Doc 0000147394

The visual content of this page consists of a stylized graphic on the left and text on the right. The graphic on the left depicts a large, metallic vault door with intricate mechanical details, including multiple circular dials and levers, rendered in shades of gray and blue. The right side of the page contains text in white, with the heading "THE BLACK VAULT" rendered in a distinctive, bold, white font with a blue outline. Below the heading, there is a paragraph of text explaining that the document was obtained from "The Black Vault," an online database of declassified government documents, specifically mentioning the MKULTRA/Mind Control Collection. At the bottom, a yellow URL, "http://mkultra.theblackvault.com," is prominently displayed. There are no photographs, handwritten annotations, official stamps, forms, diagrams, tables, redactions, or visual evidence of experimental procedures visible on this page. ~~ .-~-·.:..-~--- ,:-.·. .· ...... ,. .... _, :.~~=-=· --~-:-:-.--=·· -·· ·- •. ~-;~ l.L.·.::.= .. -~ ~:.~.;, 1.·.~·. .. :,, t·• ·-·l:··:a .c .,,. ,,:: .. ,, I·· :•·a!' ·c: ''••• -~-~= •1 , .• ·., i•! •..• , ·! •. ,.. . . .._ :. •• ··•· ·' r r •'··: o4 ··,.i ·:: l r ,..~ ~'"·:' .~ l •·;..-•-: c i·~ •, ,.. .... ~ . .,..,! c-!"'"i: .!ny. ,, •.l lt•r. l ~ ,.,.., c..( !..it c: ;:--.U•. ~'; 1'·.···'.!.., .. ·· •··•'!'· •!•: ~·· '•' '·!r•:tt" :c! .·.·~· .. f\:•, · ·:.~··:·': ·· .·. • :..~·~~ .. ··!····"';. (r) "fl;:"' t.U:I:"'.;::r:•··l r•:ill;,;:a •:r,: .. _. •..:, :·n·l (~·· ·.• t•\tt ::\ ~-.: •.• :•:.-: i:.t·.&,l.·~.'.! .,; :."~;·.,,,;.;,..,L ( !J )',.:r,·~~·. ~,,,,:. ·~· •. \.? .'';· · · ·• !·•r"l •·: •.,•. l' •: .a ·; • ·· .· • ·.·.:·~,.~··:- ~.,: •. :·':':•rl. 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The c::.:.:Lil sho::'d t..: ~=~- -d by l!;e p.:r:.-:>:l r.l.~b;: t=:c c!.:.:O 0::' e:s C.:cly nuthc.:i:.cJ l\"j'm::e::b.liv~ •. Thcr.e shou!:ll·c sin~D : :cr.r:H·~ n!\c! ,.:!.:!:cHt·s o~ :,;, Ft'::'~O:ll who r:::•:: Lu c::~tit!r.tl l•l c:or::;>.:::~:.liu:: o:: ~<:wt:nt o( Ct':l.~h, l~;:d!.:::r '1\-ith t~e r.c!:l~.::J o( : ~n:a:\ =~i::; ::'!·d.1~, w!:.ic!:. tilo::::l b:: :.r.o:ll to !Jy th'! pc;:;oa C::l~itlcd lo ror.ar.r::~:<..lliuo, or by til:: }'-::~on ll'Jtl:or!1.d to . 0:1 ,..~ b:t. . ~r. Oo1U:o~ o: c!.:.i:J•n:~t; rt>;i:!Z:t: ir:t !c~ei:;-:1 cou::h!:.'~ s!tould be r:u~c bc!o~c .'\ l:roilccl Sb.tcs co:lsubr o!!iccr or ~Ct'teb.ry r;,! k·;:,1t:on U t..::urc :1 l.lc:ll c,;-;:~:.:1, ~ cc::i!:c:t.t:: c! s;.;.:~ t:::ilcd S!.:.tc!\ cu:su;;r c:~ci.::1l or :ecrtl:t.ry of Jc;;.:.Uo:l .s!lC.loi.::;; tl:.: ::.ut!a..,;ily r,! , ).JC:.l o!:ci:~.l to .:l~::::i.:.is!~·r c.:\lhs ,:,ou!tl be :n:c:ted. A Ctrtw::d COllY d :::.:: c::-~1!1 ccrti!:c.:llC: s'!:.~uld n:co:::p~oy thls tl.:.im. >~!1:\l!O.:l t.L t~:: W~ lc.::l c( t:!.s sucet. . )! (be 11:!