1. Your Full Name:

• Last: Jackson
  First: Angela
  Middle:

2. Birthdate:

• 04/OCT/1995

3. Birthplace:

• Los Santos, San Andreas

4. Sex:

• [—] Male
  [X] Female

5. Race/Ethnic Category:

• [—] Black
  [—] Hispanic
  [—] Asian
  [X] Caucasian
  [—] Pacific Islander
  [—] American Indian or Alaskan Native
  [—] Filipino
  [—] Two or more races

6. Address:

• 151 Vicenza Road, Richman, Los Santos 806

7. Contact Number:

• 105090

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8. Employer: San Andreas Network

• If you are self-employed, PLEASE indicate.
  Position/Job Title: Chief Executive Officer
  Business Address: Star Tower, Los Santos, San Andreas
  Work/Mobile No: 1-800-NEWS-TIPS
  
  Provide a brief description of your job duties as it applies to the need for an LSPD media card:
  I am the head leader of San Andreas Network and my responsibilities include the overall management of the media business, the general appearance to the public, the daily projects and of course the development and supervision of every SAN member.
  The LSPD media card would be a commodity for those who serve SAN for a long time because it provides access to books and channels that can help the business expand, that includes my wish to confirm the environment surrounding a media card.
  Also i do provide journalism services to high profile entrepreneurs and important legal personalities from all government agencies.

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9. I certify that I have carefully read the information submitted on this application, and that it is true and complete. I understand any false information or withholding of information is grounds for the denial or revocation of my LSPD News Media Identification Card.

Signature in Full: Angela Jackson

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10. Timezone (GMT):

• GMT+2

11. Provide a link to your LS-RP community forum account:

• ACCESS

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