|jv U. 8. Department of Justice
Immigration and Naturalization Service
HANDBOOK
for
o
IMMIGRATION AND NATURALIZATION SERVICE
HANDBOOK FOR CONTACT REPRESENTATIVES
INTRODUCTION
This hook contains general information guides, facsimiles
of forms ^ and succinct explanations as to the usage and
requirenents of the most commonly used forms.
Contact Representatives have a basic responsibility in
providing accurate responses to persons seeking assistance
and information from the Immigration and Naturalization
Service, The specific purposes of this book are to provide
Contact Representatives with a ready reference auide, to
keep holders informed of changes in policy, and serve as
a training manual for newly appointed employees.
Revision Procedures. When manual revisions are necessary,
pertinent panes will be reprinted with the revised text or
form for distribution to all handbook holders. Each Contact
Representative to whom the book is assigned is responsible
for keeping it up to date.
Information Services Division
Immigration and Naturalization Servi
425 Eye Street NW
Washington, DC 20536
April 1 , 1980
TABLE OF CONTENTS
CONTENTS
INDEX (BY CHAPTER) i
INDEX (BY FORM NUMBER) i>
CHAPTER PAGE
1. GENERAL INFORMATION
Fee Schedule 1-1
Definitions 1-5
Explanation of Name Usage 1-10
Fingerprints 1-15
Classes of Nonimmigrants 1-17
Classes of Immigrants 1-21
ADIT Procedures 1-25
Handling Status Inquiries 1-33
Employment Authorization Requests 1-36
2. INFORMATION AIDS
Obtaining Birth and Death Records in the United States
and Outlying Areas 2-1
Obtaining Birth and Death Records of United States
Citizens Born or Deceased Abroad or Birth Certificates
for Alien Children Adopted Abroad by United States
Citizens 2-11
Obtaining Marriage Records in the United States and
Outlying Areas 2-1.3
Obtaining Divorce Records in the United States and
Outlying Areas 2-23
American Diplomatic and Consular Offices Issuing Visas. 2-31
Regional and District Office Areas and Addresses 2-41'
3. PETITIONS AND APPLICATIONS PERTAINING TO NONIMMIGRANTS
Form 1-17 - Petition for Approval of School for Attendance
by Nonimmigrant Students 3-1
Form I-20A&B - Certificate of Eligibility fo-r Nonimmigrant
F-l Student Status 3-10
Form 1-102 - Application By Nonimmigrant Alien for
Replacement of Arrival Document 3-18
Form 1-126 - Report of Status by Treaty Trader or
Investor 3-21
Form I-129B - Petition to Classify Nonimmigrant As
Temporary Worker or Trainee 3-27
Form I-129F - Petition to Classify Status of Alien
Fiancee or Fiancee for Issuance of Nonimmigrant Visa .. 3-37
11
CHAPTER PAGE
Form 1-190 - Application for Nonresident Alien Border
Crossing Card 3-46
Form 1-506 - Application for Change of Nonimmigrant
Status and Requests for Change of Nonimmigrant Status
Not Requiring a Fee or Application „. 3-48
Form 1-515 - Notice to Student or Exchange Visitor 3-50
Form 1-538 - Application by Nonimmigrant Student (F-l) for
Extension of Stay, School Transfer, or Permission to
Accept or Continue Employment 3-61
Form 1-539 - Application to Extend Time of Temporary
Stay 3-69
Form IAP-66 - Certificate of Eligibility for Exchange
Visitor Status , 3-76
Documentary Requirements Necessary to Apply for a New
or Revali dated Nonimmigrant Visa for Aliens Returning
from Abroad 3*77
4. PETITIONS AND APPLICATIONS PERTAINING TO IMMIGRANTS AND LAWFUL
PERMANENT RESIDENTS
Form 1-90 - Application by a Lawful Permanent Resident
for an Alien Registration Receipt Card - Form 1-551 ... 4-1
Form 1-130 - Petition to Classify Status of Alien Relative
for Issuance of Immigrant Visa 4-5
Revalidation of Relative Visa Petition Upon Death of
Peti ti oner 4-17
Form I-130E/I-485H - Petition to Classify Status of Alien
Relative for Issuance of Immigrant Visa and Application for
Status as Permanent Resident 4-18
Form 1-131 - Application for Issuance or Extension of
Permit to Reenter the United States 4-26
Form 1-140 - Petition to Classify Preference Status of
'Aliens on Basis of Profession or Occupation 4-33
Form 1-407 - Abandonment by Alien of Status as Lawful
Permanent Resident 4-41
Form 1-485 - Application for Status as Permanent
Resi dent 4-43
Form I-485A - Application by Cuban Refugee for
Permanent Residence 4-51
Form I-485C - Application for Creation of Record of
Lawful Admission for an Indochinese Refugee 4-59
Form 1-526 - Request for Determination that Prospective
Immiqrant is an Investor 4-67
CHAPTER
Form ETA 750 - Application for Alien Empli
Certification
5. APPEALS, MOTION, AND CERTIFICATIONS
Motions to Reopen and Reconsider
Form I-290A - Notice of Appeal to the Boa
Immigration Appeals
Form I-290B - Notice of Appeal to the
Regional Commissioner
Form I-290C - Notice of Certification ...
6. WAIVERS
Form 1-191 - Application for Advance Perm
Return to Unrelinquished Domicile
Form 1-192 - Application for Advance Perm
Enter as Nonimmigrant
Form 1-212 - Application for Permission t<
for Admission into the U.S. after Deporta
Form 1-601 - Application for Waiver of Gn
of Excludabili ty
Form 1-612 - Application for Waiver of Fo
Residence Requirement
7. FREEDOM OF INFORMATION AND PRIVACY ACT
Form G-14 - Unidentifiable Cornmurication
Form G-23.26A - Statistics - Freedom of
Information Act
Form G-23.26B - Privacy Act Workload Reco
Form G-28 - Notice of Entry of Appearance
or Representative
Form G-342 - Transmittal Letter for Infori
Service Files
Form G-343 - Reply to Request for Inforrna
Service Files ,..
Form G-347 - Request for Information from
File
Form G-350 - Certification of Birth Data
Form G-351 - Request for Copies of Docume
Form G-396 - Request for Review of Classi
Form G-617 - Correspondence Control Cara
Form G-639 £ A - Application for a Search
of the Immigration and Naturalization Ser
Freedom of Information Act
Form G-640 - Worksheet for Freedom of Inf
Requests .
CHAPTER PAGE
Form G-641 - Application for Verification of
Information from Immigration and Naturalization
Service Records 7-38
Form G-652 - Affidavit of Identity 7-42
Form G-657 - Privacy Act Information Request 7-44
Form G-658 - Record of Information Disclosure 7-48
Form G-715 - Acknowledgment and Status of Applications. 7-52
Form G-734 - Third Agency Referral Memorandum 7-54
Form G-747 » FOI/PA Response 7-56
8. INTERNAL USE FORMS OF WHICH A CONTACT REPRESENTATIVE SHOULD BE FAMILI
Form 1-60 - Form letter re Extension of Time on Permit
to Reenter the Uni ted States 8-1
Form 1-72 - Form letter: Returning Deficient Applications
or Peti ti ons 8-2
Form 1-171 - Notice of Approval of Relative Immigrant
Visa Petition 8-3
Form I-171C - Notice of Approval of Nonimmigrant Visa
Petition or of Extension of Stay of Nonimmigrant
H or L Al i en 8-5
Form I-171F - Notice of Approval of Nonimmigrant Visa
Petition for Fiance or Fiancee 8-7
Form 1-210 - Voluntary Deaprture Notice 8-11
Form 1-464 - Notice of Third or Sixth Preference
Petition Approved under Section 203a of the I&N
Act , as amended 8-12
Form 1-486 - Medical Examination and Immigration
Interview 8-13
Form 1-508 - Waiver of Rights, Privileges, Exemptions,
and Immunities 8-18
Form 1-512 - Authorization for Parole or Conditional
Entry of an Alien into the United States 8-20
Form 1-546 - Order to Appear (Deferred Inspection) 8-23
Form 1-564 - Form Letter - Reply to General
Inquiries 8-26
Form G-22.17 - Workload Record - Records
Administration 8-27
Form G-56 - General Call-In Letter 8-29
Form G-100 - Request for File on Loan 8-31
CHAPTER PAGE
Form G-325B - Biographic Information 8-37
Form G-711 - Individual Fee Register Receipt 8-43
Form G-712 - Summary of Fees Recorded on Individual
Fee Regi ster Recei pts 8-44
Form G-714 - Receipt for Funds and Valuables
Transferred 8-45
9. OTHER FORMS OF IMPORTANCE
Form 1-53 - Alien Address Report 9-1
Form 1-94 - Arrival/Departure Record 9-2
Form 1-134 - Affidavit of Support 9-3
Form 1-196 - Application for United States Citizen
Identification Card 9-9
Form G-62 - Requisition for Federal Textbooks on
Citizenship , 9-13
Form G-325 - Biographic Information 9-14
Form G-325A - Biographic Information 9-15
10. CITIZENSHIP AND NATURALIZATION FORMS
General Information and Charts 10-1
Form N-300 - Application to File Declaration of
Intention 10-6
Form N-470 - Application for Preservation of Residence
for Naturalization Purposes 10-9
Form M-132 - Information concerning Citizenship
Education to meet Naturalization Requirements . ., 10-20
Form N-400 - Application to File Petition for
Naturalization 10-25
Form N-400B - Supplement to Application to File
Petition for Naturalization 10-39
Form N-336 - Application for 30-day Waiver -
Naturalization 10-42
Form N-455 - Application for the Transfer of the
Petition for Naturalization 10-45
Form N-604 - Application for Child's Certificate
of Citizenship submitted by Parent 10-55
Form N-402 - Application to File Petition for
Naturalization in behalf of Child 10-61
VI
CHAPTER PAGE
Form N-458 - Application to Correct
Certificate of Naturalization 10-70
Form N-565 - Application for a new Naturalization
or Citizenship Paper 10-73
Form N-600 - Application for Certificate
of Citizenship 10-79
Form M-7 - Cur Constitution & Government 10-103
Form M-8 - Our Constitution & Government -
Simplified Edition 10-104
Form M-35 - Federal Textbook on Citizenship 10-105
Form M-39 - Our Constitution & Government 10-106
Form M-40 - Our Constitution & Government 10-107
Form M-41 - English, Home and Community Life 10-108
Form M-43 - English & Federal Government 10-109
Form M-45 - English & Federal Government 10-110
Form M-74 - Gateway to Citizenship 10-111
