PRISMScanned Document

Page  I  of  I

| Field | Extracted information |
|---|---|
| Document | U.S. Department of State — Application for U.S. Passport (Form DS-11), Page 3 of 4 |
| Applicant name | REDACTED |
| Photo attached | Yes (passport-style photo at bottom-left) |
| Signature | Present (applicant signature, dated 11/27/2002) |
| Mailing address / City / State / ZIP | REDACTED |
| Country / In care of | REDACTED |
| Sex | F (female) — marked |
| Place of birth | France (handwritten) |
| Date of birth | REDACTED |
| Social Security Number | REDACTED |
| Height | 5'3" (appears) |
| Hair color | Brown |
| Eye color | Brown |
| Occupation | Businesswoman (handwritten) |
| Mother's full / maiden name | REDACTED |
| Applicant identifying document (box 23a) | Nat. Cert. (noted) |
| Travel plans (box 20) | Trip date ~ 12/05/2002; Length ~ 1 week; Countries to be visited: United Kingdom |
| Application/processing stamps/marks | Multiple red pen stamps and handwritten annotations; barcode at top-right (partially visible) |
| Date on form / signature date | 11/27/2002 (visible) |

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

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