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: