Employer) 55 Water St. New York,N.Y.00 ..... . (Address of Employer in full. by Number. Street, City) The Nature of the Employer's Business is Stoelc. BrOkezA FULL NAME OF APPLICANT (Pleas. Print) I ..fgr.(41 ( SOCIAL SEICURITY NUMBER Date of Birth Are you an American citizen? VC. S. Singl