~lil'>!l$!.!? to tb:: t!o::t: .... C.::t r:.C ~ny J>crso.:: c:~tillcd to chim co;t;;>e:~~tion u" tb:t.f. oC r.-1u;>tioo, r. ccrU!c:d C•'FY o! t!Jo cr o~ ~J~;.llo!l s!:~dJ ::.cc·:.:.:p:~nr t~is cbi:n. · - lh:::t:7.r:l Lilt·· in tha~:ic::.:.: conri:a!; t~:o: c:c!ic:.l r.ctl L:Jris.1 e...:pcns.:o~ .;,l:o•.altl ),c subuoi!tcd wil!a t!.ae cbiu1. ===== .. k'-·~-' .. 'D •. ~ ., __ ~ • :"'\.,- . . .J : Full nnmc or dcccnsl'd CIUjlloyce •••• :::::::~_:;};::.?.oo:.;-:.-:.1...~~~·-'?!1 ••••• ----·····-·--------········--·----------- A gn ••••~ :3- .----·· 3 • S C::t.·--·· . J .· ' • ·--·-········ ~ 1 . 0 C c I . · : } , n t' !O n ••••S.\•.: -';.).·~ ·-··r·-:= = '·· - = o -- - J . . • •• ? w• . • i • o • c ' :" r .: . . . - , .~ - ·• . . : .- . ~ ....- ! ••••••••••• __ l ---·······-·-····-····----=---· Wns c!t>ccnseu nb!o to spe-:1~~ En~ii~h? ._¥::;:~--~---- G. IC not, whnf. 1:-~~u~~c? Timo of injury: ('') _JI.~~~h?.!.". ........ -----; (b) ••.•••.. 2:;l....... (c) ••• 1Q53........ (d) •.. ~:.=!SL .... ~_. r:1: . • • • (."..o.·..·.·. . " :.:o.:..~l··s ... .,~,""- ~-,_c o..~..·..·..l.. ...... •. .. ,.....; "-· :·. .. o ... - . •. ·, ,J ..,.,.. (f" •I ll " ' ,a.u.c..• }1 .. • . . :.. J Plnco ,,},era The document is a typed form with handwritten entries. The form appears to be an obituary or claim form for a deceased employee, detailing personal and professional information, as well as details surrounding the death. Handwritten entries include the full name of the deceased, age, occupation, date and place of death, and information about surviving relatives including their names, ages, and relationships. There is also a handwritten signature at the bottom of the form. The document contains no photographs, official stamps, diagrams, or evidence of experimental procedures. This page appears to be a scanned document, likely a government form, with a significant amount of handwritten text and markings. There is a printed form titled "CLAIM'S CERTIFICATE" with several blank fields. Handwritten entries are visible, including a date "19" and a number "296" in a circle in the top right corner. Another section at the bottom is titled "CERTIFICATE OF OFFICIAL SUPERIOR" with a handwritten date "28 November 1955." There are numerous dots of varying sizes scattered across the page, which could be artifacts of the scanning process or part of the original document's appearance. While no explicit photos or diagrams of experimental procedures are visible, the nature of the forms and handwritten entries suggests a personal or official record related to an incident. ••• 1Q53........ (d) •.. ~:.=!SL .... ~_. r:1: . • • • (."..o.·..·.·. . " :.:o.:..~l··s ... .,~,""- ~-,_c o..~..·..·..l.. ...... •. .. ,.....; "-· :·. .. o ... - . •. ·, ,J ..,.,.. (f" •I ll " ' ,a.u.c..• }1 .. • . . :.. J Plnco ,,},era 1n JU-:j O<'c-.:rrctl •••• ::. ••'' .:: .•••.