PRISMScanned Document

Page  I  of  I

| Field | Extracted value |
|---|---|
| Form | U.S. Department of State — Application for U.S. Passport / Registration (DS-11) |
| Name (First & Middle) | CHIS[A]INE NOELLE (handwritten, partially unclear) |
| Last name | MAXWELL |
| Mail passport to (street) | (redacted) |
| Mail passport to (city) | ST THOMAS |
| Mail passport to (state) | USVI / W.I. |
| Mail passport to (ZIP) | 00802 |
| Country / In care of | c/o AMERICAN YACHT HARBOR (handwritten) |
| Sex | F |
| Place of birth (city) | MAISONS LAFFITTE (handwritten; likely Maisons-Laffitte) |
| Place of birth (country) | FRANCE (circled) |
| Date of birth | (redacted / blacked out) |
| Social Security Number | (redacted / blacked out) |
| Height | 5' ? (handwritten, partly illegible) |
| Hair color | Brown |
| Eye color | Brown |
| Occupation | Business woman |
| Permanent address (city) | ST THOMAS |
| Permanent address (state) | W.I. |
| Permanent address (ZIP) | 00802 |
| Father's full name | MAXWELL (surname visible) |
| Mother's full / maiden name | MELINDA ELIZABET / (handwritten, partially illegible) |
| Have you ever been married? | (handwritten — appears checked/annotated) |
| Ever issued a U.S. passport? | No (boxed) |
| Emergency contact | (blank / not provided) |
| Travel plans — Date of trip | 12/25/2002 (handwritten) |
| Travel plans — Length of trip | 1 week |
| Travel plans — Countries to be visited | United Kingdom |
| Applicant photo | 1 passport-style photo attached (female, short hair) |
| Applicant signature / date | Signature present; dated 11/27/2002 |
| ID presented (applicant's or father's identifying documents) | Nat. Cert. noted; "Christiane N. Maxwell" and numbers visible (handwritten ID numbers) |
| Fee / disposition | Fee $0.00 (handwritten stamp/notation) |
| Notes | Several fields are blacked out or handwritten and partially illegible; red stamps and annotations present (e.g., "EM PP", departmental stamps). |

https://ccdi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc?p_hash=9722EF4329... 2/24/2020

EFTA00029692