◆ SpookStack

-1 0 FD-482 Rev. 2-za-as! .E.RINIE.D.-602$ ~- QU_u_;,_,¢,bn1.¢/H1»; SEC 1:1 2/ 1. Name E-_ 2. Aliases '3. Date and Place of Birth 4. Citizenship t 5. Sex Oriental Other 6. Race 7. Height a. Heigh [:1 Hhite - [:1 Black W [:1 9. Hair 10. Eyes E] 11. Scars, marks and identifying characteristics 12. [:1 Single [:1 Married [:1 SeparatedE] Divo rced K13. Residence 14. Home Phone . .p' .1 A 15. Occupation/Employer includes academic institutions! 16. Hork Phone Date Taken ___ 17. Identifying Information Passport No. Social Security No. U.S. Person [:1 Yes [:1 Name Name Name Spouse: Mother: Father: Alien Registration No. DOB DOB DOB No Naturalized U.S. citizen E] Yes E] No POB POB POB Country of Issue Date of Issue Visa Type Date of Entry .__i_._i_-1 _.i_.__.________- .____._j_-i Siblings: Name DOB P08 Member Supporter Associate [:1 Financial Predication for investigation 18. Group affiliation Backers 19 Official position