WPC  77WPC >?A\ ?t @[?vOs?c=j?j=>z<(Vz^o~zZ{7>  (  (Untitled)'3,h , ,   UB ) 3    *     +     ,     /0ghjklmnopqrstuvwxyz{|}~<* * c:\inf42\forms\ad349.wpf c:\product\forms\informs\ad\ad349.wpf >?f eh Terminal 1 ! d !  d      Terminal eb Arial " ! 2     d    Arial ev Times New Roman  ! 2 F  d    Times New Roman ex Helvetica-Narrow " ! &     d    Helvetica-Narrow eb Roman  ! 2    B    Roman eh Helve-WP " ! ?     d     Helve-WP ej Wingdings  ! } F  d     Wingdings eX  ! ? !  d     eh MS Serif  ! ? !  d     MS Serif ed Modern 2 ! 2    B    Modern ej Bodoni-WP  ! ? !  d     Bodoni-WP er MS Sans Serif " ! ? !  d    MS Sans Serif ed System " ! XS  d    System er CG Times (WN)  ! ? !  d    CG Times (WN) ef Courier 1 ! d !  d     Courier en Univers ATT " ! ? !  d     Univers ATT ep Times CG ATT  ! ? !  d     Times CG ATT ep Arial Narrow " ! &     d     Arial Narrow ?Ad A{?z jV c:\inf41\database\ AD349.DBFHISTORY   i,Action_Code     h  ACTION_CO0 i'Agency     h AGENCY i/Effective_Date     h  EFFECTIVE2 i%Name  T   h NAMET i$SSN     h SSN i/Street_Address  n   h  STREET_AD5n i'Apt_No     h APT_NO i*City_Name  A   h CITY_NAMEA i3State_Country_Name  -   h  STATE_COU8- i)Zip_Code     h ZIP_CODE i*City_Code     h CITY_CODE i,County_Code     h  COUNTY_C11 i3State_Country_Code     h  STATE_CO12 i0Street_Address2  n   h  STREET_A13n i(Apt_No2     h APT_NO2 i+City_Name2  A   h  CITY_NAME2A i4State_Country_Name2  -   h  STATE_CO16- i*Zip_Code2     h ZIP_CODE2 i+City_Code2     h  CITY_CODE2 i-County_Code2     h  COUNTY_C19 i4State_Country_Code2     h  STATE_CO20 i.Employee_Sign  _   h  EMPLOYEE21_ i*Date_Sign     h DATE_SIGN ?z@d @}?vOXX } FORM AD-349  } (REV. 12/93) ? !"#                            <  <&&&    t@X } AGENCY USE B !"#                            <  &&&&    7@X Action_Code!"-./5B6789:;>?@ABCG                         < #    d $     '    Y@$.,! *  < &&& = &&&    F! & d AGENCY& Agency!"-./5G6789:;>?@ABCG                         < #    d $     '    Y@$.,! *  < &&& = &&&    <# Effective_Date!"-./5L6789:;>?@ABCG                         < #    d $     '    Y@$.,! *  < &&&& =   &    <@HASVALUE (Effective_Date) and #UPDATONLY  %  Effective_Date  ~      A@datevalue (@datetext (Effective_Date, "%2-%1-%5")) %  Effective_Date   %2-%1-%5  "  #  >@VALUE (@DATETEXT (Effective_Date,"%5"))<=29 %  Effective_Date   %5  "  x         @SETVALUE (Effective_Date, @DATEVALUE (@CONCAT (@DATETEXT (Effective_Date,"%2-%1"),"-20",@DATETEXT (Effective_Date,"%5"))),TRUE) '  Effective_Date %  Effective_Date   %2-%1  "   -20 %  Effective_Date   %5  "      #       aX^ } 1. NAME (Last, First, Middle)X Name!"-./56 7:89::;>?@ABCG                         < #    d $     ' T  Y@$.,! *  < &&  = &&&    a` ^ } 2. SOCIAL SECURITY NO.` SSN!"-./5=6 789:;>?@ABCG                         < #    d $     ' ,--  Y@$.,! *  < &&  = &&&    eZ  ^ } 3. STREET ADDRESS OR P.O. BOX Street_Address!"-./56 7D89:D;>?@ABCG                         < #    d $     ' n  Y@$.,! *  < &&  = &&&    O ^ } 5. CITY NAME City_Name!"-./567&89:&;>?@ABCG                         < #    d $     ' A  Y@$.,! *  < &&  = &&&    N  } CITY CODE City_Code! "-./5!6789: ;>?@ABCG                         < #    d $     '   Y@$.,! *  < &&&& = &&     d ^ } 6. STATE or COUNTRY NAME State_Country_Name! "-./5)6789:;>?@ABCG                         < #    d $     ' -  Y@$.,! *  < &&  = &&&    M! ^ } 7. ZIP CODE Zip_Code! "-./5G67 89: ;>?@ABCG                         < #    d $     '    Y@$.,! *  < &&  = &&&    `X } 13. SIGNATURE OF EMPLOYEEX Employee_Sign!"-./567:89::;>?@ABCG                         < #    d $     ' _  Y@$.,! *  < &&& = &&    T`  } 14. DATE SIGNED` Date_Sign!"-./5=6789:;>?@ABCG                         < #    d $     '   Y@$.,! *  < &&&& = &&    7@HASVALUE (Date_Sign) and #UPDATONLY     Date_Sign  ~      <@datevalue (@datetext (Date_Sign, "%2-%1-%5"))    Date_Sign   %2-%1-%5  "  #  9@VALUE (@DATETEXT (Date_Sign,"%5"))<=29    Date_Sign   %5  "  x         @SETVALUE (Date_Sign, @DATEVALUE (@CONCAT (@DATETEXT (Date_Sign,"%2-%1"),"-20",@DATETEXT (Date_Sign,"%5"))),TRUE) "  Date_Sign    Date_Sign   %2-%1  "   -20    Date_Sign   %5  "      #       0  d This form was electronically produced by Elite Federal Forms, Inc.  !"#                            <  &&    XtX } U.S. DEPARTMENT OF AGRICULTURE  }  EMPLOYEE ADDRESS  # !"#                            <  <&&&    @ X d ACTION  d CODE B !"#      P                       <      #  d EFFECTIVE  d DATE L !"#      P                       <  &&    t$L & SECTION I N !"