTIFICATE WITH YOUR RECORDS.

' ' . - *

4

DB Cooper-37914

Phi, Mbit

ts
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=

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es

Bee x

==== Part 86 · PDF page 71 ====
y t

TO THE ADMINISTRATOR
NORTHERN VIRGINIA DOCTORS HOSPITAL

I hereby acknowledge receipt of a copy of PERSONNEL POLICIES
of NORTHERN VIRGINIA DOCTORS HOSPITAL.

t have read, thoroughly understand, and hereby agree to carfy out the
policies outlined to the best of my ability.

Position

To be signed and submitted to the Administrator before receiving first pay.

DB Coopér-37915 ©

==== Part 86 · PDF page 72 ====
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Northern Virginia Doctors Hospital .
Approval of Employment and Payroll Authorization

—caepelr
bast

NAME mY 74-4
First

"Middle

ORs

DEPARTMENT

SHIFT

FORMS COMPLETED BY EMPLOYEE: a ae are
State Tax Withholding Statement Sf Se Dopey
" "Federal Tax Withholding Statement 7a
Pet Hospitalization: None
_ 7 : Individual . INP .
be Pamily ; ;

PHYSICAL RECUIREMENTS:

(To be initialed by Departments)

4 . "os . 2 : so Pre

XSRAY

LABORATORY we.

FORMS COMPLETED BY BUSINESS OFFICE: / aa

BY

Payroll 'Record © / oP in
vo an

Leave Record !

Switchboard Tab_ yo

TT

. THIS FORM Ss TO BE RETURNED TO THE BUSINESS. OFFICE. NO
- CHECKS WILL BE ISSUED WITHOUT THIS PORM.- > oy ,

moe ra wey .
fe Yap # O Be NN a FY
: ' er "age ' - a
~*. . rie ra . woos *. * '
er . e Sy eee ' : a vy rhts
° an .
aT core nae aa ae
veo . . . a mn) -
an ' :

Lene t. Be

; "employee Signesye . La
; pe

FH#I04
Revised

2-24-69

Pay Ve POR ene tik

. . ~ repo,
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' ss
+
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at
vets'
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arn

ee ea ee |

fab ctile
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==== Part 86 · PDF page 73 · Bates DB Cooper-DB Cooper-3 ====
\ FD-340a (Rev. 3-12-74) ; ,
i
\
Teem | Dare Filed i ee " iz Disposition
ae life PE ae me
i 1847 VED 3 -é7 |
5 \sfefra | Ghat! fy | | ae
| | Suehsfedn PLAS got a as
' 14¢0 Sfetfyy F tear ht Me: wile aa Za —
| Laer 1s/s/22 Ligpy & ' pcb 9a AOA LATTES
t [vez le/s/y Cn , ae te LA 2 27\ 5
; [Sed sel LEAL f LLL debs MY At be lees Ke) '
| (@Oos | hag/2P WN hin US Pri Dalvee
{ sma [ Se
4 Le baoM fa has bated! any prelihy
3 f
| (oor bela Cobar |
| wor oh Zea He wis Y cr Tiwtree! (he b6
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| Vode b7D
r esar
; gr: i
| ~ er Se 2 Medes fae :
SERIALIZED... "i MO ee
'ae MAY4 1977
y Fil — SEA 6
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DB Cooper-3/791/7

==== Part 86 · PDF page 74 · Bates DB Cooper-DB Cooper-37918 ====
b6 ij

FD-340 REV, {6-24-65} b7C

Jo¥-b)—/n7 Ge)

rie Ne-yo I6¥¢-§)- JY30

Date i WE 2

ii / Marron a

{ADDRESS OF EONTRIBUTOR}

Ae —

Howe bi SP ATES
S C

To Be Returned [| Yes Receipt Given [| Yes

[| No [-] No

Description : .
uy of I Ae%

b6
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DB Cooper-37918

==== Part 86 · PDF page 75 · Bates DB Cooper-DB Cooper-37919 ====
FD-340 REV, (6-24-65)

b6
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le ¥- 8-14 Ge)
File No. [le €-8/ 2 YCI-

Date i of. "26/2 Z
From on
Din i eta

{ADDRESS OF TA
g a

To Be Refurned ["] Yes Receipt Given L] Yes

[| No [_] No

Description ;:

copy ff DEA

b6
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DB Cooper-37919

==== Part 86 · PDF page 76 · Bates DB Cooper-DB Cooper-37921 ====
b6 7

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a)
1b4- db 1l-/RK
DEPARTMENT OF MOTOR VEHICLES
DRIVER RECORDS
The attached photostatic copy of the Washington State Driver's
License/Identification Card/Instruction Permit was issued
on ST ~ ES & we Z
\
DR-552-6 B/W Photo Issue Date (R/9/75)
£

DB Cooper-37921 4

==== Part 86 · PDF page 77 · Bates DB Cooper-DB Cooper-37922 ====
FD-340 REV. (6-24-65)

otk Sen @

-¢! b6
File No.__/@¢- * be
Date Received___'/ /i gl2>

{NAME OF CONTRIBUTOR)

(ADDRESS OF CONTRIBUTOR}

CUM Pr, WAS it

b6
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{NAME OF SPECIAL AGENT)

To Be Returned [7] Yes Receipt Given [7] Yes

Met No Et No

Description :
b6
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DB Cooper-37922

==== Part 86 · PDF page 78 · Bates DB Cooper-DB Cooper-37924 ====
>>
DAA. Apia
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a DB Cooper-37924

==== Part 86 · PDF page 79 · Bates DB Cooper-DB Cooper-37925 ====
asi summa: —_

#D-340 REV. (624.651

: FileNo /6Y -silt

Date zt "hh, t.f22

From.

DWV

(ADDRESS oF OT tr
Ce a

Jo:Be Roturned [| Yes Recelpt Given

ae
Description YY? OF
Dice Laces

{] Yes
[xe

~ =

b6
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b6
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DB Cooper-37925

==== Part 86 · PDF page 80 · Bates DB Cooper-DB Cooper-37927 ====
b6
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| SE /eY Pr,
DB Cooper-37927 |

==== Part 86 · PDF page 81 · Bates DB Cooper-DB Cooper-37928 ====
FD-340 REV. (6-24-65)

14}- 81-lar
File No. /@%~€/ Sus 7

Date Received Y {73/29
From ibiet tf? NAG Dray

(NAME OF CONTRIBUTOR)

{ADDRESS OF CONTRIBUTOR)

Meveern Wey

b6
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(NAME OF SPECIAL AGENT)

To Be Returned [7] Yes Receipt Given [| Yes

[SI-No [XSNo
Description :
be :
~ catey OF bIC

Las ee . SFA

Die HS a7

DB Cooper-37928

==== Part 86 · PDF page 82 · Bates DB Cooper-DB Cooper-37930 ====
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—

DB Cooper-37930

wns,

==== Part 86 · PDF page 83 · Bates DB Cooper-DB Cooper-37931 ====
~ FD-340 REV. (6-24-65} . *

b6
bIC
File No 164-8(-lpn
Date Received 7/2/77
From E fx _
{NAME OF CONTRIBUTOR)
{ADDRESS OF CONTRIBUTOR)
Ao bth ve
; b6
| Te

NAME OF SPEC

To Be Returned [| Yes Recoipt Given T] Yes

coe [Ke
Description:
Phe, wv prinTon pe

b6
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DB Cooper-37931

==== Part 86 · PDF page 84 · Bates DB Cooper-DB Cooper-37932 ====
~ PURT _ TIEFIN LLP? S:89:Bs BS Snes a tat Lm
@ NAPEY re RACE-H: SEX-M: DOR | ee BE
WANT STATUS-HO WANT ~~: JAIL STATUS-NOT IN CUST :TEMPERAMENT—TEMP UNKNOUM, - e
° HETGHT S18: WETGHT—15o: HATROBLACK: EVE-BROWM: LICH Jim. STA. —
@ ADDRESS (SPOKANE = MA: IDENT PRT H- sd
FURGED- " MISC-REPORTS| } —_ °
@
@ ®
° oe EMD_OF RECORD ee ce oe °
| S SC DB Cooper-37932 @

==== Part 86 · PDF page 85 · Bates DB Cooper-DB Cooper-37934 ====
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DB Cooper-37934

==== Part 86 · PDF page 86 · Bates DB Cooper-DB Cooper-37935 ====
t
» FD-340 REV, (6.24.65)

_ 4

reno, _ /le/- &/~/A
Date Received yf af, Z7 - *
From( dn cA a1 Age—

(NAME OF CONTAIBUTOR)

{(ADBRESS OF CONTRIBUTOR)

{CciTY AND STATE}

(NAME OF SPECIAL AGENT}

Yo Be Returned [| Yes Receipt Given [] ¥es

[| Ne [| Ne

Description:

CLEL EY -

Liem Qua fom 00-20

DB Cooper-37935

==== Part 86 · PDF page 87 · Bates DB Cooper-DB Cooper-37 ====
|

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we ote

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> RECEWEL
Ja 24.366 3

==== Part 86 · PDF page 88 · Bates DB Cooper-DB Cooper-37937 ====
ok Od

=a,
AIL tot BE VARA i]

dane syetan [Ri ees TAM OCC PATION AND OT Wu

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sha =

oie . REPORT OF ECPARATION FA%M THE ied
Wi | ARMED FORGES OF THK UNITED STATES ATR LT
D — FIRST WANG or BIVGLE MAME Fy] narnia nana bak gerne | a ag LITAUAENT Ano BLANEN
. . . - ATE CF APR RIE LOE
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'a BLASOR AMO | AUTHORITY ron' HPAAATION . © mace ce BEPARATION
oT) APA F310 wavherninthan ACA aucern brdz
[oo Pave oF Ora TH 0 FARCE GF RintH (Cty and State) VE BRSORIPTOON . --_ —
lear |" sent Tay Clayton "* °° _ fei ale |**5ea 1 Cop E eu oe [reise
gis t2 BEG RTERE® : 14 SEUECTIVE MERVIGE LOCAL UARD MUMDIR ICM, COMAly, SUntay raing wD —
os xe x |? | [aay feeseipigece fly ot Ustro Irperdal vo calif m ea '

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ae yt } so j tveron ART Sng nance om cuass 7 | COSMIZAMT SUsTAIgR Sa Pervey BALA COPA: Der, "Wor Colla

