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US D~middotll~trrWlIllJrHolllclrl1ld SCCllrity TSA-SLC Allation Opllntlolls 22l~ W~sr 160 North SHit Ilke City (IT 84 Il6

Interoffice JVIem0 ranClUllJ

IrrnsportatiOI1 Security Aclrninistration

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NOle Writen statemfnlJ rmder penalty ofperjury which are aso referred tQ (JJ rill-sworn statemenls or )m-sworn decaration3 are statements wJch are not sworn 10 or alfinned by wltnesser but rather slbscribed 10 aimiddotoeing Inle Wltnerur who slgl written slatemenu declare under penalty ofperjury thaI their statements are tme alld correct Witnesus who sublcrilie to false rlalemelI IInder penalty ofpeTjury may be charged witlr perjury just ar Ifihlufolements had boellmode rmder oath

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US O()11111middott1l1~Jlt of nomeI( ~eclitr TSA-SLC Avlalion 0lwrlIou 2284 Vest 160 North Salt Lalw Cit UT HtJ6

frltlnsportationS~CUl1ty Aclministration

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CEI iCOIlJinenlial Employee Iufollllation

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Interoffice Memorandurii

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From

Date o9Jlo9

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US Department oflomcaud S-curity TSA-SLC Aviation OJgteratioll$ 2284 West I60 Norili SuIt Lake City ur 84116

Transportation SecrtrityAdministration

Yon must Sign and Date on Page 2

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I Nole II1Iderpnalty oJperjury which qre also riferred to as Un-rworn slJJe~nfr OF un-sworn declarations are st~temenu Iwhlcn are not swam to 01 qfftrrned by witnesses but rather rubzcribed 10 aJ being true WitnfSses who sign writJen statements declarelI1Jder t peJialtj ofperjury thai their tlalemenl$ are true andcorrec1 Wilnesseswlro subsCTibe to false statementJ uruIer penalty ofperIPJI may be i charged with perjuryfwt as iftha sUltements had been mode WIder oath I

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Confid~tial Employee IniolU18tion wwwmiddottsagov

Pag 1 of2

US O()11111middott1l1~Jlt of nomeI( ~eclitr TSA-SLC Avlalion 0lwrlIou 2284 Vest 160 North Salt Lalw Cit UT HtJ6

frltlnsportationS~CUl1ty Aclministration

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that my statement is true and correct r I r

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NoteWrittelsalemenls under peiollJl operjury which are aso referred to (1S un-sworn stotements or ull-sworn decaratlons aJestalemenir ( whic1l are nOl sworn 10 or affinned by witnesses but rather subscribed 0 as being U~ i Witnesses who sigll writen statements declare under penalty 0perlilY that their statements are lnJe and correct Wimesses wlo subscribe IpoundJ false statements under penalty 0pelmy may be charged with peljllly jllst as iflhe slalemen(S had been made IInder oath

CEI iCOIlJinenlial Employee Iufollllation

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Interoffice Memorandurii

To

From

Date o9Jlo9

Re

US Department oflomcaud S-curity TSA-SLC Aviation OJgteratioll$ 2284 West I60 Norili SuIt Lake City ur 84116

Transportation SecrtrityAdministration

Yon must Sign and Date on Page 2

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Confid~tial Employee IniolU18tion wwwmiddottsagov

Pag 1 of2

Interoffice Memorandurii

To

From

Date o9Jlo9

Re

US Department oflomcaud S-curity TSA-SLC Aviation OJgteratioll$ 2284 West I60 Norili SuIt Lake City ur 84116

Transportation SecrtrityAdministration

Yon must Sign and Date on Page 2

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Confid~tial Employee IniolU18tion wwwmiddottsagov

Pag 1 of2

us Department of Homeland Security TSAmiddotSLC Aviation Operotlon~ 2284 W~t 160 North Salt Lake City U1 84116

TransportationSecurity Admin istration

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Declare un~er penalty ofperjurY

