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Social Security Administration
Office of Central Records Operations
FOIA Workgroup
P.O. Box 17772
300 N. Greene Street
Baltimore, Maryland 21290

Re: Freedom of Information Act Request

Dear Freedom of Information Officer,

I am writing this request under the Freedom of Information Act, 5 U.S.C. Section 552. I hereby request the Social Security File (SS-5, Application for Social Security Card) for the following individual:

NAME:______________________________
SOCIAL SECURITY NUMBER: ______________________________
BIRTH: ______________________________
DEATH: ______________________________

This individual is deceased, having been listed in the Social Security Administration's Death Master File. I understand the fee for this service is $7.00 when the Social Security Number is provided. Included is a check for $______ made out to the Social Security Administration to cover any administrative costs required by this request.
 

Sincerely,
 
 
 

Name/Address:

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