Glen L. Roberts
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Freedom of Information		
and Privacy Act Request


To:______________________________

_______________________________

_______________________________



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):	

	

	


Date:____________	Signature:__________________________ 


I, __________________________ a Notary Public in and for the county 
(city) and state of  __________________________ hereby certify that 
on the ____ day of _______, 19__, 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.

THIS FORM IS A PUBLIC SERVICE OF GLEN L. ROBERTS

You are encouraged to copy this form and distribute to others. Glen 
L. Roberts is editor of Full Disclosure. Glen L. Roberts, PO Box 
1533, Oil City, PA 16301. Email: glr@ripco.com. Web: 
http://pages.ripco.com:8080/~glr/glr.html

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 40202

FBI
1240 E 9th    Rm 3005
Cleveland OH 44199

FBI
Box 1277
Cincinnati OH 45201

FBI
Box 1186
Indianapolis IN 46206

FBI
P O Box 2118
Detroit MI 48231

FBI
Box 2058
Milwaukee WI 53201

FBI
111 Washington St #1100
Minneapolis MN 55401

FBI
P O Box 3007
Butte MT 59702

FBI
219 S Dearborn St #905
Chicago IL 60604

FBI
P O Box 3646
Springfield IL 62708

FBI
1520 Market  #2704
Saint Louis MO 63103

FBI
811 Grand  #300
Kansas City MO 64106

FBI
P O Box 541090
Omaha NE 68154

FBI
1250 Poydras   #2200
New Orleans LA 70113

FBI
P O Box 21470
Little Rock AR 72221

FBI
P O Box 54511
Oklahoma City OK 73154

FBI
1801 N Lamar  #300
Dallas TX 75202

FBI
2500 E T.C. Jester
Houston TX 77008

FBI
Box 1630
San Antonio TX 78296

FBI
7000 E San Antonio  #C600
El Paso TX 79901

FBI
P O Box 1229
Denver CO 80201

FBI
125 S State  #3203
Salt Lake City UT 84138

FBI
201 E Indianola  #400
Phoenix AZ 85012

FBI
301 Grand NE
Albuquerque NM 87102

FBI
700 8th Charleston Blvd
Las Vegas NV 89104

FBI
11000 Wilshire  #1700
Los Angeles CA 90024

FBI
880 Front St  #6S31
San Diego CA 92188

FBI
450 Golden Gate Ave
San Francisco CA 94102

FBI
P O Box 13130
Sacramento CA 95813

FBI
300 Ala Moana  #4307
Honolulu HI 96850

FBI
P O Box 709
Portland OR 97207

FBI
915  2nd Ave  #710
Seattle WA 98174

FBI
Box 100560
Anchorage AK 99510

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