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QUESTIONNAIRE FOR CONSIDERATION FOR UNITE~ STATES SENATE
provided as strictly confidential.This Questionnaire is designed o gather detailed information from potential candidatesfor appointment to the seat n the United States Senate which will become available upon theresignation of United States Senator Hillary Clinton. Please complete this questionnaire, usingadditional sheetsas necessary.
PERSONAL INFORMATION
Full NameHave you ever used a name other than the one given above?
(N)-Y)
If yes, please set forth the narne(s)and explain why:
BAddress
c,
Home TelephoneNumber
D.
Work TelephoneNumber
E.
Mobile TelephoneNumber
F.
Email Address
G.
Please ist your addresses or the last 10 years, including the Street Number, City, State,Zip Cocfeand Dates of Residence:
2Date of Birth
H.
Placeof BirthSocial SecurityNumber
K.
Father'sName
1
Placeof Birth2CurrentAddressOccupation
L.
Mother's NamePlaceof BirthCurrentAddress2.3Occupation
(N)-
b you havea driver's license?
(Y)-
If yes, pleaseist:
Driver's License Number
2.Issuing StateExpirationDatelass
4.
.
Citizenship,and dateof United StatesNaturalization, f any:
.MARITAL STATUS
I.
Legally SeparatedA.Single -DivorcedarriedDomestic Partner
3
If you are currently married or living with a domestic partner, please provide thefolilowing:s.
Spouse/Partner'sameCurrentAddress2.
3.
Occupation
4
EmployerName and Address
c.
If you are divorcedor legally separated, leaseprovide he nameof each ormer spouse,
and their currentaddress(es):D.Child Supportor MaintenanceObligations
Do you have any child support or maintenance obligations?
(Y)-
(N)
(N/A)-Are you currenton all of your child supportandmaintenance bligations?
.
(N/ A) -,-.,
N)-Are there any legal.proceedings pending or judgments in any court against you forhon-payment of child support or maintenance obligations?
3,
(N)(N/A)-If yes,pleaseexplainand dentify the court.
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