Doc 0000146231

'· .A'/~~ 6?~ OFFIQ~AL DISPATCH ~'·~ l_TJl . VIA __ ~·=~ ISP<"<"ily Atr"' 5->a P'>uo:hl TO Senior Reprasent~tive~ DATE -2S-Fobntazoy-l~54-- . . s--· FROM ,4 GENERAL Security SUBJECT { SPECIFIC Interview Forno 1. Ue are Sf'!nding you hcreul th Ul11 .lor oerarato c er npproxin1.at~ly t'.io hundred intcrtiew form:1~1 a1·~ designed to no you in tha rc cording of yo1.tr CMt'B in th_ . ea.. lbese for:l3 osen specifically on the discu!1s~.ons hdd prior· o your rlepertur.~ and s our belief they co~er, in g~nernl, all necessary infonnatio~ 2. To assist you and to am going e~lain A to rliscuss ench itam below. I r~~l . could easily fill out thP.sfl wi.thout form~ the elcnt'nta we Dre particuln ~t,.n1 liberty of explaining each in de . eelf-expln.na ancl ~ry sh~1Jld - into AnY rnst~riel av~l&ble any rP.ference · ·~- '•. and should solf-e~~lnnatory vas held. 5) Securit:v Pr~>c:mtions Taken - Z.!/3roly rnnk~;;~ a brief stat~r:')t3nt thot the or wnl! r;ot unri~.r gu.ar-1; .wns .s.t n ea!o houao; (da:scriba them) wcro tllken • FORM HO. 51-29 ~ K''l lfl~!l rr.-1-1:2~-! t: ~ :-O•trc"'•t•" ••tlltl~o~r. ('.,-I':. I - : .;.· ;.. - - •. -... _. . -• -~~-· .·.. - . ..... ,_, .,£'. ..-.-. - ~. . -- -..· . ." "' >"." ' . --- •..:. -.. • .. .. s/3 -~·,..·- pc:aaonnol t.o be utUized a.nd direot.ed Uo consideration or saour1ty and ita opor~t1onal or ~"\].icatlone 1n 1mplomentat1ona thtJ L'iald ~nrimcnt.o. or 3• St.atU!! t\flliCif.)l\~ • whero is it? Ito ~ror.;rll.'U7 It just oporat1on.t\l SUJ:POrt, . CJ£ TIISO:lrch and dovolop:xmt ' · •• urency aot. up in U1e \ ..... ··L . . . •. .. . •. . ~ " .t ' . .. . , . . . ~ . . ' .. ,. .. ·r. • • ... t.• : -'···· ! ,: .,. ..~ ' '' ·~ ·.-·' •• ·• ~,• .l, ~ ··.:f'.I'~,. .. y ~ •~ ).• o : o :~"'· o .....~ 't; ,l~. I • . 6) -Conolete P sical and HenW. De:Jcrl tion o! !lub ect - State ·.:.Jwoo. her~ the u.~mnl pcy~ cal dgscrl-ption • 1011 , lo.ck .ha.1.r, stocey build, cr1pp1M, wounderl, etc.). AlHo describe Sl~bjtllet• s blood heart or nny phyaicnl you pres~~, rat~, oth~r n~ifeatation~ have obst?rved or obtain~ri. vl~ sugp,est also you stnt~ th~ tnt~;)!'ct wc3 normal (int~lli~e!'lt, null·) or tloopondcnt or )H\tl att~J!'I{lt!ld This page displays a graphic that includes a large, metallic vault door on the left side against a dark background. To the right of the vault, in a stylized font, is the text "THE BLACK VAULT" in white, with a blue glow. Beneath this title, white text provides information about the document, stating it was obtained from The Black Vault, an online database of declassified government documents, specifically mentioning the MKULTRA/Mind Control Collection. The text also indicates the collection contains over 20,000 pages declassified by the CIA and provides a URL for downloading. The bottom of the page has a bright blue, blurry area. The document is a typed, official dispatch with several handwritten annotations. At the top, "A/B, 2, 6/14" and "H-B/3" are written in blue ink. There are several redactions using black