VE BEANE OF CRTZY OTHCR THAS BT INDUCTICN

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1h GRAOL — BATE OA BANE AT TURE OF
tnrer nate "ws sanvtcR

Pie WATE AnD PLACE OP UNTETINTD ACTIVE SERMICE 2 WORE AODELIDAT TNC OF RuTETIa1¢actne stcE Tot, PLUS Cus, Lownsy and Bieta, |
| [ee [ver [ee tes asetas canae 2% 223 Colinatria Jalit
2 BEATEMENY OF SERVICE FOR PAT PUNFQAES A TEARS|® WONTHS|C DATE £9 ephineeent tie PAID oat axacasion
z alaust 1 Weenies Compactee fo8 PAT PenrOrEE Racdeiiat THs Praved RA Tour | wortx TEAR | AROUNT
= 44_ NLT ATAVICE COMPLETED FOR PAY PURPOSE rule Pemiod 4 U 0 | {: "a
2 23 OTHE NIEAVICE ae of 10 Juna Tit ape ded P20 Fo ReiGm AMC OR TEA SFevirg
{ 24 TOTAL WEY BEAVICE CE EDWPLETED | fon pat PURSES 4 ' —a reant | meng vate 4
% = [27 BCCORATIONS, MEDALS, BADGES, | [ONS AND CAMPAIGN RIBRORS AWARDED OR AUTHOR!
uAMIOFA ach DL *
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U4 | 2, MOST SIGKIPICANT DUTY ASSTOANEAT 2B WOUNDS RECEIVED AS A RESULT OF ACTION WITH ENEMY FORCES {ftace and date, 1f known)
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Bide be sy eas SoUMSE Ea Car SoytEy SNALET ERS ee Eneto} wasn courses [PU SE SCE Pese® COURSES Fucceas-
Nene WA t/a 2900

ES
DOVERN MENT. imavRANce IMFOAMATION: {A) Permanent plan premigm mmti testinae te & an whan des. or withig 3| wthyt Charuniter, mf [eterning wil! jaan.
(as = lures walver jame ay (A) acre (C) Torte imurame under walrer — orem POyBenl metl be reteeed wittie i271 dips after separat

a riaitne, on Ney 2 ery 'Aauinictration Outlet Cites having jwrlidiciicn eter, te area "ieee t im Merw 47. F: renls
i= Srssietion poke} Soe VA Panehiet 6-3), When payleg premiving wie (il mamd, adress, Service Nembor, Policy Nambarie), Cram of Service, Gite of hey
<<a] &o vA "cole te center Intermation "pneerae Gaveramenl Life Inaurance.
ax) 3 DRA cinpe sursop rupvaance a minLy, parma | 2M ACTIVE SERVICE PRIOR TO ZS |33 MONTH ALLOTMEMS DISCORTINULO | 34. WONTH REAT PREWlUM DUE
= APRIL OEY
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az..2ne Inteanit: 'Codees (xo enenoan K/A N/A
ea" (39 OVAL PATELAT GPOM SEPARATION [36 TRAVEL OR BILEAGE ALLOWANCE IMs 37 DIFRURSING OFFICER'S NAWE AMD STMBOL AUMEEA
= CLUDED IN THTAL PAYNERT ks

u/A asa M/A

38 REmATRS {Continue On mn Pavereay

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$j40 dsys lv paid for b7C
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= /A/16 (P DCR: 1 Jun 53 | ] Usar
"At Sce.t ft >see € 2 Liars wes "dee MEL! 62 | Separation Officer
20_¥_ A BENESITS PREVIOUSLY APPLIED FOR (Spectiv type) 7
COMPENSATION FPEMGICK, INSUAANCE BENEFITS, ETC. M5 CtAle MVMBER " A
[4t_OATIS OF LAST CIVILIAN FEPLOTMENT | 42 "ZAIN CiviLIAM OCCUPATION 29 AWE AND ADDRESS OF EAST CIVILIAN EUPLOTER
em" i950 | 1952 | [ust Office Clerk | qulipatria calif
& | ea oxaren states citstn 26 Wanrra states] <B ON-SEAVICE COUCATION Fears successfully completed)
= LX] vs Co. [sau penne fst BECAME 5) MAJOR COURSE OF FIELO
Fe Married | 8 |4 |2 Ne USAFZ Cert

1. bebe , : ae ee al

OF PERIOM BEIKS "ae
'

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DB Cooper-37937

DOCUMENT EG.

'td
Reg pa F

ISG FEB 13 Pen 4: 4?
rank a8 pseSOL

CIAL Rew aD
L TeOUaTY, CALIF,
wei B. WESTERFIGLO

iECOROS AR
WO Fa - COUNTY REC

AP PeAMANCRT AD0EEET Pom MAING FOMPOSaz arite strsnatton (St, APU. Cy. County aad Siate)] 40 SIGRATURE
PcX 6023 Calinatria eUslif
DD ror 21 4 EDISIOM OF 4 JAK INDIVIDUALS COPY (TO BE DELIVERED TO THE INDIVIDUAL BSING EEPARATED) 1
1JUL EE ©O It CASOLETE.
| "aka ory :
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z HEREBY CERTIFY THAT THIS IS A FULL TRUE AND CORRECT COPY OF THE
DOCUMENT RECORDED IN THIS OFFICE, BOOK YZ 7 PAGES O/ OFFICIAL RECORDS.

EVALYN B. WESTERFIELD, C
DATE B

FFB 16 135¢

IMPERIAL.
DEPUTY
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==== Part 86 · PDF page 89 · Bates DB Cooper-DB Cooper-37938 ====
FD-340 (REV. @-24-G5) -

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Date Received
From

(NAME OF GONTRIBUTOR}

{ADDRESS OF GONTRIBUTOR)'

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_ Teo Be Returned: [7] Yes Receipt given (_] Yes
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==== Part 86 · PDF page 90 · Bates DB Cooper-DB Cooper-37939 ====
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==== Part 86 · PDF page 91 · Bates DB Cooper-DB Cooper-37940 ====
FD-340 REV. (6-24.65)

FileNo._/Uo44- 77 -1G- 5
Date Received__9//0 Ale
From

(yd e/-/4

(NAME OF CONTRIBUTOR}

{ADDRESS OF CONTRIBUTOR}

J
fo Be Returned [| Yes Receipt Given [| Yes
|

["] Ne [| we

Description +

| Restcard recieved by
Danbury RQ. &/4/16

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KUL QeYL 7YES DB Cooper-37940

==== Part 86 · PDF page 92 · Bates DB Cooper-DB Cooper-37941 ====
—<—<——$=————

ss {69-4 ®

KEEP ATTACHED TO EXHIBIT'

Charles Thomson Patriot

Se
US.Postate £ f
Federal Bureau of Investigation

342 Main St,
Danburys Ct. 06810

WW b6
"Yiai0s waaNVO NYO Be
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==== Part 86 · PDF page 93 · Bates DB Cooper-DB Cooper-3 ====
I.E, SKYJACKING Northwest Boeing 727 several years).
aco by passenger D.B.COOPER, J betieve| | prec
New Fairdield, ut

may be the infamous D.B.Cooper,| matches the
discription, he has flown the 727 as a crewman and
knowns the operation of the airstairs and has parachiw
te training having been a USAF pilot. He has financia'
holdings in Mexico unrdported, His expenditures far
exceed his income nt years be has purchased
& 6%. 000] 112,000 M7000 autogh , 5 1
| [snowmobiles pe7e
A he has had much expensive -work done] |
pss. He has made some statments about~the NW inciden'
about the exact date the statue of limitations rei
that only a person in the know would know. |
one night made the statement that she knew something
about Kim which would put him away for good if she

told, Danbury News Times personel if vou_want more inf
rs DB Cooper-3/7942 Z

==== Part 86 · PDF page 94 · Bates DB Cooper-DB Cooper-3 ====
n .-

FD-340 REV. (6.24.65)

SE 164-81-/4

qoX

Date Received 5/ 2/717
From__|

b6
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(ADDRESS OF CONTRIBUTOR)
Mexico, Mo.

fbi eo >

To Be Returned [| Yes Receipt Given [| Yes
fz] s EL

. 1 photo of RICHARD VINCENT CHATHAM

Description :

' Re St. Louis airtel to Seattle,
. 5/9/77

DB Cooper-3/7943

==== Part 86 · PDF page 95 ====
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==== Part 86 · PDF page 96 ====
SL Ibh-b3

Rechmed Vincent Chathanru
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DB comer sro

==== Part 86 · PDF page 97 · Bates DB Cooper-DB Cooper-37946 ====
FO-349 REV. (6-24-65)

Fite no. biol. -% \— | fF ee

Date Received

From

(NAME OF CONTRIBUTOR)

{AOPRESS OF CONTRIBUTOR)

{CITY AND STATE)

(NAME OF SPECIAL AGENT}

. "to Be-Returned imi Yoo Recelpt Givon

ee ete

[| %

GBescriptions

We

~

[] Yes

Cc enmpamermad om Ao

DB Cooper-37946

AJ

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==== Part 86 · PDF page 98 ====
Tef-2LrO

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Ld a ; s

PLEASE POST U.S. POSTAL SERVICE PLEASE POST

Case No. 242-90434-F
FBI-No. 142 798-H
Cll No, 3 908 182
May 18, 1973

Office of Inspector in Charga
San Francisco, CA 94101

Fingerprint Classification
19 M9R 100 16
Et R 100 16

WANTED FOR MAIL FRAUD

>

SIGNATURE OF PERSON FINGERPRINTED

ROBERT LEWIS ROSE

DESCRIPTION: Male, Caucasian, DOB: 01-30-47 at Modesto, CA, 5'
11", 170 Ibs., brown hair, blue eyes.
OCCUPATION: Pilot, Crop Duster

VIOLATION: ROBERT LEWIS ROSE was indicted by a Federal Grand
Jury at Sacramento, CA on 04-18-73 for violation of 18 USC 1341.

UNITED STATES MARSHAL AT SACRAMENTO, CA HOLDS WAR-
RANT FOR THE ARREST OF ROSE, Rose is known to frequently travel
between CA and Vancouver, Canada. If located please cause his immediate
arrest and notify the undersigned for the nearest Postal Inspector COL-
LECT by telephone or telegraph.

