PerFORM PRO FORM 2.02AD-349, Employee AddressJSharp11/90I+M-Employee Address A . B @. //W&W&w,w,-- f_"_"Please enter numbers in the Social Security Number and it will automatically appear with the dashes.C . D . E . F . I . K . M . N .  P .  R .  T .  dBASESwiss"DutchArial"Univers (WN)#CG Times (WN)Times New RomanTimes CG ATTWingdingsUnivers ATT" 1oZa $ 18cԔp )D[] [0Pa  M;c][Vb-b -#" -"12. FIRST LINE STREET ADDRESS M] )[Pa  N~>v; &+ &+14. CITY NAME ])0[a` %)" %"CHECK MAILING ADDRESS OTHER THAN BANK]][0a  F %/7 %/76. CITY NAME cJ -[Pa  E %"%5. THIRD LINE STREET ADDRESS sc7c -Ha  Bļ=r ='wļļ G+'G+'2. SOCIAL SECURITY NO. d#C[,T|#X  %3*%*PRIVACY ACT NOTICE FOR AD-349, EMPLOYEE ADDRESS?E%BK6c3qa` !%!%ACTION CODE 6L%Bp6cqa` 7777AGENCY 6r%B -6ca` |%%EFFECTIVE DATE ]dQ0a  I &$G &G 9. STATE OR COUNTRY NAME c]ZP0a '='10. STATE OR COUNTRY CODE (Agency Use) ],0a  K g'g'11. ZIP CODE  )Pa ,&?% ,?%15. CITY CODE (Agency Use)  d)PPa  P<>| &&+ &+16. STATE OR COUNTRY NAME c Z)PPa 7=717. STATE OR COUNTRY CODE (Agency Use) tt\ -)Pa  Rw| ++18. ZIP CODE mڟ)gB[Ta` w" * w"*20. SIGNATURE OF EMPLOYEE c) -A[Pa` $$21. DATE SIGNED- 0Pa  T;c][Vb-b '$$_ '$_13. SECOND LINE STREET ADDRESS MV| -`tX`` &"&"General This information is provided pursuant to Public Law 93-579 (Privacy Act of 1974), December 31, 1974, for individuals completing Form AD-349. Authority 5 USC 301 Purpose and Uses This form is used to obtain an employee's home address and check mailing address.  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 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 identities can only be distinguished by the SSN. E1 -#B30X 'o&'o&(Agency Use)c2atX g&"#g&#U.S. GPO: 1992-320-962/69021  -D[{PX ``&W*&W*CUT HEREE1E5c33+1+5cE7c -7c3]_T0a &*' &'7. CITY CODE  (Agency Use) f_]T0a -, -8. COUNTY CODE (Agency Use) )؟A[a ``` &'. &.19. DESIGNATED AGENT CODE 7cHa   Aļ=r ='wļļ '3 '1. NAME (Last, First, Middle) d1E5c3a `" G%N?$ G%?$U.S. DEPARTMENT OF AGRICULTUREP  EMPLOYEE ADDRESS1 -1]Jd_[[Ta  C ("! (!3. FIRST LINE STREET ADDRESS uf_Jc[TPa  D &#_$ &_$4. SECOND LINE STREET ADDRESS itJ] ` +w. +w.CURRENT RESIDENCE ADDRESS2hR\eX +7% +7%FORM AD-349 (REV. 11/90)(sy /0o%/o%DESIGN SOFTWARE: PERFORM PRO PLUS BY DELRINA