• ~.oo:.'"'..:-.-::. ) •• :.·.--:::. •• -:.'::.':• • ~::!·.· .. ! ..: :-:: ~-.:.~-: ................. ·····----··-··--·-·· · (rhco cr c.:~::1•.•.;.,~:. ~t. &I ""I<~•~ c.:"'.-.·.··. ··1::,·7 ~:o:::J·•. c!: .) N Et • : a.urc " - ndc · . . '" . " • ' cn ~ ' o!J.. .. . , J.U..M ., ! ••.i.'· . .u.l..~.).· : - ) -· l · ~ - -·- - = l · 1 · .· · . · 2 · · - : · : · 7 · . - ~ · · · a · ; - , ~ --~- . · . - · · · .c..-...;...1 · . ~ · ~···· n ·" ~ ·. - \ ~ .. , ..·... · , .~ . ~ , - ~ , o .......... -,....l..•." · ' ~ · c - . . - """ . ' .. .'. , - ., C ., - . ' • " , - ' .. - . ' . - .; " ... ' , o . . . .. . c . , : . , . . - . - .···-·- •.............. _. .. ____________. ___ ·-····-:······-··---···-···- -----·-····------d.~:!t~ ·' ---·--------·-··-··-.-----·----·-----------------~---------------:-~----·-··-·-·-------··-·--··----:--···--· Dnt.1 o! dC"r.tL ·····- -~-S- ·-!·r·o·-·.·-~-:·:·:.-'·.·:·-~·z·---1--9-5--3- -----------··-----------------··-------------··---·------·---------------- ri . .. . . co ,. • . h c ~ . c " ,1 '" . ih ,, · l 0 c ct . . r. - c.uI ·· ··· S · : · . · : ·- : · ~ · l · ~ · : ·· - ··· ; · ~ · o · ~ ·· c · J - . - '-- ~ · ; · : · : · :: · 7 · ·· Y · o · : · - ·· ~ · = · ·· C ... i . t -. : .1 . •• ' ~ :: - :T •• •• V - : o • • :- • 1 • . ~ .- -:.·-······--·--··-·-······· · · ··· Riltc or pny of dcCI!!l:SCd cmpl.,ycc :lt t~mo of injury The document appears to be a "REPORT OF DEATH" form, with a significant portion filled out in neat, typed text and some handwritten entries. The upper section of the form details information related to an injured employee, including sections for "time of injury," "time employee stopped work," and "immediate cause of death." The lower section is dedicated to the deceased employee, "Frank R. Olson," with fields for "time of death," "place of death," and "immediate cause of death" which is described as "fall from tenth floor of hotel." There are no photographs or diagrams present, and the only handwritten annotation is a circled number "297" in the upper right corner. No official stamps or redactions are visible. ·· ~ · = · ·· C ... i . t -. : .1 . •• ' ~ :: - :T •• •• V - : o • • :- • 1 • . ~ .- -:.·-······--·--··-·-······· · · ··· Riltc or pny of dcCI!!l:SCd cmpl.,ycc :lt t~mo of injury w!lic'h rcsultc~ m d.:;:l.L, s.£~0:) .... 20• •••• per .L:..!"l..:!:J.:!.. • •a nd subsislccco ~ch:cd nf. $ ________ p~r -------····---·---.:_- Rc1.lt'io::J.dup" to t~c d::ce:~::cd oi the pc~o!l cb~n~ to be cntitld fo c:ompcusslil)'l •••• }!.?:-f.-~---~---·-·····­ Dld JncC;:$tU lc:l.\".:1 :mj othn· rc1~ti-t·.:o.3 entitlcJ to compPus~tion?~ •. ;. Y:-:o~·-····---- I! so, th·c n:lt.'l~S, :.utJ:c.:>.>c:>, n;~s, :!':lcl rc1::.!~c.r...;!,:? :,.;h-,.-:rr. z..rar..l .Age z---i-c-- -"-r-;"-i·c- ~-~-~- --C-··l s·· o-:1- ----·----·-- R.P.!>.!~~5. ~~!'!e~ic!:. ~~. ·-··~- ----..