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United States Department of State

Washington, D. C. 20520

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Case No.: 200900535 Segment: PPT

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Ms. Pamela Barnett 254 1 Warrego Way Sacramento, CA 95826 Dear Ms. Barnett:
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I refer to your request letter we received on January 2,2009 under the of Information Act (Title 5 USC Section 552) for a copy of documents relating to Stanley Ann Dunham. We initiated a search of the Office of Passport Services.
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The search of the records of the Office of Passport Services has been completed and has resulted in the retrieval of six documents that are responsive to your request. These documents have been reviewed and the results are set ,.forth in the accompanying letter (with enclosures) of Jonathan M. Rolbin, . Director.
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' We have now completed the processing of your request. If you have anSf questions with respect to our handling of your case, you may write to the . Office of Information Programs and Services, SA-2, Department of State, ' . . Washington, D.C. 20522-8100. Please be sure to refer to the case number shown above in all correspondence about this case.
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We hope that the Department has been of service to you in this matter. Sincerely,

Office of Information Programs and Services Enclosures:

As stated

United States Department of State


Wmhutgton, D.C.

20520

In reply refer to: CA/PPT/L/LE - Case Control Number: 200900535 Pamela Barnett 254 1 Warrego Way Sacramento, CA 95826 Dear Ms. Barnett: The following is in response to your request to the Department of State dated January 2,2009, requesting the release of material under the provisions of the Freedom of Information Act (5 U.S.C. 5 552). We have completed a search for records responsive to your request. The search resulted in the retrieval of six documents that are responsive to your request. After careful review of these documents, we have determined that that all six documents may be released in full. We did not locate a 1965 passport application referenced in an application for amendment of passport that is included in the released documents. Many passport applications and other non-vital records fkom that period were destroyed during the 1980s in accordance with guidance from the General Services Administration. Passport records typically consist of applications for United States passports and supporting evidence of United States citizenship. Passport records do not include evidence of travel such as entrancelexit stamps, visas, residence permits, etc. since this information is entered into the passport book after issuance.

This completes the processing of your request.

Bureau of Consular Affairs Passport Services Enclosure: As stated

DEPARTMElv 1 O F S T A T E

APPLICATION FOR AMENDMENT O F PASSPORT


INSTRUCTIONS: A l l requests for i n c l u s i o n of persons must be sworn to (or affirmed) before an Agent o f the Department of State or C l e r k o f Court. Photographs, w h i c h meet the requirements below, and e v i d e n c e of c i t ~ z e n s h l pmust be submitted for a l l persons to be i n c l u d e d by t h i s amendment. I f such persons hove hod, or been i n c l u d e d in, a p r e v i o u s passport, i t should be submitted i n s t e c * of other documents, and Section C completed.

FORM A'

Amend as shown i n section:

Add v i s a pages.

IN

CARE O F

( P L E A S E P R I N T NAME I N F U L L )

( F i r s t name)

(Middle name)

(Lost name)

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o f t h e U n i t e d States, do h&by / ind~coted below.

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citizen

r e q u e s t t h a t my passport, w h i c h i s enclosed, b e amended as

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I N C L U D E MY CHILD(REN), AS FOLLOWS: ( A l s o complete Section H i f c h i l d ( r e n ) acquired c ~ t i z e n s h b ~ n o t u r o l i r o t i ~ n ,and hove not had o p r e v i o u s passport.) iy

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( P h o t o requirements for i n c l u s i o n )

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STAPLE ONE PHOTO HERE

, DO N O T MAR F A C E .
P h o t o s must be O N L Y of persons ; be i n o cluded by t h i s amendment. T h e t w o p h o t o s must b e duplicates, a p p r o x ~ m a t e l y2% by 2H i n c h e s i n size; be on thin, u n g l a z e d paper w i t h a plain, l i g h t background an<' have been t a k e n w i t h i n 2 years o f dot, submitted. P h o t o s should be f r o n t v i e w b u t n o t f u l l - l e n g t h , and may n o t be snap shot, Polaroid, a c e t o t e o r f i l m base prints. When more than 1 p e r s o n i s t o be included, a group photo i s require$. photos are acceptable.

