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L BE MAILED TO REQUESTER ONLY) *** TYPE OR PRINT LEGIBLY WITH INK *** NOTE: IF THIS FORM IS NOT LEGIBLE OR NOT PROPERLY COMPLETED, IT WILL BE RETURNED UNPROCESSED TO THE REQUESTER. A RESPONSE MAY TAKE THREE WEEKS OR LONGER TO PROCESS. WARNING: A PERSON COMMITS A MISDEMEANOR OF THE THIRD DEGREE IF HE/SHE MAKES A WRITTEN FALSE STATEMENT, WHICH HE/SHE DOES NOT BELIEVE TO BE TRUE. REQUESTER NAME ADDRESS CITY STATE ZIP CONTACT TELEPHONE NUMBER (INCLUDING AREA CODE) - - REQUESTER IDENTIFICAT.

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