UNITED STATES DISTRICT COURT DISTRICT OF IDAHO
Case Number:
STATEMENT OF SOCIAL SECURITY NUMBER(S)
Petitioner's Name (enter fu ll nam e) Social Security Number _ _ _ - _ _- _ _ _ _ or; (check if applicable)
Petitioner does not have Social Security Number
I declare under penalty of perjury that the foregoing is true and correct
Signature of Petitioner
Date
Filed under Seal
Penalty for making a false statement: Fine up to $250,000 or imprisonment for up to 5 year, or both. 18 U.S.C.§152 and §3571