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I N C L U D E M Y (WIFE) (HUSBAND), AS FOLLOWS: ( A l s o complete S e c t i o n H i f ( w i f e ) i h u r b a n d i ncouired c i t i z e n s h i o b ' n a t u r a l i z a t i o n . and/or Section I i f w i f e was ~ r e v i o u s l r r inarried befor; March 3, 1931.j (WIFE'S) (HUSBAND'S) F U L L L E G A L NAME P L A C E O F B I R T H (City, State)

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DATE OF BIRTH
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D A T E O F MARRIAGE

DO N O T S T A P L E SECOND P H O T O

ATTACH BY

PAPER CLIP

E X C L U D E PERSONS, AS FOLLOWS:
WHO I S / A R E

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0MY WIFE 0MY HUSBAND

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A P P L Y FOR S E P A R A T E PASSPORT

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I H U S B A N D * ~ ) L A S T U. S. PASSPORT D A T E ISSUED I

I N NAME O F

UIS S U B M I T T E D HEREWITH
O T H E R DISPOSITION (State)
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RENEWAL

A P P L I C A T I O N FOR AMENDMENT

0EXTENSION

REF

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:QUESTED

PROPOSED T R A V E L PLANS
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I F R E T U R N I N G T O U. S. C O M P L E T E T H E F O L L O W I N G

INTEND TO RETURN TO TH RESIDE WITHIN -

ITED

- E S PERMANENTLY TO P O R T O F DEPARTURE MONTHS

INTEND TO CONTINUE TO RESIDE ABROAD FOR THE FOLLOWING NAME O F SHIP OR AIRLINE PERIOD A N D PURPOSE
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DATE

OF

DEPARTURE

I h a v e not (and no other person ~ n c l u d e dor to be included in t h e p a s s p o r t or documentation has), s i n c e acquiring L h i t e d S t a t e s citizenship, b e e n naturalized a s a c i t i z e n of a foreign s t a t e ; taken an oath or m a h an affirmmion or a her formal declaration of a l l e g i a n c e t o a foreign s t a t e ; entered or s e r v e d in the armed forces of a foreign s t a t e ; a c c e p t e d or performed the d u t i e s of any office, p o s t , o r ernployment under the government of a foreign s t a t e or p o l i t i c a l subdivision thereof; voted in a political e l e c t i o n i n a foreign s t a t e or p a r t i c i p a t e d in an e l e c t i o n or p l e b i s c i t e to determine the sovereignty over foreign territory; made a formal renunciation of nationality e i t h e r in the .United S t a t e s or before a diplomatic or consular officer of t h e United S t a t e s in a foreign s t a t e ; ever sought or claimed t h e benef i t s of t h e nationality of any foreign s t a t e ; or been convicted by a court or court martial of competent jurisdiction of committing any a c t of treason against, or attempting by force to overthrow, or bearing arms a g a i n s t , t h e United S t a t e s , or conspiring to overthrow, put down or t o d e s t r o y by force, the Government of the United States. ( I f m y o f t h e above-mentioned a c t s or c o n d i t i o n s h w e been performed by or apply t o the applicant, or to any other person i n c l u d e d in t h e passport or documentation. t h e portion which a p p l i e s should be s t m c k out, and a sup k m e n t o r y explanatory statement under oo*, ( o r a f f i r m a t i o n ) by t h e person t o whom t h e porfron i s a p p l i c a b l e should b e attached and m a J o p a r t o f t h i s application.)

Subscribed and

NAME
I

BIRTHPLACE

BIRTHDATE

PREVIOUS MARRIAGE TERMINATED BY

S T A T E M E N T O F A C T I O N BY POST UPON D E P A R T M E N T ' S A U T H O R I Z A T I O N ( T o be e x e c u t e d o n l y in connection w i t h c a s e s r e f e r r u f t o Dept.)

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THE

0P A S S P O R T 0C A R D O F I D E N T I T Y
0C E R T I F I C A T E

WAS

0R E N E W E D T O 0A M E N D E D AS R E Q U E S T E D 0E X T E N D E D T O
(Consul o f the United States o f America)
X

AUTHORITY

O P I N I O N O F CONSULAR O F F I C E R

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(Photo reqrured for zncfusions)


STAPLEONEPHOTOHERE DO N O T MAR F A C E T h e passport photos required must be approximately 2% by 2% i n c h e s in size; be on thin unglazed paper, show full front view of applicant with a plain, light back-ground; and have been taken within 2 years of date submitted. When dependents a r e included they should be shown in a-group photograph. T h e consul will not a c c e p t photos rhat a r e not a good l i k e n e s s . Color photographs a r e acceptable.

