DOJ-OGR-00029784.tif

EE Record Request FD-125 (Rev. 4-1-93} Date b O 2. CO] O Birth © Credit AY Criminal Opeth © INS CG Maniage* O Motor Vehicle “1 Other , bé -2,-3. File Number b7c -2,-3 Zen 1o80G 2 Name and allases 0 Address Residence Business . Fonmer -_. I * Date and place of marriage (if applicable) ; - I Race Sex Age Eyes b-4 Female ‘ iJ O Male Firth date Birthplace A __ Fingerprint classification Criminal specialty ¥ Social Security Number Divers License Number Po O DLPhoto OF Other Specific information desired bTE N CEC Results of check 6 (107% 03956-8650 - DOJ-OGR-00029784