Email Address _______________________________ Phone Number ____________________
Case Information
Please provide your Social Security number ONLY if you need assistance with your Social Security, Medicare, Internal Revenue Service, or Office of Personnel Management case:
Social Security # _______________________________ Date of Birth ____________________
Case# or Annuitant Claim # _______________________________ (CSA# or CSF#)
Which federal agencies have you contacted about this issue? _______________________________
To Whom It May Concern:
I hereby authorize the Office of U.S. Senator Mazie K. Hirono to inquire about the following issue and to receive information and copies of all matters contained therein. Pursuant to the Privacy Act, I hereby release my records to Senator Hirono’s office in connection with the matter below.
Explain the assistance you are requesting. You can also attach a letter of explanation with supporting documents.
Iakwe (Aloha)
This is Paul Keju, working at the Republic of the Marshall Islands Consulate-General office here in Honolulu, and I'm kindly asking for your office's assistance to retrieve Mr. Alfred Wagner Abner (RMI citizen) I-94.
Again, thank you for your continuous assistance to our Marshallese community here in this beautiful state of Hawaii. Attached is a copy of Mr. Alfred Wagner Abner’s passport. Komol tata (Thank You)
_____________________________ Signature Date _________________
Please return a signed copy of this form by mail, email or fax to:
Office of U.S. Senator Mazie K. Hirono
300 Ala Moana Blvd, Rm 3-106, Honolulu, HI 96850
HawaiiOffice@hirono.senate.gov, tel 808-522-8970, toll-free 844-478-3478, fax 808-545-4683
Wildlife Rehabilitation Specialist at Project Wildlife, San Diego Humane SocietyWildlife Rehabilitation Specialist at Project Wildlife, San Diego Humane Society
Chief Operations Officer at Directorate For Administration Naval Health Clinic HawaiiChief Operations Officer at Directorate For Administration Naval Health Clinic Hawaii