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FS -299

Attach

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(Consul o f the United States o f America)
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64

In certaln c a s e s specific authorization by the Department will be required. In r h e s e c a s e s an extra copy of t h e form should be prepared Upon receipt of the Pepartment's reply the extra copy should be transmitted with a notarion of t h e action taken,

DEPARTMENT O F S T A T E

REQUEST BY UNiTED STATES NATIONAL FOR AND REPORT OF EXCEPTION T O SECTION 53.1, TITLE 22 OF THE CODE OF FEDERAL REGULATIONS

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REQUEST

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h c r r e been ~nformedthat m y p a s s p o r t is not valid and that a valid p a s s p o r t i s required by law to enter t h e t t . 1 request that an exception be granted to me, a s ~ r o v i d e d Section 1).2(h), T i t l e 22 o f the C o d e in Fecleral Regulations. I understand that a f e e o t $25 i s required under Section 53.2(h) and I will remit s u c h fee rI,:- P a s s p o r t O f f ~ c eDepartment of S t a t e , Washington, ,

(Sigrrature)

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REPORT

- Pursuant to Section 215 of the I m m i g r a t i o h n d Nationality Act of 1952


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Director, P a s s p o r t Office ilepartment o f S t a t e Washington, D. C. 20524 Attn: PT/AC

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STA!LEY AIW SOETORO

H C M E ADDRESS

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SUBJECT
DESCR~PT~ON

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D i a l a 1am.n &trzman 22 Pav., D jakartz, Indonesi c noluilu, 1617 South 3 e r e t ~ n i . ac~ o Stanley D / l

BIRTHDATE

NOT.
BIQ'HPLACE

342

NATURALIZATION DATE

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PASSPORT NO.,

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h!ichita, Kansas
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F 777788 R-19-65 ~onolHamii


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DEPARTURE FROM U N I T E D STATES

D A T E AND P L A C E OF D E P A R T U R E

I DESTINATION

October 196'7, Honolulu, Havhii


F L I G H T NUMBER OR VESSEL

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Djakarta, Indonesia
NAME OF CARRIER

J z p n Airlines
T R A V E L T O U N I T E D STATES

D A T E AND P L A C E OF D E P A R T U R E FROM ABROAD

October 20, 1971 D j a k ~ r t a . , Indonesia


F L I G H T NUMSER OR VESSEL

I D E N T I T Y DOCUMENTS PRESENTED

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P a s s p o r t as shorn ebove
NAME OF CARRIER

Pan American Aiw2ps


DESTINATION

October 21, 1971, Honolulu, H a w a i i


Identity and citizenship e s t a b l i s h e d . Exception granted under 22 CFR 53.2(h).

Honofulu, Iiawii
ACTION T A K E N
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POST ACTION REGISTRATION APPROVED

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Exp,res C A R D O F I D E N T I T Y AND REG.

No Fee passport

00 t f 8 c l o l posrport

0$3 fee collected (for card) 048-page p a s s p w t

TO BE COMPLETED BY AN APPLICANT WHO BECAME A CITIZEN THROUGH NATURALIZATION


I IMMIGRATED T O T H E U 5. 1 RESIDED CONTINUOUSLY I N T H E U.S. (Month, year) From (Year) T o (Year) N A T U R A L I Z A T I O N C E R T I F I C A T E NO. Subm~tted e r e w ~ t h h

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P L A C E N A T U R A L I Z E D ( C ~ t y ,state) N A T U R A L I Z A T I O N COURT

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DATE N A T U R A L I Z E D

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(WIFE'S) (HUSBAND'S) FULL LEGAL NAME

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BORN
NATURALIZATION ~ E R TFICATE NO. I

COMPLETE ONLY IF OTHERS ARE TO BE INCLUDED IN PASSPORT OR REGISTRATION AND SLP(MIT GROUP PHOTOGRAPH

' =NATIVE

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=NATURALIZED P L A C E N A T U R A L I Z E D (City, state)

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DATE NATURALIZED

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(WIF@S) (HUSBAND'S) P L A C E OF B I R T H ( c l t y , State or P r o v ~ n c s ,country)
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country)

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D A T E OF B I R T H (Ma.. Qay, Year)
2 :

NAME I N F U L L OF C H I L D R E N INCLUDED

P L A C E OF B I R T H (City, stote/povlnce.

