EFTA00036380

U.S. DEPARTMENT OF JUSTICE Employee Locator Information 04gTRUL- 11046: ytb Si, bb oonstaf by d mina Lyn tam (niers:To (Lomt coN new any Larrnmcn m Cs am mama, Czyrma del 1:0 parp8p40:02:01.1 Ramie do yos prsord cam In oetatortowth protRas d Tv Picu.YM d 1974. a0. Colon d Geo M MANDATORY, mars, b rot On GASSMAN tsta elv cloty QM mooring or overran The YMCAS:Ma AOLUMARY re10 of re CU Ainciceml to Ye ownS•Pacn Ad Sent Cat' Pr," d tiOrminb t°egnilni by t* niuMnre‘terS amend ante nom Era= mufti tem Cub yearn d To On Meet 3 you /merry pastcre rga-Sre conker d Cs am Musa teal pas oceans aft. EMPLOYEE IDENTIFICATION PRVACY ACT STAMM: SOCIAL SUMMIT NL2361-1 AUT1=ITY• En:4410 Cot/ ITMS =41 tOrenter 22, 1041 2 PL10414r An use ma sadorso2s2y Know:TOM um:1m am*, Kura tx ratetteg kalercometo to tat: pared um pun: area Lao at Co ESN aurae mitt ,0024::40 of fixate ewe-Moyom nth:0 lane in 1 EFFECTS OF NOP 00011‘4124 Maoot cid* 11:41 b MANDATORY. Fetszo 0 Sid= Co SM4 en =Sal retl oats 0 yamLy resol art COM crocomod Fire 1, =coo Co SSA yte) nate 412Yertiel ravAH24 72. n batto CMS TO BE COMPLETED BY PERSONNEL OFFICE 4. NAME (Last Past. abaft 0. =al 5. SOCIAL SECURITY SUBMISSION DATE Li CONTROL NUMBER a TYPE OF ACTDN 0 1 Crypol 0 2 Ck-ace Nice 1— .7 -O\let . t 0.2.6-1% CURREY! RESIDENCE ADDRESS FOR TAX PURPOSES PRVACY ACT STATEMENT: RESDEN0E ACIULESSI AUTHOR110*: Vat Soolcm SSA 8817 UM Si20 a Soc0x0 1ca810, 2. INPPOSE AND L. Se Toemol Co wan rop-tormea of Far* Sala alt SRNs a. I CONOntro a/ cram Regarm Maw 4 WOMAN . Faro mama Co armr1Reave Aril MCM141011,4 tmtdeon dtbo dad aCtrasat past04 preen as proscacenvrox 7. STREET ADDRESS (No., Niers, St. Dr., PL, ce.) 8. t3EQGMD UNE STREET ADDRESS CS nacessary) "-% Jorei eW t a) reini xTRy 9. CITY 10. COUNTY OR FOREIGN 11. sratEj 12 .. . IM- ZEP CURRENT RESIDENCE ADDRESS AND TELEPHONE NUMBER POMO' ACT STATEWHiT: RESDEACE N=RESS ARIDTEXPCNE MASER-1. AUTHORTIY: a USC Sxoon SOY 2 RRPOSE No LSE To OW= 400430:03 SUS cooboTte 01COn elm 00621 raw *am to ostroTroloTTSC sch or Copra. it Ann Amen to et 000Tmeathaltmallot.oarpbstb oupentsc0 OR ran-ts rated by the Fambn). a EFFECTS OP 10244TISCADSURE: tAdrrsati dym Co b VCIMNTARY. b to= to rot kart* avor4407 rov 1R1T41 lava fl MoTTTIS 4"1:4100 44 to fen of cranny *a Can TELEPHONE It ECM'S() NO any) TO BE COMPLETED BY PERSONNEL OFFICE. NUMBER 10. LOCATION CODE OP RESIDENCE I 17. MAY THE BE USED TO CONTACT YOU ON MATTERS RELATLSG TO YOUR EMPLOYMENT %MTh THE DEPARTMENT OF TM K c WAS KILOTON. DC METROPOLITAN AREA EMPLOYEES ONLY-COMMUTER CLUB (CAR POOL) INFORMATION PRVACY ACT STATEllata: 1. AUTIORrrY. Rao ro array uLtaty Or To 010 01 at Kenyon b area Ccoarlot d JA:co 0T007401h ma Canes 0144 Ito Grano Q,ab Won , ma awn= ty to Maw= WaTtlatmElcan arTna trtorrnaTcn Aomori to CorcuMrCbt Warta-4V b T4R:Rol 01 0 MINT ART tots by eat: erre. 2 MVO:ISMO ME: To rains en:bp:of teh us et paws •to Ne yi clot Fccfrrty s Nen nor p-1:01el VOLUNTARY peen oin Caren rL7etwa cm40 L On arvlopoNs rem tab otlysi, retort (400/0) ante adlon. mm Minn) rant Gprattnota watt tlein r-ccro 00.4211 ErtpkAvo La:rox Ors 4. t L 0. 12 11,12 IAffi, 31. 4,41,424 Qs ,rd 481 bdOrib Cn CoTrutfCtin a.zzgazd data Stoaslyi rystrrt eta 0=troteratron tech =arm Aso, =Royer (esexyl end cam teleytere nab& CY= Da.4.21:1 Erticbree LOSCr sore A 5347. all AS) 1 EFPECTSCR MDR, WI: MO:a= al Ols tkrtrubi b VOLUNTARY. Idliro b &wino *42 ,rad h umbra MI being a (maxi d To Oranmm cn:l holy% it crOona Worryfon eV to 10113 Co CaG IS. WASHINGTON, CC METROPOLITAN AREA EMPLOYEE-SC/4LT St you aro not In torostod In 1M Commu for Club, skip Silo q uo r on). V N R K Yet.-, ion to w re cm:7cm= 0 Ratty, my rant as proamIGNaTralon tan OsCecron-VCIth 0 Wspal fecal -I an 0 CaraltrCZ MCctat and want en Wad Ce;TallrtiCI :at% EMERGENCY LOCATOR INFORMATION PI VACYACT STATENDIT: Bekaa' LOCATOR-1.411MORnY: e use. soczas S01 CC no. 2. Rama mo LSEToga& craws/ trcCer4 ors met LINO m SA* Si 20 meld Cardcwo, t-inrcr Dana a /44.L. TS CF NONIMICU)StOM140=Inkri a/ 0a aY b VOLLZMWY =dada. Oar to ernlorech .at, a a Marto-01 PERSON TO BE sorra) IN EVENT OF EMERGENCY L3 PERSON TO BE NOTIFIED IN EVENT OF EMERGENCY 30. ORGANIZATION NAME 37. BUILDING NAME 2/' any) 38. ROOM NUMBER 39. STREET ADDRESS 40. CRY 41. COUNTY OR FOREIGN COUNTRY Al STATE 42. 21P CODE L4 TELEPHONE NUMBER 48. AREA FRS DYES ONO CODE a NON FTS, UST AREA COTE 47. SEVEN DIGIT NUMBER 46. tXTENSION(7 cry, PERSON TO BE MOTIF ID IN EVENT OF EMERGENCY 82. BUILDING CODE It ECIENS334loreey) FORM 00.1.79 ARON EFTA00036380