U.S. Department of State Son eerrarin Bare 20 Bas ‘STATEMENT OF CONSENT: EstuateD sunoen 2 ten ISSUANCE OF A U.S. PASSPORT TO A MINOR UNDER AGE 16 Attention: Rend WARNING and FORM INSTRUCTIONS on Page 4 MyOOZ, _[Fist | Gabriel puss) 20/2 [fe JPemrenteoreracee [_]soorony [Jensony Gab ‘Name Hues Qui mE Name 1G bere, i to apaty for a United States passport for my minor chi named on ths application. ty consent is unconditional in regards lo passport valllty and tave Cy _edfiuo #5 Bb _ Sanfiago ‘Street Address (non-epplying parent) ‘Apartment City, ‘State Zip Coda ($20) _926 - 9/3/ Gabriel 15.12 0303 Dama/.com aati, —“Vesstarc ear nai is OATH: dear unser ary of pars tal ste maein the eppatng dsuen re eae eet Col Me ven eH _ 2, ‘ ‘Signeture of Non-Applying: Parent or Guardian Date tema) NOTE: A cleer photocopy of the front and back of the identification you prosonted to the notary I required with this form. Name ot Notary “Jesucita Gonzalez Noreu Mt 1629 Saeite Print Name (Notary Publo) Location —Gasenc thlanco #99 villa Vasquez LOE uy City, State tN Commission Expires, alz [20/6 Date: \dentfication Presented by Non-Applying Parent or [HZ] Drivers License [—] Pesapon [7] mteryio [7] omer ispeciy Guardian! roninter _0?2~0007250-2 racers Villa yasque7 Nontsccich estonia aleize Ole omen tnt. Ler fo0 fe ing the above notated identification document and the matching ea Date of / Remizaton —Qzsdzale Date mmecinngy Page?