(Month, OF O A T E day, year)

RESIDED I N U.S. (From-To)

FORM FS-176 9-74

(OVER YOU MUST COMPLETE PAGE 2)

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FORM APPROVED B U D G E T B U R E A U NO. 47-ROO12

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Z3-1Carta, i n d o n s a i a
REGISTRATION APPROVED

KLICATION
F O I ~ PASSPORT B
(First name) (Middle name)

REGISTRAT~OQ~

POST LOCATION
PASSPORT ISS UED No.

te ALL entries in all sections that apply to you. If i n f o r m a t i o n is unknown, Inknown.'' DOnot I m biar* p r Use additional sheets .here spaa r provided b n o t adequate. PRINT OR TYPE ENTRIES.
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Z3337221

Date
Expires CARD OF IDENTITY AND REG. No. Oat'
$6 fee collected ( f o r card) 48-page 96-page passport

Date Explres

4//23/31
4/2 7/86

TO BE COMPLETED BY ALL APPLICANTS


( L e n name)

a $3 Application fee collected


a $10 Fee collected
17 N o Fee passport
Official passport APPLICANT'S B~rth Certificate a citizen

STANLEY
1.

ANN

DUNHAM
BIRTH DATE Month Day Year

o f the U n ~ t e d States, d o hereby apply f o r ( a passport) (reglmatlon). SEX

( M F ) B I R T H P L A C E (City, State o r Province, Country)

EVIDENCE OF C I T I Z E N S H I P
mssport

F
HEIGHT

p . l ! KANSAS,A , c ~ r T - U.S.A.

Nov .

1 29 1 1942

~ e r t i f i c a t e N a t u r a l i z a t ~ o n r C~tizenship of o Data:

-COLOR OF H A I R COLOR O F EYES S O C I A L S E C U R I T Y NO. (Spell out) (Spell out) ( N o t mandatory)

6 1-476
Submitted H e r e w ~ t h d a n c e l e d 81 Returned Seen & Returned

Bearer's Name.

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in.

BROWN

BROWN

535-40-8522
Place:

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NOW R E S I D I N G A T

J a l a n Daksa 1/14, Kebayoran Baru J a k a r t a Sel atan. I n d o n e s i a


Z I P Code) (If m m e as above,

MY LAST REGISTRATION AS A CITIZEN O F T H E U N I T E D STATES WAS APPROVED


Location o f Registering O f f i c e D a t e o f Registration

P E R M A N E N T RESIDENCE (Street Addrasq City, State, U.S. so indicate)

1617 South B e r e t a n i a , Apt.1008,

Hon., Hawaii
11

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949-2317

1E ANSWER

1S"YES."

EXPLAIN WHEN +ND WHY

B
(PHOTO R E Q U I R E M E N T S F O PERSONS T O B E I N C L U D E D )

Photos m u s t b e O N L Y o f persons
to be included (other than passport

I
BIRTHPLACE (Citv,.StamcrPr~Ina~, Carnay) BIRTH DATE (Mo,Day,Yr.) Submitted Herewith Canceled & Returned Seen & Returned CHILD(REN)'S E V I D E N C E

bearer). When more than one person is t o b e included, a group phot* graph o f the inclusions is required.

CHILD(REN)'S NAME(S) IN FULL CONSULATE W I L L STAPLE PHOTO O F I N C L U S I O N S HERE. D O N O T IMPRESS S E A L O N PHOTOGRAPHS.

BIRTH DATE(S) BIRTHPLACE(S) (City, State o r Country) (Mo., Day, Yr.)

