EFTA00313897.pdf

Registration No: 1026221 Person Number: 73274 Passport I do NOT have a Passport 10/11/2016 lista Dab) 10/10{2024 (Expiration Date) Email/Internet Identifiers ED I do NOT use any email addresses or Internet Identifiers. Phrase note. The registrant has reported additional online accosnts not disolayitd here co urnbadenta la:yahoo corn. reeprOpectgi atioo corn Scars/Marks/Tattoos 0 I do NOT have any ScarsMane or Tattoos. 1. (Type) (Lorton) (DeSc^oiror 2. (Tyco (Location) IDOSCriSDO) Vehicles O I do NOT own or petal/0.de. RV. trailer or moble home. Piease now: Tn. registrant has reported additional vehicles not displayed here. 1. 2013 (Year) 522rzz Ford (Make) NM (I)Rense Tog a) (gun) This vehicle is EXPEDITION (hode) Slack Truck (Colortolor SchemeI piehio• Type El NOT used as a residence O Used as a reside-ce Downed by registrant 2. 2012 Cadillac (Veer) (Make) ttx3455 (License Tag NY This vehicle is (Stale I OTHER (Mode; Black Ttudc lEoodColor Scheme) (Vette Type) NOT used as a reSadenco Used as a residence Owned by nsplimant Vessels 01•0NOTO•m•Itelisei or houseboat. Please note: The registrant has repelled Ildd*Olsel vessels not displayed here. 1. 2011 Year. yes ROOOtne:C =] White (CdoriCcox Sdiernm \erne Of Vessel) This vessel Is: El NOT used as a readers:* Used es a reullerxa Adjudication Information Date Adjudicated Crime Location of Acrjudicatkin/Conviction Vicsin Intonation t O Min?' O Ads: Gender- 2. (Co.tnty) (Sta:e) El minx O Ada Gender (Canty) (Sots) Were you or are you subject to registration or community notifications another stale? Ores O No nen, in what state? Page 3 ol6 2018-0144 8-07 18 MA EFTA00313897