the Social Security Administration
ORGANIZATIONNew York State Division of Criminal Justice Services
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. Marital Status 18.a. Country Single O Married O Divorced O Widowcd LovAiz. I 12. Have you previously filed Form 1-765? OYes ENo 13.a. Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? @Yes O No NOTE: If you answered "No" to Item Number 13.a., skip to Item Number 14. I
mber 7.d. Form 1-765 12/26/19 Page 7 of 7 EFTA00173147 Additional Inquiry Response ORI: NYFBINY00 Federal Bureau of Investigation - New York New York State Division of Criminal Justice Services Alfred E. Smith Building, 80 South Swan St. Albany, New York 12210. Tel:l-800-262-DCJS Michael C.Green, Executive Deputy Commissioner of the NYS D
l Status gs) Single 0 Married 0 Divorced K Widowed 18.a. Country 12. Have you previously filed Form I-765? 18.b. Country Oyes JNo 13.a. Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? @Yes 0 No NOTE: If you answered "No" to Item Number 13.a., skip to Item Number 14. I
12/26/19 mememestavoramasenam Page 7 of 7 EFTA00173757 Additional Inquiry Response ORI: NYFBINY00 Federal Bureau of Investigation - New York New York State Division of Criminal Justice Services Alfred E. Smith Building, 80 South Swan St. Albany, New York 12210. Te1:1-800-262-DCJS Michael C.Green, Executive Deputy Commissioner of the NYS D
your father's birth name. 16.a. Family Name (Last Name) 16.b. Given Name (First Name) Mother's Name Provide your mothers birth name. 13.a. Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? 0 NOTE: If you answered "No" to Item Number 13.a., skip to Item Number 14. If you ans
1111 DirfirMISKIVOMMVERNMIIIII Page 7 of 7 EFTA01731234 Additional Inquiry Response ORI: NYFBINY00 Federal Bureau of Investigation - New York New York State Division of Criminal Justice Services Alfred E. Smith Building, 80 South Swan St. Albany, New York 12210. Tell-800-262-DCJS xecutive Deputy Commissioner of the NYS Division of Criminal
your father's birth name. 16.a. Family Name (Last Name) 16.b. Given Name (First Name) Mother's Name Provide your mothers birth name. 13.a. Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? 0 NOTE: If you answered "No" to Item Number 13.a., skip to Item Number 14. If you ans
1111 DirfirMISKIVOMMVERNMIIIII Page 7 of 7 EFTA01684019 Additional Inquiry Response ORI: NYFBINY00 Federal Bureau of Investigation - New York New York State Division of Criminal Justice Services Alfred E. Smith Building, 80 South Swan St. Albany, New York 12210. Tell-800-262-DCJS xecutive Deputy Commissioner of the NYS Division of Criminal
arital Status 18.a. Coun Eraingle K Married K Divorced K Widowed 12. Have you previously filed Form I-765? 18.b. Country ❑Yes E'No 13.a. Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? ErYes K No NOTE: If you answered "No" to Item Number 13.a., skip to Item Number 14.
RONIMEMOIStiftifttliSMUMIIIII Page 7 of 7 EFTA01699773 Additional Inquiry Response ORI: NYFBINY00 Federal Bureau of Investigation - New York New York State Division of Criminal Justice Services Alfred E. Smith Building, 80 South Swan St. Albany, New York 12210. 'Fel: I -800-262-DCJS Michael C.Green, Executive Deputy Commissioner of the NY
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Albany
LOCATIONthe NYS Division of Criminal Justice Services
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Michael C.Green
PERSONFederal Bureau of Investigation - New York
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