S u b m i t t e d Herewith Canceled & Returned Seen & Returned

I
I

I have n o t (and n o other person included i n t h i s application has), since acquiring U n i t e d States citizenship, performed any o f the acts listed i n Section 1 o n the reverse o f this application f o r m (unless explanatory statement is attached). I solemnly swear (or a f f i r m ) that t h e statements made on all of the pages o f this appl!cation are t r u e and t h e photograph(s) attached is (are) a likeness o f me and bf those persons t o be

(SEAL)

( T o be signed a t same t i m e b y h u s b a n d w i f e to be included i n passport)

( T o be signed ;b day o f

/,L /L 17

3%-Li.,r., i 1, i Applicant i n presence of person administering a h )


4;
ki..

Subscribed a n d sworn t o (affirrnea) before me thls

A?

3 Vt, 3 Consul
OPTIONAL FORM 178 (FORMERLY FS-176)

o f t h e U n l t e d States a t

33LG & dGiL$!!

I / (OVER YOU MUST COMPLETE PAGE 2)

&gnature

o f &r&

takin<&plication) January 1 9 7 8 D e p t o f State

AlNO SWtlV 3UHM NI MU04 4 0 X3W8 NO

OF-178 1-78

PAGE 2 TO - - - - BE COMPLETED BY AN APPLICANT WHO BECAME A CITIZEN THROUGH NATURALIZATION


-

'

1
. IMMIGRATED T O THE I U.S. (Month, year)

I RESIDED U.S. F r o m (Year)

CONTINUOUSLYIN THE NATURALIZATION CERTIFICATE


T o (Year)

NO.

*
P L A C E N A T U R A L I Z E D (City, state)
I
'

q Seen and returned q Previously submitted


N A T U R A L I Z A T I O N COURT DATE NATURALIZED
I

S u b m i n e d herewith

D
OCCUPATION

TO BE COMPLETED BY ALL APPLICANTS


[VISIBLE DISTINGUISHING MARKS

PROGRAM OFFICER, FORD FOUNDATION


E -EN
I WAS PREVIOUSLY MARRIEDON I T 0 ( F u l l legal name)

none

MUST W P L E T E FOLLOYVlNG IF CHILDREN OF A PREVIOUS MARRIAGE ARE MlCLUOED OR IF PRWIUSLY MARRIED BEFORE MARCH 3,1931

WHO WAS B O R N A T (City, State, Country)

O N (Date o f b i r t h )

OFORMER HUSBAND WAS

U.S. CITIZEN

PREVIOUS MARRIAGE TERMINATED B Y

ODEATH ODIVORCE
PARBTT(S)

nFORMER HUSBAND WAS NOT U.S. -E IF APPLICANT OR ANY E m UCLlJDa


(Month) (Year) Date Applicant Wife

CITIZEN I O N (Date)

SECTION BWAS NOT B R IN THE UNITED STATES AN) C O N


IF FATHER NATURALIZED: Certificate No.
I

W CrrUENSHP

'ENTERED THE U.S.

I F KNOWN, FATHER'S RESIDENCE/ P H Y S I C A L PRESENCE I N U.S. F r o m (Year) T o (Year)

I
G

q Husband
Child RESIDENCE/CONTINUOUS P H Y S I C A L PRESENCE I N U.S. From(Year) T o (Year) Applicant

Before (Name o f Court)

Place (City, State)

I I F MOTHER NATURALIZED: Date Certificate No.

IF KNOWJ, MOTHEWS RESIDENCE/ P H Y S I C A L PRESENCE I N U.S. F r o m (Year) T o (Year)

3, I
\
0

Wife Husband Child

(
d

Before (Name of Court)

Place (Ciw, State)

PROPOSED TRAVEL PLANS (Not Mandatorv)

I I N T E N D T O C O N T I N U E T O RESIDE A B R O A D FOR T H E F O L L O W I N G P E R I O D A N D PURPOSE

Two y e a r s c o n t r a c t w i t h Ford Foundation f r o m January 1981


D A T E O F DEPARTURE
4

December 1982.

! I I N T E N D T O RETURN T O THE U N I T E D STATES PERMANENTLY T$ RESIDE W I T H I N

Y E A.... -. R S

MONTHS .. .. . .

