996 FormSocial Security Number Record Request for

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Allow 4 to 6 weeks for a reply. I hereby request an extract or photocopy of my application s for a social security number. Full Name Used Name Shown on Last Social Security Card if different from full name now used Full Name at Birth Date of Birth MM/DD/YYYY Gender Place of Birth city county and state or foreign country Male Female Full Maiden Name of Mother whether living or deceased Full Name of Father whether living or deceased I declare under penalty of perjury that I have examined all the...

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