Scanned Document Collection

Page 1 of 4

U.S. PASSPORT RENEWAL APPLICATION FOR ELIGIBLE INDIVIDUALS

OWB APPROVAL NO. 1405-0020
EXPIRATION DATE: 12-31-2013
ESTIMATED BURDEN: 45 MIN

Please Print Legibly Using Black Ink Only





9776-0775988900000



https://ccdi.state.osis.gov/pls/PPT/rpt_passport_images.display doc all?p_hash=CF15C41... 2/24/2020


EFTA00099206

Scanned Document Collection

Page 2 of 4





DB-82 12-2010


https://ccdi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=CF15C41... 2/24/2020

EFTA00099207

Scanned Document Collection

Page 3 of 4



PASSPORT NO.
922 16th Avenue South 204 New York NY 10003
Tel: (123) 775-8970 Fax: (123) 616-2268
Unauthorized


Letter of Authorization

To: The US Passport Office



Passport Rush, LLC. to submit my passport and collect it when issued.

The following visas are required prior to my departure:



Thank you for your prompt attention to this matter.



For my son/daughter

Prohibited

https://ccdi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=CF15C41... 2/24/2020

EFTA00099208

Scanned Document Collection

Page 4 of 4




https://ccdi.state.osis.gov/pls/PPT/rpt_passport_images.display_doc_all?p_hash=CF15C41... 2/24/2020


EFTA00099209