Doc 0000144973

.. .. .. (. .. ·. ' . . . • .. -.~ . .. .. • • .• ... . • .,. .' .. . , . . . ..• • . ~ ... .. .' . .· . • . .. . • = · .. .· . . .. ~ .. - . . . • ·- •• .. ... CT_ ___ .. .I. : ·' '· . Office Me1?20?a!zdttln · UNITED STATES GOVER1'\'::.r:=:NT • ' . TO : Colonel Edwar . .d s : Di'I.TE: Z December ·! 953 fRO:>t Chief, SSD OLSON,·'Franklin • Su'!:::lj~ct's death ce:-tificate, a copy (?~cto::;tatic} of which has bee~· o~tained a:.cl is bei":1~ fo:-•.va:-C:ed, inc:!c:1tes :-:.i.s occup~~io::. as a biocher:1ist ~nd business where this occu?atio:1 used as 110. S. Army Post". It also gives his wiie 1s na:-:1.: a."lc ,.,!1-ere .· they lived. With reference to cause o! death, it states death caused by multi?le !:-act-:=.:-es, shock a."'lc h.e~.or:-!lage; j~:nped o:- fell from 1 Oth.Iloor hotel. Ti:e ce:-ti.!icate was s i_ir.cd by 2.:1 Assista:1t Medical E;.:a.:niner whose signatur.e is illegi~le • . . I • • . .. . . • ~ . . • . -.; . . ~ • • " ~ • .... . • . ·.\ . -....... - .. . .. . • .. " ! . . ... .. • • .• . ..i t . • . ... . :.1)-, • ! • j • . . .. . .. ......... . . · -··· --~·: - .. ·(),, "·' : 'I\ ~, . CUY OF r-::w :Y. , .· · OEPASTM~NT 0~ ifEAliti ... 6U!\EI\U Vi· RtCOitDS At-;o :01.\ltSiiCS / • MANHATT,\N, Nto• Y~rl. N. Y,~._ D~C ·2 1D53 • .. It~ ... ;, o _.~rc-,lo!:: copy of..o ,,.,,;r:,o!·· ,.:.,. t:-"~":" t:. .. e• ••.. ,,. ,..r• R. . c,J: .. .,d s,,,;,!:u c1 ,;.., D·:p.::••,..,.,., of ~t..o:t:. c-1 !~c· ca~ ,.r t!.·- Y~ ,1 .. ~- .. . . .· .• .· ·. & -. .. - • Thia u to ccrtiry tnol tJ.e (oro9oi"9 is 0 lrve copy o.( o . . .r . e co . r . d iA .., . c . u .. u . o . - . j y .. . .. •.. ... .. • . ·~ C.lll L. H:iU:)l IY .:,. .1 '· I :.· " .· c. ..u or or a. .... The image displays a stylized graphic that acts as a header for a declassified document. It features an illustration of a vault door with intricate mechanical details and a bright blue glow emanating from its right side. To the right of the vault, the text "THE BLACK VAULT" is rendered in a bold, white, handwritten-style font against a dark blue, hazy background. Below this title, white text provides information about the document's origin and content, including a URL in bright yellow. There are no photographs, handwritten annotations, stamps, forms, diagrams, tables, or redactions visible in this image. . .r . e co . r . d iA .., . c . u .. u . o . - . j y .. . .. •.. ... .. • . ·~ C.lll L. H:iU:)l IY .:,. .1 '· I :.· " .· c. ..u or or a. .... .... ...." '•.;Is:•.- .• • • .· \'l;.:::i:'\~: CO l':vr ACCI.i·T i!~:S f!«A•:~.C~I?i lJ!':t:. .. s ::;: ~.~:"':'-'. I. ... SCJ.l 0:" ft-1: :>!i'ol.::.r.,.~::H C~· H:At~ :! !':. .\ffiX;.:; J~!~.~.!.\;:t i.t;.; r:. •;•: ~- c: n...r.:s. DUCTi':N JU,:ISC."W•r IS F~C':i.i!:to. NOT:CE: 1. . in,.:. • ~ tJ.:, lrcnt:rip' ol ,;. .. Rr-;crd. tJ,,. D~;>e''"'~ :r H.•"!•', .. ~ th-. _ C:t _ y o _ l _ :: : ... YcrC ~,..:, ,.,, r~rt.lv 1.., t\..• ""I" nf t!-- t!ol··~::-~• -r.n:o.' ., ~ft,,~­ . . .,,_.,..o..a,. .f. lo;..,.~,_:,., 01 · t.o -'"·•. l - o~ - h - ;.-o,- !-, ...-... po•:J. .. J L., I:. .. . . .. . . • 1' . ' ~ 0c · ,o ; w1·e n> J:' • . , C -1-1 -~ Cr/J /7!~ :/ The document is a typed office memorandum with several handwritten annotations. At the top right, there is a circled number '284', written in ink. The memorandum itself is on a standard government letterhead and includes fields for "TO", "FROM", "SUBJECT", and "DATE", which are filled in. The body of the text is typed and discusses a subject's death certificate. There are no photographs, diagrams, organizational charts, or explicit visual evidence of experimental procedures present on this page. The page is primarily text-based with minimal graphical elements. This document is a declassified CIA document from the MKUltra collection. It appears to be a photostatic copy of a birth certificate from the City of New York, Bureau of Records and Statistics, for the borough of Manhattan, dated December 2, 1953. The main body of the document is a form with many fields, mostly filled with handwritten text and symbols, but it is largely illegible due to the poor quality of the photocopy and inherent document degradation. There is a handwritten annotation at the bottom stating "Bad Xerox Copy" and another annotation, possibly a signature, that is also largely illegible but ends with what looks like "com." There is no photographic content, diagrams, or organizational charts visible on this page.