-.--~-~!1~·---·--·--· :.;~:~. ." 1~£1;;. . _Q;!;:;:;~.-----·-·-·--­ ---------· •... .J --·-·-----·-----•• ----·· --- __? _ n ...... 1'~-,Z~"t!L.~------ ;~l~.::n.x!\~ . .. 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J. 75 ···-·-·:··-----····-··-···----·•·•••••••• IS: · ·--- ··-·······--·-··cs;;..;~-.;:~-;;~~;---------···· :!!.. .a.!:.!!..». ." :~: l:!.!!..l.. ·--····-··--·---~-- ······.·· ·-----·,·. . ·-·--·--· ··----·-cc;~)---··· -.:~-,- h,. . Cl:. . :::•s C~;:T Ll C:/.-~-.s . ( \:>) /'(; j ·----·------~--. -~ ---··--·----·------ •• CJ ~ ~.J !· :. ·;:..;. . :·.~:· .... ·.·:. .•• ···.:.~~ ... • .. ·:· ~.,·: ·-·····-··-··-·- -····-··-··· ••. •••·· -······· ... ·-----·-··-···------- --------·----·---- --··-·----------------·---···------·-----~ :of •• ____: ,___ ________ , c:~plo;·cc's c!c:~fh 1~ -----------·--·---- ct ~u:e ct cJc::~lh --·_ ------------------- _____· -------·-·---- --------------- --__ _ --------------- ___,_ ---------·---·--------=----------------·------ ----·--------------- tr~ulc>ry c:~use or cc:~tb. ------- ---·-----....----·---~----- ------·-----------·----·-·--·---------- .. ____ _ -----------------,-------··-----·~"';;;.. history o! injury &h·c:: b t~~ c::.!c:! ---------- Jr so, &tate IL briefly ·--------------------·----------- ot.:r c-;.:n!t~o, T.'"AS :l.c: ~,::~~c.! !~t ct:~Z:,~C'~cc.Ccc te, t~ch !:.~·::y~ ···---··"-·--·-------·-··'=··-··-··--~·-·----~ • ------------• --• * • --------·----- -_-- ---------·--------------··---··-·--· ___________ -;------·----·--·-·----··--·--··· _:_ o: u::u"&D\" cJ:~Tll''X' tL&t. c:~use or cc:~tb. ------- ---·-----....----·---~----- ------·-----------·----·-·--·---------- .. ____ _ -----------------,-------··-----·~"';;;.. history o! injury &h·c:: b t~~ c::.!c:! ---------- Jr so, &tate IL briefly ·--------------------·----------- ot.:r c-;.:n!t~o, T.'"AS :l.c: ~,::~~c.! !~t ct:~Z:,~C'~cc.Ccc te, t~ch !:.~·::y~ ···---··"-·--·-------·-··'=··-··-··--~·-·----~ • ------------• --• * • --------·----- -_-- ---------·--------------··---··-·--· ___________ -;------·----·--·-·----··--·--··· _:_ o: u::u"&D\" cJ:~Tll''X' tL&t. U::c .e.uswcrs to tho: =-bo,·o: qu~stio:lS .e.re true to the best C)" l.:no"lcdcc =-nd belief• ..... .. .A.ddrc"': -------············-·------- ... (Srroc.l •=d e:o=bu) '-· ·:.. ---· : --------- (Cl&J) C,St&~) 1 ir.ar-•,tt:r.t. th~~ a~o~·c cc:rt!!;u!e be h:r:;isbcd, but. if fc.r ll.OT c:~u:e lt. C:lnuot. be aecurcd 0 :h·e !uU c:q:l:.:::~.tic::. l;,:!o7f li'Dit ~>o.:ch o:l:c: p;od c.C c.:~t!l e.\ :ut:\f l>•: obt~i=b!c. ------------- -------·~---------·- CERTlFICATS OF OFFICIAL SUPERIO:l _.,.-- . l"&nr.nT ct:nTI':'T tl·:t. n.e pc:no:l on :.ccou:lt. o( "'!:O!C c~tb U::c f.;:,rc::;oiu;: &;b!::a is ru:~.\lc 'r."li.S Ct:J~lorc:.d_ br H::c t:nitd. ~ .. • • • . c:.:t 1 · 1\ · l 'lfC:• 1 !U:: d c .