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Written statemenuwuler p~lty ofperjury which are also rtrforred 0 as rmrworn statements or IDI-swom declarations are saemenu 11 are not swom to or qffinned by witnwu butratJru subscriled to as being tnle Witnesses who sign written stalemmtr declare lJ1Id~r lly ofperjuiy H that tAeir ita1emenJs arB tnle and correct Willzerses who subscribe It1 Jab slatBllte1ulDlder penalty ofperjury may be ~with perjuryjust as Ithe statements had bel1J ode unrl oath

CEI Confidential Employee Information

Page 2 0(2

US OeptJtment of Ifornehmd Securit) TSAmiddotSLC Aliation OperaHons 2284 Wesl160 North Salt Lake City UT 84116

Interoffice Memorandum

To (Print Full Name and ntle)

From

Date

Re

You must Sign and Date on Page 2

Note Wrtlel stoltmenlJ WIder penalty 01pel]middotury which are auo reftrred to allllhtlflOm stattmenlJ OT unmiddotsworn declaremons ar slaJements which Drt not sworn fo or ajft17lJ8d by witnesses buJ alAer rubsaibed to 01 being nil Wltnemu who Ilgn wrlJl1l slatemenu dtclare under penDt) olprjwy- thai their stalementr arelrue and correct Wimmes who subscribeloftlslI statemenlJ unde penalty operjury I7IIJ)I be cJwoge4 wilhplljwy jUJf IU ifill slatcmlntr had been made under oalh

CEl ConlidClltial Employee Information

wwwsa ~Qy Page I 0(2

US OeptJtment of Ifornehmd Securit) TSAmiddotSLC Aliation OperaHons 2284 Wesl160 North Salt Lake City UT 84116

Interoffice Memorandum

To (Print Full Name and ntle)

From

Date

Re

You must Sign and Date on Page 2

Note Wrtlel stoltmenlJ WIder penalty 01pel]middotury which are auo reftrred to allllhtlflOm stattmenlJ OT unmiddotsworn declaremons ar slaJements which Drt not sworn fo or ajft17lJ8d by witnesses buJ alAer rubsaibed to 01 being nil Wltnemu who Ilgn wrlJl1l slatemenu dtclare under penDt) olprjwy- thai their stalementr arelrue and correct Wimmes who subscribeloftlslI statemenlJ unde penalty operjury I7IIJ)I be cJwoge4 wilhplljwy jUJf IU ifill slatcmlntr had been made under oalh

CEl ConlidClltial Employee Information

wwwsa ~Qy Page I 0(2

bull US Department of Homeand Security TSA-SLC Aiamptlon Operatlonl 2284 West 160 North Salt Lake City UT 84116

lransportation Securi~ Administration

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CEI Confidential EmplOYeD In1orDIation

wwwmiddotuagoy IPap2ot2

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Date

fntcroffoice lVfeiTlorandurn

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Note Writlell statemellts tllder plwiry aperjury whltlr are also referred 10 as lin-SIllOm statements OF IIII-sworn declaral(ons aJe statements which are Jot SWO71 to or affirmed by witnesses bUI ralher subscribed 10 aJ being Ine Witnesses who sign wrWeJ1 slalemCJJls declara IInder

penalty oJperjllry that their statements are true and correct Witnesses who SIIbscribe lojalse statemenlllllltier penalry oJpfJury may b cI(rrged willi peljllry jllsr as Iflhe rlaemenl[ had barn marie imdu oath

CEI Confidential Employelt Information

Page J of2

-- ---- ----------- - --------

I

us Department of Homeland Securit TSA-SLC Aviation OperatIons 2284 West 16l North bull Salt Lake City VT 84116

Transportation Security Administration

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I 1---___________ Declare un~er pen8lty ofpeIjury

that my statement is tru~ and correct I I I IDate 7( t i )

which are nol sworn to or ajJInned by witnesses bulralher subscribed 10 ClJ belli true Witnesser who sln WImiddotmen slatemenfJ declart U71der pellolty operjury tAat thtlrstatemenlJ art bUll tmd coec Witnesses who subscribe toalu statements U71der pmalty operjury may be ~Jlfl1gtd with pitjulYJust as flAB statementr had beell made under oath

