Social Security Administration
Office of Central Records Operations
FOIA Workgroup
P.O. Box 17772
300 N. Greene Street
Baltimore, Maryland 21290 

Dear Freedom of Information Officer,

Please send me a copy of the application for a social security card (Form SS5) filed by the following person. I found the information on the Social Security Death Master file CD by GenRef, Inc. GenRef gathered its information from the Social Security Death Master file compiled by the Social Security Administration.

My understanding is that the fee is $7.00 if I supply the social security number, or $16.50 if the social security number is unknown or incorrect. Enclosed is a check or money order for $___________, made payable to the Social Security Administration. Thank you for your assistance.

NAME 
SOCIAL SECURITY NO. 
Birth: DATE 
Death: DATE
Sincerely,