My street address: ___________________________________
My city, state, and zip: _________________________________
July 5, 2013
United States Secret Service
Freedom of Information and Privacy Acts Branch
245 Murray Drive, Building 410
Washington, DC 20223
FREEDOM OF INFORMATION ACT / PRIVACY ACT REQUEST
Dear Sir or Madam:
This is a request for records under the provisions of the Freedom of Information Act and the Privacy Act. Please process this request under both statutes to release the maximum number of records.
I request copies of all files, correspondence, or other records concerning myself. To assist you with this search I am providing the following information about myself:
My full name: ________________________
Other names used: ________________________
My date of birth: ________________________
My place of birth: ________________________
My Social Security number: _________________
This is an individual request for research and study purposes, and I agree that I will pay up to $30 for fees, if necessary. Please notify me in advance if fees are expected to exceed that amount.
If you have any questions, please call me at ____________________.
I declare under penalty of perjury that the foregoing is true and correct. Executed on the following date: ________________.