••c• ~ .. - .. · , h.f. ·-:.r•. 1. · : r < J .C ~ '- · • ' • 1 '\. . U m.'\u . C • : ou -·-·• · 2 ·- 8 ·· ·· ? · ·! · o · · · . · ~ · : · : · : · : · : · - · ~ · :- ··- 1 ·· ; ·· s · s ·': :..---- (&l•IC) rr~rt·.:~.·:':-••.-s t_u,., .:'·""' • :•:r~ t ·~.., t!'-A r ':-.r: .. ::•~:, 'L"'.~t•! 1:.1 ~!'~ ,.~.~~ r. :' .-fl C'f \!1 ... :~, V: Jl :!':.., l~·; 1 !".1;a:,CO d~:t~l .... !~ a:ar ct 1~• r.~'!l::::t c:!a '~ IJf u..;.;,,~·~· ~~. ;, ... h·•·.~;.,.·J &~nc • l..U ''•~~~:)·::.:.r--:a..;.lc :. ... ~ :...:.:. ..· J •. ,, ,. • I I m.'"lr~': ·-·-----------·-·------···--·-----------;.;:._ ____ ...,__.;.:,_ --· --·--- . ----·-·-----····-:-:--··--···---·--··--·---·-. - . · · ·· ·- - - ~ - .. - -- . -·------.. . --------------------···-···--·-·-·--. ---. -··· . ·-········ . - ·-------------... ~-:-·-·-···-------. ® A· ,,!:'. .. :.•: nr :..c.~ c: .• :.~~_:' ~·:~•" .:1: r')· .. :-{~•·"_:._''-'·~-1 , -;:Jji7. ---=-=-==·-··· • =-=-··. rr ,...._..,,,...,~- ~-~··= i . . . - I. D~n I arLmr . n t ··---=~ ( " u '. ·, : , . , 1 ; ; . ,r . y .. , . t" . '. . l. . ) ......... 2. Burcnu or OH&C.C ••••• .&.,...__._...~ . • . • . The image is a scanned document, likely a form, with typed and handwritten entries. It appears to be an accident or injury report. Several sections of the form are filled in, detailing information such as place of employment, employee name, date of injury, and cause of injury. There are also handwritten annotations in the margins, including numerical labels and partial words. Some areas of the document appear to be redacted or obscured, making the content unreadable. The overall visual impression is of an official document with administrative and factual information recorded for an incident. . . . - I. D~n I arLmr . n t ··---=~ ( " u '. ·, : , . , 1 ; ; . ,r . y .. , . t" . '. . l. . ) ......... 2. Burcnu or OH&C.C ••••• .&.,...__._...~ . • . • . " I * J '· .. , " . t : ,J - ir . tn . . . _ . ,. . ., . . . . ~ . ~ ~ . . .. . ' . " · ) · ·--·--- • ----/. . . ,, ..... 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(.nowr,•·"'·O"il.n.) >• Fmt. dc.y er::~plo\'Co wa-> e.blo to re:>wno work ............~ ---• Hi~ ------············---·-·--· ; -----.......... , .::':1. • (.ll&ll.) • (U:r•f•urt.} ( • 1...:r,c • .,, .,. .... ). Did croplcycc return to tho same work nnd at. sau:o rate of P'~): dtcr tcrmiun~ioo (;( clis~Lility L ....... -··· ·--~- or I£ &o, \":hen~ .........................................- II not., st,nto cb:..rncter work pcrlormccl \tpC':l rc·:.uru to ·duty aou rr.t~_p:~id cmplo:.