You
must sign your request and have it notarized or state,
"Under penalty of perjury, I hereby declare that I am the
person named above and I understand that any falsification of
this statement is punishable under the provisions of Title 18,
United States Code (U.S.C.), Section 1001 by a fine of not more
than $10,000 or by imprisonment of not more than five years,
or both; and that requesting or obtaining any record(s) under
false pretenses is punishable under the provisions of Title
5, U.S.C., Section 552a(i)(3) as a misdemeanor and by a fine
of not more than $5,000." You may use the: