EFTA00313897.pdf

Registration No: 1026221 Person Number: 73274 Passport I do NOT have a Passport 10/11/2016 10/10{2024 lista Dab) (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 Ford EXPEDITION Slack (Year) (Make) Truck (hode) (Colortolor SchemeI piehio• Type 522rzz (I)Rense Tog a) NM (gun) This vehicle is El NOT used as a residence O Used as a reside-ce Downed by registrant 2. 2012 Cadillac OTHER Black (V eer) (Make) Ttudc (Mode; lEoodColor Scheme) (Vette Type) ttx3455 NY This vehicle is NOT used as a reSadenco Used as a residence Owned by nsplimant (License Tag (StaleI Vessels 01•0NOTO•m•Itelisei or houseboat. Please note: The registrant has repelled Ildd*Olsel vessels not displaye d here. 1. 2011 White Year. (CdoriCcox Sdiernm \erne Of Vessel) yes ROOOtne:C =] 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 (Co.tnty) (Sta:e) O Min?' O Ads: Gender- 2. (Canty) (Sots) El minx O Ada Gender Were you or are you subject to registration or commu nity notifications another stale? Ores O No nen, in what state? Page 3 ol6 2018-0144 8-07 18 MA EFTA00313897