DOJ-OGR-00029784.pdf

--- Page 1 --- **Document Image Extraction** **Header** Record Request PD-125 (Rev. 4A-93) **Date** 06/08/2007 **Form** Birth Credit Criminal Death INS Marriage* Motor Vehicle Other **ISS** Return to SA To Name and aliases of subject, applicant, or employee, and spouse **Address** Residence Business Former **File Number** 31E-MM-108062 **Name and aliases of subject, applicant, or employee, and spouse** [Blank] **Date and place of marriage (if applicable)** [Blank] **Race** W **Sex** Female **Birth date** [Blank] **Birthplace** [Blank] **Alter Number** [Blank] **Fingerprint classification** [Blank] **Criminal specialty** [Blank] **Divers License Number** [Blank] **Social Security Number** [Blank] **Specific information desired** NCIC / Mappquest Results of check **Handwritten Notes** ISS 31E-MM-108062 [6/12/02] **Footer** 03956-8650 DOJ-OGR-00029784