CEI Confidential Employe Information

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Page20f2

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statements uncUr penalty operjury which art also referred to as JlIhlWOl7lltalements or ulImiddotswom decorations are rtalementr

US Dcpnrfm~nt ofHomeJnd SC(lIdty TSAmiddotSLC Aviation OperntiolS 2284 Vles1160 North Salt Lake City UT 84 16

Transportation SecurityAdministrationInteroffice Memorandum

To (Print FilII Name and 1ftle)

From _~___ __ fPJiIfuJ-Name mU)eL_ ___~ __ ~__ _

Date

Re

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Nole JJrillen statements JI7Ider pen41ty aperjury which arl alto referred 10 aSIIIIrwOI7l statements or un-sworn decorations are sllZemenD Iwhich ar not 1110171 to or ajJfnned by wiblssllS but ratAer Ilibscrlhd to OJ being true ffIllnmes who sign written statements declare lI1IIier penalty ofperjury Ihat tll elr slatementf are true and correct WilneJsu who ubscrtbe to folse IlaJemenfl WIlier penalty ofperjwy may be ch4rged with perjury just a1 iflh slatemenU had bllpoundn made UIIdu oatlt

CEI Confidential Employee loformation

wwwt~_lQ1I

Page 1 of2

US Department of Homeland Security TSA-SJJC Avilltlon Ooeratlons 1284 Wut 160 North SnIt Lnke Citl rJT 84 116

Iransportation Security Administration

_ _-_ _-

--------------------------------------~---~--~---~---~-~---------~-----~-~-----

I PiiiIJ FuU Name and nte

that my statement is true and correct

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INOle Written ltatementl und ptnolty ofperjury which are also rriferred to as lUI-sworn statements or IUI-swom declaradolll or statemen$ which are no sworn 10 or aiftrmed by witnesses but rather subscribed 0 (JI being true ITflnesses who sign written slalemellu ~declQre Wldr pUlaJty ofperjury that their liatements arB true and correct Witnesres who subscribe to falre sttItementr under penalty ofpel]ury may be ~lilJrgd IVth peTjUl Just as iftht statements had been de Il1Ider oath I

- CEI ConfideotiaJ Employee InfOlmation lW(Ytsalov I

Pagl20(2 I

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US DepaJtment of Ilomclllnd Sccurit) TSA-SLC Aviation Operations 2284 West 160 NorrIl Salt Lnke CltymiddotOT 84 116

Interoffice Memorandum Transportation SecurityAdministration

To (Print Full Name and 1flle)

From

Date

Re

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INot Wrlttn statements under penalty ofperju) which are also referred 10 al WIsworn statemlnu or un-sworn deciaratfoll arB statements which are not SWOI7I to or affilfltd by witnllSSeJ but rtJlher S1JbJcribed 0 III being tnJ6 WllneJtls who Jlp written saltments declare IIMer penalty apelfwY thallheir JlDlementJ ar trulf and correct Witnessel who S1Jbscllbe toftlse Jlalemenu under penalty aperjury may bl cuJrgsd with JM1jury just aslftA statemnts had bUll made under oath

CEl Confidential Employee Infotmation

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Note Writlell statemellts tllder plwiry aperjury whltlr are also referred 10 as lin-SIllOm statements OF IIII-sworn declaral(ons aJe statements which are Jot SWO71 to or affirmed by witnesses bUI ralher subscribed 10 aJ being Ine Witnesses who sign wrWeJ1 slalemCJJls declara IInder

penalty oJperjllry that their statements are true and correct Witnesses who SIIbscribe lojalse statemenlllllltier penalry oJpfJury may b cI(rrged willi peljllry jllsr as Iflhe rlaemenl[ had barn marie imdu oath