ink, obscuring parts of the "DISPATCH NO", "ATTENTION", and various fields on the form. A stamp indicating "CLASSIFICATION" is present, with the actual classification level obscured by redactions. A form labeled "FORM NO. 51-29" with an issue date of "JUN 1949" is visible at the bottom left of the page. Redacted text also appears near the bottom center of the document, over a section that appears to be a coordination officer designation. Several instances of the letter "A" are written in red ink in the margins. her~ the u.~mnl pcy~ cal dgscrl-ption • 1011 , lo.ck .ha.1.r, stocey build, cr1pp1M, wounderl, etc.). AlHo describe Sl~bjtllet• s blood heart or nny phyaicnl you pres~~, rat~, oth~r n~ifeatation~ have obst?rved or obtain~ri. vl~ sugp,est also you stnt~ th~ tnt~;)!'ct wc3 normal (int~lli~e!'lt, null·) or tloopondcnt or )H\tl att~J!'I{lt!ld suicide or osc~o racgnt~· or ~1otevnr cloo you:reg~rd as impor tant data •. 7) Briar Eack - Olvo hare a .. ··. .. ·,: brier backgr~~~ of su hist.or;r. StRto wh~ther or wl~ h~ l-1&3 bePn n3~~ w conn~:w·th the? uan not · ·had been uso . ' Qr 0) Cbjnctivee tha Int~rvicw - A. is aelf-explanntor,y. B and C ure rela tad and it. is i.Jnpor ennt that. you axplain brl~f'ly why /.11'! ICHUK!: wAs used m1d 1! cortnin specl!ic d'l taUs ~re de !Sired, e::actly whnt. tho so dotcl.ls w~o. 9) r.~:J".llts- Fill in h!?rc ('X::\Ctly rJhat.. th? int'!."rVif'W ol•tnlnf13rl. If cerl<iin qu'lal.iona hnve be-::'n enewcr'9d, cornm,.nt on }h9S"' l!.n1 . if tho .::n:;~ officP.rl! expr~ss oat.is!a.ation or <ll~sat.isfaction,. ·· com:~nt on thin also. · · " ~- f!CTEa Qu~stloi13 through 9 (F~ge 1) a1·o for· a g~nf!ral ptUC: po5~ nnd are ds::JignP.d to be ablo to be shown t.rh~re nGceasRZ:i in tl~e , g~ncy. Pas~ 2, howPv~r, i:s fer ~m3 consu11~tion or for l.ho:1~ with_ n ntrul to knolf nnd ore t.o kno-w complete detAils. entitl~~td ~ohnicnl 10) Co~r,r l13ed - !lr.icfly r.t:\t~ hF'l'l'? lwv t.!K· ::Pbj~ct 'tH!o ~ppr:-,g~herl, wlmtJ1er it-llP.S a mn•:U.cal C:l'.t"r or uheth"lr thP. eubj~ct hnd "volun• tnrllyt' r"qn,.stc1 th~ int.~rvl~~.r or nimtflv~r !n-:-thor! yo'.l havo un-:;d. 11) 1ir.rr~>t:tvl!) r:~nort of 1r!tl'!r'Jlcw - thln nh:uld br- a brl~f e;to.te r.cnt or e~E\ctly llhnt oocurr~'' in tho lnt~x~,,. I ~H M<i !'llwul,1 cow~ let or in rlot~.ll m~nctlJ "'olhnt. ,;~nt on, ~b:lnR t.:1r:1 tlr.~-r., tll~ ~r:t.h·ltif'~, rl~~crlpt.iona of t.h~J arrJr~, nnci nll cin.·:un"'t::~n~~n thet. nre pr.rtin!'nt.. .. 1?.) Clinicnl nata- Thie eh~tlrl be a brief, exact st~t~~nt ~r ' any chenti.cals used, dor.:nr,es, te!ta mado, desC'.ript.ions of administra tion of chemicals -- intravenous or etc. otherwi~~, - : 2 .. I .. .,. -.... -·. 'a. - ~·b '· 13) lt ttsa - S~t out. h-:'rn in br!