POSTAL INSPECTOR IN CHARGE

San Francisco, CA 94101

Tek: 42£5-556-2098

5. RIGHT LITTLE

GPO 802-737

==== Part 86 · PDF page 99 · Bates DB Cooper-DB Cooper-37950 ====
U.S. POSTAL SERVICE
CHIEF INSPECTOR'S DEPARTMENT

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE TO AVOID
PAYMENT OF POSTAGE, $300

DB Cooper-37950

==== Part 86 · PDF page 100 · Bates DB Cooper-DB Cooper-37951 ====
i FD-340 REV. (6-24.65) - y
yf ae b6
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4 File No._SEATTLE 164-81 - Ja eons
é Date Received al to29
'From M4 neta, .
' (NAME OF CONTRISUTOR}
{ADDRESS OF CONTRIBUTOR)
. S| TD
b6
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To Be Returned Yes Receipt Given Yes |
i" Ce 3
' XK! No No
: aoe
Description :
whe) a aphs of
and list of b6
furloughed NA pilots (2). b7C
|
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DB Cooper-37951

==== Part 86 · PDF page 101 · Bates DB Cooper-DB Cooper-37957 ====
' ,
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DB Cooper-37957

==== Part 86 · PDF page 102 · Bates DB Cooper-DB Cooper-37958 ====
FD-340 REV. (6-24-65)

.

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File No LY¥-& | — REZ

Date i c/s LAZ

From

b6

DM bIC

drvero of A woe LE | ia
To Be Returned [ } Yes Receipt Given [| Yes
Ol» Os
Description:
4 a a

b6
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NAME OF SPEC! NT)

DB Cooper-37958

==== Part 86 · PDF page 103 ====
"

CO" MP 094

DEPARTMENT OF MOTOR VEHICLES
DRIVER RECORDS

Date DOL

The attached photostatic copy of the Washington State Driver's

License/Identification Card/Instruction Permit was issued

on ¥-X-PS

DR-552-6 B/W Photo Issue Date (R/9/75}

be |
b7C

DB Coaper-37960

==== Part 86 · PDF page 104 · Bates DB Cooper-DB Cooper-37961 ====
FD.340 REV. (6-24.65)

ENCLOSURE TO SEATTLE

SE 164~ 81 | ~ GLE?

b6
bIC
File No. LE$¢ ~ LM
Date Raaoluast EZ: Sf: 22 _
rom bIC

om OF GONTRIBUTOR)
*

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To Be Returned im Yes Receipt Given [_] Yes

Py ve Byte

' Description:

Sb S90 +

on threw

RLY DB Cooper-37961

==== Part 86 · PDF page 105 · Bates DB Cooper-DB Cooper-37962 ====
_ §/~ [-

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SECS PERCHED TO EXHIBIT

.
te
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Person interviewed bic

Mee AY 7 — - = ~ RSNA ue ge CARL BES
.
Place interviewed - OS SPhanshAaees' OFFICE
Wat eT TPG EME ne, Ee et ee ant OR BESS ie ae eA tare tagtatetene Nn TOT Zhe
, 5 ered 6/¢
Date intaryvisyed - ; 6 /%, 77
ro Mo A er tenders Seer pe eA eg nr sete pret te aber poten 2 Setanta ae

Time interview becan Zits y Sea]

PAIR SST a OTE Sy Ue ors ee TI AS Or OG 3 af Ee
.

Ti me wad ved pee SQAnce d - ?, { SY At RARE PA ES TI NE aS cake zine

Time waiver. signgd ~~ Ler. WAVE | Pikbang

Wa FET IAAL rrp
Time statement commenced oP - vneorensoce.» asarmengnis
Time statement ended Wy .
Time interviewea read statement AY ;

SN Ses PALA AO MSA EA TENA
Date and time arrested MOF~ Ghpeovel . sete
Place arrested . .
ee we o _f.
Aprasting officers
Requestse-conplaintseacti on takent
t
Tt Se OF NCA. ata r ERAS

Sort arene ee to ta wes Dex, sates aot S BAD SS NTE EE ay SS, y Yate he

;
Time interview ended: _ 7. Yomi

Signed:

7 Title Rat

Sayre aps, ae

C Mgnt, UE, Fe 22, 10

"
re Re | cme mame PETTY 8 a ee rah iat heel re Semen! ot 0," ¢ v 1 a SOT ae & - *' Ah
eines bela So MOU ea ee aE ee ere een ete tere RE EE NR RTT tN

a co Sunt 5 alt yma aveetersey awe 7 the Te es re =e = = Se Tr TNF Atri, Sais eee

DB Cooper-37962

CTE STAT ew OE ee oy et Ie em Tad oe wwe Sar A" CP RL ORR OS Pea

==== Part 86 · PDF page 106 · Bates DB Cooper-DB Cooper-37963 ====
PD-385 (Rev. 10-10-67)

INTERROGATION; ADVICE OF RIGHTS

YOUR RIGHTS

Place Sow Aine, 7x
Date ° KT 77

Time SY BP?

Before we ask you any questions, you must understand your rights.
You have the right to remain silent.
Anything you say can be used against you in court.

You have the right to talk to a lawyer for advice before we ask you any
questions and to have him with you during questioning.

If you cannot afford a lawyer, one will be appointed for you before any
questioning if you wish.

If you decide to answer questions now without a lawyer present, you
will still have the right to stop answering at any time. You also have the right
to stop answering at .any time until you talk to a lawyer.

WAIVER OF RIGHTS

I have read this statement of my rights and I understand what my rights

'are. Iam willing to make a statement and answer questions. I do not want a

lawyer at this time. I understand and know what Iam doing. No promises or.
threats have been made to me and no pressure or coercion of any kind has been

used against me. - Aelia | a es
by SA -cleclemele "Re Atwtae fu hen dae Cc
S Mita? Ax Pant wrh Bigned (2 ecto? 5G Faz.
Witness Lecco HigeZ, P&L, SAT /g/r>
Witness i MISE, hon ~ Ea Bemics, Cea £Ky/P7

Time: 7). Se ten,

DB Cooper-37963

==== Part 86 · PDF page 107 ====
FD-340 REV. (6-24.65)

ENCLOSURE TO SEATEE
SE 164-81~| A &O

b6
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titeno, /64— "0
Date Received é /: A; 72
From
{NAME OF CONTRISLUTOR})
{ {ADDRESS OF CONTRIBUTOR)
bé
BIC

¢

To Boe Returned J Yes Receipt Given ["] Yes

ccc
yb li

Description :

, AhtrFA :
KL LLU JIG), Cooper-37964-

==== Part 86 · PDF page 108 · Bates DB Cooper-DB Cooper-37965 ====
SE Jf & - jp D>

KEEP ATTACHED TO EXHIBIT

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2

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DB Cooper-37965

==== Part 86 · PDF page 109 · Bates DB Cooper-DB Cooper-37966 ====
FD-340 REV. (6-24-65)

It 0-6 Pe?

File Nollie 4 - ¥/-TF STO
Date Received 4/72/27)

From_ _
PMU / lve Yourmato Bac

7" {ADDRESS OF CONTRIBUTOR)

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CO Lissarcgs jl
SC

To Be Returned [7] Yes Receipt Given [|] Yes

[| No [ {No

Description :

ory CLK

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; KEY AY ASTO DB Cooper-37966

==== Part 86 · PDF page 110 · Bates DB Cooper-DB Cooper-3 ====
b6 7
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7 OPUS (77
DEPARTMENT OF MOTOR VEHICLES
DRIVER RECORDS

The attached photostatic copy of the Washington State Driver's

License/Identification Card/Instruction Permit was issued

on fO-5-72Z

DR-552-6 B/W Photo. Issue Date (R/9/75) .

faa .

DB Cooper-3/7968 |

==== Part 86 · PDF page 111 · Bates DB Cooper-DB Cooper-3 ====
FD-340 (REV. 6-24-05)

[lo (Eq
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b6
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By anne
To-Be Returned [] Yes Receipt given [| Yes
Description: ,

[CrvrecDiza tat

Netex ten

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DB Cooper-3 7969

1 RW OWN F6//

==== Part 86 · PDF page 112 ====
a AvyAGH", in EXHIBIT }
O-/

==== Part 86 · PDF page 113 · Bates DB Cooper-DB Cooper-37971 ====
z ae
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| Jee F- Et- Yaz,

DB Cooper-37971

==== Part 86 · PDF page 114 · Bates DB Cooper-DB Cooper-37974 ====
FD-240 (REV. 224-45) 2

|
ot LID)

| File Ko Le Y- f 0 "JAY

2/21
Date R 7
From_ ppic
{ADDRESS i
"by
(NAME OF SPECIAL AGENT?
To Be Returned {7} Yes Receipt given [] Yes
7H — -E}-Ho~

Sutece a

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: rr' ALY Jet DB Cooper-37974

==== Part 86 · PDF page 115 ====
<G £¢-*¥— 26 O-JAS

i

<REP AT 'AGHED TO EXHIBIT

==== Part 86 · PDF page 116 · Bates DB Cooper-DB Cooper-37976 ====
DB Cooper-37976

==== Part 86 · PDF page 117 · Bates DB Cooper-DB Cooper-37992 ====
Volume XVII No. 6

The New York State Credit Union League

Jan.Feb., 1973

NCUA Final Regulation Governing Records Preserva-

Sadi' Aiso i COOPER
TOT Cooper was appointed Managing Director

tion Program Effective January 1, 1973

WE WELCOME
OUR NEW
MANAGING
DIRECTOR

BONALD K.

of the New York State Credit Union League, Inc.,
effective January 15, 1973.

Don comes to New York with twenty years of
consumer finance experience, nine and a half years
of which were spent in the small loan and discount
fields where he received his basic training.

Realiziu.g that a greater service could be rendered
through credit unions, he started his credit union
career with the East Moline Works Credit Union,
East Moline, Illinois, as its first full-time Loan Officer.

Don was appointed as Assistant General Manager
of the State Capitol Credit Union, St. Paul, Minnesota,
to assist in the reconstruction of one' of the country's
largest credit unions to be taken over by a regulatory
body because of prior mis-managemient.

After this credit union was well on its way to re-
covery, and once again taking its place as a multi-
million dollar credit union, Don accepted the chal-
lenge of League work in North Dakota where he
spent three and a half years as Managing Director.

