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RD 19 U.S.C. 66, 1551, 1555, 1565, 1624, 1641; 19 CFR 112.42, 118, 122.182, 146.6 Please Type or Print 1. TYPE OF ACTIVITY REQUIRING IDENTIFICATION CARD Cartman/ Lighterman CBP Security Area Identification Broker's Employee 2. DATE OF THIS APPLICATION Warehouse Officer or Employee Container Station Employee Foreign Trade Zone Employee CES Employee 3. NAME (Last, First, & Middle) 4. SOCIAL SECURITY NUMBER 5. LIST ANY OTHER NAMES YOU HAVE EVER BEEN KNOWN BY (Nicknames, aliases, etc.).

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