**The Office of the Honorable Peter J. Roskam**

**Member of Congress Illinois -- 6**

Please address all inquiries to Lee Campuzano at:

150 S. Bloomingdale Road

Bloomingdale, Illinois 60108

Phone- 630-893-9670

Fax- 630-893-9735

Name:
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Address:
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Date of Birth:
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S.S. Number:
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Passport Locator Number If Known:
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Phone Number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Work Number:
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Fax Number: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Cell Number:
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Date Applied: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Paid Expedite Fee:
![](media/image1.png){width="0.16666666666666666in"
height="0.14583333333333334in"} YES
![](media/image1.png){width="0.16666666666666666in"
height="0.14583333333333334in"} NO

Where Applied:
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When traveling:
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Where Traveling:
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Is a visa required for entry into the country:
![](media/image1.png){width="0.16666666666666666in"
height="0.14583333333333334in"} YES
![](media/image1.png){width="0.16666666666666666in"
height="0.14583333333333334in"} NO

Other Notes:
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I authorize the Office of Congressman Peter J. Roskam

to make inquiries on my behalf regarding my pending Passport Application

Signature
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Date \_\_\_\_\_\_\_\_\_\_\_\_\_\_

**ATTN:** Due to the high volume of passport applications

the Passport Agencies are only allowing inquiries up to two weeks
before,

with exceptions ONLY to specific types of cases.

due to the work load of the Passport Agencies, duplicated work efforts
can be unproductive, Please take that into consideration when making
personal calls to any of the Passport Agencies.

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