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Get Statement Regarding Mutilated Passport

To submit this form or who do not provide all the requested information may be denied a passport, related document, or service. CERTIFICATION I, the undersigned, certify that the information furnished herein is correct and complete to the best of my knowledge and belief, and that I have not given my passport to another person or disposed of it in an unauthorized manner. If I subsequently find or recover it, I will immediately return it to Passport Services (Attention: Correspondence Branch), Dep.

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