Form N-17 - Naturalization Requirements and
General Information 10-112
Form N-315 - Declaration of Intention 10-113
Form N-405 - Petition for Naturalization 10-117
Form N-407 - Petition for Naturalization 10-121
Form N-408 - Application to take Oath of Allegiance
and Form of such Oath 10-125
Form N-426 - Request for Certification of Military
or Naval Service 10-131
Form N-430 - Request that Applicant Appear with
Witnesses 10-135
Form N-461 - Notice to Produce Witness 10-138
Form N-462A - Interrogatories in Deposition
of Witnesses 10-139
Form N-550 - Certificate of Naturalization 10-143
Form N-560A & AA - Certificate of Citizenship 10-145
Form N-561 - Certificate of Citizenship 10-148
Form N-570 - Certificate of Naturalization 10-149
Form N-577 - Application for a Special Certificate of
Naturalization to Obtain Recognition as a Citizen of the
United States by a Foreign State 10-151
Form N-578 - Special Certificate of Naturalization .... 10-154
Form N-580 - Application for a Certificate of
Naturalization or Repatriation 10-155
r
FORMS INDEX
r
CONTENTS
FORM NUMBER PAGE
Form ETA 750 - Application for Alien Employment
Certification 4-91
Form G-1A - Unidentifiable Communication Follow-up .... 7-1
Form G-22.17 - Workload Record - Records
Administration 8-27
Form G-23.26A - Statistics - Freedom of Information
Act 7-6
Form G-23.26B - Privacy Act Workload Record 7-10
Form G-28 - Notice of Entry of Appearance as
Attorney or Representative 7-13
Form G-56 - General Call -In Letter 8-29
Form G-62 - Requisition for Federal Textbooks
On Citizenship 9-13
Form G-100 - Request for File on Loan 8-31
Form G-102 - File Routed on Loan 8-33
Form G-253 - Daily Reoister of Receipts 8-35
Form G-325 - Biographic Information (2 copy) 9-14
Form G-325A - Biographic Information (4 copy) 9-15
Form G-325B - Biographic Information (3 copy) 8-37
Form G-342 - Transmittal Letter for Information
from Service Files 7-18
Form G-343 - Reply to Request, for Information
from Service Fi les 7-20
Form G-347 - Reauest for Information from
Naturalization File 7-22
Form G-350 - Certification of Birth Data 7-24
Form G-351 - Request for Copies of Documents 7-26
Form G-396 - Reauest for Review Classification 7-28
Form G-617 - Correspondence Control Card 7-30
Form G-639 & A - Application for a Search of the Records
of the Immigration and Naturalization Service under the
Freedom of Information Act 7-32
Form G-640 - Worksheet for Freedom of Information
Act Requests 7-36
Form G-641 - Application for Verification of Information
from Immigration and Naturalization Service Records ... 7-38
Form G-652 - Affidavit of Identity 7-42
Form G-657 - Privacy Act Information Request 7-44
Form G-658 - Record of Information Disclosure 7-48
Form G-711 - Individual Fee Register Receipt 8-43
Form G-712 - Summary of Fees Recorded on Individual
Fee Register Receipts 8-44
Form G-714 - Receipt for Funds and Valuables
Transferred 8-45
Form G-71 5 -Acknowledgment & Status of Applications ... 7-52
Form G-734 - Third Agency Referral Memorandum 7-54
Form G-747 - FOI/PA Response . , 7-56
Form 1-17 - Petition for Approval of School for
Attendance by Noninmi grant Students 3-1
Form 1-20 A&B - Certificate of Eligibility for
Nonimmigrant F-l Student Status 3-10
Form 1-53 - Alien Address Report 9-1
Form 1-60 - Form Letter - Re: Extension of Time on
Permit to Reenter the United States 8-1
Form 1-72 - Form Letter Returning Deficient
Applications or Petitions 8-2
Form 1-89 - ADIT Card Collection Form 1-29
Form 1-90 - Application by a Lawful Permanent Resident
for an Alien Registration Receipt Card - Form 1-551 ... 4-1
Form 1-94 - Arrival-Departure Record 9-2
Form 1-102 - Application by Nonimmigrant Alien for
Replacement of Arrival Document , 3-18
Form 1-126 -- Report of Status by Treaty Trader
Or Investor 3-21
Form I-129B - Petition to Classify Nonimmigrant as
Temporary Worker or Trainee 3-27
Form I-129F - Petition to Classify Status of Alien
Fiance or Fiancee for Issuance of Nonimmigrant Visa ... 3-37
Form 1-130 - Petition to Classify Status of Alien
Relative for Issuance of Immigrant Visa 4-5
Form I-13QE/I-485H - Petition to Classify Status of Alien
Relative for Issuance of Immigrant Visa and Application for
Status as Permanent Resident 4-18
Form 1-131 - Application for Issuance of Extension
of Permit to Reenter the United States 4-26
Form 1-134 - Affidavit of Support 9-3
Form 1-140 - Petition to Classify Preference Status
of Alien on Basis of Profession or Occupation 4-33
Form 1-17"! - Notice of Approval of Relative
Immigrant Visa Petition 8-3
Form I-171C - Notice of Approval of Nonimmigrant Visa
Petition or of Extension of Stay of Nonimmigrant
H or L Alien * 8-5
Form I-171F - Notice of Approval of Nonimmigrant Visa
Petition for Fiance or Fiancee 8-7
Form 1-190 - Application for Nonresident Alien
Border Crossing Card 3-46
Form 1-191 - Application for Advance Permission to
Return to Unrelinquished Domicile 6-1
Form 1-192 - Application for Advance Permission
to Enter as Nonimmigrant 6-5
Form 1-196 - Application for US Citizen
Identification Card 9-9
Form 1-210 - Voluntary Departure Notice 8-11
Form 1-212 - Application for Permission to Reapply for
Admission into the U.S. After Deportation or Removal .. 6-9
Form I-290A - Notice of Appeal to the Board of
Immigration Appeals 5-3
Form I-290B - Notice of Appeal to Regional
Commissioner 5-5
Form I-290C - Notice of Certification 5-12
Form 1-407 - Abandonment by Alien of Status as
Lawful Permanent Resident 4-41
Form 1-464 - Notice of Third or Sixth Preference
Petition Approved under Section 203a of the I&N Act,
as amended 8-1 2
Form 1-485 - Application for Status as Permanent
Resident 4-43
Forn I-485A - Application by Cuban Refugee for
Permanent Residence '. 4-51
Form I-485C - Application for Creation of Record of
Lawful Admission for an Indochinese Refugee 4-59
Form 1-486 - Medical Examination and Immigration
Interview 4-13
Form 1-506 - Application for Change of Nonimmigrant
Status and Requests for Change of Nonimmigrant^ Status
Not Requiring a Fee or Application 3-48
Form 1-508 - Waiver of Rights, Privileges, Exemptions,
and Immunities 8-18
Form 1-512 - Authorization for Parole or Conditional
Entry of an Alien into the United States 8-20
Form 1-515 - Notice to Student or Exchange Visitor 3-50
Form 1-526 - Request for Determination that Prospective
Immigrant is an Investor 4-67
Xll
Form 1-538 - Application by Nonimmigrant Student (F-l)
for Extension of Stay, School Transfer, or Permission
to Accept or Continue Employment 3-61
Form 1-539 - Application to Extend Time of
Temporary Stay 3-69
Form 1-546 - Order to Appear (Deferred Inspection) 8-23
Form 1-564 - Form Letter - Reply to General
Inquiries 8-26
Form 1-570 - Application for Issuance or Extension
of Refugee Travel Document 4-72
Form 1-600 - Petition to Classify Orphan as an
Immediate Relative 4-81
Form 1-601 - Application of Waiver of Grounds of
Excludability 6-13
Form 1-612 - Application for Waiver of Foreign
Residence Requirement 6-21
Form IAP 66 - Certificate of Eligibility for Exchange
Visitor Status 3-76
Form M-6 - Regional and District Office Areas and
Addresses 2-41
Form M-7 - Our Constitution & Government 10-103
Forn M-8 - Our Constitution & Government 10-104
Form M-35 - Federal Textbook on Citizenship 10-105
Form M-39 - Our Constitution & Government 10-106
Form M-40 - Our Constitution & Government 10-107
Form M-41 - English, Home & Community Life 10-108
Form M-43 - English & Federal Government 10-109
Form M-45 - English & Federal Government 10-110
Form M-74 - Gateway to Citizenship 10-111
Form M-132 - Information Concerning Citizenship
Education to Meet Naturalization Requirements 10-20
Form N-17 - Naturalization Requirements & General
Information 10-112
Form N-300 - Application to File Declaration
of Intention 10-6
Form N-315 - Declaration of Intention 10-113
Form N-336 - Application for 30-Day
Waiver - Naturalization 10-43
Form N-400 - Application to File Petition for
Naturalization 10-25
Form N-^OOB - Supplement to Application to File
Petition for Naturalization 10-39
Form N-402 - Application to File Petition for
Naturalization in Behalf of Child 10-61
Form N-405 - Petition for Naturalization 10-117
Form N-407 - Petition for Naturalization 10-121
Form N-408 - Application to take Oath of Allegiance
and Form of Such Oath ". 10-125
Form N-426 - Request for Certificate of Military
or Naval Service 10-131
Form N-430 - Request that Applicant Appear with
Witnesses 10-135
Form N-455 - Application for the Transfer of the
Petition for Naturalization 10-45
Form N-458 - Application to Correct Certificate
of Naturalization 10-70
Form N-461 - Notice to Produce Witness 10-138
Form N-462A - Interrogatories in Deposition of Witness. 10-139
Form N-470 - Application for Preservation of Residence
for Naturalization Purposes 10-9
Form N-550 - Certificate of Naturalization 10-143
Form N-560A & AA - Certificate of Citizenship 10-145
Form N-561 - Certificate of Citizenship 10-148
Form N-565 - Application for a New Naturalization
or Citizenship Paper 10-73
Form N-570 - Certificate of Naturalization 10-H9
Form N-577 - Application for a Special Certificate of
Naturalization to Obtain Recognition as a Citizen of
the United States by a Foreign State 10-151
Form N-578 - Special Certificate of Naturalization 10-154
Form N-580 - Application for a Certificate of
Naturalization or Repatriation 10-155
Form N-600 - Application for Certificate of
Citizenship 10-79
Form N-604 - Application for Child's Certificate of
Citizenship Submitted by Parent 10-55
CHAPTER 1.
