n, I will report the circumstances immediately to the Passport Office or the nearest U.S. Embassy/Consulate. NAME: Tecfreq Fp-4e kn (Please Print.Name Legibly) SIGNATURE: DATE: -7:35 I CD EFTA00316225 Hrnll 1.3 (12. C;tritt At hy: 3ort let 38e. t • :en, :r. Sinn it: SAN FRANCISCO SECOND