Doc 0000144964

·ev .. •" .~· .. E;\IPLOYEE,S :\OTICE OF 1::\Jt:HY QH OCCt:l,ATIO:\AL DISEASE Federal f-mployc~:s' Comprnulion ~ict or Thi~ notic~ ,.hm•lrl lw:- ~,,!.mittr.l to the immfdi:l!r ~uprrior h~· :~n injun•<! ch·il t'mpl,~·('~ lht- rfdrr:~1 Con•rr.:"':rnt, or Lr !'omr·onc un l•i" h~h::~f. "cJ!,Ja h i:our~ :tltt·r lh•· i'!j1:ry. :\ntic-1' t:::t~ br ::i••·n t•iriu·r r•·r~n:.:~lly or by !'I ;ail. J.J ,:::.•.ld be rcl:~inr.J b~· 11:1' ro;! •. -i.ll <11:1\'flftr u::!<'•' I he i:1j11r~· C;tll•l'" ai;:ahit:ry i~or ,.nrk .,..,.,,uillll· rlar or ~hiil wlu·n iniun· o,·r.•rrrri. or rr~ulr,. in .:\Jiy ch;:r::•• :t::.::•n·l rh,• J;.:~,·:Ju lur t:wrih·al t•'l;;:rn•c. "t·c·n il'•!wnld It,• fnr":lrc,•clln lht' l'. ~. IH:I'.\I:T:.:t::'\"(' OF 1• . \1:01:. J:un·:tu 1r! J:;:~•-lu~···· .. • l'u:nru·n~:~rion. to::t"lhrr '~<llh rhc •· :ici:1l ~uJ>rrior·,. n·J~urt o( injury, Fo~n1 C. A.:!. ;:.(ure contpcn~:~l ion i.s l"•i•l. ,,·ru t.::1 cl.ain~ on I urm C ••\ . -1 mu•t Ire l'iuhmillt·tl= tu= t=he= J=:u=r•·=:~=u. ==================== --~'?..i.19;G.;;l1.g_r_ 1~...5.3 \ Date o! this notice , 1. I hereby certify th~t I am cn1ployed as a ... S:J~n:i,•tQ:"'J. .. :E:~.Q:~~.;i.:.'t.. __________ . · . .' \ (Ckcuralioft) at the ___S _Q.l)i:;:!s.i.P . : . . ,- --~:l9 .~P.l!?;...c.~..l .. 1~:~~::'- .-~:.. .~::~~s . ...... ______ ..._ __________ . _ __ and on _:..e ." . " : ' ! ~ " . . T r . . f ~ ! . : • . J ;: .. : , : ,. - • . _ , : -_ 1 _ _ _ ' _ , _ ~ · _ , _ . _ ; _ ' , { . _ _, ·\ • . -?..~: (P ~J I. . & : c : e ? : o : f ~ ; e. ; m ; r - • ~ :. ~ < : l : ., : < z l = \ . 1 _ , 1 . .. _ , I \ , , : . . ; . , .. A H C > :_' . .. ~ . l ~- . - J • J a - t- ~ - ==-~~":"'-~~:!:!.. m. . Cl'•J' of .. nir.l • \ 1Da:e)· .. r . \. ·.. . "CJ·I0 <1r, a. m.,or p. 111.1 \ I \\ . a s m . ; . u rcc 1 . m ll tc p " .. 1 · f 0 1 . m :mcc o r m~ \. d u t 1 ' es . The image depicts a digital banner advertising "THE BLACK VAULT," a website containing declassified government documents. It features an illustration of a large, metallic vault door with intricate locking mechanisms, symbolizing security and hidden information. The text explains that the document is from the MKULTRA/Mind Control Collection, a compilation of over 20,000 declassified CIA documents available for free download at a specific URL. There are no photographs of people, locations, equipment, or subjects, nor are there any handwritten annotations, signatures, official stamps, filled-in forms, diagrams, schematics, or tables. There is also no visual evidence of experimental procedures, equipment, or facilities, nor any redactions or obscured content. r . \. ·.. . "CJ·I0 <1r, a. m.,or p. 111.1 \ I \\ . a s m . ; . u rcc 1 . m ll tc p " .. 1 · f 0 1 . m :mcc o r m~ \. d u t 1 ' es . .. . t. -- . -- t = ' - C - . -- - - " - ~ - : !. C . L - . - L -- V ·--- J -- . . - . --·;·------------- J - - ' - · - ' ~ : I ..L.. c-.-. --~.... ... -.·..: ~. . . . ...· (Locad'ln ..· locre h>juf7 ocourr.dl ~ ---------------------- ------------------~----- .~- !. Cnuse of injury ___ ...:..__J:!;l.?..Ji.~!.::-;,;_::L~:'.;!..-::~.O:l ...... _ .. ________________________________ _ (~ rriw u ~~~ )<nl un tow a no!·"'"' injou,. ..., • .,,.,, ----------------------------- .. ------------------- /' ---- ----·--- .,~-.