1. GENERAL INFORMATION
Ftt Schedule .. ....1-1
Definitions 1-5
Explanation of Name Usage 1-10
Fingerprints , 1-15
Classes of Nonimmigrants 1-H7
Classes of Immigrants 1-21
ADIT Procedures 1-2 5
Handling Status Inquiries..... l-;33
Employment Authorization Requests 1-36
FEE CHART FOR APPLICATIONS AND PETITIONS
LISTED BELOW ARE THE FEES PRECRIBED FOR VARIOUS SERVICES PERFORMED BY THE
IMMIGRATION SERVICE, THE FORM ON WHICH TO APPLY FOR THE SERVICE, AND THE
FEE FOR THE FORM.
THE IMMIGRATION AND NATURALIZATION SERVICE WILL ACCEPT PERSONAL CHECKS IN
PAYMENT OF FEES FOR APPLICATIONS AND PETITIONS. HOWEVER, A CHARGE OF $5.00
WILL BE IMPOSED IF A CHECK IN PAYMENT OF A FEE IS NOT HONORED BY THE BANK
ON WHICH IT IS DRAWN, AND PROCESSING OF THE APPLICATION OR PETITION MAY BE
HELD UP PENDING COLLECTION OF THIS CHARGE AND THE FEE FOR THE APPLICATION.
FOR FILING APPLICATION FOR SCHOOL APPROVAL, EXCEPT
IN THE CASE OF A SCHOOL OR SCHOOL SYSTEM OWNED OR
OPERATED AS A PUBLIC EDUCATIONAL INSTITUTION OR
SYSTEM BY THE UNITED STATES OR A STATE OR POLITICAL
SUBDIVISION THEREOF 1-17 $20. 0(
FOR FILING APPLICATION FOR ALIEN REGISTRATION RECEIPT
CARD (FORM 1-151), IN LIEU OF ONE LOST, MUTILATED, OR
DESTROYED, OR IN A CHANGED NAME 1-90 $15. 0(
FOR FILING APPLICATION FOR ARRIVAL- DEPARTURE RECORD
(FORM 1-94) OR CREWMAN'S LANDING PERMIT (FORM 1-95),
IN LIEU OF ONE LOST, MUTILATED, OR DESTROYED 1-102 $ 5.0(
FOR FILING PETITION TO CLASSIFY NONIMMIGRANT AS TEMPORARY
WORKER OR TRAINEE I-129B $15.0(
FOR FILING PETITION TO CLASSIFY NONIMMIGRANT AS
FIANCEE1 OR FIANCE1 I-129F $15.01
FOR FILING PETITION TO CLASSIFY STATUS OF ALIEN RELATIVE
FOR ISSUANCE OF IMMIGRANT VISA 1-130 $10.01
FOR FILING APPLICATION FOR ISSUANCE OR EXTENSION
OR REENTRY PERMIT 1-131 $ 5.01
1-140 $25.01
FOR FILING APPLICATION FOR DISCRETIONARY RELIEF
(RETURNING RESIDENTS) 1-191 $35.01
FDR FILING APPLICATION FOR DISCRETIONARY RELIEF I
(NONIMMIGRANTS) 1-192 $15.00
FOR FILING APPLICATION FOR PASSPORT WAIVER PRIOR TO OR
AT THE TIME APPLICATION IS MADE FOR PERMANENT ADMISSION 1-193 $ 5.00
FOR FILING APPLICATION FOR A UNITED STATES CITIZEN
IDENTIFICATION CARD 1-196 $ 5.00
FOR FILING APPLICATION FOR PERMISSION TO REAPPLY FOR
AN EXLUDED OR DEPORTED ALIEN, AN ALIEN WHO HAS FALLEN
INTO DISTRESS AND HAS BEEN REMOVED AS AN ALIEN ENEMY,
OR AN ALIEN WHO HAS BEEN REMOVED AT GOVERNMENT EXPENSE
IN LIEU OF DEPORTATION 1-212 $20.00
FOR FILING APPEAL FROM OR MOTION TO REOPEN OR
RECONSIDER ANY DECISION UNDER THE IMMIGRATION
LAWS IN ANY TYPE OF PROCEEDING OVER WHICH THE
BOARD OF IMMIGRATION APPEALS HAS APPELLATE
JURISDICTION. WHEN THE MOTION TO REOPEN OR
RECONSIDER IS MADE CONCURRENTLY WITH ANY APPLICA-
TION UNDER THE IMMIGRATION LAWS, SUCH APPLICATION
WILL BE CONSIDERED AN INTEGRAL PART OF THE MOTION
AND ONLY THE FEE FOR FILING THE MOTION OR THE FEE
FOR FILING THE APPLICATION, WHICHEVER IS GREATER,
IS PAYABLE I-290A $50.00 ^
FOR FILING APPEAL OR MOTION TO REOPEN OR RECONSIDER "
ANY DECISION UNDER THE IMMIGRATION LAWS IN ANY TYPE
OF PROCESSING OVER WHICH THE BOARD OF IMMIGRATION
APPEALS DOES NOT HAVE APPELLATE JURISDICTION I-290B $50.00
FOR FILING APPLICATION FOR ADJUSTMENT OF STATUS
TO THAT OF A PERMANENT RESIDENT 1-485 $30.00
FOR FILING APPLICATION FOR CREATION OF RECORD OF
ADMISSION FOR PERMANENT RESIDENCE 1-485 $30.00
FOR FILING APPLICATION TO RECORD LAWFUL ADMISSION
FOR PERMANENT RESIDENCE. (FIANCES AND FIANCEES) 1-485 $30.00
FOR FILING APPLICATION FOR CHANGE OF NONIMMIGRANT
CLASSIFICATION . 1-506 $10.00
FOR FILING APPLICATION FOR EXTENSION OF STAY OF
A NONIMMIGRANT, OTHER THAN AN ALIEN CLASSIFIED
"F", "J", OR "B-2" 1-539 $ 5.00
FOR FILING APPLICATION FOR ISSUANCE OR EXTENSION
OF REFUGEE TRAVEL DOCUMENT 1-570 $ 5.00
10/1/80
FOR FILING PETITION TO CLASSIFY ORPHAN AS AN
IMMEDIATE RELATIVE (WHEN MORE THAN ONE PETITION
IS SUBMITTED BY THE SAME PETITIONER IN BEHALF OF
ORPHANS WHO ARE BROTHERS OR SISTERS, ONLY ONE FEE
WILL BE REQUIRED 1-600 $35.00
FOR FILING APPLICATION FOR WAIVER OF GROUND OF
EXCLUDABILITY 1-601 $35.00
FOR FILING APPLICATION FOR WAIVER OF THE FOREIGN-
RESIDENCE REQUIREMENT 1-612 $35.00
FOR FILING APPLICATION FOR VERIFICATION OF LAWFUL
PERMANENT RESIDENCE OF AN ALIEN G-641 $ 5.00
FOR FILING APPLICATION FOR VERIFICATION OF INFORMATION
CONTAINED IN SERVICE RECORDS G-641 $ 5.00
FOR CERTIFICATION OF TRUE COPIES, EACH G-641 $ 1.00
FOR ATTESTATION UNDER SEAL G-641 $ 3.00
FOR FILING APPLICATION FOR CERTIFICATE OF
CITIZENSHIP BY A PARENT N-400 $15.00
FOR FILING APPLICATION FOR TRANSFER OF PETITION
FOR NATURALIZATION N-455 $10.00
APPLICATION TO PRESERVE RESIDENCY FOR
NATURALIZATION PURPOSES N-470 $10.00
FOR FILING APPLICATION FOR A CERTIFICATE OF
NATURALIZATION OR DECLARATION OF INTENTION
IN LIEU OF A CERTIFICATE OR DECLARATION ALLEGED
TO HAVE BEEN LOST, MUTILATED, OR DESTROYED;
OR FOR A CERTIFICATE OF CITIZENSHIP IN A CHANGED
NAME N-565 $10 00
FOR FILING APPLICATION FOR A SPECIAL CERTIFICATE
OF NATURALIZATION TO OBTAIN RECOGNITION AS A
CITIZEN OF THE UNITED STATES BY A FOREIGN STATE N-577 $10.00
FOR FILING APPLICATION FOR A CERTIFICATE OF
NATURALIZATION OR REPATRIATION N-580 $ 5.00
FOR FILING APPLICATION FOR CERTIFICATE OF
CITIZENSHIP N-600 $15.00
FOR FILING A MOTION TO REOPEN OR RECONSIDER ANY DECISION
UNDER THE IMMIGRATION LAWS (EXCEPT ON APPLICATIONS FILED
BY STUDENTS ON FORM 1-538, EXCHANGE VISITORS ON FORM DSP-66,
4/1/81
CUBAN REFUGEES ON FORM I-485A FILED UNDER THE ACT OF NOVEMBER 2,
1966 OR G-4 NONIMMIGRANTS ON FORM 1-566 FOR WHICH NO FEE IS
CHARGEABLE). WHEN THE MOTION REOPEN OR RECONSIDER IS MADE
CONCURRENTLY WITH ANY APPLICATION UNDER THE IMMIGRATION LAWS,
SUCH APPLICATION UNDER THE IMMIGRATION LAWS, SUCH APPLICATION
WILL BE CONSIDERED AN INTEGRAL PART OF THE MOTION AND ONLY THE FEE
FOR FILING THE MOTION OR THE FEE FOR FILING THE APPLICATION, WHICH-
EVER IS GREATER, IS PAYABLE. (THE FEE OF $25.00 SHALL BE
CHARGED WHENEVER A MOTION IS FILED BY OR ON BEHALF OF TWO OR MORE
ALIENS AND ALL SUCH ALIENS ARE COVERED BY ONE DECISION)
$50.00
10/1/80
l- LIST OF PERTINENT DEFINITIONS:
1. THE TERM "ALIEN" MEANS ANY PERSON NOT A CITIZEN OR NATIONAL
OF THE UNITED STATES.
