EFTA01306399.pdf

Scanned Document Collection Page I 01.1 APPLICATION FOR A U S PASSPORT BY MAIL nerves elect the document tor doormen. ) for huh you are •PIArr-9 Ir _ . „Hama tar— — — — — — un GM Clo La DP trk3 • IC bp ..j° \N I ; I r.rst R Hetet 2. Dots of nth (nol'Od11)104 tall's' 11\I \(}I LII 3. Sex 4. Moo of MM. (Dry &SUM Or Ory /1 CounOy a% 4 el aresensor Mosel Social Sooratly Wags- 014E 6. Mailing Addmas .•-ret,rkilt • or PO Box Parnmt or um a C.rtY Soo Zip Cotse (to • In Care Of a Country, if acolkatre 7, Contact Mom rum 2r Er AL re (OP me JI — — — — — e C c -e — 1 9. Mave You try Used • Deftercot N. ,e (Moan knc.a Knape ZS9 M—ie thrspe)' IS }45, please eons*.e (Mom admen" peen record) 2 10. Passport Sock co Passport Card Information Nroa r...vM of Wel on your nog men( pasmal a POMPOrt Card COX NOLIA.1 %JAM% Eli /1 3 Varc) —fre WC Kan! passim took a Peeent k at pato (mni/ddfrryo) 11. frame Mango Infonnation Conger, a'nane o oaten than tast passim toot a pastime Card RaoHad OW9O (0/y/SC.Ke) Dam (myYdd,yy)1') Q Omr9M the Menage Mel a/ at my —i• C )Nis 'I i TO 1 1C • 2 --0. MI a SIGN t - JATI 'rr. PL. - IC IN - _ C ' aN. "". Al EMILLOVar I dmiare min Omar. - . %Moneta are or e. ..,.. . - r - , . • • . ' • •• r . r . -- . . r , = ing r 0 = te n ItP e. n It 5 . 4V • ,,ratarototan et a anha c. hold, eml.......... f se. arc S.. Jaw. ei. a 4 und.120% Ow war-ev or pa,,,t ono ow poren. up .(. Mc H carocK IN. aedlen to Yea/ rot only ❑ il tignade Caine Date cf MinutoBlace Issued: CI Can Colo Doe AleO/Coun, D atter O Matted POT Fee_ 7C.. FP POdape Celt 67 ° D562 02.2006 asst of - 7n A 77 /Thl//010 SDNY_GM_00323943 EFTA 00196628 EFTA01306399 Scanned Document Collection Page 2 of 3 name of Apohunt Rost f, x 4»00e) Date of Birth fnmV04010,r) SI \\NI I I .61 Is! W.1 'a »II I 12 Height 13.11* 02Iof 14. eye Color 15. Occumoon 16. [raployet WEDS' 17.00003faal~1110,411raoliC9 i ___ _ _____ .__. 3 O, `1:r, O Cal ] Cs I antra ❑o I OWt o 1.9. Pornennt Ackfra SONIIRFD o fh0 Pa Bar) oust , I CM State lo Cade 19. Emonnocy Contact me aberration old penal kw< baring ael slid to be contacted often'« den onerxy Merle AOM StreetRFD • or P.O. Bar ~KO or an; e Gry 1 gate HI] lp Coz9 Ohcne AvnOer t iI 20. Trani Man Date or Tro (~00/1)57) kena0 0 "ro koroles to be ~eel 77.. LY 4-4,,L. j.410fro-lel .:„<c — / z.. v STOP! YOU HAVE COMPLETED YOUR APPLICATION BE SURE TO SIGN AND DATE PAGE ONE ell-, byghost, ,,,,,- 2> ,---=--z-Pf ' 04 i ti CSC iiiiii=iiiiiii OS SI '1, 41, 070 SDNY_GM_00323944 Ern[A_oo)96629 EFTA01306400 Scanned Document Collection Page 3 of 3 Innen You neeu It Fast 1961 Travisa Passport & Visa Service Letter of Authorization C Pt 9 ?cog I al$'2..k• et \leen , Date of Birth: Place of Birth: I AUTHORIZE TRAVISA PASSPORT & VISA SERVICE TO SUBMIT MY PASSPORT APPLICATION TO A U.S. PASSPORT AGENCY. AND TO ACCEPT DELIVERY OF THE PASSPORT ON MY BEHALF. Under the provolone of the Privacy Act of 1974 (Public Law 93-579.1 no information may be released from U.S. Government files without poor wntton consent of the individual in question consequently. an employee of the 11 5 • oort ' lane), cannot disc, s the details of your passport application with T•avna Panport I /isa vnmout you' nen ss,on Please ^moo•• one of me 7 • authorize , Pr sport. le -v to di 'us any rohlew Passport sew...anon w,th ...visa l-esvpOrt VI*. aervicv uch V ans. •th my ❑ I want the U.S. Passport Agency to contact me directly should a problem anse with my passport application which concerns mallets other than the date on which the passport will be ready for pick up (OrigOal Signature) 2/24/2020 SDNY_GM_00323945 EFTA_00196630 EFTA01306401