---\ .. Il'l-;.:!:.:. .......... _ .. ___________________________ _ Nature of injury_ -~-----Chssif'i.c.d . • /'. (!otalftC , .. u .. r .lo-.!r a-•t\~t-t~J--(-r&R.-lun-d l-et! Joe, l.-r\li•t'\1 ri._:M,_ ~ .. mlo, etc.) - 7· b.t ~- r. ___ u_w j~jUI"Y -~0 ..::. __v _._~_._ -~-L---·-----· Names o! witnesses to __"_ "' _... \ ,, / \ I! this notice w~..s not gi,·cn within.-IS hom·s,:lfter.,t~tc injury, cxpbin rcn;:.~-;;for ci;i;;:~;nd stnte -;;~:-:1~ • • \ f tt..J.. LL , \ A • J ,., · __ I .. . , : . . ._ . v • ~ ....CUJ... ~l!' , · .. ~ .. ~ ~ , ~ ,.... . ._" .~ ~ \ .·\:::-'"'•·l . • .. \ • 1. • · If: .. ~ .. .O f perso r n to :whom no~H~e \\":lS first ' i g i\"Cn, :llld when_:.:__-_~ --:~-- :r · : ~-~ • ' ' :· \ _ ...... ...:.~.: I• • • :;- 0 - - e A -: •- , . .. • . l" . '\ : _• . : c . : , ~. - : - . 1 " r : - ' ' " - ' ' J r = - - ~ · ·" - = = - - · ~ " - ' ~ 0: " . ' . \ " - (' . J - - '? ~ . ~-:-: , - ' I . - r J \ . ~ : " - "" - ·" - The provided document is a scanned copy of an "EMPLOYEE'S NOTICE OF INJURY OR OCCUPATIONAL DISEASE" form, dated November 27, 1953. The form has several handwritten entries, including the employee's name, occupation, location of employment, and details about the alleged injury. There are also handwritten signatures and some scribbled marginalia, particularly in the section explaining the reason for any delay in reporting the injury. The document also contains a circled number "276" in the upper right corner, which could be a document identifier. No photographs, diagrams, or visual evidence of experimental procedures are present. - ~ · ·" - = = - - · ~ " - ' ~ 0: " . ' . \ " - (' . J - - '? ~ . ~-:-: , - ' I . - r J \ . ~ : " - "" - ·" - ". , .', ~ ~ . · & - .« ~ . ~ .· ~ . ' . ~, . ~." . .', ! ' t . :. ~. . - . . . • _ . • ; . ~ t ~, - ... • ~ - l. - .. - ) .. -. - : . . : ~ \ - ' ' : .. . .. . ~ U. , .- : . " ., . · . •. . · . . .! ' . ,. ! . - L ~ , - ;• - . ~ . ~ .!_ -~ ,. . '\ . . \ . . , . ! ! . : - . ! _ . 'c . - ; -r . . 1 , ~ ••• " .'-•"-.'. . \ ~ } ·•· ·..'r···, }.( { ,-{. ,. . · ~, . ~. - '· .)\ .." ..', ' ~..J · , - \,, , , \o~.•-, ' ' " I """ . ' -'l 1 ~ • ' . ..' [' t '' ; o, . . .. ~ , I t.l. { ~~ ;. ( , ';,. • J .;:_k..l' .. • • ... I· ,.t_\..'.· '·. ·I ~ - ~~ •' • " •. • \ ---~~--=--=·- '> ~·_.,.., , •• ---·-·---------------------------·-;----~-~-----··.:..--···-.:"··--~·--/..0.!. :-~ . This injury wns no~ c:mscd br my will!t:l m!sconc!uct, intention to hrin~ nbout th~ injur):-or dc:nh of y.scl! or of :moth~r: nor by my inloxic::ttio:~. :l:~d I hcrdJy m:~.l•~ clnim fot"' compensation ::t'"lld n1c<li.:i\l c:ltmcnt to \\'hich 1 m:~y bl! entitled by 1"~:\.son oi the injm·~· sust.:dt:cd hy me. ' . :") Name , · '-1_ _•_ c_-:_--_0_ •_ tI:I:._/._ •_ _K u \ • ·' ..-:-:::-:- -'1-:.....~,,- '.Fr~l!: ?.. C'!::on . Address ;1.?. . J. ·:=> ... : .. · . : .. ~.-.:.!.-.e.:.-..~.-.::. . l . : - . . -~·~"·.·.!·'"-."·1.·::·:·::·3· ····-- --~---······---.J lSU .... , &no! 1\ulftborrl ......" ..... " ...... •nc• ae-c:.au·• -cci;;;;·;;;;;-------·· . ' . .. . . J. ·:=> ... : .. · . : .. ~.-.:.!.-.e.:.-..~.-.::. . l . : - . . -~·~"·.·.!·'"-."·1.·::·:·::·3· ····-- --~---······---.J lSU .... , &no! 1\ulftborrl ......" ..... " ...... •nc• ae-c:.au·• -cci;;;;·;;;;;-------·· . ' . .. .