Just prior to his arrival on the New York scene,
Don completed a one-year tour in Uganda, East Africa,

(Continued on page 3)

The provisions of the new regulation are as follows:

1. The Treasurer of the credit union must develop
and maintain a records preservation program (RPP)
to include off-site storage for duplicate vital records
at a place sufficiently removed from the location of
the credit union. The responsibility for the RPP may
be delegated to the person who manages the day-to-
day operations of the credit union.

2. The RPP must be developed by May I, 1973, or
four months after date of credit union's share insur-
ance certificate, whichever is later.

The initial set of duplicate records must be sent to
the off-site Vital Records Center (VRC) by July 1,
1973, or six months after the effective date of the
credit union's share insurance certificate, whichever
is later.

8. Thereafter, credit unions using Electronic Data
Processing (EDP) shall send duplicate records to the
VRC on a quarterly basis and mailed no later than
the 30th day of the following month.

Non-ED? credit unions shall also prepare and send
duplicate vital records to the VRC on a quarterly
basis to be mailed by the 30th day of the following
month.

4, Duplicates of the following vital records must
be stored:

a. A listing of member's share and/or deposit
and loan balances.

b. Member's account number.

c. A financial and statistical report as of the
record: clate,

ad. Credit unions using EDP which maintains

its members' share and/or deposit and loan —

ledgers on a data processing system shall be
deemed to have met the requirements of this

(Continued on page 6)

lol -6-%4 J

DB Cooper-37992°

==== Part 86 · PDF page 118 ====
FEDERAL BUREAU OF INVESTIGATION
FOU/PA

DELETED PAGE INFORMATION SHEET
FOV/PAH 1:16-cv-G1790-62

Total Deleted Page(s) = 17
Page 11 ~ b6; b7C;
Page 17 ~ b6; b7C;
Page 19 ~ b6; b7C;
Page 20 ~ b6; b7C;
Page 21 ~ b6; b7C;
Page 23 ~ b6; b7C;
Page 25 ~ b6; b7C;
Page 33 ~ b6; b7C;
Page 34 ~ b6; b7C;
Page 35 ~ b6; b7C;
Page 36 ~ b6; b7C;
Page 45 ~ b6; b7C;
Page 73 ~ b6; b7C;
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Page 98 ~ b6; b7C;
Page 101 ~ b6; b7C;
Page 111 ~ b6; b7C;

XXXXXXXXXXXXXXXXXXXXXXXX
X Deleted Page(s} xX

X No Duplication Fee X

X For this Page X
XXXXAXXAXXXAXXXXXXXXXXAXAXX

==== Part 86 · PDF page 119 · Bates DB Cooper-DB Cooper-37993 ====
; P re BS a te he ST Ot al eae ? 7 6 ae ee ate ey ay
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==== Part 86 · PDF page 120 · Bates DB Cooper-DB Cooper-37994 ====
~ \
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DB Cooper-37994

==== Part 86 · PDF page 121 · Bates DB Cooper-DB Cooper-37995 ====
wt

LOUISIANA STATE PENITENTIARY
UNIT OF THE DEPARTMENT OF CORRECTIONS

% .
LOUIS M. SOWERS Angola, ~Esuisiana 70712 . _ © MURRAY HENDERSON

Director of Corrections Warden

£ ie 7
. ¢ b7C

JOHN J. McKEITHEN

Governor

Aprii 6, 1972
Records Office QV
Federal Corredtional Institute ' ' cer"
Terminal Island NO
Los Angeles, Salif. 90000 ———

, RE: }
LSP:

RACE: White/Male
Your :[ ]

YOUR NO:| |

Bear Sir;

The above Wi ceived at this institution on | | to .
serve a term o for the crime off

We have information that he was confined at your institution from

So that we Lay errecuavely plan for this inmate from the standpoint of custody, b6
discipline, work, and all other phases of training and treatment, we will appreciate bi7c

your sending us copies of any classification, social history, medical conduct, or.
any other reports available to you, which will reflect his past history and adjust-
ment at your institubion. If complete reports are not available, please furnish
information regarding, the items s¢ecified on the reverse of this letter.

To be of maximum value to us, we need this information at the earliest possible
gate. .

We appreciate your cooperation and will be glad to reciprocate upon request.

Sincerely yours,

jee \ , ve

CL~3A

We of agaw they Duk

Eiul My i 9 472

DB Cooper-37995

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==== Part 86 · PDF page 122 · Bates DB Cooper-DB Cooper-37996 ====
she

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File No. Le€-EO ~/4/ @

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Description:

4

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DB Cooper-37996

==== Part 86 · PDF page 123 · Bates DB Cooper-DB Cooper-37997 ====
KEEP
XC

et, «

- 4 .
. it 2 EXHIpY? | mt .
LAL US. PROBATION OFFICE.
8443 Uf. S. QQURTSSHSE .
PHOENIX, ARMLORA 25925 «Phoenix
25 May 1972
at\

f > \ \ b7C
wv. 5S. Board of Parolis fe , SEARCHED : |
101 Indiana Aveme NW a SERIE Le
ashingten,—Ds~ Cs" 20537 ED
37. ; £8t —1ONSAS CiTy_| b6

. ij . y prc
5 _
On| lwas given authority to b6-
relocate from Long Beach, California to Heber, Arizona, where' b7C
' he was promised a job with Air-Land,.Ine., operated by| |
Subject reported in as directed and advised he was the[ _| r .
fox the mentioned company, We wish to report the: >
'following violations of his releases i
bé
i. bIC
3.
DETATISs | received a b6
. three=vear A~Eype sentence on | [Zor al BIC
ne | 1 | He is also up for sentence in Penver, Colorage on J
8
| |
lvas convicted by the —_
' State of California on .
| | on or about | |: -
| | b6
in Greeley, Colorado and El Monte, California. Theseal b7C
have been traced to |
} above casa pending pesi~ .
tive identification. The three subjects ali left the Phoenix
axea on or abovt May 9 and their present whereabouts are unknown.
cont'd
DB Cooper-37997

aa

==== Part 86 · PDF page 124 · Bates DB Cooper-DB Cooper-3 ====
Page 2
Ltr to| j~ Washe REs
25 Hay 71 ReMand 4 |

According to the polica department an all-points bulletin has
heen placed throughout the western states. Further, a police

_infoxmant at Albuquerque, New Hexico stated that on
believed to be a
___| Sm Albuquerque; lwexe in
posscesien o€ |
| .

co | advised sha had seen 2
She further advised that| [was]

ay | in Bl Monts, California—|

reportedly

The police further advised that on| | pox 'the
visitor's register at | |
visited[ | fox 1-3/4 hours, signing in as employer.

The above information was furnished by the Phoanisx Police
Department - and | | o£ the
Bl Monte Police Department, El Monte,. California.

zt ia respectfully recommended that a Parole Violator''s Warrant
ba issted immediately.

|
_U. Se Probation Officer

TSY imp

ees USEO - Long Beach, California
USPo ~ Denver, Colo.
USP ~ |p

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==== Part 86 · PDF page 125 · Bates DB Cooper-DB Cooper-37999 ====
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DB Cooper-37999

==== Part 86 · PDF page 126 · Bates DB Cooper-DB Cooper-38000 ====
DEPARTMENT OF MOTOR VEHICLES
DRIVER RECORDS

Date At et 1

* The attached photostatic copy of the Washington State Driver's

License/Identification Card/Instruction Permit was issued

on BP

DOR-552-6 BAV Photo Issue Date (R/9/75)

i ae re a a '

DB Cooper-38000

==== Part 86 · PDF page 127 · Bates DB Cooper-DB Cooper-38 ====
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==== Part 86 · PDF page 128 · Bates DB Cooper-DB Cooper-38003 ====
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==== Part 86 · PDF page 129 · Bates DB Cooper-DB Cooper-38004 ====
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==== Part 86 · PDF page 130 ====
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==== Part 86 · PDF page 131 · Bates DB Cooper-DB Cooper-38006 ====
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==== Part 86 · PDF page 132 · Bates DB Cooper-DB Cooper-38008 ====
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==== Part 86 · PDF page 133 · Bates DB Cooper-DB Cooper-38012 ====
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==== Part 86 · PDF page 134 ====
FD-340 REV, (6.24.65)

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(NAME OF CONTRIGUTGR) *

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==== Part 86 · PDF page 135 · Bates DB Cooper-DB Cooper-38016 ====
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==== Part 86 · PDF page 136 · Bates DB Cooper-DB Cooper-38017 ====
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==== Part 86 · PDF page 137 · Bates DB Cooper-DB Cooper-38018 ====
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==== Part 86 · PDF page 138 · Bates DB Cooper-DB Cooper-38019 ====
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==== Part 86 · PDF page 139 · Bates DB Cooper-DB Cooper-38020 ====
\ : FD-340 REV. (10-1-76;

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' Le Date Received 10/13/77
_ From

' {NAME OF CONTRIBUTOR) "<->

(ADDRESS OF CONTRIBUTOR) -- 3. |

(CITY AND STATE
%

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. .

To Be Returned. |" | Yes

Receipt Given me Yes

. eee" | No CI No

Description:

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One copy of let of | _ __
to| , dated 7/10/77

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==== Part 86 · PDF page 140 · Bates DB Cooper-DB Cooper-38021 ====
se /bl-sy- [A (422)

KEED ATPYACHED TO EXHIBIT

and cooperation on the film you intended to produce.

<
3 .
AYA

!

'duly 10, 1977

United Productions Ltd. b6
3921 Deervale Or. . b7c
Sherman Oaks, CA 91403

dear 7]

Several months ago you called me in Toledo, Ohio relative to
the "D.B. Cooper' skyjacking case.

In response to your questions I gave you some limited infor-
mation on the incident. [t was my understanding from your
conversation that you were soon to meet with Mr. Nyrop of
NWA and that you had, or expected to receive, NWA's blessing

I indicated, based on the above, that I would be interested,
pending further information, on helping you with the intended
project.

I have since learned that Northwest is not interested in the
project and are in fact very much opposed to it. On that basis
I could not participate in any way in the project and I further
request that you do not use any of the information I gave you
on the phone fn connection with my name.

In view of Northwest's feeling about the project it could be
very difficult for me if you were to use my name in any way
in connection with furnishing of information or cooperating
with you on the project. .

I am sorry the circumstances are such but know you will re-
Spect my wishes.

