Freedom of Information and Privacy Act Request 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 _______, 19__, 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:___________________ INSTRUCTIONS To find out if you have an FBI (or any federal agency) file and obtain a copy of it, fill out the above information, have this form notarized (you must sign it in front of a notary and provide the notary sufficient identification), and mail to the FBI (or other agency). A request should be sent to each field office that might have files as well as FBI Headquarters. Make a copy of your signed and notarized form for your records. Please note that it is a criminal offense to represent yourself as another in attempt of obtaining information. THIS FORM IS A PUBLIC SERVICE OF GLEN L. ROBERTS You are encouraged to copy this form and distribute to others. Glen L. Roberts is editor of Full Disclosure. Glen L. Roberts, PO Box 1533, Oil City, PA 16301. Email: glr@ripco.com. Web: http://pages.ripco.com:8080/~glr/glr.html FBI P O Box 366269 San Juan PR 00936 FBI JFK Federal Bldg Rm 900 Boston MA 02203 FBI 150 Court St Fifth Fl New Haven CT 06510 FBI 1 Gateway Market St 22nd Fl Newark NJ 07101 FBI 26 Federal Plaza New York NY 10278 FBI James F Foley Bldg. 5th Fl 445 Broadway Albany NY 12201 FBI 111 W Huron Buffalo NY 14202 FBI P O Box 1315 Pittsburgh PA 15213 FBI William Green Bldg Sixth & Arch St 8th Fl Philadelphia PA 19106 FBI DC Field Office 1900 Half St SW Washington DC 20305 FBI Headquarters J Edgar Hoover Bldg 10th & Pennsylvania Ave Washington DC 20535 FBI 7142 Ambassador Rd Baltimore MD 21207 FBI 111 Green Court Rd Richmond VA 23228 FBI P O Box 3828 Norfolk VA 23514 FBI 6010 Kenley Ln Charlotte NC 28217 FBI Box 137 Columbia SC 29202 FBI 77 Forsyth St SW Atlanta GA 30303 FBI 220 E Bryan St Savannah GA 31401 FBI Box 8928 Jacksonville FL 32239 FBI 16320 NW 2nd Ave Miami FL 33169 FBI Box 172177 Tampa FL 33672 FBI 2121 Bldg #1400 Birmingham AL 35203 FBI P O Box 2128 Mobile AL 36652 FBI 710 Locust St #600 Knoxville TN 37902 FBI Clifford Davis Fed Bldg #841 167 N Main Memphis TN 38103 FBI 100 W Capitol #1553 Jackson MS 39269 FBI 600 Martin Luther King Jr Pl Louisville KY 40202 FBI 1240 E 9th Rm 3005 Cleveland OH 44199 FBI Box 1277 Cincinnati OH 45201 FBI Box 1186 Indianapolis IN 46206 FBI P O Box 2118 Detroit MI 48231 FBI Box 2058 Milwaukee WI 53201 FBI 111 Washington St #1100 Minneapolis MN 55401 FBI P O Box 3007 Butte MT 59702 FBI 219 S Dearborn St #905 Chicago IL 60604 FBI P O Box 3646 Springfield IL 62708 FBI 1520 Market #2704 Saint Louis MO 63103 FBI 811 Grand #300 Kansas City MO 64106 FBI P O Box 541090 Omaha NE 68154 FBI 1250 Poydras #2200 New Orleans LA 70113 FBI P O Box 21470 Little Rock AR 72221 FBI P O Box 54511 Oklahoma City OK 73154 FBI 1801 N Lamar #300 Dallas TX 75202 FBI 2500 E T.C. Jester Houston TX 77008 FBI Box 1630 San Antonio TX 78296 FBI 7000 E San Antonio #C600 El Paso TX 79901 FBI P O Box 1229 Denver CO 80201 FBI 125 S State #3203 Salt Lake City UT 84138 FBI 201 E Indianola #400 Phoenix AZ 85012 FBI 301 Grand NE Albuquerque NM 87102 FBI 700 8th Charleston Blvd Las Vegas NV 89104 FBI 11000 Wilshire #1700 Los Angeles CA 90024 FBI 880 Front St #6S31 San Diego CA 92188 FBI 450 Golden Gate Ave San Francisco CA 94102 FBI P O Box 13130 Sacramento CA 95813 FBI 300 Ala Moana #4307 Honolulu HI 96850 FBI P O Box 709 Portland OR 97207 FBI 915 2nd Ave #710 Seattle WA 98174 FBI Box 100560 Anchorage AK 99510