REQUEST UNDER FREEDOM OF INFORMATION ACT Date: ___________________________ To: ________________________________
Dear ______________________:
Pursuant to the Federal Freedom of Information Act, I request disclosure of such information on me as may be maintained in your files, and to the extent said disclosure is required by law. Please forward said information to the address below. I appreciate your cooperation.
In the presence of: ______________________________ Witness _______________________________ Name (Printed or Typed) _______________________________ Other Known Names _______________________________ Address _______________________________ _______________________________ _______________________________ Social Security No. _______________________________ Signature