CEI Confidential Employelt Information

Page J of2

-- ---- ----------- - --------

I

us Department of Homeland Securit TSA-SLC Aviation OperatIons 2284 West 16l North bull Salt Lake City VT 84116

Transportation Security Administration

I

I I I

I 1---___________ Declare un~er pen8lty ofpeIjury

that my statement is tru~ and correct I I I IDate 7( t i )

which are nol sworn to or ajJInned by witnesses bulralher subscribed 10 ClJ belli true Witnesser who sln WImiddotmen slatemenfJ declart U71der pellolty operjury tAat thtlrstatemenlJ art bUll tmd coec Witnesses who subscribe toalu statements U71der pmalty operjury may be ~Jlfl1gtd with pitjulYJust as flAB statementr had beell made under oath

CEI Confidential Employe Information

owWtsaQV

Page20f2

--~----~~-----------------------+----------------------

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statements uncUr penalty operjury which art also referred to as JlIhlWOl7lltalements or ulImiddotswom decorations are rtalementr

US Dcpnrfm~nt ofHomeJnd SC(lIdty TSAmiddotSLC Aviation OperntiolS 2284 Vles1160 North Salt Lake City UT 84 16

Transportation SecurityAdministrationInteroffice Memorandum

To (Print FilII Name and 1ftle)

From _~___ __ fPJiIfuJ-Name mU)eL_ ___~ __ ~__ _

Date

Re

cs k i- ~ Cli) V) vJ~ ~I S 4 j1A~-e oillmiddot w -+ocent ki t

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Nole JJrillen statements JI7Ider pen41ty aperjury which arl alto referred 10 aSIIIIrwOI7l statements or un-sworn decorations are sllZemenD Iwhich ar not 1110171 to or ajJfnned by wiblssllS but ratAer Ilibscrlhd to OJ being true ffIllnmes who sign written statements declare lI1IIier penalty ofperjury Ihat tll elr slatementf are true and correct WilneJsu who ubscrtbe to folse IlaJemenfl WIlier penalty ofperjwy may be ch4rged with perjury just a1 iflh slatemenU had bllpoundn made UIIdu oatlt

CEI Confidential Employee loformation

wwwt~_lQ1I

Page 1 of2

US Department of Homeland Security TSA-SJJC Avilltlon Ooeratlons 1284 Wut 160 North SnIt Lnke Citl rJT 84 116

Iransportation Security Administration

_ _-_ _-

--------------------------------------~---~--~---~---~-~---------~-----~-~-----

I PiiiIJ FuU Name and nte

that my statement is true and correct

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-Date

INOle Written ltatementl und ptnolty ofperjury which are also rriferred to as lUI-sworn statements or IUI-swom declaradolll or statemen$ which are no sworn 10 or aiftrmed by witnesses but rather subscribed 0 (JI being true ITflnesses who sign written slalemellu ~declQre Wldr pUlaJty ofperjury that their liatements arB true and correct Witnesres who subscribe to falre sttItementr under penalty ofpel]ury may be ~lilJrgd IVth peTjUl Just as iftht statements had been de Il1Ider oath I

- CEI ConfideotiaJ Employee InfOlmation lW(Ytsalov I

Pagl20(2 I

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US DepaJtment of Ilomclllnd Sccurit) TSA-SLC Aviation Operations 2284 West 160 NorrIl Salt Lnke CltymiddotOT 84 116

Interoffice Memorandum Transportation SecurityAdministration

To (Print Full Name and 1flle)

From

Date

Re

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INot Wrlttn statements under penalty ofperju) which are also referred 10 al WIsworn statemlnu or un-sworn deciaratfoll arB statements which are not SWOI7I to or affilfltd by witnllSSeJ but rtJlher S1JbJcribed 0 III being tnJ6 WllneJtls who Jlp written saltments declare IIMer penalty apelfwY thallheir JlDlementJ ar trulf and correct Witnessel who S1Jbscllbe toftlse Jlalemenu under penalty aperjury may bl cuJrgsd with JM1jury just aslftA statemnts had bUll made under oath

