To:________________________________________________________
This letter constitutes my formal request for information pursuant to the provisions of the Freedom of Information and Privacy Acts, 5 USC 552. I am requesting copies of all information maintained by your agency that pertain to myself as described below:
Full Name:
Current Address:
Social Security No.:
Date and Place of Birth:
Former Addresses (use reverse if more space needed):
Date:____________ Signature:__________________________
I, __________________________ a Notary Public in and for the county
(city) and state of __________________________ hereby certify that
on the ____ day of _______, year 200__, before me personally appeared
__________________________, who is known by me to be the identical
person whose name is subscribed to, and who signed and executed the
foregoing instrument. In witness thereof, I have hereunto set my hand
and official seal this day and year above.
My commission expires:____________Signature of
Notary:___________________
LIST OF ADDRESSES TO SEND TO
P O Box 366269 San Juan PR 00936
JFK Federal Bldg Rm 900 Boston MA 02203
150 Court St Fifth Fl New Haven CT 0651
1 Gateway Market St 22nd Fl,Newark NJ 07101
26 Federal Plaza New York NY 10278
James F Foley Bldg. 5th Fl 445 Broadway Albany NY 12201
111 W Huron Buffalo NY 14202
P O Box 1315 Pittsburgh PA 15213
William Green Bldg Sixth Arch St 8th Fl Philadelphia PA 19106
DC Field Office 1900 Half St SW Washington DC 20305 B
Headquarters D J Edgar Hoover Bldg 10th Pennsylvania Ave Washington DC 20535
7142 Ambassador Rd Baltimore MD 21207
111 Green Court Rd Richmond VA 23228
O Box 3828 Norfolk VA 23514
6010 Kenley Ln Charlotte NC 28217
Box 137 BColumbia SC 29202
77 Forsyth St SW Atlanta GA 30303
220 E Bryan St Savannah GA 31401
Box 8928 Jacksonville FL 32239
16320 NW 2nd Ave Miami FL 33169
Box 172177 Tampa FL 33672
2121 Bldg #1400 Birmingham AL 35203
P O Box 2128 Mobile AL 36652
710 Locust St #600 Knoxville TN 37902
Clifford Davis Fed Bldg #841 167 N Main<BR>Memphis TN 38103
100 W Capitol #1553 Jackson MS 39269
600 Martin Luther King Jr Pl Louisville KY 40202
1240 E 9th Rm 3005 Cleveland OH 44199
Box 1277 Cincinnati OH 45201
Box 1186 Indianapolis IN 46206
P O Box 2118 Detroit MI 48231
Box 2058 MMilwaukee WI 53201
111 Washington St #1100 Minneapolis MN 55401
P O Box 3007 Butte MT 59702
219 S Dearborn St #905 Chicago IL 60604
P O Box 3646 Springfield IL 62708
1520 Market #2704 Saint Louis MO 63103
811 Grand #300 Kansas City MO 64106
P O Box 541090 Omaha NE 68154
1250 Poydras #2200 New Orleans LA 70113
P O Box 21470 Little Rock AR 72221
P O Box 54511 Oklahoma City OK 73154
1801 N Lamar #300 Dallas TX 75202
2500 E T.C. Jester Houston TX 77008
Box 1630 San Antonio TX 78296
7000 E San Antonio #C600 El Paso TX 7990
P O Box 1229 Denver CO 80201
125 S State #3203 Salt Lake City UT 84138
201 E Indianola #400 Phoenix AZ 85012
301 Grand NE Albuquerque NM 87102
700 8th Charleston Blvd Las Vegas NV 89104
11000 Wilshire #1700 Los Angeles CA 90024
880 Front St #6S31 San Diego CA 92188
450 Golden Gate Ave San Francisco CA 94102
P O Box 13130 Sacramento CA 95813
300 Ala Moana #4307 Honolulu HI 96850
P O Box 709 Portland OR 97207
915 2nd Ave #710 Seattle WA 98174
Box 100560 Anchorage AK 99510