~r how H wm• ue~d; 1-thnt C'Y:eJ' ~-.8 and, used to i..'1troduce it, longth or ti.mo in effect in gen~rru., what result a Wflre obtained. · 14) J.mes1a - Amnoeia is nl.uay-s inportnnt t:> us a! :rou knmr The image is a scanned page of a typed document with significant handwritten annotations. At the top, a date "10/8 22 Coober 1954" is visible, along with some illegible scribbled text. Throughout the document, there are multiple instances of handwritten annotations, primarily in the margins and interspersed with the typed text. These include single letters like "A", "G", "H-B/3", and "B/3", all written in a dark ink. There are also several dark redactions that obscure parts of the typed text, particularly in the middle and right sections of the page. The document appears to be a set of questions and notes related to "ARTICHOKE". 'a. - ~·b '· 13) lt ttsa - S~t out. h-:'rn in br!~r how H wm• ue~d; 1-thnt C'Y:eJ' ~-.8 and, used to i..'1troduce it, longth or ti.mo in effect in gen~rru., what result a Wflre obtained. · 14) J.mes1a - Amnoeia is nl.uay-s inportnnt t:> us a! :rou knmr P.l"'1 "" w-..m l·l llkfl a brio! fJf!sct"irtion or whoth~r it oe~Jrnvt nr.tl ln~1 in your opinion it vns obtnined. ~lh<'!thtJr by dirf!ct. H, drug or r.hl)mir.al &gl'tnt.s,. '. lS) Rllmllt& - nus qu~:;Ll'm .i3 a:Ulllr.r t.o s· !:u i: h \ ~~~ wn w 1ul t or lik~ to h~ve ]~ur personol L~ros~lon lha rcsalt~ o~Leined eith.,r from what infomation 1ftUJ GP:urod enrl/or r.r~~ en E''"ql!'ri m-ntal point or Tie-... It. 1a p~J!!!1.bl~ thnt. this q"J~,tion vill hav., to lie continul'}u on the othl'r ~iuc or ft·jJI! 2 \U11:!r ~'.lf'!\t.:bn 21.. l6) \o;as InV.,rv:i••w Iionil.ored - l'he qu:.·nti'>n ie sF..·lf-~Y.plr..n:~t.ory. 17) HN''J !'h'Jt. . .,~r~)h9 'fll~rm - Thin ir! also uclf-expln.unto%7. ·. . ~ e '?d ·r'e ~>ul rl e/3 .,., you uee t ruv ti.Jne ~~i.rlt~rv-ln'\11 or art~l-,.a.r-io tm·i tho rotlt;')nt lj' y!')u uoed ~~nd what r~3Ul:t'!d. Tldfl nay be V'Jr:/ important !ron a or p~Jlnt vlow 'J! croe!J•chcoking ranult3. 1?) (Cnt Pt!~~ 3) Ol.HJ~rvt~U,.,ns l'.n i Cm•r,t-:'nt.::; - ;:ct. out hnt·.., n1~' infCJrn.,tbn yO'...l ro~lll":;j'QT &G prrl.inont aS'Co t·~chnl·.;:~~SJ r.upport; etc. · . i~~BBJ ~ LO) n11co~n,!ation3 • P.P.re you ehoul~ cor:t.1nnt ns ···to uhat. rc~om- ·· Jr.P.nrir. \.ion~ you mafie ill t.hP. ~1Jpoui tion c£ t.br:J •,C.:l'G (if ri:!(\UI':~~d) ~. ·.~ l)nr:\ roco::J11emd nny idett~~ y:>u nay have n~ to i'ut\u·c 1.zo:.'k or tec:}Uli't:l!rs. "" ' 21) Mry Aclilt1.ona.1 Infor.nat.ioll - S~lf-oxpla.nntory. ). \·ie h<i.v-~ ntt.,~ t.~rt t., 94lt o\\t ln t>G l;ri~! a •i~C.C2 U:) poD~ !.i:l~ t..he c: ~i r;niflcnnt clr:.•::r.nt..s th~t. sbolllti b~ cymr~d in thil! H rr:~. f,ll ur- "-l'C' ttE:rc~cl that. r\Jll :.h\>ltld !e~l fr~g to :rpp~n'l t.:J th,:>~:? fornn cnr <>d'!J.tLm3l inforntttion ;r:'a f~r.-1 p;.,l·tint>nt. or if th~ :orm3 nl'i! r.·J '- Lm·~· cn·,::c~: n·H pa.gns lal you ~i ~:h con·J~~~~~''l• Th~:J"' !cl'rn5 wHl l;~ !or,;ordcd to . or tromnn.to1.1i'm t'.J lioarlquart~rv. · . 1,. ~.11 or UCJ linrr'l arr. W:lldltn~ Cor r)~'1tclop:-lent.5 :t'\ th. ...~ 'Ti.':W'i{1~ W')r}: wl. th ":1""'"'1:. in t~r,.nt. Ho dt') ntJt 1rtr,h t") plac~ nny unn9Ct'!73t1ry burd~N~ on you lut. y~ur corr:1:r:-nta conc~rninR th11 lnrk oth~r than these offlc1~1 r~p,:-t~ would 'bP. 3 .. ,·.·f.