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[DRAFTING DIVISION] [srnssw ADDRESS] ICITY, STATE, ZIP cons] [1-10m'H, DAY, YEAR] ALL INFORMATION CONTAINED HREIH I5 umcLAssIF1En DATE 06-01~2u0? BY 6Sl?9 nu/K
RfJW inn./uns./Ms.1'lcomPLsTs NAME or POC1 [TITLE, IF AVAILABLE] [NAME or COMPANY] [PHYSICAL swans? ADDRESS - NO P.O. BOX} ECITY, STATE - no ZIP cons] DEAR IMR./MRS./MS.] [LAST NAME]: Under the authority of Executive Order 12333, dated December 4, 1981, and pursuant to Title 15, United States Code U.S.C.}, Section l681u a] the Fair Credit Reporting Act, as amended!, you are hereby directed to provide the Federal Bureau of Investigation {FBI} the names and addresses of all financial institutions {as defined in Title 12, U.S.C., Section 3401! at which the belownamed consumer s! maintains or has maintained an account: NAMEIS!: ADDRESS{ES!: [if available] DATE S! OF BIRTH: [if available] SOCIAL SECURITY NUMBERIS!: {if available] In accordance with Title l5, U.S.C., Section l68lu a!, I certify that such information is sought for the conduct of an authorized investigation to protect against clandestine intelligence activities, and that such an investigation of a United States person is not conducted solely on the basis of activities protected by the First Amendment to the Constitution of the United States.