.
Cs ee Zz

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DB Cooper-38021 f

==== Part 86 · PDF page 141 · Bates DB Cooper-DB Cooper-38022 ====
° "4 FO.840 REV, (6.24.65)
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+ (ADDRESS OF CONTRIBUTOR)
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; : ! t0 Bo Roturned [| Yos Reccipt Givon [| Vos ,

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==== Part 86 · PDF page 142 · Bates DB Cooper-DB Cooper-38027 ====
FD-340 REV. (10-1-76;

169 -SL (ACAY

File No. /Gsf_. Gf

Date Received | Lo - Bf. l Tt

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NAME UF CONTRIBUTOR)
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To Bo Returned im" Yes Racalpt Given LJ Yes
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==== Part 86 · PDF page 143 · Bates DB Cooper-DB Cooper-38028 ====
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==== Part 86 · PDF page 144 · Bates DB Cooper-DB Cooper-38029 ====
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==== Part 86 · PDF page 145 ====
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==== Part 86 · PDF page 146 ====


==== Part 86 · PDF page 147 · Bates DB Cooper-DB Cooper-38032 ====
— 7 ti rise epee oi nay ee

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DB Cooper-38032

==== Part 86 · PDF page 148 · Bates DB Cooper-DB Cooper-38033 ====
DB Cooper-38033

==== Part 86 · PDF page 149 · Bates DB Cooper-DB Cooper-38034 ====
FD-340 REV, (6-24-65)

tile No. 64-5 /-l4 (625)

/ i Date Received //.3/ 2.7
| Fro — | c

"(ADDRESS OF CONTRIBUTOR)

To Be Returned ry Yes: . Receipt Given CL] Yes

tS oO . o Ee: . [] No

Description : :

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==== Part 86 · PDF page 150 · Bates DB Cooper-DB Cooper-38036 ====
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Prl-34U REV, (6-24-65}

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Fro Cetpeditet Que L_?
(NAME OF GONTRIBUTO

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DRESS OF CONTRIBUTER)

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To Be Returned Lj Yes Recsipt Given [| Yes

Description: [a [1%
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DB Cooper-38036

==== Part 86 · PDF page 151 · Bates DB Cooper-DB Cooper-3803 ====
FD-395 (Rev. 10-10-67)

INTERROGATION; ADVICE OF RIGHTS

YOUR RIGHTS
26 piace 14 hoeZEn Ke.
SE L b fo rime ae Date oe SLE

Before we ask you any questions, you must understand your rights.
You have the right to remain silent.
Anything you say can be used against you in court.

You have the right to talk to a lawyer for advice before we ask you any
questions and to have him with you during questioning.

If you cannot afford a lawyer, one will be appointed for you before any
questioning if you wish.

If you decide to answer questions now without a lawyer present, you
will still have the right to stop answering at any time. You also have the right
to stop answering at any time until you talk to a lawyer.

WAIVER OF RIGHTS

i have read this statement of my rights and I understand what my rights
are. I am willing to make a statement and answer questions. I do not want a
lawyer at this time. I understand and know what I am doing. No promises or
threats have been made to me and no pressure or coercion of any kind has been '
used against me. 7

_ Si ned dpresuteet A hog ho ne
Witness: Ss fp, FLL, Ka fees yee - Ne fl b7C

Witness:

Time: M0 SAT

DB Cooper-3803/7

==== Part 86 · PDF page 152 · Bates DB Cooper-DB Cooper-38038 ====
Or iy pee 3 :

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DB Cooper-38038

==== Part 86 · PDF page 153 · Bates DB Cooper-DB Cooper-38039 ====
we

FD-340 {REV. 6-24-65)
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File Ho. [64-136 -/fP
Date Received {- 2-73
From | _ 'é
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(ADDRESS OF CONTRIBUTOR)
Te KeoT. Ca.
: (CITY AND STATE)
By.
(NAME OF SPECIAL AGENT)
Te Be Returned [1] Yes Receipt given [j Yes
Milo Wer Ho
Bescription:
Advice oF RIGHTS F INTERVIEW
LOG OF b6
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DB Cooper-38039 !

==== Part 86 · PDF page 154 · Bates DB Cooper-DB Cooper-38040 ====
FO+368 (Rev, 9-23-66)

VOLUNTARY APPEARANCE; ADVICE OF RIGHTS
YOUR RIGHTS

Before we ask you any questions, you must understand your
rights. You have the right to remain silent. Anything you say can be used
against you in court. You have the right to talk to a lawyer for advice be-
fore we ask you any questions, and to have him with you during questioning.
You have this right to the advice and presence of a lawyer even if you cannot
afford to hire one. We have no way of giving you a lawyer, but one will be
appointed for you, if you wish, if and when you go to court. If you wish to
answer questions now without a lawyer present, you have the right to stop
answering questions at any time. You also have the right to stop answering
at any time until you talk to a lawyer.

WAIVER

I, have come to

=~

the yew oRLEANS Office of the Federal Bureau of Investigation (FBI)

of my own choice to talk with Special Agents of the FBI about a crime which
they are investigating. I know that Iam not under arrest and that I can leave
this office if I wish to do so.

Prior to any questioning, I was furnished the above statement

of my rights at jo: as on_ 4-2&-73 at NeW oRLEANS LA.
(time) (date) (place) -
by Special Age of the FBI. Ihave (read)

(had read to me) this statement of my rights. I understand what my rights
are. I am willing to answer questions and make a statement. I do not want

a lawyer. I understand and know what I am doing. No promises or threats

we

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have been made to me and no pressure

SE
KE

) Signed_|
Lh 5 f= pe? )

~

rime (date) (place

Witnes

Witnes

DB Cooper-38040

Gc Vlpt 407 Vt Glan, th, Wal o3 |
, Pe, Now Ophroun, A G- 25-72, |

==== Part 86 · PDF page 155 ====
4-2 F723
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LARPER RED AT Ther NEW ORLEANS FRT oF FICE _

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==== Part 86 · PDF page 156 · Bates DB Cooper-DB Cooper-38042 ====
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==== Part 86 · PDF page 157 · Bates DB Cooper-DB Cooper-38043 ====
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==== Part 86 · PDF page 158 · Bates DB Cooper-DB Cooper-38044 ====
FD-340 (REV. 6-24-65}

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==== Part 86 · PDF page 159 ====


==== Part 86 · PDF page 160 · Bates DB Cooper-DB Cooper-38046 ====
DB Cooper-38046

==== Part 86 · PDF page 161 ====


==== Part 86 · PDF page 162 ====
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==== Part 86 · PDF page 163 · Bates DB Cooper-DB Cooper-38049 ====
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==== Part 86 · PDF page 164 · Bates DB Cooper-DB Cooper-38050 ====
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==== Part 86 · PDF page 165 ====
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==== Part 86 · PDF page 166 ====
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==== Part 86 · PDF page 167 · Bates DB Cooper-DB Cooper-38053 ====
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==== Part 86 · PDF page 168 · Bates DB Cooper-DB Cooper-38054 ====
FD-395 (Rev. 10-10-67)

INTERROGATION; ADVICE OF RIGHTS

YOUR RIGHTS

Place a Clk.
Date _ @ /22/97?
Time L0:16 Bn

Before we ask you any questions, you must understand your rights.
You have the right to remain silent.
Anything you say can be used against you in court.

You have the right to talk to a lawyer for advice before we ask you any
questions and to have him with you during questioning.

If you cannot afford a lawyer, one will be appointed for you before any
questioning if you wish.

-If you decide to answer questions now without a lawyer present, you.
will still have the right to stop answering at any time. You also have the right
to stop answering at any time until you talk to a lawyer.

WAIVER OF RIGHTS

IT have read this statement of my rights and I understand what my rights
are. Iam willing to make a statement and answer questions. I do not want a
lawyer at this time. I understand and know what Iam doing. No promises or
threats have been made to me and no pressure or coercion of any kind has been
used against me.

. b6
Signed X | a b7C

Witness: | ice FOL FM er Genaeg | br. 6/21/72

Witness: _| SE FEL , /ergomery, Ab. 6/2277

Time: (0:29 Bm

SE y-s. 4- EW

KEEP ATYACHED TO EXHIBIT

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==== Part 86 · PDF page 169 ====
FO-340 REV, (10-1-76:

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==== Part 86 · PDF page 170 · Bates DB Cooper-DB Cooper-38056 ====
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==== Part 86 · PDF page 171 ====


==== Part 86 · PDF page 172 · Bates DB Cooper-DB Cooper-3 ====
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==== Part 86 · PDF page 173 · Bates DB Cooper-DB Cooper-38059 ====
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==== Part 86 · PDF page 174 · Bates DB Cooper-DB Cooper-38060 ====
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==== Part 86 · PDF page 176 · Bates DB Cooper-DB Cooper-38062 ====
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==== Part 86 · PDF page 177 · Bates DB Cooper-DB Cooper-38064 ====
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==== Part 86 · PDF page 178 · Bates DB Cooper-DB Cooper-38065 ====
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==== Part 86 · PDF page 179 · Bates DB Cooper-DB Cooper-38066 ====
FD-395 (Rev. 10-10-67)

INTERROGATION; ADVICE OF RIGHTS

YOUR RIGHTS

—
6 Place Rlhleo LXA S

Date 2-/6-"72
Time 3:2 2 C2 =

Before we ask you any questions, you must understand your rights.
You have the right to remain silent.
Anything you say can be used against you in court.

You have the right to talk to a lawyer for advice before we ask you any
questions and to have him with you during questioning.

If you cannot afford a lawyer, one will be appointed for you before any
questioning if you wish.

If you decide to answer questions now without a lawyer present, you

will still have the right to stop answering at any time. You also have the right
to stop answering at .any time until you talk to a lawyer.

WAIVER OF RIGHTS

I have read this statement of my rights and I understand what my rights
are. I am willing to make a statement and answer questions. Ido not want a
lawyer at this time. I understand and know what I am doing. No promises or
threats have been made to me and no pressure or coercion of any kind has been
used against me.

i fe b7

Witness 5A ppp, GeV eek La ae A"
Tt Rekha nage ete"

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Time: 2.2 XY rn.