2. THE TERM "IMMIGRANT" MEANS EVERY ALIEN EXCEPT AN ALIEN WHO
IS WITHIN ONE OF THE CLASSES OF NONIMMIGRANT ALIENS. (NON-
IMMIGRANT CLASSES BEGIN ON PAGE 1-15).
3. THE TERM "SPECIAL IMMIGRANT" MEANS--
a. AN IMMIGRANT, LAWFULLY ADMITTED FOR PERMANENT RESIDENCE,
WHO IS RETURNING FROM A TEMPORARY VISIT ABROAD;
b. AN IMMIGRANT WHO WAS A CITIZEN OF THE UNITED STATES AND MAY,
UNDER SECTION 324(a) OR 327 OF TITLE III, APPLY FOR REACQUISITION
OF CITIZENSHIP;
c. AN IMMIGRANT WHO CONTINUOUSLY FOR AT LEAST TWO YEARS IMME-
DIATELY PRECEDING THE TIME OF HIS APPLICATION FOR ADMISSION
TO THE UNITED STATES HAS BEEN, AND WHO SEEKS TO ENTER THE
UNITED STATES SOLELY FOR THE PURPOSE OF CARRYING ON THE
VOCATION OF MINISTER OF A RELIGIOUS DENOMINATION, AND WHOSE
SERVICES ARE NEEDED BY SUCH RELIGIOUS DENOMINATION HAVING
A BONA FIDE ORGANIZATION IN THE UNITED STATES; AND THE SPOUSE
OR THE CHILD OF ANY SUCH IMMIGRANT, IF ACCOMPANYING OR
FOLLOWING TO JOIN HIM; OR
d. AN IMMIGRANT WHO IS AN EMPLOYEE, OR AN HONORABLY RETIRED FORMER
EMPLOYEE, OF THE UNITED STATES GOVERNMENT ABROAD, AND WHO HAS
PERFORMED FAITHFUL. SERVICE FOR A TOTAL OF FIFTEEN YEARS, OR
MORE, AND HIS ACCOMPANYING SPOUSE AND CHILDREN: PROVIDED, THAT
THE PRINCIPAL OFFICER OF A FOREIGN SERVICE ESTABLISHMENT, IN HIS
DISCRETION, SHALL HAVE RECOMMENDED THE GRANTING OF SPECIAL IMMI-
GRANT STATUS TO SUCH ALIEN IN EXCEPTIONAL CIRCUMSTANCES AND THE
SECRETARY OF STATE APPROVES SUCH RECOMMENDATION AND FINDS THAT
IT IS IN THE NATIONAL INTEREST TO GRANT SUCH STATUS.
4. THE TERM "LAWFULLY ADMITTED FOR PERMANENT RESIDENCE" (LAPR) MEANS
THE STATUS OF HAVING BEEN LAWFULLY ACCORDED THE PRIVILEDGES OF RESIDI
PERMANENTLY IN THE UNITED STATES AS AN IMMIGRANT IN ACCORDANCE
WITH THE IMMIGRATION LAWS, SUCH STATUS NOT HAVING CHANGED.
5. THE TERM "NATIONAL" MEANS A PERSON OWING 'PERMANENT ALLEGIANCE
TO A STATE.
6. THE TERM "NATIONAL OF THE UNITED STATES" MEANS (A) A CITIZEN
OF THE UNITED STATES, OR (B) A PERSON WHO, THOUGH NOT A CITIZEN
OF THE UNITED STATES, OWES PERMANENT ALLEGIANCE TO THE UNITED STATES.
7. THE TERM " UNITED STATES", EXCEPT AS OTHERWISE SPECIFICALLY HEREIN
PROVIDED, WHEN USED IN A GEOGRAPHICAL SENSE, MEANS THE CONTINENTAL
UNITED STATES, ALASKA, HAWAII, PUERTO RICO, GUAM, AND THE
VIRGIN ISLANDS OF THE UNITED STATES.
8. THE TERM "OUTLYING POSSESSIONS OF THE UNITED STATES" MEANS
AMERICAN SAMOA AND SWAINS ISLAND.
9. THE TERM "RESIDENCE" MEANS THE PLACE OF GENERAL ABODE; THE
PLACE OF GENERAL ABODE OF A PERSON MEANS HIS PRINCIPAL, ACTUAL
DWELLING PLACE IN FACT, WITHOUT REGARD TO INTENT.
10. THE TERMS "SPOUSE", "WIFE", OR "HUSBAND" DO NOT INCLUDE A SPOUSE,
WIFE, OR HUSBAND BY REASON OF ANY MARRIAGE CEREMONY WHERE THE CON-
TRACTING PARTIES THERETO ARE NOT PHYSICALLY PRESENT IN THE PRESENCE
OF EACH OTHER, UNLESS THE MARRIAGE SHALL HAVE BEEN CONSUMATED.
11. THE TERM "UNMARRIED", WHEN USED IN REFERENCE TO ANY INDIVIDUAL
AS OF ANY TIME, MEANS AN INDIVIDUAL WHO AT SUCH TIME IS NOT
MARRIED, WHETHER OR NOT PREVIOUSLY MARRIED.
12. THE TERM "CHILD" MEANS AN UNMARRIED PERSON UNDER TWENTY-ONE YEARS
OF AGE WHO IS --
a. A LEGITIMATE CHILD; OR
b. A STEPCHILD, WHETHER OR NOT BORN OUT OF WEDLOCK PROVIDED
THE CHILD HAD NOT REACHED THE AGE OF EIGHTEEN YEARS AT THE
TIME THE MARRIAGE CREATING THE STATUS OF STEPCHILD OCCURRED; OR
c. A CHILD LEGITIMATED UNDER THE LAW OF THE CHILD'S RESIDENCE
OR DOMICILE, OR UNDER THE LAW OF THE FATHER'S RESIDENCE OR
DOMICILE, WHETHER IN OR OUTSIDE THE UNITED STATES, IF SUCH
LEGITIMATION TAKES PLACE BEFORE THE CHILD REACHES THE AGE OF
EIGHTEEN YEARS AND THE CHILD IS IN THE LEGAL CUSTODY OF THE
LEGITIMATING PARENT OR PARENTS AT THE TIME OF SUCH LEGITIMATION;
d. AN ILLEGITIMATE CHILD, BY, THROUGH WHOM, OR ON WHOSE BEHALF
A STATUS, PRIVILEGE, OR BENEFIT IS SOUGHT BY VIRTUE OF THE
RELATIONSHIP OF THE CHILD TO ITS NATURAL MOTHER;
e. A CHILD ADOPTED WHILE UNDER THE AGE OF FOURTEEN YEARS IF THE
CHILD HAS THEREAFTER BEEN IN THE LEGAL CUSTODY OF, AND HAS
RESIDED WITH, THE ADOPTING PARENT OR PARENTS FOR AT LEAST TWO
YEARS: PROVIDED, THAT NO NATURAL PARENT OF ANY SUCH ADOPTED
CHILD SHALL THEREAFTER, BY VIRTUE OF SUCH PARENTAGE, BE ACCORDED
ANY RIGHT, PRIVILEGE, OR STATUS UNDER THIS ACT;
f. A CHILD, UNDER THE AGE OF FOURTEEN AT THE TIME A PETITION IS
FILED IN HIS BEHALF TO ACCORD A CLASSIFICATION AS AN IMMEDIATE
RELATIVE UNDER SECTION 201(b), WHO IS AN ORPHAN BECAUSE OF THE
DEATH OR DISAPPEARANCE OF, ABANDONMENT OR DESERTION BY, OR
SEPARATION OR LOSS FROM, BOTH PARENTS, OR FOR WHOM THE SOLE OR
SURVIVING PARENT IS INCAPABLE OF PROVIDING THE PROPER CARE AND
HAS IN WRITING IRREVOCABLY RELEASED THE CHILD FOR EMIGRATION
AND ADOPTION; WHO HAS BEEN ADOPTED ABROAD BY A UNITED STATES
10/1/80
CITIZEN AND SPOUSE JOINTLY, OR BY AN UNMARRIED UNITED STATES
CITIZEN AT LEAST TWENTY-FIVE YEARS OF AGE, WHO PERSONALLY SAW
AND OBSERVED THE CHILD PRIOR TO OR DURING THE ADOPTION PROCEED-
INGS; OR WHO IS COMING TO THE UNITED STATES FOR ADOPTION BY A
UNITED STATES CITIZEN AND SPOUSE JOINTLY, OR BY AN UNMARRIED
UNITED STATES CITIZEN AT LEAST TWENTY-FIVE YEARS OF AGE, WHO
HAVE OR HAS COMPLIED WITH THE PREADOPTION REQUIREMENTS, IF ANY,
OF THE CHILD'S PROPOSED RESIDENCE: PROVIDED, THAT THE ATTORNEY
GENERAL IS SATISFIED THAT PROPER CARE WILL BE FURNISHED THE
CHILD IF ADMITTED TO THE UNITED STATES: PROVIDED FURTHER, THAT
NO NATURAL PARENT OR PRIOR ADOPTIVE PARENT OF ANY SUCH CHILD
SHALL THEREAFTER, BY VIRTUE OF SUCH PARENTAGE, BE ACCORDED ANY
RIGHT, PRIVILEGE, OR STATUS UNDER THIS ACT.