·i~t t'.J lioarlquart~rv. · . 1,. ~.11 or UCJ linrr'l arr. W:lldltn~ Cor r)~'1tclop:-lent.5 :t'\ th. ...~ 'Ti.':W'i{1~ W')r}: wl. th ":1""'"'1:. in t~r,.nt. Ho dt') ntJt 1rtr,h t") plac~ nny unn9Ct'!73t1ry burd~N~ on you lut. y~ur corr:1:r:-nta conc~rninR th11 lnrk oth~r than these offlc1~1 r~p,:-t~ would 'bP. 3 .. ,·.·f.·i~t '. ~· ~-------- ·~-..~ ~_:·~-.---· .. ·· ..• ·.~· ••. -:._ ...- -..... :-:-.A.:. ... - .... .. : . . . _ .... -~~ . -,. . ._ ..... .. · . . ' --···· ._ ...... ..·. ...... . ,"',I •. -; ·-·--. ~ . · ~-..~ .. · would be greatly oppr"oia~d at ll!V tim'!. FUrth~roor!'1 it you t eel that. ... ~ .. you nrt:t in nP.od of adrli tional euppli,.e end cnn::ot obtain them locally 1 plPr.e~ lfl"lt-1'? to u:; 11r acnrl a dispntch an1 uo rlill at.tempt to procure tm necessnr,y 1t~n. . ' Encl Approx 200 forma (S/C) Pr~ F~-~J.rl - Or5.g (., ?. so - 1 :RI Copy - SO File ...... ' ~ ..... ___ . - 4 . .. . - . ~:-:-._ . .. -..· • .. •" . -~ _.,,· , r !vI_ ·.·• .·. •·.·., • ~ .,.;. . ... I. : · , · r. ." l : l ... . . . . . l. .:-.l i . l • f 8 r,e 1 ..... .. . ~ • . . tri · ~ iJ:TICHC}.~ I!:'ERVIEi·/ ( Genen:l) .. -if3 ., De t.e :-ie port ;; "'a •• en ..-.-_. '. 1. :::.1 :E --------------------------- I' - ------ or CCD!: LESIGFJ..TlOJ .. ~ ~ 2. FI..;.CZ: }:.;,;:DI...ED ----------------------------- 7. • -t::; ..; o._T..h...',T.r. ' _ J: . .f CY .u .r t ' t C•U . N . 1r J (•r~ SU ~ ; : v .r ~ ;;· c·r J ' . , J ' \ i l D c·1·.:;~.-"...·.J ;•:. T ~. " J " '1l " · : - J ~- V - (u,,L·O•. d l:-ecn used rreviousl,r?) -.. '~T n: 'T::'.S .f,IW HCoU!\5 ;~fl:VCLVE.D IJ; mT~~~'lEh'/S ~~ 1' .. ·'. ------------------- .. - L. :-?.E.SEI:T ----~· "· Ted.!ll Chief .. ----------------------------- E. Assistinc 'l'ea.rn !·;ember .. c. r. Doctor --------------------------------- ! . .... r~chnicil:.Il ~· J;" C!'! se Office - r - / ~ s - - -- - - - - - -- - - - - - - - The document is a scanned page of a typed report, designated "B/3". There are several handwritten annotations, including the numeral "B/3" in the upper left corner and a handwritten "2" near the bottom, indicating page two of the document. Several sections of text are obscured by black redactions of varying sizes. The document appears to be a form or report with numbered sections (6 through 12) that outline specific information to be provided. Additionally, there are some faint, illegible markings in the upper right and bottom margins of the page, possibly stamps or routing marks. .. - L. :-?.E.SEI:T ----~· "· Ted.!ll Chief .. ----------------------------- E. Assistinc 'l'ea.rn !·;ember .. c. r. Doctor --------------------------------- ! . .... r~chnicil:.Il ~· J;" C!'! se Office - r - / ~ s - - -- - - - - - -- - - - - - - - -- - - - - - - - -- - - - - - -- - - - - - - - - -~: F. lnterpretor 8. CEJEC':'Iit'L.3 lJF TH:: INTI:HVIEW / \ G. Observers or lJtbers l \..rhy pr~ sent) __ _ i... Open. . tional or E:-:perirr.ental ... _,. B. :-!hy Jd'lJICi:CKE '.:as used/rec!uestf:'d C. ·.. :bGt infornation or det:::.ils desired :· 5. SECU?.ITY fF.EC.hU'!'IONS Tid·:::Ell 1· .