etted nos Atmod 0 imemaucnal 00 0 c F. Conviction 0 Federal 0 Local 0 International Conviction Date: Subject Orniplian Code (—)• For 6F, 0, Hdretide Agency Cale 0 Fenny or 0 Misterneamor 0 Pin or ❑Toil Slaw Sal District J. Civil Rico Matters Dale Alsocomplete 'Scotian C• Other Civil Petters Date