13. THE TERMS "PARENT", "FATHER", OR "MOTHER" MEAN A PARENT, FATHER OR
MOTHER ONLY WHERE THE RELATIONSHIP EXISTS BY REASON OF ANY OF THE
CIRCUMSTANCES SET FORTH IN (5) ABOVE, (REGARDLESS WHETHER THE RELA-
TIONSHIP IS BY BLOOD OR OTHER CIRCUMSTANCES.)
14. IMMIGRANTS NOT REQUIRED TO OBTAIN VISAS. AN IMMIGRANT WITHIN ANY OF
THE FOLLOWING CATEGORIES SHALL NOT BE REQUIRED TO OBTAIN AN IMMIGRAN
VISA:
a. ALIENS LAWFULLY ADMITTED FOR PERMANENT RESIDENCE. ANY ALIEN
LAWFULLY ADMITTED FOR PERMANENT RESIDENCE WHO IS NOT REQUIRED
UNDER THE REGULATIONS OF THE IMMIGRATION AND NATURALIZATION SERV
TO PRESENT A VALID IMMIGRANT VISA UPON RETURNING TO THE UNITED
STATES.
b. ALIEN MEMBERS OF UNITED STATES ARMED FORCES. AN ALIEN MEMBER
OF THE ARMED FORCES OF THE UNITED STATES WHO IS IN THE UNIFORM
OF, OR WHO BEARS DOCUMENTS IDENTIFYING HIM AS A MEMBER OF, SUCH
ARMED FORCES, WHO HAS BEEN PREVIOUSLY LAWFULLY ADMITTED FOR
PERMANENT RESIDENCE, AND WHO IS PROCEEDING TO THE UNITED STATES
UNDER OFFICIAL ORDERS OR PERMIT OF SUCH ARMED FORCES.
c. ALIENS ENTERING FROM GUAM. PUERTO RICO OR VIRGIN ISLANDS.
AN ALIEN LAWFULLY ADMITTED FOR PERMANENT RESIDENCE WHO SEEKS
TO ENTER THE CONTINENTAL UNITED STATES OR ANY OTHER PLACE
UNDER THE JURISDICTION OF THE UNITED STATES DIRECTLY FROM
GUAM, PUERTO RICO OR THE VIRGIN ISLANDS OF THE UNITED
STATES.
d. CHILDREN BORN SUBSEQUENT TO ISSUANCE OF VISA TO ACCOMPANYING
PARENT. AN ALIEN CHILD BORN SUBSEQUENT TO THE ISSUANCE OF AN
IMMIGRANT VISA TO HIS PARENT, WHO WILL ARRIVE IN THE UNITED
STATES WITH, AND APPLY FOR ADMISSION DURING THE PERIOD OF
VALIDITY OF THE VISA ISSUED TO, THE PARENT.
e. AMERICAN INDIANS BORN IN CANADA. AN AMERICAN INDIAN BORN IN
CANADA AND HAVING AT LEAST FIFTY PER CENTUM OF BLOOD OF THE
AMERICAN INDIAN RACE.
II. OTHER COMMON TERMS EXPLAINED:
1. "VISA" IS A "PERMIT TO KNOCK ON THE DOOR; NOT A PERMIT TO ENTER".
2. "ACCOMPANYING" OR "ACCOMPANIED BY" MEANS, IN ADDITION TO AN ALIEN
IN THE PHYSICAL COMPANY OF A PRINCIPAL ALIEN, AN ALIEN WHO IS ISSUED
AN IMMIGRANT VISA WITHIN 4 MONTHS OF THE DATE OF ISSUANCE OF A VISA
TO THE PRINCIPAL ALIEN, WITHIN 4 MONTHS OF THE ADJUSTMENT OF STATUS
IN THE UNITED STATES OF THE PRINCIPAL ALIEN, OR WITHIN 4 MONTHS FROM
THE DATE OF THE DEPARTURE OF THE PRINCIPAL ALIEN FROM THE COUNTRY
IN WHICH HIS DEPENDENTS ARE APPLYING FOR VISAS IF HE HAS TRAVELED
ABROAD TO CONFER HIS FOREIGN STATE CHARGEABILITY UPON THEM. AN
"ACCOMPANYING" RELATIVE MAY NOT PRECEDE THE PRINCIPAL ALIEN TO THE
UNITED STATES.
3. "FOLLOWING TO JOIN." A SPOUSE OR CHILD IS CONSIDERED TO BE "FOLLOWING
TO JOIN" AS THAT TERM IS USED IN SECTIONS 101(a) (27) (D) , AND 203(a)(9)
OF THE ACT AS AMENDED, REGARDLESS OF THE PERIOD OF TIME WHICH MAY
ELAPSE BETWEEN THE ISSUANCE OF THE VISA TO THE PRINCIPAL ALIEN AND
10/1/8C
TO THE SPOUSE OR CHILD, A SPOUSE OR CHILD ACQUIRED SUBSEQUENT
TO THE ADMISSION OF A PRINCIPAL ALIEN UNDER SECTIONS 101(a)(27)(D)
OR 203(a)(l) THROUGH (6) IS NOT ENTITLED TO THE STATUS ACCORDED
BY THOSE SECTIONS. (SEE 22 CFR 42.25, NOTE 2 AND 22 CFR 42.32,
NOTE 3). (AMENDED)
"PRINCIPAL ALIEN" MEANS AN ALIEN FROM WHOM ANOTHER ALIEN DERIVES
A PRIVILEGE OR STATUS UNDER THE LAW OR REGULATIONS.
"SON11 OR "DAUGHTER" SHALL NOT INCLUDE AN ALIEN WHO WOULD NOT
QUALIFY AS A "CHILD" WITHIN THE MEANING OF SECTION 101(b)(l) OF
THE ACT IF THE ALIEN WERE UNDER THE AGE OF 21 AND UNMARRIED.
"WESTERN HEMISPHERE" MEANS NORTH AMERICA (INCLUDING CENTRAL
AMERICA), SOUTH AMERICA AND THE ISLANDS IMMEDIATELY ADJACENT
THERETO INCLUDING THE PLACES NAMED IN SECTION 101(b)(5) OF THE
ACT.
"NOT SUBJECT TO NUMERICAL LIMITATIONS" MEANS THAT THE ALIEN IS
ENTITLED TO IMMIGRANT STATUS AS AN IMMEDIATE RELATIVE WITHIN THE
MEANING OF SECTION 201 (b), AS A SPECIAL IMMIGRANT WITHIN THE MEANING
OF SECTION 101(a)(27) OF THE ACT, OR AS A NONQUOTA IMMIGRANT AS DE-
FINED IN THIS SECTION.
iAPTER: GENERAL CONSIDERATIONS
JBTITLE: NAMES
• USE OF MAIDEN NAMES:
THERE IS NO OBJECTION TO THE ISSUANCE OF AN ALIEN REGISTRATION 01 264.2
CARD IN THE MAIDEN NAME OF A MARRIED WOMAN, IF REQUESTED BY HER,
AND IF THE USE OF THE MAIDEN NAME IS SANCTIONED BY THE LAW OF
THE STATE IN WHICH SHE RESIDES.
. CHINESE NAMES AND SIGNATURES:
EVERY PERSON OF THE CHINESE RACE, REGARDLESS OF WHETHER HE IS 01 103.2
A CHINESE NATIONAL OR NOT, WHOSE NAME HAS BEEN ANGLICIZED FROM
THE CHINESE, WHO MAKES ANY APPLICATION TO THE SERVICE OR IS THE
SUBJECT OF INVESTIGATION BY THE SERVICE, SHALL BE REQUESTED TO
INCLUDE THE PROPER CHINESE CHARACTERS OF HIS NAME IN ADDITION
TO HIS USUAL ANGLICIZED SIGNATURE. THE CHINESE CHARACTERS SUB-
MITTED SHALL BE CHECKED AGAINST THOSE IN HIS PASSPORT. IF THE
CHARACTERS DO NOT COINCIDE, THE PERSON SHALL BE REQUESTED TO
EXPLAIN THE DISSIMILARITY AND TO SUBMIT ANOTHER SPECIMEN OF HIS
NAME .IN CHARACTERS MATCHING THE NAME AS WRITTEN IN HIS PASSPORT.
