ittled Reaat
11 1).12$ (Rev.4.143)
Date O 6/00 o07
0 Birth 0 Credit KCriminal 0 Death 0 INS 0 Marriages 0 Motor Vehicle Other
Buded
TO -SS
Return to File Number
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Name and aliases of subject, applicant, or emplo e, and spouse
Address
Residence
Business
Former
ar Date and place of marriage
(if applicable)
OM
Race Age Height Weight Hair Eyes
is m Birthplace
Arrest Number Fingerprint classification Criminal specialty
,
Spcial Security Number Divas License Number
0 D/L Photo 0 Other
I maribt.k.47 A cc1/4,...c;(1+ Calhassz, A.Arcs
Speciic information desired
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Results of chcdc Q. 1
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Sret 06.40-
MM01-VICTIMS 14-19 BINDER-000327
EFTA_00046188
EFTA01250551