[Editor’s note: The pages reproduced below are “Guyana immigration form, undated, RYMUR 89-4286-FF-4-A-177” and “Parental Consent and Power of Attorney, March 9, 1976, RYMUR 89-4286-BB-31-a-41 – BB-31-a-42,” which are taken from here and are better copies of the pages found on this pdf. The lower-quality versions of these pages on this pdf may be found at RYMUR 89-4286-U-1-C-1 (52) – (55).]
*Information to be supplied by persons
desirous of immigration into Guyana.
1. Full Name (Block Capitals, surname first) STOEN, Jon Victor
2. Address: 6300 Eastside Calpella Road, P.O. Box 126, Ukiah, Calif.
3. Nationality U.S.A.
4. Date of Birth January 25, 1972
5. Place of Birth Santa Rosa, California
6. Profession, trade or occupation N/A
7. Married or single Single
8. Wife’s (Husband’s) name and nationality N/A
9. Names and dates of birth of dependent children N/A
10. Schools and other educational institutions attended and periods of attendance N/A
11. Academic, Professional, Technical, and other qualifications N/A
12. Assets (including cash) Assets are to be imputed to the Peoples Temple Agricultural Mission in Guyana (which has leased land under the Government’s FCH program).
13. State whether you are prepared to work and live in the interior of Guyana Yes
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14. Details of the farming experience N/A
The applicant is a member of Peoples Temple’s Agricultural Mission in Guyana. All such applications are to be processed through the Ministry of Home Affairs.
Declaration: I certify that to the best of my knowledge and belief the foregoing statements are true and made in good faith.
[signed] Grace L. Stoen
Signature.
* The applicant is also requested to submit, together with the information furnished above, a certificate for the police authority for the country (or countries) where he (she) has been resident during the last ten (10) years, to the effect that there has been no conviction against him (her).
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PARENTAL CONSENT AND POWER OF ATTORNEY
State of California
County of Mendocino
United States of America
I, Grace L. Stoen and Timothy Stoen, hereby declare:
1. I am the natural parent/ legal guardian of John Stoen, a minor, born April 27, 1974.
2. I hereby consent to said minor going to Guyana, South America, to live and be cared for there under the Guardinaship [Guardianship] or custody of Joyce Touchette.
I hereby appoint Sharon Cobb of Redwood Valley, Calif. and Jim Jones of S.F., Calif. and Helen Swinney of Redwood Valley, Calif. as my attorneys-in-fact, jointly and severally, to take any and all action any of them deem fit for the welfare of said minor. By this power of attorney, I give each of the aforesaid attorneys-in-fact the right to the care, custody, supervision, and control of said minor anywhere throughout the world, and to travel anywhere with said minor throughout the world.
Executed on this 9th day of March
1976 at Ukiah, California
Signed /s/ Grace L. Stoen
/s/ Timothy O. Stoen
Wkr___
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State of California
County of (blank)
United States of America
On March 9th before me, the Undersigned, a Notary Public in and for said County and State, personally appeared Grace L. Stoen and Timothy Stoen known to me to be the person whose names are subscribed to the within instruments and acknowledged to me that they executed the same.
WITNESS MY HAND AND OFFICIAL SEAL.
/s/ James R. Randolph
[Notary seal]