DS9 Document EFTA01248827

N Record Requeu ED-12S (Rev. 44 83) Date 7/7 1/4 -0-r7 o Birth o Credit 0 Criminal 0 Death 0 INS 0 Marriage 0 Motor Vehicle 0 Other To Mr we c 4.0SA-te Ca Buded Return to 7:41." rerldieflat-er File Numba 3/e-- ann. 1° rob 2 - Name and aliases of subject; applicant, or employee. and spouse Address Residence Business Forma • Date and place of marriage (if appl icablc) Race W Sex 0 Male Age Height I Weight Hair Eyes Birth date a Birmplace Arrest Num Fingerprint classification Criminal specialty Social Security Number Divas IicenseNumber fl (L Photo 0 Other Specific information desired 04•4(2 l•Oi . cct I 1 Ako.....,:d/i/m4 71,.., I 0 i_ P4.t4 Results dank CONFIDENTIAL MM01-VICTIMS 1-7 BINDER-000152 3501.222-022 Page I of I EFTA_00075009 PROT0