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Eight M Org. Seg. (OST only) Line of Business (FAA only) lbs. Weight Office Routing Symbol Social Security Number Office Phone Number(s) DOT Administration/Agency ft. in. Date/Place of Birth Eye Color Hair Color F Sex (M/F) Citizenship Issuing office use Office (Street) Address Office e-mail address - - - - - - - Contractors Only - - - - - - Contractor Company Contract Number & Expiration Date Contracting Officer Name and Phone Number (printed) - - - - - - - Reason for Issuance- - .

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