This letter constitutes my formal request for information pursuant to the provisions of the Freedom of Information and Privacy Acts, 5 USC 552. I am requesting copies of all information maintained by your agency that pertain to myself as described below:
Full Name:
Current Address:
Social Security No.:
Date and Place of Birth:
Former Addresses (use reverse if more space needed):
I, .............................................................. a Notary Public in and for the county (city) and state of …................................................... hereby certify that on the …........ day of …............., 20….... , before me personally appeared ..........................................................., who is known by me to be the identical person whose name is subscribed to, and who signed and executed the foregoing instrument. In witness thereof, I have hereunto set my hand and official seal this day and year above.
My commission expires: .............................
Signature of Notary: ......................................................
INSTRUCTIONS
To find out if you have an FBI (or any federal agency) file and obtain a copy of it, fill out the above information, have this form notarized (you must sign it in front of a notary and provide the notary sufficient identification), and mail to the FBI (or other agency). A request should be sent to each field office that might have files as well as FBI Headquarters. Make a copy of your signed and notarized form for your records. Please note that it is a criminal offense to represent yourself as another in attempt of obtaining information.
FBI
P O Box 366269
San Juan PR 00936
FBI
JFK Federal Bldg Rm 900
Boston MA 02203
FBI
150 Court St Fifth Fl
New Haven CT 06510
FBI
1 Gateway Market St 22nd Fl
Newark NJ 07101
FBI
26 Federal Plaza
New York NY 10278
FBI
James F Foley Bldg. 5th Fl
445 Broadway
Albany NY 12201
FBI
111 W Huron
Buffalo NY 14202
FBI
P O Box 1315
Pittsburgh PA 15213
FBI
William Green Bldg
Sixth ” Arch St 8th Fl
Philadelphia PA 19106
FBI DC Field Office
1900 Half St SW
Washington DC 20305
FBI Headquarters
J Edgar Hoover Bldg
10th ” Pennsylvania Ave
Washington DC 20535
FBI
7142 Ambassador Rd
Baltimore MD 21207
FBI
111 Green Court Rd
Richmond VA 23228
FBI
P O Box 3828
Norfolk VA 23514
FBI
6010 Kenley Ln
Charlotte NC 28217
FBI
Box 137
Columbia SC 29202
FBI
77 Forsyth St SW
Atlanta GA 30303
FBI
220 E Bryan St
Savannah GA 31401
FBI
Box 8928
Jacksonville FL 32239
FBI
16320 NW 2nd Ave
Miami FL 33169
FBI
Box 172177
Tampa FL 33672
FBI
2121 Bldg #1400
Birmingham AL 35203
FBI
P O Box 2128
Mobile AL 36652
FBI
710 Locust St #600
Knoxville TN 37902
FBI
Clifford Davis Fed Bldg #841
167 N Main
Memphis TN 38103
FBI
100 W Capitol #1553
Jackson MS 39269
FBI
600 Martin Luther King Jr Pl
Louisville KY 4020
