ussia 29/08/2014 (xinnyy) 4. Date of (dtwity) birth 20/01/1953 5. Sox )( F I 11. Passport N° 516923892 Date of issue (flerrnmY1) 30/06/2014 Isbubd by US DEPARTMENT OF STATE Valid until (datnnfiy) 29/06/2016 12. Typo of passport diplomatic I olacial . tourist __. other please specify 13