REQUEST FOR CONGRESSIONAL ASSISTANCE

Please Print And Return To:

Congressman Frank Wolf

13873 Park Center Rd, Ste 130

Herndon, VA 20171-5802

Phone: (703) 709-5800

Fax: (703) 709-5802

Full Name:
Address:
City:		State:		VA	Zip:
Telephone:	(H)		(W)
E-mail:
Social Security Number: *
Identification / Case File Number: *
*My office needs these identification numbers to assist in handling you case.

I,________________________________________________________________, do hereby request that Congressman Frank R. Wolf contact the appropriate agency(ies) on my behalf. I understand that this will open my private files to the Congressman so that he can assist me in my difficulties as explained below.

Please include a complete written description of your situation and enclose photocopies of pertinent documents, letters and certificates. PLEASE DO NOT SEND ORIGINAL COPIES OF ANY DOCUMENTS.

Signature:______________________________Date:_____________________________