Document ExbBwaX4kYoqmo9yN7prZVomn

Docusign Envelope ID: 73B0691A-3FC8-4E8A-8910-97A202D9443D Legal Nam1 b 6 IDAHO SENATOR MIKELCRAPO PRIVACY RELEASE FORM Phone #: Address: b 6 (b (6) E-mail b 6 City and Zip b 6 Please complete only applicable fields to your case: ate of Birth: b 6 Social Sec. #: Service #: CSA #: Alien #: USCIS Receipt #: Passport App #: Visa Case #: Place of Birth: EIN#: Loan #: Other: Please orovide a detailed exolanation of your concerns: (b)(6): Information that, if disclosed, would invade another individual's personal privacy. *Please feel free to attach additional information and documentation. This form and associated documentation will be handled in accordance with Senator Crapo's Privacy Policy. Due to the Privacy Act of 1974 (Ft 93-579), federal and state agencies may be unable to release personal information without my consent. My signature gives Senator Crapo and/or his representatives permission to contact officials and/or send a copy of this form and any attached letters or supporting documentation to agencies and/or organizations in connection with this matter. My signature authorizes all federal agencies to release information related to my case, to the extent permitted by law, to Senator Crapo and his staff. I certify, under penalty ofperjurv, that 1) I provided or authorized all of the information in this privacy release and any document submitted with it; 2) I reviewed and understand all of the information contained in my privacy release and submitted with it: and 31 all of this information is complete, true, and (b)(6) Date: 02/24/2025 Please sign and mail or fax to your nearest office: Southwestern. Main State Office 251 E. Front St. Suite 205 Boise, ID 83702 (208)334-1776 (208)334-9044 fax Eastern Idaho, North 410 Memorial Drive Suite 204 Idaho Falls, ID 83402 (208)522-9779 (208)529-8367 fax Eastern IcLaho, South 275 S. 5til Ave. Suite 100 Pocatello, ID 83201 (208)236-6775 (208)236-6935 fax South-Central 202 Falls Ave. Suite 2 Twin Falls, ID 83301 (208)734-2515 (208)733-0414 fax North Idaho 610 Hubbard Suite 209 Coeur d' Alene, ID 83814 (208)664-5490 (208)664-0889 fax North-Central 313 'D' St. Suite 105 Lewiston, ID 83501 (208)743-1492 (208)743-6484 fax Sierra Club v. Dept of Interior - 3:25-cv-05375-PHK 0000341 SC_EVERSPLIT0013188 Docusign Envelope ID: 73B0691A-3FC8-4E8A-8910-97A202D9443D IDAHO SENATOR MIKELCRAPO THIRD PARTY AUTHORIZATION FORM Note: This is an optional page and is only required if you would like to give our office permission to speak with a third party concerning your case. Legal Name b 6 Date: 02/24/2025 I authorize Senator Crapo's staff to share information about my case with the following individual(s). For example, you may wish to list a relative, friend, attorney or others. Have you contacted another congressional office? If yes, which office(s)? Do you give our office permission to discuss this issue with other Congressional Offices? ['Yes ONo Signature (b)(6) Sierra Club v. Dept of Interior - 3:25-cv-05375-PHK 0000342 SC_EVERSPLIT0013189