Scanned Document Collection Page 1 of 7 m O V.S. Oepartrtnt of Sae APPLICATION FOR U.S. PASSPORT BY MAI' M1 228W0111 1 j STREET : RFD OR P 0 BOX N CARE OF irF APPLICA EnEe PLACE OF BIRTH C ty E State or City a CouertrEr APT. STATE ?IP CODE HEIGHT Feet kx.hes 5 8 HAIR COLOR COLOR HOME TELEPHONE Dark Br Brown NOTE: Most recent r T be enclosed! U.S. PAt PCP Nu Eh . _ISSUE DATE PLACE OF ISM .',NCE ! I OCCUPATION raw maNfareor Yew , _ _ ..._ ) I 4 1 21 , 0 1 ..:, Vial' - . a5SPC 'C A Y ; PEPARTLAE CA II --- 1ITF awl r.Ar:s (NW fitaneatarr•Ar Al_ tbligt ekik, WI:: TR .T1 )F STAY OVor Mandatory, March 16, 2003 I tric::let estlay °.-dan, Saudi Arabia 09 7 ANN : 1 PERMANENT ADDRESS (Do not Il l P.O. Sox/ End e 111 Data D OP III SOCIAL SECURITY taJMIIER $ IAA LAW1101Kit W lawtriS$ ssa, F BUSINESS TELEPHONE 57AT-rim__ I EMERGENCY CONTACT. II you wish. you may MON IhIl name. address. end telephone numbef of a person not vin•Ing with you to be contested in cam of emergency. NAME STREET TELEPHONE I !RELATIONSHIP I OATH AND SIGNATURE: • I have Tot. tantenditio or:wring United States CItIlt-IS1 D. T.tiftrmed ...Hy of the acts listed sonar two Otielia .[ANT UnCer *Acts Cr Co n:, on the leveSSE o! lir : r,1 Olio ....less explanatory n4OTOS "ATM LIGHT, RAIN statement es atfached.I BACKGROUND •• NOTE: APPLICANT MUST SIGN & DATE I solemnly swear (or *thrall that the statements made onthis application are true and the photo that I have not boon issued a passport s SIGNAT DO NOT WRITE BELOW THIS SPACE - F APIlakn APinvel I I Eraenoe of Name Change DATE 03-06-2003 DO NOT WRITE BE OW THIS SPACE O 1.lan np. Col Date Elect • ,J0 - .41! 1.1 7 i •24 CI CK {MOO To _ _ _ :',25 EC CK 160.00 weroft n accordance with 5 CFR 1320 SIM poisons we not remised to (*VOW to the gMlIttlen of this Information unless this form displays • amend), valid 0/AS control numbs, . Pope 3 (a 0