treet address) (City, State, County, Zip Cod.) ittratat, t- IMIC 3. Home Telephone Number (Area Code, Number): 4. Aliases/Nickname: Nor Apph4.4:4 S. Citizenship (List the country you are a citizen of): A 6. Social Security Number: 7. Date of Birth (Month, day, year): Ba. Sex: 8c. Height: MA Le. Le, /5-11 Bb