Re: Freedom of Information Act Request

Dear Freedom of Information Officer,

I am writing this request under the Freedom of Information Act, 5 U.S.C. Section 552. I hereby request a copy of the SS-5, Application for Social Security Card, or a corresponding NUMIDENT printout (see below) for the following individual:

MCCLENDON, ELIZABETH
587-72-1872
Birth: 11 Sep 1892
Death: May 1972

This individual is deceased, having been listed in the Social Security Administration's Death Master File. I understand the fee for this service is $27 for copy of original SS-5 application OR $16 for copy of an abbreviated NUMIDENT printout when the Social Security Number is provided. I am requesting a (circle one: SS-5 copy OR Numident printout) Included is a check for $______ made out to the Social Security Administration to cover any administrative costs required by this request.

Please respond to my request upon receipt of this initial correspondence. Thank you for your attention and assistance.

Sincerely,




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