- . -

TR information solicited o n this f

PRIVACY ACT STATEMENT

is authorized by, b u t n o t l i m i t e d to, those statutes codified i n Titles 8, 18, and 22, UnitedStatesCode, n d all dified, and all regulations issued pursuant t o Executive Order 11295 o f August 5, 1966. T h e p r i m a r y purpoaa f o r predecessor statutes whether o r n o soliciting t h e information i s t o establish citizenship, identity and entitlement t o issuance o f a U n i t e d Stater Parrport or related facility, and t o properly administer and enforce t h a laws pertaining thereto.

T h e i n f o r m a t i o n is made available B a r o u t i n e use o n a needto-know basis t o personnel o f t h e Department o f Stata and other g o v w m e n t agencies having statutory o r other lawful a u t h o r i t y t o maintain such information i n t h e performance of their official duties; pursuant t o a rubpoene o r c o u r t order; and, ar set f o r t h i n Part 6a, T i t l e 22, Code o f Federal Regulations (See Federal Register V o l u m e 40, pages 45755, 45756,47419 and 47420). Failure t o provide t h e information requested on this f o r m m a y result i n t h e denial o f a U n i t e d States P a p o r t , related document individual seeking such passport, document o r service.

or

r e w i c e to t h e

N O T E : T h e disclosure o f y o u r Social Security Number o r o f t h e i d e n t i t y and location o f a person t o be n o t i f ied in t h e event o f death or r c i d e n t is entirely voluntary. However, failure t o provide t h i s information m a y prevent t h e Department of State f r o m providing y o u w i t h t i m e l y assistance o r protection i n t h e event y o u should encounter an emergency situat:-? w h i l e outride t h e U n i t e d States.

I:
.

ACTS OR CONDITIONS
( I f m y of t h e b e l o w m e n t i o n e d acts o r conditions have b w n performed b y or apply t o t h e applicant, o r t o any other person t o b e i n c l u d d in t h e passport, t h e p o r t i o n which applies should be struck out, and a supplementary explanatory statement under oath ( o r affirmation) b y t h e p n w n to w h o m t h e p o r t i o n is applicable should be attached and made a p a r t o f this application.) I have n o t ( a n d n o other person included i n this application has), since acquiring U n i t e d States citizenship, been naturalized as a citizen o a f r f o m mt.; taken an o a t h o r made an affirmation o r other f o r m a l declaration o f allegiance t o a foreign state; entered or served in t h e s m e d f o r c r of e foreign rar; accepted o r performed t h e duties o f any office, post, o r employment under t h e government o f a foreign state o r political subdivision themof; m.d. a f o r m a l renunciation o f nationality either in t h e U n i t e d States or before a diplomatic o r consular officer o f t h e U n i t e d States in a foreign state; ever sought o r claimed t h e benefits o f t h e nationality o f any foreign state; o r been convicted b y a court o r c o u r t martial o f competent jurisdiction o f c o m m i t t i n g any act o f treason against, or attempting b y force t o overthrow, o r bearing arms against, t h e U n i t e d States, o r conspiring t o overthrow, put d o w n o r t o destroy b y force, the Government o f t h e U n i t e d States. W A R N I N G : False statements made knowingly and w i l l f u l l y i n passport applications o r i n affidavito o r other supporting documents l u b m i M thwwith are punishable b y f i n e and/or imprisonment under t h e provisions o f 18 USC 1001 andfor 1 8 USC 1542. Alteration o r m u t i l a t i o n o f 8 pr00t-t b d u pursuant t o this application is punishable b y f i n e and/or imprisonment under t h e provisions o f 18 USC 1543. T h e use o f e p-ort i n v i o l m i o n of the restrictions contained therein o r of t h e passport regulations is punishable b y f i n e and/or imprisonment undor 18 USC 1644. A l l rtoasmenta and documents submitted are subject t o verif icaticn.

J
'APPLICANT'S I D E N T I F Y I N G D O C U M E N T E )

(FOR USE OF OFFICE TAKING APPLICATION)

q
U

Certificate of Naturalization or Citizenship , Passport D r i v e f s License

Issue Date: place of Issue: Issued i n Name of:

I D E N T I F Y I N G DOCUMENT(S) O F W I F E / H U S B A N D T O B E I N C L U D E D I N PASSPORT q Certificate o f Naturalization o r Citizenship No.: q Passport Issue Date: Driver's License Other (Specify): . " Place o f Issue: Issued i n Nerne of:

Qther (Specify):