THE PROPER CHINESE CHARACTERS AND THE SIGNATURE SHALL BE PLACED
ON ANY APPLICATION AND ON FORM 6-138, SIGNATURE SPECIMEN FORM,
IN TRIPLICATE. IF A PERSON OF THE CHINESE RACE IS UNABLE TO SIGN
THE CHINESE CHARACTERS DENOTING HIS NAME AND QUALIFIED PERSONNEL
OF THE SERVICE ARE NOT AVAILABLE TO DO SO IN HIS BEHALF, HE SHALL
BE REQUESTED TO HAVE THE PROPER CHINESE CHARACTERS OF HIS NAME
FURNISHED BY ANOTHER PERSON WHO IS CONPETENT TO WRITE CHINESE,
PROVIDED THAT THE CIRCUMSTANCES ALLOW THIS COURSE OF ACTION TO
BE PURSUED.
10/1/80
3. SPANISH NAMES:
a- PURPOSE: TO PROVIDE FOR PROPERLY RECORDING AND IDENTIFYING
RECORDS RELATING TO SPANISH AND LATIN -AMERICAN NAMES. THE
FOLLOWING INFORMATION REPRESENTS THE GENERAL USAGE OF SPANISH
AND LATIN-AMERICAN NAMES, (DO NOT APPLY THIS INSTRUCTION TO
PORTUGESE NAMES AS A PORTUGESE NAME IS WRITTEN WITH THE SUR-
NAME OF THE MOTHER PRECEDING THAT OF THE FATHER WHEN BOTH
SURNAMES ARE USED AND SHOULD BE INDEXED AS NAMES IN THE ENGLISH
LANGUAGE.)
b- GIVEN NAMES: A LARGE NUMBER OF SPANISH GIVEN NAMES CONSIST
OF MORE THAN ONE WORD, SUCH AS MaHa de IPS Angeles, Maria
de la Luz, Maria del Carmen. WHEN USED IN THIS MANNER, THE
NAME SHOULD BE TREATED AS ONE GIVEN NAME, BUT IF NOT CONNECTED
WITH THE de_ or de la THE NAME SHOULD BE DIVIDED INTO A FIRST
AND MIDDLE NAME, AS Maria Luz OR Maria Carmen. IN RECORDING
SPANISH NAMES, EQUIVALENT NICKNAMES SHOULD NOT BE USED. A
GREAT MANY OF THE SPANISH GIVEN NAMES HAVE EQUIVALENT NICK-
NAMES WHICH ARE COMMONLY USED AS A FIRST NAME. FOR EXAMPLE,
"Pancho" FOR Francisco, "Pepe" FOR Jose. CARE SHOULD BE TAKEN
IN INDEXING RECORDS TO SEE THAT A NICKNAME IS NOT USED AS A
FIRST NAME.
c* SURNAMES; SPANISH AND LATIN -AMERICAN PEOPLE CUSTOMARILY USE
THE SURNAMES OF BOTH PARENTS, NEITHER OF WHICH IS CONSIDERED
A MIDDLE NAME. THESE TWO SURNAMES ARE DERIVED FROM THE FIRST
SURNAME OF THE FATHER AND THE FIRST SURNAME OF THE MOTHER.
THE SURNAME OF THE FATHER PRECEDES THAT OF THE MOTHER. THE
TWO SURNAMES MAY, OR MAY NOT, BE CONNECTED BY THE WORD "y"
(MEANING "AND"). FOR EXAMPLE, Juan Gomez y Conde HAS Juan
AS THE FIRST OR GIVEN NAME, Gomez AS THE SURNAME OF HIS FATHER,
FOLLOWED BY Conde, THE SURNAME OF HIS MOTHER. FOR RECORD PUR-
POSES, ALL DOUBLE LAST NAMES SHOULD BE HYPHENATED WITH THE
FATHER'S SURNAME FIRST FOLLOWED BY THE MOTHER'S SURNAME
(Gomez-Conde). ONLY THE FIRST SURNAME SHOULD BE CONSIDERED
IN INDEXING IN EITHER ALPHABETICAL OR SOUNDEX SYSTEM.
THE PREPOSITION "de" WITH THE ARTICLES "el", "la", "los",
"las", WILL APPEAR IN A NUMBER OF SPANISH OR LATIN-AMERICAN
NAMES. FOR EXAMPLE, THE SURNAME WILL BE SHOWN AS De la Torre,
De Alba, Del Arco, De la Cruz. PREPOSITIONS OF THIS NATURE
PRECEDING THE FIRST SURNAME SHALL BE IGNORED IN INDEXING.
FOR EXAMPLE, THE NAME OF Jose De la Torre Munoz SHOULD BE
INDEXED AS TORRE-MUNOZ, Jose De la.
MARRIED NAMES: IT IS COMMON PRACTICE FOR A MARRIED WOMAN TO
DROP THE SURNAME OF HER MOTHER AND ADD THE FIRST SURNAME OF
HER HUSBAND PRECEDED BY "de" (INDICATING "WIFE OF"). THUS,
Maria Gomez-Garcia, WHEN MARRIED TO Juan Martinez Ramirez,
WOULD BECOME Maria Gomez de Martinez AND SHOULD BE INDEXED
AS GOMEZ de Martinez, Maria. IN THE EVENT OF THE HUSBAND'S
DEATH, THE WOMAN RETAINS THE SAME NAME AND ADDS "vda. de"
(MEANING "WIDOW OF"). FOR EXAMPLE, AFTER THE HUSBAND'S DEATH,
THE WOMAN'S NAME WOULD BE Maria Gomez vda. de Martinez AND
SHOULD BE INDEXED AS GOMEZ vda> de Martinez, Maria. IT WILL BE
NOTED THAT THE WOMAN'S FIRST SURNAME NEVER CHANGES; THEREFORE,
AS MENTIONED IN PARAGRAPH "c" ABOVE, ONLY THE FIRST SURNAME OR
MAIDEN NAME SHALL BE USED FOR INDEXING PURPOSES. FOR INSTANCE,
IN THE EXAMPLE USED HERE, THE NAME WOULD BE INDEXED UNDER Gomez
IN ALL CASES. IN MANY CASES, SPANISH OR LATIN-AMERICAN WOMEN,
AFTER ADMISSION TO THE UNITED STATES FOR PERMANENT RESIDENCE,
ADOPT THE AMERICAN USAGE OF THEIR NAME AND USE THE HUSBAND'S
NAME AS THEIR LAST NAME. FOR THIS REASON A CROSS-REFERENCE
INDEX CARD ON FORM 6-361, IN DUPLICATE, MUST BE PREPARED UNDER
THE HUSBAND'S SURNAME. SHOW ON THE PRIMARY INDEX CARDS THAT
CROSS-REFERENCE INDEX CARDS EXIST AND THE NAME UNDER WHICH CROSS
REFERENCED. ON THE CROSS-REFERENCE INDEX CARD, USE THE HUSBAND'S
SURNAME AND SHOW THE FILE NUMBER, DATE AND PLACE OF BIRTH, AND
"SEE (PRIMARY NAME)." FORWARD THE ORIGINAL OF THE CROSS-REFERENCE
INDEX CARD TO THE CENTRAL OFFICE AND FILE THE DUPLICATE CARD IN
THE FILES CONTROL OFFICE INDEX.
10/1/8U
FOR IMMIGRATION SERVICE WRITE-UP, FILING, AND IDENTIFICATION
PURPOSES, THE FIRST (FATHER'S) SURNAME SHOULD BE WRITTEN FIRST
FOLLOWED BY THE SECOND SURNAME AND THE FIRST NAME IN THAT
ORDER (AM 2703.05). THE FIRST AND SECOND SURNAME SHOULD BE
SEPARATED WITH A HYPHEN. FOR EXAMPLE: Juan Ramirez-Canal es
AND Francisco Ayala-Campo WOULD BE WRITTEN IN THE FOLLOWING
MANNER:
FAMILY NAME
/First Surname Second Surname/ Given Name
Ramirez - Canal es Juan
Ayala - Campo Francisco
IN THE CASE OF SINGLE AND MARRIED WOMEN THE SAME SYSTEM IS USED
FAMILY NAME
/First Surname Second Surname/ Given Name
Martinez - Cavazos Marcela
AFTER Marcela's MARRIAGE, SHE WILL RETAIN HER FIRST SURNAME
BUT HER SECOND SURNAME WILL BE THAT OF HER HUSBAND AND WILL BE
WRITTEN ACCORDINGLY.