CEl Confidential Employee Infotmation

wwwtsaqoy I 1Page J 0(2 j

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-- ---- ----------- - --------

I

us Department of Homeland Securit TSA-SLC Aviation OperatIons 2284 West 16l North bull Salt Lake City VT 84116

Transportation Security Administration

I

I I I

I 1---___________ Declare un~er pen8lty ofpeIjury

that my statement is tru~ and correct I I I IDate 7( t i )

which are nol sworn to or ajJInned by witnesses bulralher subscribed 10 ClJ belli true Witnesser who sln WImiddotmen slatemenfJ declart U71der pellolty operjury tAat thtlrstatemenlJ art bUll tmd coec Witnesses who subscribe toalu statements U71der pmalty operjury may be ~Jlfl1gtd with pitjulYJust as flAB statementr had beell made under oath

CEI Confidential Employe Information

owWtsaQV

Page20f2

--~----~~-----------------------+----------------------

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statements uncUr penalty operjury which art also referred to as JlIhlWOl7lltalements or ulImiddotswom decorations are rtalementr

US Dcpnrfm~nt ofHomeJnd SC(lIdty TSAmiddotSLC Aviation OperntiolS 2284 Vles1160 North Salt Lake City UT 84 16

Transportation SecurityAdministrationInteroffice Memorandum

To (Print FilII Name and 1ftle)

From _~___ __ fPJiIfuJ-Name mU)eL_ ___~ __ ~__ _

Date

Re

cs k i- ~ Cli) V) vJ~ ~I S 4 j1A~-e oillmiddot w -+ocent ki t

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If

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I You mnst Sign and Date on Page 2

Nole JJrillen statements JI7Ider pen41ty aperjury which arl alto referred 10 aSIIIIrwOI7l statements or un-sworn decorations are sllZemenD Iwhich ar not 1110171 to or ajJfnned by wiblssllS but ratAer Ilibscrlhd to OJ being true ffIllnmes who sign written statements declare lI1IIier penalty ofperjury Ihat tll elr slatementf are true and correct WilneJsu who ubscrtbe to folse IlaJemenfl WIlier penalty ofperjwy may be ch4rged with perjury just a1 iflh slatemenU had bllpoundn made UIIdu oatlt

CEI Confidential Employee loformation

wwwt~_lQ1I

Page 1 of2

US Department of Homeland Security TSA-SJJC Avilltlon Ooeratlons 1284 Wut 160 North SnIt Lnke Citl rJT 84 116

Iransportation Security Administration

_ _-_ _-

--------------------------------------~---~--~---~---~-~---------~-----~-~-----

I PiiiIJ FuU Name and nte

that my statement is true and correct

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I IDeclare under penalty ofperjury

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-Date

INOle Written ltatementl und ptnolty ofperjury which are also rriferred to as lUI-sworn statements or IUI-swom declaradolll or statemen$ which are no sworn 10 or aiftrmed by witnesses but rather subscribed 0 (JI being true ITflnesses who sign written slalemellu ~declQre Wldr pUlaJty ofperjury that their liatements arB true and correct Witnesres who subscribe to falre sttItementr under penalty ofpel]ury may be ~lilJrgd IVth peTjUl Just as iftht statements had been de Il1Ider oath I

- CEI ConfideotiaJ Employee InfOlmation lW(Ytsalov I

Pagl20(2 I

I i I

US DepaJtment of Ilomclllnd Sccurit) TSA-SLC Aviation Operations 2284 West 160 NorrIl Salt Lnke CltymiddotOT 84 116

Interoffice Memorandum Transportation SecurityAdministration

To (Print Full Name and 1flle)