•, ' ,, -----·---------------------------------------- .. ----· 6. CC•l·:FlETE FHYSIC.t.L J.J:D l:li:TJ..L DESCniFTJC.'Ii OF 5\.:BJE:CT ------------------------------------ 9 • .PJ:3ULT.S (~f.ecific d~tt.:ils--fevcraUe, ·•. l.r1i'c:\·n·d·le) .. \ . ~ ... . . -,·eRie eil ... ·' r. . . .. .. . . .. •. .... .. .. ·· . ~ . .. · .. . :,_ . - ' ·. . ' .. ... : ......... ~·i --------- ' .•. ..: ., - 1-' f\' -. 1\.J ,, '0 ll'] 0 (") 0 r:; ~ .. :.•1 0 ... 0,_ , ~ ,. . ; ~] H . :t':1. n .. ... {,) ' ) ... I-I ,, .. :.:.- (") rn t:) 0 Q ~ ~ ""3 .. t•l .. - - ... ... • ......... ... -~- :"' .f\J ...... . ·- td .. >-1 :...:.· •< ~ :-:--- ::· - . c . : 1 t t : : : ? ! t'; H ""3 ,...., H _ _ , (") _...., --ij ~ t"' tt.l. . r .., 1 •...- I., :;l. ·~ <.:). \--i f-; (.J I .- H ''1 •r·;. ''1 H r; ~ 'l ~~ .... ~ ' ~ ~ ', ~. ,I This page contains a form with numbered questions, some of which appear to be partially filled in or annotated. There are handwritten markings in the margins, including "B/3" in two locations and a large "A" on the left side. Some text is obscured by black redactions, particularly in questions 17 and 18, and in section 3. The page also has a handwritten number "3" at the bottom, likely indicating a page number. The overall appearance suggests a document from the MKUltra project, with administrative notations and remnants of experimental procedures. The image is a scanned document page with several sections of text and some visual elements. There is handwriting in the top right corner that reads "B/3" and a distinct "A" handwritten on the left side. Several sections of the document are heavily redacted with black marker, obscuring portions of text and what appear to be printed elements. One redaction on the left side covers a significant portion of a line of text with an "A" drawn to its left, and another redaction near the top right also obscures text. A checkmark is visible next to "SO File". This page is a form titled "ARTICHOKE INTERVIEW (General)". It contains mostly blank lines for recording information about an interview, with printed questions about the subject, place, dates, personnel present, and objectives. There is a handwritten annotation "B/3" in the upper right corner, and a smudge or redaction over a portion of line 7. The document appears to be a standard report form, not containing any images or diagrams of procedures, equipment, or facilities. The page appears to be a form with numbered sections and lines for text or signatures. There are no photographs, diagrams, tables, or filled-in fields visible. The text includes numbered sections such as "19. OBSERVATIONS AND COMMENTS:", "20. RECOMMENDATIONS:", and "21. ANY ADDITIONAL INFORMATION:". There is also a line with "SIGNATURE OF EXECUTING OFFICER" printed beneath it, indicating a space for a signature. Some content appears to be redacted with black ink, particularly in the lower left portion of the page. The page is also marked with "page 3".