IF Marcela MARRIES A MAN NAMED Manuel Rocha Madero, HER NAME
WILL THEN APPEAR AS:
FAMILY NAME
/First Surname Second Surname/ Given Name
Martinez de Rocha Marcela
52
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10/1/80
CLASS DESCRIPTION
PERIOD
OF
ADMISSION
EXTENSION &
APPLICATION
FORM
EMPLOYMENT
A-l AMBASSADOR, PUBLIC MINISTER
CAREER DIPLOMAT OR CONSULAR
OFFICER, AND MEMBERS OF
IMMEDIATE FAMILY
DURATION OF
STATUS
N/A
REFER TO OFFICE
OF THE CHIEF OF
PROTOCOL DEPT. OF
STATE
A-2 OTHER FOREIGN GOVERNMENT
OFFICIAL OR EMPLOYEE, AND
MEMBERS OF HIS IMMEDIATE
FAMILY
DURATION OF
N/A
AS ABOVE
A- 3 ATTENDANT, SERVANT, OR
PERSONAL EMPLOYEE OF A-l
AND A-2, AND MEMBERS OF
IMMEDIATE FAMILY
1 YEAR
YES
1-539
AS ABOVE
B-l TEMPORARY VISITOR FOR
BUSINESS
MAXIMUM 1
YEAR
YES
1-539
NO
B-2 TEMPORARY VISITOR
PLEASURE
MAXIMUM 1
YEAR
YES
1-539
C-l ALIEN IN TRANSIT
MAXIMUM 29
DAYS
NO
NO
C-2 ALIEN IN TRANSIT TO UNITED DURATION OF N/A
NATIONS HEADQUARTERS STATUS
NO
C-3 FOREIGN GOVERNMENT OFFICIAL,
MEMBERS OF IMMEDIATE FAMILY,
ATTENDANT, SERVANT, OR
PERSONAL EMPLOYEE IN TRANSIT
MAXIMUM 29
DAYS
NO
NO
D-l
CREWMAN
TIME VESSEL
IS IN PORT,
OR MAXIMUM 29
DAYS
NO
NO
TREATY TRADER, SPOUSE,
1 YEAR
YES
1-539
1-126
PRINCIPAL MAY ONLY
WORK FOR EMPLOYEE
THRU WHICH E VISA
GAINED - FOR SPOUSE
& CHILDREN SERVICE
WILL NOT AUTHORIZE
BUT WILL NOT DEPORT
IF EMPLOYED
TREATY INVESTOR, SPOUSE
AND CHILDREN
1 YEAR
YES
1-539
1-126
AS ABOVE
STUDENT
1 YEAR
YES
1-538
YES
1-538
SPOUSE OR CHILD OF STUDENT
1 YEAR
YES
1-538
NO
PRINCIPAL RESIDENT
REPRESENTATIVE OF
RECOGNIZED FOREIGN
MEMBER GOVERNMENT TO
INTERNATIONAL ORGANIZATION
HIS STAFF, AND MEMBER OF
IMMEDIATE FAMILY
DURATION OF
STATUS
N/A
SERVICE WILL NOT
AUTHORIZE BUT WILL
DEPORT IF EMPLOYED
OTHER REPRESENTATIVE OF
RECOGNIZED FOREIGN MEMBER
GOVERNMENT TO INTERNATIONAL
ORGANIZATION, AND MEMBERS OF
IMMEDIATE FAMILY
DURATION OF
STATUS
N/A
AS ABOVE
REPRESENTATIVE OF NON-
RECOGNIZED OR NONMEMBER
FOREIGN GOVERNMENT TO
INTERNATIONAL ORGANIZATION,
AND MEMBERS OF IMMEDIATE
FAMILY
N/A
AS ABOVE
INTERNATIONAL ORGANIZATION DURATION OF
OFFICER OR EMPLOYEE, AND STATUS
MEMBERS OF IMMEDIATE FAMILY
N/A
AS ABOVE
10/1/80
G-5 ATTENDANT, SERVANT, OR
PERSONAL EMPLOYEE OF G-l
G-2S G-3, AND G-4 CLASSES,
AND MEMBERS OF IMMEDIATE
FAMILY
1 YEAR
YES
1-539
AS ABOVE
H-l TEMPORARY WORKER OF
DISTINGUISHED MERIT
AND ABILITY
NOT TO EXCEED
ONE YEAR
YES
1-539
OR I-129B
N/A
H-2 TEMPORARY WORKER PER-
FORMING SERVICES UN-
AVAILABLE IN THE UNITED
STATES
NOT TO EXCEED
ONE YEAR
YES
1-539
OR I-129B
N/A
H-3
TRAINEE
NOT TO EXCEED
ONE YEAR
YE.S
1-539 OR
I-129B
N/A
H-4 SPOUSE AND CHILD OF ALIEN
CLASSIFIED H-1.H-2.0R H-3
NOT TO EXCEED YES
ONE YEAR 1-539
NO
REPRESENTATIVE OF FOREIGN
INFORMATION MEDIA, SPOUSE
AND CHILDREN
ONE YEAR
YES
SERVICE WILL NOT
AUTHORIZE, BUT WILL
NOT DEPORT IF
EMPLOYED
J-l
EXCHANGE VISITOR
NOT TO EXCEED YES
ONE YEAR IAP-66
REFER TO SPONSOR
J-2 SPOUSE OR CHILD OF
EXCHANGE VISITOR
NOT TO EXCEED YES
ONE YEAR IAP-66
YES - MUST REQUEST
PERMISSION FROM INS
K-l FIANCE OR FIANCEE OF U.S.
CITIZEN
90 DAYS
NO
YES - AUTHORIZED
ON ADMISSION
K-2 MINOR CHILD OF FIANCE OR
FIANCEE OF U.S. CITIZEN
90 DAYS
NO
YES - AUTHORIZED
ON ADMISSION
L-l
INTRACOMPANY TRANSFEREE
NOT TO EXCEED YES
I YEAR 1-539
N/A
10/1/80
L-2 SPOUSE OR MINOR CHILD
OF ALIEN CLASSIFIED L-l
NOT TO EXCEED YES
1 YEAR 1-539
NO
NATO 1, REPRESENTATIVES TO NATO
2,3,4
DURATION OF
STATUS
N/A
SERVICE WILL N01
AUTHORIZE BUT W]
NOT DEPORT IF
EMPLOYED
NATO 5 EXPERTS; MEMBERS OF CIVILIAN
6,7 COMPONENT; AND ATTENDANTS
SERVANTS, AND PERSONAL
EMPLOYEES OF 1,2,3,4
NOT TO EXCEED YES
1 YEAR 1-539
AS ABOVE
TWOV
TRANSIT WITHOUT VISA
8 HOURS, OR
FIRST AVAILA-
BLE FLIGHT
NO
NO
10/1/80
CLASSIFICATION SYMBOLS
CLASSIFICATION SYMBOLS. A VISA ISSUED TO AN IMMIGRANT ALIEN WITHIN
ONE OF THE CLASSES DESCRIBED IN THIS SECTION SHALL BEAR A SYMBOL TO
SHOW THE CLASSIFICATION OF THE ALIEN.
(a) THE FOLLOWING SYMBOLS SHALL BE USED IN THE CASES OF IMMIGRANTS
WHO QUALIFY UNDER CLASSES CREATED BY SPECIAL LEGISLATION
ENACTED PRIOR TO OCTOBER 3, 1965:
CLASS
SECTION OF THE LAW
SYMBOL
TO BE
INSERTED
IN VISA
BENEFICIARY OF SECOND PREFERENCE PETITION FILED
PRIOR TO JULY 1, 1961.
BENEFICIARY OF THIRD PREFERENCE PETITION FILED
PRIOR TO JULY 1, 1961.
BENEFICIARY OF FIRST PREFERENCE PETITION FILED
PRIOR TO APRIL 1, 1962.
SPOUSE OR CHILD OF ALIEN CLASSIFIED K-23
ENEFICIARY OF FOURTH PREFERENCE PETITION
FILED PRIOR TO JANUARY 1, 1962 WHO IS REGIS-
TERED PRIOR TO MARCH 31, 1954.
SPOUSE OR CHILD OF ALIEN CLASSIFIED K-25
25(a), Act of 9-26-61
2, Act of 10-24-62
1, Act of 10-24-62
(b) THE FOLLOWING SYMBOLS SHALL BE USED IN CASES OF ALIENS WHO ARE
SPECIAL IMMIGRANTS:
RETURNING RESIDENT
PERSON WHO LOST U.S. CITIZENSHIP BY MARRIAGE.
PERSON WHO LOST U.S. CITIZENSHIP BY SERVING
IN FOREIGN ARMED FORCES.
MINISTER OF RELIGION—- •
SPOUSE OF ALIEN CLASSIFIED SD-1-
CHILD OF ALIEN CLASSIFIED SD-1-
CERTAIN EMPLOYEES OR FORMER EMPLOYEES OF U.S.
GOVERNMENT ABROAD.
ACCOMPANYING SPOUSE OF ALIEN CLASSIFIED SE-1.
ACCOMPANYING CHILD OF ALIEN CLASSIFIED SE-1.
101(a)(27)(A)
101(a)(27)(B) AND 324(a)
101(a)(27)(B) AND 327
101(a)(27)(C)
101(a)(27)(D)
10/1/80
CLASS
SECTION OF THE LAW
SPOUSE OF U.S. CITIZEN — -—
CHILD OF U.S. CITIZEN
ORPHAN ADOPTED ABROAD BY U.S. CITIZEN-
ORPHAN TO BE ADOPTED BY U.S. CITIZEN-
PARENT OF U.S. CITIZEN — — — — •
201(b).
(d) THE FOLLOWING SYMBOLS SHALL BE USED IN CASES OF IMMIGRANTS
WHO ARE SUBJECT TO THE NUMERICAL RESTRICTIONS SPECIFIED IN
SECTION 201 (a) OF THE ACT:
FIRST PREFERENCE:
FIRST PREFERENCE:
SECOND PREFERENCE:
SECOND PREFERENCE:
.ECOND PREFERENCE:
THIRD PREFERENCE:
THIRD PREFERENCE:
THIRD PREFERENCE:
FOURTH PREFERENCE:
FOURTH PREFERENCE
FOURTH PREFERENCE:
FIFTH PREFERENCE:
FIFTH PREFERENCE:
UNMARRIED SON OR DAUGHTER.
CHILD OF ALIEN CLASSIFIED Pl-1
SPOUSE OF ALIEN RESIDENT.
UNMARRIED SON OR DAUGHTER
OF ALIEN RESIDENT.
CHILD OF ALIEN CLASSIFIED
P2-1 OR P2-2.
PROFESSIONAL OR HIGHLY
SKILLED IMMIGRANT.
SPOUSE OF ALIEN CLASSIFIED
P3-1.
CHILD OF ALIEN CLASSIFIED
P3-1.
MARRIED SON OR DAUGHTER
OF U.S. CITIZEN.