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==== Part 86 · PDF page 180 · Bates DB Cooper-DB Cooper-38067 ====
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==== Part 86 · PDF page 181 · Bates DB Cooper-DB Cooper-38068 ====
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==== Part 86 · PDF page 182 · Bates DB Cooper-DB Cooper-38069 ====
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==== Part 86 · PDF page 183 ====


==== Part 86 · PDF page 184 ====
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==== Part 86 · PDF page 185 · Bates DB Cooper-DB Cooper-38072 ====
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==== Part 86 · PDF page 186 · Bates DB Cooper-DB Cooper-38073 ====
NOTICE OF ADULT PROBATION

DALLAS COUNTY CRIMINAL DISTRICT COURTS
DALLAS, TEXAS

at,
~

 pire._Mazeh 13,1972
NAME__SCHVAND?, RICHARD PRANK
ADDRESS _ Box 112, Clearwater, Minn.

SEX___M RACE__¥ aGE_27. DATE OF BiRTs__8-3-4

HBIGHT 612. wRiGHT280.__s yes. blue Harr. B2nd_ comPpLExXION____. __

EMPLOYER
OFFENSE.....£8E , SENTENCE 2 years ae
COURT No tgath Judicial: District DOCKET No,__S72-2907-RH - " a
DATE OF PROBATION...3-20-72. PROBATION CASE No 112-058 ne
PROBATION OFFICER | | _ «bye
FBI No. DPS No.Le4852738s0 No.273792__ pep wo.LVY_ (frab os)

Form 69 0 POLICE DEPARTMENT - DALLAS, TEXAS /7H#379

Belew Sage 4 36

ATTEST: | +00

TOME. ELLIS, County Clerk a

By: 4 io

pso_209_ 520 wg 08h WC

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==== Part 86 · PDF page 187 · Bates DB Cooper-DB Cooper-380 ====
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WILSON E. SPEIR
Director

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THE STATE OF TEXAS
DEPARTMENT OF PUBLIC SAFETY

AUSTIN

4

Form 6

- The following is a transcript of the record, including the most recently reported data, as shown in the files of the

Hentification & Criminal Records Division concerning

DPS* 1,486,738

FC: -17/ $-9 U IOI 15
: L 2 U OL 15 .
Joel Tisdale, Chief
identification & Criminal Records Division
ARRESTED OR CONTRIBUTOR OF NUMBER NAME CHARGE , DISPOSITION
10-11-68 | Dallas, Tex. S0#173702|Richard Frank Drunk & Disorderly
. Schwandt. \
* \
7-18-69 Dallas, Tex. $0#1.73702|Richard Frank Pass, Worthless
Schwandt Checks, Dist. Peace
. Lenore Ric Frankie Prob Viol, PWC (2)

2-28-72

Da llas . Tex

Schwandt

MAR 15 1979

ta

* Representa notatione unsupported by ingvtrrints.

DB Cooper-380/74

For completion of out records, please supzsy dispositions to this. Bureau in eny ? the foregoing cases where they do not appear.

==== Part 86 · PDF page 188 · Bates DB Cooper-DB Cooper-38075 ====
* a
. 7 .

}. H. Kitching,

ILL DECKER, SHERIFF

Form 138

ALIAS

DALLAS COUNTY, TEXAS
Chief, Bureau of di Page
Identification and Records |
; Race &
NAME_SCHWANDT RICHARD FRANK Sex Wu DOB §~3.))))
t
DPD # ppes«__12486,738 FBI #__

pso #173702

The following is a transcript of the record of the above named subject as shown in the files of the Bureau of Identification

and Records.

RELEASE

ARREST ARREST
CARD d DATE CHARGE DISPOSITION DATE
450004 10-11~ 68] DRUNK & DISORDERLY XEATEOGAEY ROO 10=12-68
el i PAID FING IN JAIL OFFICE
474,907 ' 7~18-69 | Passing Worthless Check
- see #CCr68-765~-C Posted $300.00 bond, -
- H/F DeSoto PD )
- Disturbing Peace $25.00 fine pd in J/o. 7-18-69
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~ 518473. —|- 8-13-70 | Pass worthless checks | 60 days Jail, $100 fine,
- CCR68=765=G $45 cost (PROBATED TO
ze ce 2-13-71) Paid Cost 8-13-70
581207 2=28+72 |PASSING WORTHLESS CHECK
~ #CCY71-23))9- REC 5 DAYS $50 FINE $108 cost
- .1CCC#1 SVD 37 DAYS
PASSING WORTHLESS CHECK ;
#C71-2907-+KN {REC 2 YEARS TDC FROB $10 COST
PGBCT #195th
PROBATION VIOLATION PASSING
WORTHLESS CHECK #CCr68-765~C|REC 60 DAYS PROB $100 FINE $72
COST CCC#3 SVD 1 DAY ON F/C
PD BAL $167 IN JO ,

-

DB Cooper-38075

3-10-72

==== Part 86 · PDF page 189 · Bates DB Cooper-DB Cooper-38076 ====
| . , | .
wry Ts PROBATION DEPARTMENT
. CRIMINAL DISTRICT COURTS OF DALLAS COUNTY
, ( , DALLAS, TEXAS . oo,
) Dkt. No._C71=2907-KN
Neme___ RICHARD PRANK SCHYANDT Address: ear: 5

' Wrignt County
Phone No._nOne—_.. Rect_ty. . Sex _—__]f__ Age 27 DOB Ba Qaiftp pob__Resnesten, finsy—————

Employe__lans to attend school adaress: Phone:
Martial Status: §_M__W____0.X_ sep.__Hesith:,__Good | _ Salary:
Description: "Ht Ot2" " we'__180 setr_ Bind. 'tyes Bhue Complexion —__ Light
'gea-ttuse-teto0n Right shoulder "u.s.a.", Share on left arn : :
\
| Status |

Education: __Preshnan. shoel_ ot St. Cloud tniv., £t, Cloudy Mtnnsision _"_ None
Mil, Service: ALX_AF M N cG FromBnti-6) rl Ba 3-64 ASN 1 7599133 Type Dise. Hanorahlie_

Resources, Prop WITT attend school on 6,T Bi part omer of Clear Take
rj (sky~diving) Star Factory

Payments or Rent: $__Nong—_—-. Auto._ Nong. Make & Modbi Lic.#
Minn. Op. . .
Driver Lic. 55307 382616 xp. Date Soc|sl Security # 472-06-7756
Fat ops_1, 86,738 s0-34 3102 — DPD
Probation Oste____ darch LO, 3970 0 Expiration March 10, 1974
Offense BuIC : : Dat. Attorn¢ Pros. Attorney:
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==== Part 86 · PDF page 190 · Bates DB Cooper-DB Cooper-38077 ====
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Searched by

Classed by:
Filed by:

j

RICHARD

FIRST NAME

i

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DPD

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TEXAS
Last NAME
sexit

SCHWANDT

Form 102

DALLAS,

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RACE.

BIL-DECKER, SHERIFF
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==== Part 86 · PDF page 191 · Bates DB Cooper-DB Cooper-38078 ====
Sane, aera

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- SCARS, MARKS AND TATTOOS: PATTs USA L/snorEpee — ae

i ;
SOC.SEC.NO. %NENOUH a DRAFT REGIS. NO.
ADMITS PREVIOUS ARRESTS
DATE INSTITUTION OR TOWN CHARGE HOW RELEASED
. * . ' '

t '. . . y I 2

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FATHER: = WILLARD SCH*ANDT.—(DEQ ADD: FAT : -
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EMPLOYER: __S© B ADD: (2 back y
ORGANIZATIONS, LODGES, OR UNIONS:

. Lo DB Cooper-38078 |

==== Part 86 · PDF page 192 ====
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==== Part 86 · PDF page 193 ====
oper-38080

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==== Part 86 · PDF page 194 · Bates DB Cooper-DB Cooper-38081 ====
FD-395 (Rev. 10-10-67)

INTERROGATION; ADVICE OF RIGHTS

Place ficlhirfaenr) Tex BS

Date FF 7 >
Time 7 2¢ p>

YOUR RIGHTS

Before we ask you any questions, you must understand your rights.
You have the right to remain silent.
Anything you say can be used against you in court.

You have the right to talk to a lawyer for advice before we ask you any
questions and to have him with you during questioning.

If you cannot afford a lawyer, one will be appointed for you before any
questioning if you wish.

If you decide to answer questions now without a lawyer present, you
will still have the right to stop answering at any time. You also have the right
to stop answering at any time until you talk to a lawyer.

WAIVER OF RIGHTS

I have read this statement of my rights and I understand what my rights
are. I am willing to make a statement and answer questions. I do not want a
lawyer at this time. I understand and know what I am doing. No promises or
threats have been made to me and no pressure or coercion of any kind has been
used against me.

b6
Signed b7c

— S#,I8FD Diller hile
SR ABT Dallas Tey afupe .

Witness: 7.

DB Cooper-38081.

==== Part 86 · PDF page 195 · Bates DB Cooper-DB Cooper-38082 ====
. mee tree ee epee

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AGENT /

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Recelpt given [_] Yes

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==== Part 86 · PDF page 196 · Bates DB Cooper-DB Cooper-38083 ====
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==== Part 86 · PDF page 197 · Bates DB Cooper-DB Cooper-38084 ====
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FD-340 REV, (6.24.65)

/44-3(- 4 (ELE
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Date i 2/7/7265"
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(NAME OF CONTRIBUTOR)

BRANIE® AIRWAYS

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TAME OF SPECIAL AGENT)

To Be Returned [] Yes Reaccipt Given [| Yes

YX No [I No
Description:

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==== Part 86 · PDF page 198 · Bates DB Cooper-DB Cooper-38086 ====
DB Cooper-38086

==== Part 86 · PDF page 199 · Bates DB Cooper-DB Cooper-38087 ====
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==== Part 86 · PDF page 200 · Bates DB Cooper-DB Cooper-38089 ====
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==== Part 86 · PDF page 201 ====
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==== Part 86 · PDF page 202 · Bates DB Cooper-DB Cooper-38092 ====
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==== Part 86 · PDF page 203 · Bates DB Cooper-DB Cooper-38093 ====
FD-395 (Rev. 10-10-67}

INTERROGATION; ADVICE OF RIGHTS

YOUR RIGHTS

[64 -¥,- 4A-(693 1 Place, lar, Ge reagle
Date ctf VERT 3
Time Z2t¢v3 "7%

Before we ask you any questions, you must understand your rights.
You have the right to remain silent.
Anything you say can be used against you in court.

You have the right to talk to a lawyer for advice before we ask you any
questions and to have him with you during questioning.

