36th Annual John and Jennie Davis Davis Family Reunion

SECURITY CLEARANCE REQUEST INFORMATION

for

WHITE HOUSE, PENTAGON AND CAPITAL HILL TOURS

Please return to Terri Davis-Warren no later than December 15, 2015 by
Davis Family Reunion, C/O Terri Davis-Warren
US Mail: 18428 Cherrylawn St., Detroit, MI 48221 or
Scan & Email: Tdaviswarren@hotmail.com
FULL NAME (as indicated on gov't issued id)
Ex: Jane Marie Doe

GENDER DATE OF BIRTH

F
1/1/1970

CITY/STATE OF RESIDENCE
Henderson, Tennessee

CITIZENSHIP
United States

SOCIAL SECURITY #
123-45-6789

Notice: All information submitted will be kept confidential and only for the sole purpose of the tours listed above for
security clearance only and will be destroyed immediately thereafter.
All visitors 18 years and older must have a current and valid U.S. Passport, U.S. Passport Card, Driver's License or State Identification Card with photograph for
entry into the Pentagon.
All visitors 14 years and older are required to submit photo identification with their name exactly as it was submitted on the clearance for entry into the White
House.