From

Date

Re

Ij

I I i I I i

INot Wrlttn statements under penalty ofperju) which are also referred 10 al WIsworn statemlnu or un-sworn deciaratfoll arB statements which are not SWOI7I to or affilfltd by witnllSSeJ but rtJlher S1JbJcribed 0 III being tnJ6 WllneJtls who Jlp written saltments declare IIMer penalty apelfwY thallheir JlDlementJ ar trulf and correct Witnessel who S1Jbscllbe toftlse Jlalemenu under penalty aperjury may bl cuJrgsd with JM1jury just aslftA statemnts had bUll made under oath

CEl Confidential Employee Infotmation

wwwtsaqoy I 1Page J 0(2 j

I

US Dcpnrfm~nt ofHomeJnd SC(lIdty TSAmiddotSLC Aviation OperntiolS 2284 Vles1160 North Salt Lake City UT 84 16

Transportation SecurityAdministrationInteroffice Memorandum

To (Print FilII Name and 1ftle)

From _~___ __ fPJiIfuJ-Name mU)eL_ ___~ __ ~__ _

Date

Re

cs k i- ~ Cli) V) vJ~ ~I S 4 j1A~-e oillmiddot w -+ocent ki t

i I

I

If

I I I I

I I

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I You mnst Sign and Date on Page 2

Nole JJrillen statements JI7Ider pen41ty aperjury which arl alto referred 10 aSIIIIrwOI7l statements or un-sworn decorations are sllZemenD Iwhich ar not 1110171 to or ajJfnned by wiblssllS but ratAer Ilibscrlhd to OJ being true ffIllnmes who sign written statements declare lI1IIier penalty ofperjury Ihat tll elr slatementf are true and correct WilneJsu who ubscrtbe to folse IlaJemenfl WIlier penalty ofperjwy may be ch4rged with perjury just a1 iflh slatemenU had bllpoundn made UIIdu oatlt

CEI Confidential Employee loformation

wwwt~_lQ1I

Page 1 of2

US Department of Homeland Security TSA-SJJC Avilltlon Ooeratlons 1284 Wut 160 North SnIt Lnke Citl rJT 84 116

Iransportation Security Administration

_ _-_ _-

--------------------------------------~---~--~---~---~-~---------~-----~-~-----

I PiiiIJ FuU Name and nte

that my statement is true and correct

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I I I

I IDeclare under penalty ofperjury

r i i

-Date

INOle Written ltatementl und ptnolty ofperjury which are also rriferred to as lUI-sworn statements or IUI-swom declaradolll or statemen$ which are no sworn 10 or aiftrmed by witnesses but rather subscribed 0 (JI being true ITflnesses who sign written slalemellu ~declQre Wldr pUlaJty ofperjury that their liatements arB true and correct Witnesres who subscribe to falre sttItementr under penalty ofpel]ury may be ~lilJrgd IVth peTjUl Just as iftht statements had been de Il1Ider oath I

- CEI ConfideotiaJ Employee InfOlmation lW(Ytsalov I

Pagl20(2 I

I i I

US DepaJtment of Ilomclllnd Sccurit) TSA-SLC Aviation Operations 2284 West 160 NorrIl Salt Lnke CltymiddotOT 84 116

Interoffice Memorandum Transportation SecurityAdministration

To (Print Full Name and 1flle)

From

Date

Re

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INot Wrlttn statements under penalty ofperju) which are also referred 10 al WIsworn statemlnu or un-sworn deciaratfoll arB statements which are not SWOI7I to or affilfltd by witnllSSeJ but rtJlher S1JbJcribed 0 III being tnJ6 WllneJtls who Jlp written saltments declare IIMer penalty apelfwY thallheir JlDlementJ ar trulf and correct Witnessel who S1Jbscllbe toftlse Jlalemenu under penalty aperjury may bl cuJrgsd with JM1jury just aslftA statemnts had bUll made under oath

CEl Confidential Employee Infotmation

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US Department of Homeland Security TSA-SJJC Avilltlon Ooeratlons 1284 Wut 160 North SnIt Lnke Citl rJT 84 116

Iransportation Security Administration

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I PiiiIJ FuU Name and nte

that my statement is true and correct

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I IDeclare under penalty ofperjury

