ailed information. 1. Name Last DOE First & Middle O JOHN I OR EID 00 OOP End. a Exp 3. Sex EMDF 4. Place of Birth (City & State or City & Count ' is presently known) CITY OF BIRTH, AL 6. Mailing Address: Street/RFD # or P.O. Box 2. Date of Birth (ram/dd./MT) 01 01 1970 5. Social Sec