ECTION C • Registratiotnformation Name: erney 1 (fi-G, C Alias: SSN#:0/1 0%-1/41÷33Y /Alien If: Fist ( /hit* DOB: [ -CI Si POB: PG/ '1.), - VI Driver's License#: 0 0 0 0 c3 21-Q 3 ki Exp. Date: /- 2-0 if -- mom i v 0 WA' Race: “-, Sex: N HI: to WI r o Hair: Ot t ) Eyes: V Scars, Marks, Tat