Other

Due to the provisions of the Privacy Act of 1974, you will also need to complete and sign the “Authorization Form” which accompanies this form. Any federal agency I contact on your behalf will need your written consent to communicate with me about your specific situation.

You can print the Authorization Form by clicking here and mail, fax, or scan it to me at:
P.O. Box 1830
Hickory, NC 28603
Fax: 828.327.8311