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+S 4 . -_ tdentification Record Request 1 FD-g (Revs 4028-65} @ INSTRUCTIONS , : This form may be submitted in legible hand printing. 5. Indicate office for teply in lower right comer Lopes only. Aiso list tn lower right corner all offices Use separate form for cach intividual on whom which should receive copies of available records, record is requested, : Inchide carbon of FD-9 for each office receiving copies and forward with original to Bureau. Make effort to furnish FBI identification number, law enforcement identification number, or 6. Donot fill tn block in lower left comer. military service number, . Furnish descriptive data and fingerprint classification only when FBI nwnder not available. : DIRECTOR, FBI Attention: Identification Division Pate 12/9/71 NOR JAK . Field File No. 264-115 Furnish The Known Identification Record of the Following: aa “ eee | ™ ™ a ee Fingerprint Classification Scors, marks and tattoos Also Furnish: EX Photo () Fingerprints (F) Hendwriting Specimens: Identification Division's Reply /a-ee/- 7/ Bemre Reply geen oe (J On besis of information furnished, page eovietroit unoble to identify: 5 | Send Copies To: (Cj Photo Not Avoiloble {—) Fingerprints Attached (7) Handwriting Specimen Attached SEASCHE x stake Dien DEC 27 1971