U.S. DEPARTMENT OF JUSTICE

U.S. DEPARTMENT OF JUSTICE Employee Locator Information et1THUL- 01441 Tlb Si, bb Wansta6 by d cnsloymu prima critymara Howt cniiterrner any Herncal m roam calm Olson WWI to parp7paloGY me fxr,.b pis pared cam altatartmeh Ws Renton d to Mom An d1974. Winbalon d Gpb IdANDAIDRY. caw= b rot cn TIVOUNTACH OW Wm stabb AM cowries* or roam. He MAICATOSH U VOLISIITARt mum of re 84:6 tarea' M =GA FacmY Ad Mann Cat' PnP3 d b maer.mae by "" C(nirelterS t'Sm 441"94674941 nom &TOO= man tem moo mean dro On MAIL 6 wu The cAestcre rugnecorpobal MCP am Rasa ttmA ter pcactmd eon EMPLOYEE IDENTIFICATION PRWCY ACT STAMM: SOCIAL SECURITY NL8361-1- 41171. . Excom Om= =0 tOnnter ZL He 2 RAM& AND USE TM Sall Seca MMor MN) Is wet Al ilL170A Intrana Or natettegkatorrocce0 to tab carurrM urd pun: Gra Lao cl Co EGNawasconweent4cton d RICOD21 be came reA7n lane nom 1 EFFECTS OF Na' Gonna sr' Cbcbuto dna MN ts MWDATORY. Feb= O Ss&za 205571m esseabal 6,1 otsA hp/tern ask rc Lem trxese1 Fenn to tbezne Cs 8574 HO/ metedmena011sf bbb ewer not berm MOW TO BE COMPLETED BY PERSONNE. OFFICE 4. NAME (4/61, FM. Mean fly 13. SUBMISSION DATE LI 2. CONTROL NUMBER &TYPE OF ACTCH CI 2 Ckmoo CURRENT PURPOSES PRVACY ACT STATELIER: RESCOTEACCRESSI AUTHDRITt BLUM 8016518. EMUS Ma 28 WM SonlasECOI en 8131 2 1APPOSE AND LAE Tomettm mean rommatea of FOAM Saw UCH bit -a I Mulawn at arra RMIttloo Mtpt4 IINOATORY. Fan Onto= Cm arrant Roans Arse al Man41011/4 Mtote m, d 010 Cited ingtrZenn1 pale pceCmn pros:Hot Mon 7. STREET ADDRESS 8. tbe-QCAD LIKE STRF-ET ADDRESS pi necessity) rei(1i anRy 9. CITY 10. COUNTY OR FOREIGN P4 11. STATE CURRENT RESIDENCE ADDRESS AND TELEPHONE NUMBER PIWAGT ACT 8TATEMT:RESDENCE AGGRESS HETZLER= NUMBER-1. AVTHORITY:6 USC excon MI. 2 RRPOSE AND USE To or= ectreas 0218trombrice cricom elm cOete nem mem to 892 tarp WITS/ 4121 Co DtpmtcrI CI Lorca Amon to 011 ttawce.on b Yrtmal b t4 *HAWAII oupentsals) OR HenTLM4 Atottocl by the getroblan a CFaCT9 OF 10:414:180.05URE:SLIrmaM d Va Wt IsCLASNTARY. I he= to nct 34ncl, cabal Ptitanturl him nal bri; cr001033 to racen fen el cranny tea adaria. TELEPHONE NUMBER 17. MAY THE. DEPARTMENT OF Yt3 El R3 WAS FLNOTON. DC METROPOLITAN AREA EMPLOYEES ONLY—COMMUTER CLUB (CAR POOL) INFORMATION HavAcY ALT sT ATEMZ NT: 1 AUGORITY. Pero tiro caw uLtoty a Anne aim Knew Hence Dann= d Mato cnylortn1 h Cs COrnegf Olt De arnum aa WOOD, n ccer:nd by elf. vestbaln omit cnrach 74 41615:41404614P-1 S 07r/MI C19 ItMT881-410 b naiad ma CAR4TMY Lew LyeaoMmamxt 2 maance Nouse To sew nano. Mb us d paws um be 5, am pnotrrey b Cs br alp:Cerp p-meits VOLUNTARY Wtn rmOartmmab bo rem LI On cntopet ratahrn cams, retort Hemy) Take 8127614 4C04 MEM= IleMIT Gprattnota ratty ream 2caoCCU-ZSI Errptwo Lamm ors 4. t 6 0.12 11, it M.87, 31. a 41.42. 43, N, W4S, edOamlloro Orrutvilun amtent den pootranyl rystrn Tte Oatuter Olt MIST arcetwo nano, arowar osoryt rd cam Myhre ruttier /74m C01231 Ertylwee to A8 47. all 46) 1 EFEECTSCE COMOSIPIL Mixteuro d Ots tkrtrubib NZ:VS.0MT FaLrota &wino wiz +nen unceara noi bang u mewed to Ono" az cm MS 0 arpopa Worronon a to leg b Co CbG 6. ECTINSTO NO cry) TO BE COMPLETED BY PERSONNEL OFFICE 16. LOCATION CODE OP RESIDENCE I BE USED TO CONTACT YOU ON MATTERS RELATING TO YOUR EMPLOYMENT YAM THE I8 WASHINGTON, CC MEIROPOLITAM AREA EMPLOYEES CKLY (It you aro not 'n1479.109 In 1M Com mu tor Club, skip Ulla uo o on). V N R LI Yet -4 sets to Mn On CortrIMOS. 0 %cmmy ram at mom/ 7.famticn tan N CcamMCILA 0 WIFOIttcal Cal 0Camamrat MCC= Mtn= al Wad Ce7PII 21:01 :3019 EMERGENCY LOCATOR INFORMATION %LACY ACT BTATEMDIT EMEICI9CY LECATCR-1. NJENCRITY: 6 USC Sabra 911 citl MI. 2. RAPOSE AND W MTeeth=aaybtere4atrya Nana WelMrs Ael at Ammo L-my <4 :nets & HstL. TS OF NON425CLOSURS umber d na GM b vatamTARY ream Oar 70 ASV lekb PERSON TO BE ten FED IN EVENT OF EMERGENCY L3 PERSON TO BE POEM IN EVENT Of EMERGENCY 30. ORGANIZATION NAME 37. BUILDING NAME if any) 38. ROOM NUMBER 39. STREET ADDRESS 40. CRY 41. COUNTY OR FOREIGN COUNTRY 42 STATE 41 ZIP CODE L4 TELEPHONE TLEMBER 48. AREA FT8 OYES OHO CODE KON MU:WARE* COM 47. SEVEN DIGIT NUMBER 46. tATENSION(7 Tryl PERSON TO BE KETTIFED IN EVENT OF EMERGENCY 82. BUILDING CODE 16. ECTENSIONTWHA FORM CC 1.m Apt IN EFTA00142583