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INOle Written ltatementl und ptnolty ofperjury which are also rriferred to as lUI-sworn statements or IUI-swom declaradolll or statemen$ which are no sworn 10 or aiftrmed by witnesses but rather subscribed 0 (JI being true ITflnesses who sign written slalemellu ~declQre Wldr pUlaJty ofperjury that their liatements arB true and correct Witnesres who subscribe to falre sttItementr under penalty ofpel]ury may be ~lilJrgd IVth peTjUl Just as iftht statements had been de Il1Ider oath I

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US DepaJtment of Ilomclllnd Sccurit) TSA-SLC Aviation Operations 2284 West 160 NorrIl Salt Lnke CltymiddotOT 84 116

Interoffice Memorandum Transportation SecurityAdministration

To (Print Full Name and 1flle)

From

Date

Re

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INot Wrlttn statements under penalty ofperju) which are also referred 10 al WIsworn statemlnu or un-sworn deciaratfoll arB statements which are not SWOI7I to or affilfltd by witnllSSeJ but rtJlher S1JbJcribed 0 III being tnJ6 WllneJtls who Jlp written saltments declare IIMer penalty apelfwY thallheir JlDlementJ ar trulf and correct Witnessel who S1Jbscllbe toftlse Jlalemenu under penalty aperjury may bl cuJrgsd with JM1jury just aslftA statemnts had bUll made under oath

CEl Confidential Employee Infotmation

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US DepaJtment of Ilomclllnd Sccurit) TSA-SLC Aviation Operations 2284 West 160 NorrIl Salt Lnke CltymiddotOT 84 116

Interoffice Memorandum Transportation SecurityAdministration

To (Print Full Name and 1flle)

From

Date

Re

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INot Wrlttn statements under penalty ofperju) which are also referred 10 al WIsworn statemlnu or un-sworn deciaratfoll arB statements which are not SWOI7I to or affilfltd by witnllSSeJ but rtJlher S1JbJcribed 0 III being tnJ6 WllneJtls who Jlp written saltments declare IIMer penalty apelfwY thallheir JlDlementJ ar trulf and correct Witnessel who S1Jbscllbe toftlse Jlalemenu under penalty aperjury may bl cuJrgsd with JM1jury just aslftA statemnts had bUll made under oath

CEl Confidential Employee Infotmation

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USllepmiddot[l1WII( of lInrnrmiddotland SelllilT TSA-rI Alillti(lll 1)lIliuns nSmiddotIIVust 1(0 NIgttlh 1~lllt Ln[cl Citl rJT l1116

I raJ1SportatlOn Secudty Achnicris tration

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Note Written statements lIllder perjlry which are also referred to (1f 101-rw0I11 statements or un-rWO7 declaration are statements which are not sworn 10 or affirmed wtrnesses blllrather subscribed 10 as being lrue Wiblesses who sigll written statements declare IIhdey penalty 0perjury that their rtatemellls are lnJe and correct Wlrnesses who subscribe lolalse sl11temenls tmder penalty 01pejury may be charged with perjurys as ithe statemeniJ had been made under omh

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CEl Confidential Employ~~ Infonnatiol

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US Department of Homeland Security TSAmiddotSLC Aviation Operations 2284 Vest 160 Nortb Salt Lake City OT 84116

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1---_____-- Declare under penalty ofpetjury

that my statement is true and correct

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NOleWriltenstatemenlS Wet Mnalty operjury which are aso rtUeea to 11 unsworn statements or WI-SWOI71 declaradons art statements which are not Mom 10 or afftnned by witnlrsu but rather subscribed to ill being true Witnesses who sign written stalementr declare WIder

plIIlllty ofperjury that their statemellts ar true and cOf7ecL Wil1lerses who subscribe to false statemmts under penalty ofperjury may be charged with perjwyjust as ifthe statemenlJ had been made under oath

