/ajov -,Fic EFTA00789774 Recood Kapott It -125 (Ftcv. 4.143) Date 0 (9/ 0O 0 0 7 K Birth K Credit KCriminal K Death K INS K Marriage• K Motor Vehicle '❑ Other VS Buded b6 b7c Return to s/4- Name and aliases of subject, applicant, or employee, and spouse File Number ae-myyk- oKa(, Address Re