If you cannot afford a lawyer, one will be appointed for you before any
questioning if you wish. °

If you decide to answer questions now without a lawyer present, you
will still have the right to stop answering at any time. 'You also have the right
to stop answering at any time until you talk to a lawyer.

WAIVER OF RIGHTS

I have read this statement of my rights and I understand what my rights
are. I am willing to make a statement and answer questions. I do not want a
lawyer at this time. I understand and know what I am doing. No promises or
threats have been made to me and no pressure or coercion of any kind has been
used against me.

Signed

Witness: <"% LLL. {en fptece! tip oa ne
/ 3 f ve lol S24 f73

Witness:

Time: ZLeO& Pp

2 Ctl plot acetyl) Oger tig

DB Cooper-38093

==== Part 86 · PDF page 204 · Bates DB Cooper-DB Cooper-38094 ====
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it ito C1 oa

Deseription:,

DB Cooper-38094

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==== Part 86 · PDF page 205 · Bates DB Cooper-DB Cooper-38095 ====
FD-395 (Rev. 10+10+67}

INTERROGATION; ADVICE OF RIGHTS

YOUR RIGHTS

[bea (4 bet Leper Ce
Time 7; 34744

Before we ask you any questions, you must understand your rights.
You have the right to remain silent.
Anything you say can be used against you in court.

You have the right to talk to a lawyer for advice before we ask you any
questions and to have him with you during questioning.

If you cannot afford a lawyer, one will be appointed for you before any
questioning if you wish.

If you decide to answer questions now without a lawyer present, you
will still have the right to stop answering at any time. You also have the right
to stop answering at any time until you talk to a lawyer.

WAIVER OF RIGHTS

I have read this statement of my rights and I understand what my rights
are. I am willing to make a statement and answer questions. I do not want a
lawyer at this time. I understand and know what I am doing. No promises or
threats have been made to me and no pressure or coercion of any kind has been
used against me.

Signed

y FB a
Wit : 5 : - 4.
itness et Lila Litem rs 6 f LLomccooe! Srrengt BAL Cte?

Witness:

Time: Wet Ay

Y 2ege arte Ae cenclomte Gt <a, 28,

DB Cooper-38095

==== Part 86 · PDF page 206 · Bates DB Cooper-DB Cooper-38096 ====
~~

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*

==== Part 86 · PDF page 207 · Bates DB Cooper-DB Cooper-38097 ====
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==== Part 86 · PDF page 208 · Bates DB Cooper-DB Cooper-38098 ====
'| FD-840 REV. (6-24.65)

af. am VA ol
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==== Part 86 · PDF page 209 · Bates DB Cooper-DB Cooper-38099 ====
Oe
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Department of Commerce
Bureau of the Census

,

CERTIFICATE OF BIRTH

COMMONWEALTH OF VIRGINIA

DIPARTHENT OF HEALTH
Byuetau OF VITAL STATISTICS "

Registered Ivo.

% USUAL R
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= &) How many other children were bom alive bot tre raw dea®?__
(c} How many children were bors dead?._

~ If chitd Is not yet ;
«ZL Foil nane of child. * named, leave Diank.
cad 6. Twin or Y - Hf 89, bora Ts, €& Warths > | "7. 1s mother marrled BOs "Ss ts gh aah
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22, hereby cestfy thet f aitended the birth of this chit wha was 2S?

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JAN? 1975

Date Isseed DEANE HUXTABLE, Stote Registrar

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a see hb ol345 ness to signatic The ond bros =
. . NOTICE OF VERIFICATION

FOR OFFICIAL GOVERNMENT USE ONLY
{To Be Retained by Using Agency)

This is to verify that the foregoing is a reproduction
of the original record on file in the Bureau of Vital
Statistics, Virginia Department of Health, Richmond,

Virginia.

DB Cooper-38099

==== Part 86 · PDF page 210 · Bates DB Cooper-DB Cooper-38100 ====
7

4 PINT NYT at 7 |

FD-340 REV, (6.24.65)

} ENCLOSURE TO SEATTLE FROM BUFFALO

3EZ /64-$/(- A- (617
File No. VEG=-Y6~

| Date Repalued LL L/2F
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DB Cooper-38100

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==== Part 86 · PDF page 211 · Bates DB Cooper-DB Cooper-38102 ====
b6 -
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DB Cooper-38102

==== Part 86 · PDF page 212 · Bates DB Cooper-DB Cooper-38103 ====
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==== Part 86 · PDF page 213 · Bates DB Cooper-DB Cooper-38104 ====
ao ~

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ERP APTACHED TO LAHIBIT

DB Cooper-38104

==== Part 86 · PDF page 214 · Bates DB Cooper-DB Cooper-38105 ====
FD+335 (Rov. 10-10-67}

INTERROGATION; ADVICE OF RIGHTS

YOUR RIGHTS

Place Rae ; Olarde

Date 7/19/73
Time __/a:¢ AG

Before we ask you any questions, you must understand your rights.
You have the right to remain silent.
Anything you say can be used against you in court.

You have the right fo talk to a lawyer for advice before we ask you any
questions and to have him with you during questioning.

If you cannot afford a lawyer, one will be appointed for you before any
questioning if you wish.

If you decide to answer questions now without a lawyer present, you
will still have the right to stop answering at any time. You also have the right
to stop answering at any time 'until you talk to a lawyer.

WAIVER OF RIGHTS

I have read this statement of my rights and I understand what my rights
are. Iam willing to make a statement and answer questions. I do not want a
lawyer at this time. I understand and know what I am doing. No promises or
threats have been made to me and no pressure or coercion of any kind has been
used against me.

Si
Witne bly GLY, iy TT Gut
Witness? LE

Time: Le Gb Af]

DB Cooper-38105.

b6
b7C

==== Part 86 · PDF page 215 ====
FEDERAL BUREAU OF INVESTIGATION
FOU/PA

DELETED PAGE INFORMATION SHEET
FOV/PAH 1:16-cv-G1790-62

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X Deleted Page(s} xX

X No Duplication Fee X

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==== Part 86 · PDF page 218 · Bates DB Cooper-DB Cooper-38106 ====
File ~ Serial Charge Out
FD-5 (Rev. 6-17-70)

File lf a G)

Date
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{_] Pending (_} Closed Date
Serial No. wescription of Serial Charged

ALS lipo Talat fash

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To From

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DB Cooper-38106

==== Part 86 · PDF page 219 · Bates DB Cooper-DB Cooper-38107 ====
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DB Cooper-38107

==== Part 86 · PDF page 220 · Bates DB Cooper-DB Cooper-38108 ====
te FD-340a (Rev, 11-12-89) lan Aon

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DB Cooper-38108

==== Part 86 · PDF page 221 · Bates DB Cooper-DB Cooper-38109 ====
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==== Part 86 · PDF page 222 · Bates DB Cooper-DB Cooper-38110 ====
"FD-340 (REV. 6-24-68)

b git
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To Be Returied wh Receipt given (] ¥,
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DB Cooper-38110

==== Part 86 · PDF page 223 · Bates DB Cooper-DB Cooper-38240 ====
FD-340 (REV. 6-24-65) ", Wa

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Fite Ho ZL, J - S0 f- JAS
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To Be Retuyned [] Recefpt given [J Yes
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Description:

Coyprze Lf.

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DB Cooper-38240

==== Part 86 · PDF page 224 · Bates DB Cooper-DB Cooper-38289 ====
Routing Slip
FD-4 (Rev. 12-22-69)

To: £7) Director : Date
Att: pie i Ib Gelol
Titl
Csac me
(C1) ASAC No pats
(_} Supv.
([} Agent
J SE
I
ole RE:
cIce
(] Steno
("} Clerk (] Rotor #:
ACTION DESIRED
(ly Acknowledge (J Open Case
(CCl Assign Reassign —__—s—s [(_] Prepare lead cards
[_] Bring file (3 Prepare tickler
fj Call me {7} Return assignment card
() Correct (1 Retum file
(1 Deadline (}Seorch ond return
[_] Deadline passed [7] See me
(__] Delinquent (_} Serial # .
(7j Discontinue {}Post [jRecharge (Return
(} Expedite (Send to
[_) File (_] Submit new chorge out
(C) Fer information ((7} Submit report by
(_jHondle {—} Type

C}lnitiol & return
{_] Leads need attention

{_} Return with explanation or notation as to action taken,

See reverse side Office

eS

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# GPO! 1971 421-419 DB Cooper-38289

==== Part 86 · PDF page 225 · Bates DB Cooper-DB Cooper-38299 ====
To Be Returned Cys Recefpt given (] Yes

=
Description: Don 4 |

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DB Cooper-38299

==== Part 86 · PDF page 226 · Bates DB Cooper-DB Cooper-38300 ====
OPTIGNAL FORM Xo. [0
MAY [962 EDITION
SSA FeMr (41 CFR) s01-51.6

UNITED STATES GOVERNMENT

Memorandum

TO : SAC (164-101) DATE: }; /21/72
FROM ; 5A —
b7D
SUBJECT:
OF ag on 1. /20/72, a kNowledgeable source furnished the following
N iad . b6
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Buy U.S. Savings Bonds Regularly on the Payroll Savings Plan DB Cooper-38300
S10+168 04 .

==== Part 86 · PDF page 227 · Bates DB Cooper-DB Cooper-38304 ====
FD-240 (REV. 6-24-65}

Co
} phn o

File Ho. L6G- 57 - 7/63

Date Reni 12/27 hy
_ he

;

(ADDRESS OF CONTRIBUTOR) b6

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4

"To Be Returned [] Yes Receipt given (] Yes

E Sct Ho Ei Ho
Description:

fon.

DB Cooper-38304

==== Part 86 · PDF page 228 · Bates DB Cooper-DB Cooper-38305 ====
YOUR_RIGHTS_.

Pe

Place
Date Tee, 5 Va IE We =

rime 10/2 552)

Before we ask you any questions, you must understand
your rights.

You have the right to remain silent.
Anything you say can be used against you in court.

You have the right to talk tol a lawyer for advice
'before we ask you any questions and to pave him with you during
questioning. 7

If you cannot afford a lawyer, one will be appointed
for you before any questioning, if you Wish. :

If you decide to answer questions now without a lawyer
present, you will still have the right to stop answering at any
time. You also have-the right. to stop answering at any time
until you talk to a lawyer. i

i
} ;
1

; WAIVER OF RIGHTS

I have read this statement of my rights and I
understand what my rights are. I am willing to make,a state-
ment and answer questions. I do not want a lawyer at this
time. I understand and know what.I am doing. No promises
or threats have been made to me and no pressure Or coercion

of any kind has_been_used againge*—-

Witness '

Time JO: 86 pm !

