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Get DS-4240 2013

Dress 6. Place of Birth 2 Third Party Authorization Complete this section if you are authorizing release of your records to another person. I, , pursuant to 5 U.S.C. Section 552a(b), authorize the U.S. Department of State to release any and all information relating to me to Name of Third Party Address of Third Party Type of Third Party (check one): Parent Custodial Guardian Legal Representation Other I declare under penalty of perjury under the laws of the United States of America th.

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