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Date Commander, U.S. Fleet Forces CommandATTN:  Privacy Coordinator1562 Mitscher Ave, Suite 250Norfolk, VA  23551-2487 Dear Privacy Act Coordinator: I request the following information pertaining to me: (Provide a detailed description of the documents/records you want, and a description of the nature, time, place and circumstances of your association with U.S. Fleet Forces Command, in order for a search for responsive records to be conducted.) Under penalty of perjury, I hereby declare that I am the person named below and I understand that any falsification of this statement is punishable under the provisions of Title 18, United States Code (U.S.C.), Section 1001 by a fine of not more than $10,000 or by imprisonment of not more than five years, or both; and that requesting or obtaining any record(s) under false pretenses is punishable under the provisions of Title 5, U.S.C., Section 552a(i)(3) as a misdemeanor and by a fine of not more than $5,000.” My contact information is as follows:  (Mailing address is required; telephone and email information is optional, but failing to provide it may potentially delay the final response.)   FULL NAME/SIGNATURE (Required) 

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