' ' f DB Cooper-38305

D6
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==== Part 86 · PDF page 229 · Bates DB Cooper-DB Cooper-38306 ====
FD-340 REV. (6.24.65)

File No. V/A SF " |A- lA
Date Received 4. SECA? 7
From

{NAME OF CONTRIBUTOR)

{ADDRESS OF CONTRIBUTOR}

{cttY AND STATE)

(NAME OF SPECIAL AGENT)

i To Bo Returned | Yes Receipt Given [| Yes
ae

Ag Sout PE

DB Cooper-38306

==== Part 86 · PDF page 230 · Bates DB Cooper-DB Cooper-38307 ====
FD-395 (Rev. 1-10-67}

INTERROGATION; ADVICE OF RIGHTS

YOUR RIGHTS

Place fAnywowr€
Date 2/44/77
Time 72.5% La

Before we ask you any questions, you must understand your rights.
You have the right to remain silent.
Anything you say can be used against you in court.

You have the right to talk to a lawyer for advice before we ask you any
questions and to have him with you during questioning.

If you cannot afford a lawyer, one will be appointed for you before any
questioning if you wish.

If you decide to answer questions now without a lawyer present, you

will still have the right to stop answering at any time. You also have the right
to stop answering at any time until you talk to a lawyer.

WAIVER OF RIGHTS

I have read this statement of my rights and I understand what my rights
are. Iam willing to make a statement and answer questions. I do not want a
lawyer at this time. I understand and know what I am doing. No promises or
threats have been made to me and no pressure or coercion of any kind has been
used against me.

Signed b6

Witness: | AB, fo. fon p- _ KB, i
Witne yy Jt 7 BI Lynckise geod,

Time? PZT ST Pm

heel! SCE"

DB Cooper-38307

==== Part 86 · PDF page 231 · Bates DB Cooper-DB Cooper-38308 ====
FO-340 REV, (6.24.65)

File No. LO F— SFA /fil

Date Received BL C CL? VA

From

(NAME OF CONTRIBUTOR)

(ADDRESS OF CONTRIBUTOR)

Lhd fo veh

Lett 4p OF SPECIAL AGENT?

\ Yo Be Returned Ci Yes Receipt Given [7] Yes

qn

Description:
WV Ais
| pi

DB Cooper-38308

==== Part 86 · PDF page 232 · Bates DB Cooper-DB Cooper-38309 ====
or a ee ae
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ae ~~ — —. -—
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elegans may es. _ ~ — — — ver yaa ~~ ——— ~e _ ~~ ~
i ee ——_— me ee ee ae ca ge moe —
_ mn te te mo ee _ a »~ ves ne
a ee we ee ~ es _— ee eee
we eee a ae ~

DB Cooper-38309 |

SR a a ne ee pti * cee a oa : a a

==== Part 86 · PDF page 233 · Bates DB Cooper-DB Cooper-38310 ====
FD-340 REV. (6.24.65)

wit pH?

File No. "i. 59-6!"

Date Received LBoLt

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Foi3 Lo. Le Vj) 7m

f ,
, Te Be Returned Yes Recsipt Given
i ae pt Ae Yes

Description:

DB Cooper-38310 ;

==== Part 86 · PDF page 234 · Bates DB Cooper-DB Cooper-38311 ====
FD-395 (Rev. 10-10-67)

INTERROGATION; ADVICE OF RIGHTS

YOUR RIGHTS

Place Diterbe Ah

Date Da - 30 /F27fP
Time "S40 2

Before we ask you any questions, you must understand your rights.
You have the right to remain silent.
Anything you say can be used against you in court.

You have the right to talk to a lawyer for advice before we ask you any
questions and to have him with you during questioning.

If you cannot afford a lawyer, one will be appointed for you before any
questioning if you wish.

If you decide to answer questions now without a lawyer present, you
will still have the right to stop answering at any time. You also have the right
to stop answering at any time until you talk to a lawyer.

WAIVER OF RIGHTS

I have read this statement of my rights and I understand what my rights
are. I am willing to make a statement and answer questions. Ido not want a
lawyer at this time. I understand and know what I am doing. No promises or
threats have been made to me and no pressure or coercion of any kind has been

used against me.

Sign

Witness: _ e a#-, FbZ

Witness:

Timer 3742 £79:

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DB Cooper-38311

==== Part 86 · PDF page 235 · Bates DB Cooper-DB Cooper-38312 ====
FD-S40 REV, (6-24.65)

lp Ul

wat

File No. /6 Sf —- SS jee

Date Received 4 Lz of Zé

From
(NAME OF CONTRIBUTOR)
{ADDRESS OF CONTRIBUTOR)
BS
LD7C
' To Bo Returned [] Yes Reccipt Given Yes
Description:

biknviu' Fog, OW

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DB Cooper-38312

==== Part 86 · PDF page 236 · Bates DB Cooper-DB Cooper-38313 ====
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ED. _ aT gat BIC

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L240 -AD- a Ond ~ (lnclgunene. :

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DB Cooper-38313

==== Part 86 · PDF page 237 · Bates DB Cooper-DB Cooper-38314 ====
: Description:

670
gest"

File No. 16 ¢ —357 Lb '7

Date Recelved L LB ", LIE
From

{NAME OF CONTRIBUTOR)

{ADDRESS OF CONTRIBUTOR)

b6é
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| To Bo Returned [| Yes Recolpt Given [| Yes

g= oe

pepe,
JAalornvinw

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DB Cooper-38314

==== Part 86 · PDF page 238 · Bates DB Cooper-DB Cooper-78219 ====
DB Cooper- 78219 ,

==== Part 86 · PDF page 239 · Bates DB Cooper-DB Cooper-38316 ====
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a ee ne en en ~ - a me eee re ee oan ey " ~_—. —
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ee ane ee eno ce coon neh orn ey ee os
*
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whe ee - —— — eee ee ae ret tite a - ~ -
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_ DB Cooper-38316

==== Part 86 · PDF page 240 ====
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==== Part 86 · PDF page 241 · Bates DB Cooper-DB Cooper-38318 ====
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DB Cooper-38318

ake ote eee eg ie er

==== Part 86 · PDF page 242 · Bates DB Cooper-DB Cooper-38319 ====
na Tote .
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tes weet ee ee coe - ; ; eee ee eee ve
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we see _—_ epee snes onan, eee ee - See eee
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ene nev ume wut cee mun cco eae ite uae inten anes ae nonpeiiney ty cee pupae pgs es nna aman eens mies a gunn (pu ns
eo seer ses aces enue peruano epee ein te . a oe ae
- cee eee we eg a. nt i ee en te eae
- ee ee ee wc came ge rune ae pep ee ee ate _

DB Cooper-38319

==== Part 86 · PDF page 243 · Bates DB Cooper-DB Cooper-38320 ====
FRA1Q BEY S1477) "1 cara oo

; To Seattle , File # 164-81-/)
From Portland, File #° 164-41
: Portland_airtel _, Dated _1/5/79__
. Field File No.
, 00 and File No.
f Date Received
From

{NAME OF CONTRIBUTOR)

{ADDRESS OF CONTRIBUTOR}

{CITY ANO STATE)

By.

(NAME OF SPECIAL AGENT)

To Be Returned [| Yes Recsipt Given L] Yes

ne [Er Ke

i Description:

One business card of D. B.
COOPER, Director, Cooper's Sky Diving
: School, Sky Harbor, Salem, Oregon.

*
ioe ee ry

ern en eee an -

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um

de ver (C80

Beer ie PONE NOMC a Lek De Siaebees-oaerz ac lot loans att mer rnc eer tereeeg hed

le a

DB Cooper-38320'

==== Part 86 · PDF page 244 ====
_™

-
4

Cooper's Sky Diving School - |;

Specializing in Night Jumps * ii
From Large Jet Aircraft

D. B. Cooper Sky Harbor Field
Director Salem, Oregon
Airline Jump Operations 503 $200,000

==== Part 86 · PDF page 245 · Bates DB Cooper-DB Cooper-38322 ====
FD-250 (itei-s8

_ DB Cooper-38322

3 i

==== Part 86 · PDF page 246 ====
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FD-340 REV. (6-14-77)

@

Field File No._/ o4/~ 81 lA

00 and File No /@ Y-/ 2S

Date Receiyed—s 3H of) 2

From "Ex IVE NV

(NAME OF CONTRIBUTOR)

(ADDRESS OF CONTRIBUTOR)

ATED

By-

AGENT)

To Be Returned CI Yes Reccipt Given, C] Yes

[ee ——"isCSEET we

Description:

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==== Part 86 · PDF page 247 ====
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==== Part 86 · PDF page 248 · Bates DB Cooper-DB Cooper-38325 ====
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Tol GLE lwdItkK fer BB sail, $s

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VITIC. Qtr Thasrescnerse, Ev bay te. VECO
NNW PL . fExokdr~ WOT" [PE Cogs

==== Part 86 · PDF page 249 · Bates DB Cooper-DB Cooper-38326 ====
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DB Cooper-38326

==== Part 86 · PDF page 250 · Bates DB Cooper-DB Cooper-38327 ====
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==== Part 86 · PDF page 251 ====
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==== Part 86 · PDF page 252 ====
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==== Part 86 · PDF page 253 · Bates DB Cooper-DB Cooper-38330 ====
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==== Part 86 · PDF page 254 · Bates DB Cooper-DB Cooper-38331 ====
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==== Part 86 · PDF page 255 · Bates DB Cooper-DB Cooper-38332 ====
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==== Part 86 · PDF page 256 · Bates DB Cooper-DB Cooper-38333 ====
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==== Part 86 · PDF page 257 · Bates DB Cooper-DB Cooper-38334 ====
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==== Part 86 · PDF page 258 ====
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==== Part 86 · PDF page 259 ====
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==== Part 86 · PDF page 260 · Bates DB Cooper-DB Cooper-38337 ====
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| | | | | PART NO, DESCRIPTION STOCK Size SPEC'S, | « NWA STK. NO,
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==== Part 86 · PDF page 261 · Bates DB Cooper-DB Cooper-38338 ====
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