atives in the United States? Number of former spouses: Former Spouse's Name (1): Date of Birth: Country/Region of Origin (Nationality): Place of Birth City: Place of Birth Country/Region: Date of Marriage: Date Marriage Ended: How the Marriage Ended: Ittiorikeac.state.gov/CenNN/conenon/printapplicat

Birth Date . . : Oper Lic Cntry : Sex • ****** *** 0 T H Case Number . : Person Type . : Street Number : City County Business Phone : Birth City . . Race Ethnic Origin : Weight 1-97-002687 MOS Ana 17 United States gaNNOMMSENOMI FL White WHITE 504 120 Black Parted in Center Fair

0 Black Parted in Center Fair Normal Normal BLK JEANS 1-97-002687 (Continued) Prompt valid in: IMMONEW FL 334110000 Home Phone Birth Date Birth City VICTIM I N F Case Number 1-97-002687 Street Number : IMOMMON'DR City • LOXAHATCHEE, FL 33470 : 561/MOI4MMIL 11/1./111NI. 14 Unknown

(LCi7 Height- Ft/M. Weight Complexion Halr Col6r 1> l Eye Color Body Build Sca ns/Marksfrattoos - Description and Location #461 ✓C Cc Birth City /County Birth State Birth Country Citizenship Ethnic Primary Canguage `(Cr rc4. 1 Religion Understand English? Marital Status Highest Grade