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Dorian Mayhew Rothschild 60 Arthur St.

San Rafael, CA 94901 April 26, 2012 Information & Privacy Coordinator Central Intelligence Agency Washington, DC 20505 Dear Coordinator: The purpose of this letter is to request information pursuant to the Freedom of Information Act, 5 U.S.C. section 552, and the Privacy Act, 5 U.S.C. section 552a. Please furnish me with copies of all records about me, which are retrievable through the use of an individual identifier and through the use of any combination of identifiers. In order to identify these records and to facilitate your research of the records systems, I am providing the following information: Dorian Mayhew Rothschild 60 Arthur St. San Rafael, CA 94901 Date of Birth: Place of Birth: City: County: State: Country: Sex: Social Security No: April 19, 1985 San Rafael California California United States Male 123-45-6789

Additional Information: prior military service, possession of a top secret security clearance If any part or all of my records are withheld under an FOIA exemption, please provide a list of the information withheld and mark any deleted sections. Please provide the specific exemptions that form the basis for any deletion from a record or the complete withholding of a record. Please provide me with an itemized statement of the applicable fees. If search and copying fees are estimated to exceed $100.00, please contact me before proceeding with this request. To further narrow my request, I would like the opportunity to review the records, or have an authorized representative review the records, in order to select the records to be copied.

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Please contact me at the above address if you have questions or need additional information. I can also be contacted by phone at (415) 485-1945 or (415) 848-1234. As provided for by section 552(a)(6)(A)(i) of the Freedom of Information Act, I expect to receive a reply within twenty (20) business days. Thank you for your prompt attention to this request.

Sincerely,

Dorian Mayhew Rothschild

STATE OF __________________________________, COUNTY OF ____________________________, ss: On this ______________ day of ____________, ______, before me personally appeared __________________________________, known to me to be the individual described in and who undersigned the above letter, and who acknowledged to me that he/she signed it for the purpose stated.

_________________________________________ Notary Public My commission expires: ______________________________

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