CEI Confideotial Employee Information

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f C~ JV1fj (-r j I 1_ntel 0 JJC tC1J1 JJ cULLLJ1

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CEl Confidential Employ~~ Infonnatiol

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US Department of Homeland Security TSAmiddotSLC Aviation Operations 2284 Vest 160 Nortb Salt Lake City OT 84116

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NOleWriltenstatemenlS Wet Mnalty operjury which are aso rtUeea to 11 unsworn statements or WI-SWOI71 declaradons art statements which are not Mom 10 or afftnned by witnlrsu but rather subscribed to ill being true Witnesses who sign written stalementr declare WIder

plIIlllty ofperjury that their statemellts ar true and cOf7ecL Wil1lerses who subscribe to false statemmts under penalty ofperjury may be charged with perjwyjust as ifthe statemenlJ had been made under oath

CEI Confideotial Employee Information

wwwtsagoy Page20f2

US Department of Homeland Security TSAmiddotSLC Aviation Operations 2284 Vest 160 Nortb Salt Lake City OT 84116

Transportation SecurityAdministrationmiddot

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NOleWriltenstatemenlS Wet Mnalty operjury which are aso rtUeea to 11 unsworn statements or WI-SWOI71 declaradons art statements which are not Mom 10 or afftnned by witnlrsu but rather subscribed to ill being true Witnesses who sign written stalementr declare WIder

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CEI Confideotial Employee Information

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US Depatment of Homeland Security TSAmiddotSLC Aviation Operltions 2284 West t60 North Snit Lake City OT 84116

Transportation Security

Interoffice Memorandum Administration

--- ---___ _-- -

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You must Sign and Date on Page 2

Not4 Written slolemenlJ under p411airy aperjury wlJicll are DUD eferred to os unrllDI7I tlalementJ OT un-sworn d4c1aradons an rloelnlJltJ whlcll are not 1wom to or aflrmed by witnessu buJ DIAr IIIbrcrlJId 10 os being tnJe Wltnusu who sign written Itatlmena declare lJ1IIler penalty opuur] IAat their stDemlna Qle tru and cor1lc1 Witneltl who subscribe toftlse SIDlemlTll under pentJlty aperjury l71tJy be chllrrd Wirlt plljJrjurl Qf Vlhe slalemtnlS h(1d bee mod rmder O(1Jr

CEI ConfideutiaJ EapJO)ClC Information

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US Dapartment of Ifomeland Se(urity TSA-SLC Avilltion Operations 2184 Vest 160 North Salt Lake City UT 8411 n

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Transportation Security Administration

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that my statement is tru~ and correct I I

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Nok Written statement uruI ptlIalty ofperjury which are also referred to as lin-sworn statements or unmiddotnvorn declarations are statements which are not swom to or qfJIrmed by witnesses but rather $Ubscribed to IJJ being tru~ Witnesses who tm written statements declare Il1Jder IpenalfJ olperJvrYraquo that their statements are 11111 and correct HiIIIesses who subscribe Ie falre statements under pellalty ofpeJjwy may be Icharged with psrjwy just as Ijthe statements had been mOd rmder oath i

CEI Confidential Employee Infolllution

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US Dapartment of Ifomeland Se(urity TSA-SLC Avilltion Operations 2184 Vest 160 North Salt Lake City UT 8411 n

--~~~7~~~~~~~==~====~========--bull- ~---- - ----

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Transportation Security Administration

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that my statement is tru~ and correct I I

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Nok Written statement uruI ptlIalty ofperjury which are also referred to as lin-sworn statements or unmiddotnvorn declarations are statements which are not swom to or qfJIrmed by witnesses but rather $Ubscribed to IJJ being tru~ Witnesses who tm written statements declare Il1Jder IpenalfJ olperJvrYraquo that their statements are 11111 and correct HiIIIesses who subscribe Ie falre statements under pellalty ofpeJjwy may be Icharged with psrjwy just as Ijthe statements had been mOd rmder oath i

CEI Confidential Employee Infolllution

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