#                            <  <& &    q$ & Complete Section I with your current or new residence mailing address. This address is used to  & mail out employee Pay and TSP statements, W-2 forms and other personal documents.  &A NOTE: This form does not change the U.S. Savings Bond address. N !"#                            <  <&&&    J!Z ^ } 4. APT NO. Apt_No!"-./5G6 7 89: ;>?@ABCG                         < #    d $     '    Y@$.,! *  < &&&& = &&&    x  } AGENCY USE  !"#                             <      R  } COUNTY CODE County_Code! "-./506789: ;>?@ABCG                         < #    d $     '   Y@$.,! *  < &&&& = &&     c  } STATE OR COUNTRY CODE@ State_Country_Code! "-./5?6789: ;>?@ABCG                         < #    d $     '   Y@$.,! *  < &&&& = &&     u $L & SECTION II N !"#                            <  <& &    E<$ &  FOR EMPLOYEES WITH DIRECT DEPOSIT COMPLETE BLOCKS 13 AND 14 ONLY.  &n Employees who wish to receive their checks in the mail complete blocks 8 through 14 with  & your current or new check mailing address. N !"#                            <  <&&&    f* ^ } 8. STREET ADDRESS or P.O. BOX Street_Address2!"-./567D89:D;>?@ABCG                         < #    d $     ' n  Y@$.,! *  < &&  = &&&    Q^ } 10. CITY NAME City_Name2!"-./567&89:&;>?@ABCG                         < #    d $     ' A  Y@$.,! *  < &&  = &&&    O } CITY CODE City_Code2!"-./5!6789: ;>?@ABCG                         < #    d $     '   Y@$.,! *  < &&&& = &&     f^ } 11. STATE or COUNTRY NAME State_Country_Name2!"-./5)6789:;>?@ABCG                         < #    d $     ' -  Y@$.,! *  < &&  = &&&    O!^ } 12. ZIP CODE Zip_Code2!"-./5G67 89: ;>?@ABCG                         < #    d $     '    Y@$.,! *  < &&  = &&&    K!*^ } 9. APT NO. Apt_No2!"-./5G67 89: ;>?@ABCG                         < #    d $     '    Y@$.,! *  < &&&& = &&&    ??x } AGENCY USE  !"#                             <      S } COUNTY CODE County_Code2!"-./506789: ;>?@ABCG                         < #    d $     '   Y@$.,! *  < &&&& = &&     d } STATE OR COUNTRY CODE@ State_Country_Code2!"-./5?6789: ;>?@ABCG                         < #    d $     '   Y@$.,! *  < &&&& = &&     ?=de =?^ #  &   Information Regarding Disclosure of Your Social Security Number Under Public Law 93-579 Section 7(b) (Privacy Act of  & 1974)   & Disclosure by you of your Social Security Number (SSN) is mandatory to obtain the services, benefits, or processes that you  & are seeking. Solicitation of the SSN by the United States Department of Agriculture is authorized under provisions of Executive  & Order 9397, dated November 22, 1943. The SSN is used as an identifier throughout your Federal career from the time of  & application through retirement. It will be used primarily to identify your records that you file with the U.S. Department of  & Agriculture. The SSN also will be used by the U.S. Department of Agriculture and other Federal agencies in connection with  & lawful requests for information about you from your former employers, educational institutions, and financial or other  & organizations. The information gathered through the use of the number will be used only as necessary in personnel  & administration processes carried out in accordance with established regulations and published notices of systems of records.  & The SSN also will be used for the selection of persons to be included in statistical studies of personnel management matters.  & The use of the SSN is made necessary because of the large number of present and former Federal employees and applicants  & who have identical names and birth dates, and whose identifies can only be distinguished by the SSN.  K !"#                            <  &&&    ^$ &   Purpose and Uses  & This form is used to obtain an employees home address and check mailing address.  N !"#                            <  &&&&    ^& &   Authority  & 5 USC 301. * !"#                            <  &&&&    ^ $ & General  & This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 31, 1974, for individuals  & completing Form AD-349. N !"#                            <  &&&&    ^$ }7 PRIVACY ACT NOTICE FOR AD-349, EMPLOYEE ADDRESS N !"#                            <  &&&&    ?=d =<(defgh <B^o elite10.DLL IVALID FILLER This form was Designed by Elite Federal Forms and requires the Elite/Novell Filler! Call 410-647-9691 for more information. elite10.COM IVALID FILLER This form was Designed by Elite Federal Forms and requires the Elite/Novell Filler! Call 410-647-9691 for more information. WPIN$ELITE10FunctionSet,4.1 ^=Z1ws