-co !or such "·ork ---------------------------~ ---------·---····------ : ----·-------------------------------------------------------------------------------------------------------------------------------------- ) • .Actus! time ilisahlec (including Sundays and },oliJ:l._:s) ·--·-·····--------------------·--------··- dnys. L. N\lrobcr oC dnys {or which cmr1oyec would ha\c rccch-i:d pn~· had he not been diso.blcd -·-·-------days. ~. li cmpl~yco was rceci·dub suL.;istc:-.ec :l.S p:1rt o£11is "'n;cs, was such ~ubsistcnc:c furcisbcd curing e:-:.ti:c period or dist.bil!tyl ···--···-·-····· If DOl1 gi>o dntc.d on "·bicb .suhsitlCrlCO WI!:!!. not.furnisbcJ ......- --·-···--·····-- ----· The image appears to be a scanned document, likely a legal or administrative form, filled out in both typed and handwritten text. The form itself includes pre-printed fields that have been completed with names like "Alice Smith Hicks Olson," dates such as "November 25th, 195," and monetary amounts like "$693.52." There are no photographs of people, locations, or equipment visible. Some portions of the document are obscured by a grainy texture, indicating potential redactions or simply the limitations of the scanning process. In the top right corner, there's a handwritten number "274" and a checkmark next to a field. Finally, there are handwritten signatures present at the bottom, indicating official acknowledgment or authentication. dnys. L. N\lrobcr oC dnys {or which cmr1oyec would ha\c rccch-i:d pn~· had he not been diso.blcd -·-·-------days. ~. li cmpl~yco was rceci·dub suL.;istc:-.ec :l.S p:1rt o£11is "'n;cs, was such ~ubsistcnc:c furcisbcd curing e:-:.ti:c period or dist.bil!tyl ···--···-·-····· If DOl1 gi>o dntc.d on "·bicb .suhsitlCrlCO WI!:!!. not.furnisbcJ ......- --·-···--·····-- ----· ·----·---------------···---------------------·---·-------------------------------:---..:.-.-.------ 3. Ho.s employee been pnid for :my portion oC.nho>c absence co nccounl o[- ·. 1..--·---·------------· ....................... ----------------·- (a) .Annu~l kn,·e: .. (Girt u~r! lctu.) (b) Sick 1e :1 ,.c L .........- --------·-·-------------------··--···· ······--···----····--··---------------· -·--·- (Ciiu tnr:.t::rs.) · (c) .'..ny other reason ...................- -----·---------···-··-----··..:. ........- -------·-······--·--·--··--··--·-·-·'• - 4. N~l\1 r.:: or i.zij Ur)· ······-··--···············-··-"--···---····-·--·········-······-~---.. ___. . _____________________: .. •••.. - ... ------- 5. TI !'Ill :I r ~:s ................................~ ····---·--·---···----·-·----·-··--····------·················--··-----·---·-··--·------··---···· ... .. IThc r• • ;hwinc: inf•Jr:'ll!'l(inn i~ to hr (nn:i•ht~ •mlv in c:t•c: c>! t!·::lth ri'•.ult:nc:: fr"O\ :.u j,,jur~· "1-•:::in-cri whilr h t:~r. n·~rn::.t:U:CC' t•f ;~lr. H ,;,:.·!• r.·<:,:•~ ira~l:l<.•l;3:.::1y, or ii r.o l~"=?<J:~ (If lz:jt:ry l::-..-1 prc\·i ... t•"IY b.·~ .;:zl.:uith·u, .ur.!t rc:po:~, en forrn t:. ~-:, ~ist•~<!d :!on'."I ll ci~rl ho:rc·wi<h.J REPOR-r OF DEATH ·. . -··-== Full n::tna of dccc-:: .. 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