SPOUSE OF ALIEN CLASSIFIED
P4-1.
CHILD OF ALIEN CLASSIFIED
P4-1.
BROTHER OR SISTER OF U.S.
CITIZEN.
SPOUSE OF ALIEN CLASSIFIED
P5-1.
)(9)-
CLASS
SECTION OF THE LAW
SYMBOL
TO BE
INSERTED
IN VISA
FIFTH PREFERENCE: CHILD OF ALIEN CLASSIFIED
P5-1.
SIXTH PREFERENCE: NEEDED SKILLED OR UNSKILLED
WORKER.
SIXTH PREFERENCE: SPOUSE OF ALIEN CLASSIFIED
P6-1.
SIXTH PREFERENCE: CHILD OF ALIEN CLASSIFIED P6-1.
NONPREFERENCE IMMIGRANT
P5-3
P6-1
P6-2
P6-3
NP-1
I
10/1/80
CLASS
SECTION OF THE LAW
SYMBOL TO
BE INSERTED
IN VISA
PREFERENCE: CHILD OF ALIEN CLASSIFIED
P5-1
PREFERENCE: NEEDED SKILLED OR UNSKILLED WORKER
PREFERENCE: SPOUSE OF ALIEN CLASSIFIED
P6-1
PREFERENCE: CHILD OF ALIEN CLASSIFIED P6-1
EFERENCE IMMIGRANT
203(a)(9)
203(a)(6)
203(a)(9)
203(a)(8)
P5-3
P6-1
P6-2
P6-3
NP-1
10/1/80
ADIT PROCESSING (FORM 1-89)
I, USE:
APPLICATION FOR ISSUANCE OF FORM 1-551, ALIEN REGISTRATION RECEIPT CAR!
OR FORM 1-586, MEXICAN BORDER CROSSING CARD.
II. ELIGIBILITY:
1. FORM 1-551
a. ONLY A LAWFUL PERMANENT RESIDENT OF THE UNITED STATES MAY
BE ISSUED AN ALIEN REGISTRATION RECEIPT CARD, FORM 1-551.
b. MUST BE FILING APPLICATION (GENERALLY FORM 1-485) FOR
PERMANENT RESIDENT STATUS, OR FILING APPLICATION (FORM 1-90)
FOR REPLACEMENT OF PREVIOUSLY ISSUED ALIEN REGISTRATION
RECEIPT CARD.
2. FORM 1-586
a. ONLY A MEXICAN NATIONAL MAY BE ISSUED A MEXICAN BORDER
CROSSING CARD.
b. WILL BE FILING APPLICATION FOR THE BORDER CROSSING CARD
ON FORM 1-190.
III. REQUIREMENTS:
1. COLOR PHOTOGRAPHS MEETING ADIT SPECIFICATIONS.
a. FOR ISSUANCE OF FORM 1-551 - TWO PHOTOGRAPHS
b. FOR ISSUANCE OF FORM 1-586 - ONE PHOTOGRAPH
IV. COLLECTION OF DATA:
1. FORM 1-89 IS THE DATA COLLECTION FORM TO BE COMPLETED AND SUBMITTE
TO THE IMMIGRATION CARD FACILITY TO INITIATE PRODUCTION OF AN 1-55
OR 1-586.
2. FORM I-89A IS AN INSTRUCTION SHEET DENOTING WHICH ITEMS OF FORM I-
ARE TO BE COMPLETED UNDER GIVEN CIRCUMSTANCES.
3. THE ADIT DATA COLLECTION MANUAL CONTAINS DETAILED INSTRUCTIONS FOR
COMPLETION OF EACH ITEM ON FORM 1-89.
SIDE ONE OF FORM 1-8.9.:.
a. ENTER ALIEN'S PERSONAL BIOGRAPHIC DATA.
b. COLLECT PRESS PRINT OF ALIEN'S RIGHT INDEX FINGER AND ALIEN'S
SIGNATURE ON CAMERA CARD PART OF 1-89, USING TEMPLATE TO
ASSURE PROPER PLACEMENT.
c. IF FINGER OTHER THAN RIGHT INDEX IS USED FOR PRINT, ENTER
DESIGNATED SYMBOL IN ITEM 19 ON 1-89 (SEE ADIT DATA COLLEC-
TION MANUAL FOR SYMBOL).
d. INITIAL BLOCKS 26, 27 AND 28 ON 1-89 TO VERIFY COLLECTION
OF PHOTOGRAPH, SIGNATURE AND FINGERPRINT. IF REQUIREMENT
FOR ANY OF THE THREE IS WAIVED, INITIAL BLOCK AND ENTER "W"
ON APPROPRIATE LINE TO THE RIGHT.
e. COMPLETE ITEM NO. 29 WITH "A" NUMBER AND ITEM NO. 30 WITH
THE THREE-ALPHA-CHARACTER DESIGNATOR FOR THE OFFICE PROCESS-
ING THE APPLICANT.
f. LIGHTLY ENTER NAME AND "A" NUMBER OF ALIEN ON BACK OF ^^
PHOTOGRAPH.
g. STAPLE PHOTOGRAPH AND/OR OLD 1-551 OR 1-586 TO FORM 1-89
IN DESIGNATED SPACE.
SIDE TWO OF FORM 1-89:
a. SIDE TWO OF FORM 1-89 IS ONLY FOR CHANGE IN DATA, I.E. NAME,
DATE OF BIRTH, ETC., ON PREVIOUSLY ISSUED 1-551 OR 1-586.
(SEE I-89A - TRANSACTION 7). SIDE TWO IS NOT TO BE USED
FOR CHANGE IN DATA IF ALIEN WAS PREVIOUSLY ISSUED 1-151
AND HAS NEVER BEEN ISSUED AN 1-551. LIFT PREVIOUSLY ISSUED 1-551
OR 1-586 FOR SUBMISSION TO THE IMMIGRATION CARD FACILITY.
DO NOT MUTILATE OLD 1-551 OR 1-586. LIFTED FORMS 1-151
ARE TO BE DESTROYED IN ACCORDANCE WITH OUTSTANDING INSTRUC-
TIONS.
b. NEW PHOTOGRAPHS, FINGERPRINT AND SIGNATURE ARE REQUIRED
UNLESS PREVIOUSLY ISSUED 1-551 OR 1-586 IS LESS THAN ONE
YEAR OLD AND CONTAINS SERVICE ERROR IN DATA. IN THIS CASE,
NEW PHOTOGRAPHS, FINGERPRINT AND SIGNATURE ARE NOT REQUIRED.
10/1/80
c. TWO ITEMS OF DATA ON 1-89, NO. 13 AND NO. 14, IF CHANGED,
WILL NOT RESULT IN ISSUANCE OF NEW 1-551. IN THESE CASES,
DO NOT LIFT PREVIOUSLY ISSUED CARD. FORM 1-89 IS FORWARDED
TO ICF WITHOUT OLD CARD.
d. SIDE TWO OF 1-89 WILL ACCOMMODATE NAME CHANGE AND UP TO TWO
OTHER DATA CHANGES. IF MORE DATA ITEM CHANGES ARE REQUIRED
SIMULTANEOUSLY, SUPPLEMENTAL FORMS 1-89 MUST BE SUBMITTED.
IN THIS CASE ENTER ONLY "A" NO. AND DATA RELATED TO ITEM
BEING CHANGED ON SUPPLEMENTAL FORMS. STAPLE ALL FORMS 1-89
RELATING TO APPLICANT TOGETHER IN UPPER LEFT HAND CORNER
AND NUMBER FORMS CONSECUTIVELY IN UPPER RIGHT HAND CORNER,
E.G., 1 OF 3, 2 OF 3, 3 OF 3.
10/1/80
IMMIGRATION AND
NATURALIZATION SERVICE
1-551 PHOTOGRAPH INSTRUCTIONS - Two color photos
with white background are required; photos must be
glossy, un-retouched, and not mounted; dimension of
"aciai image should be about 1" from chin to top of hair;
subject should be shown in % frontal view showing right
side of face with right ear visible; using pencil or felt pen,
li'jh'ily print name (and alien registration receipt number
if known) o:> the back of each photograph.
4/1/81
1-551 OR t-586 CARD DATA COLLECTION FORM
Refer to Form 1-89A ,'or completion of //!i> application
I I I f I I j I T«USS 5 5 OLD ".ABO I [ ; I I I 1 1 1 r
I I I I I I | |™.» "ECO^cD! j | I | I I | ! !
"ES KO CARD FAC:. T> -S£ DNi.
cnn
1. Z REGULAR 1-551
2. I COMMUTER 1-551
3. "• MEXICAN I-586
4. Z CANADIAN 1-586
12 CITY Of PES'CSNCc .\-tN
_L_L
LOCATION DF CONiU.-A"£ '23
•-ADMAC, lA'j SIM so
•c r-.£es=
DESiGMA-0=
mrrr
S'ATE 15 Z1PU1DE
cj
^
32225C3
INITIAL
I pwnTr«;i»Apw »rrAcnfp ., ._
»s^-
Sf 2^- — 27
| QJ.-.WAT ,nc noTAiMFn
h "S ~
""^ = £ M
1 rj»..',EHPBiHT lIBTAINFi)
S" ^ ,C
-
2 '?: S
A| I 1 Ml
FORM NO.
1-89
EDITION
R27
T1TUC ,
,'J)TT C.VRD DATA COtLECTIOtC TORM
SITE
INSTRUCTION JLSJnBRJCNC£
8 X 10 1/2
USE
reru w coKjrocnoH WITH THE ADIT DATA coLLEcncm WJTOAL w nru) PERSOKHEI. TO woctss APTtiCAMts TOR
ADIT CARDS 1-531 OK 1-586
PR TOTTTOWS MAT >JOT HE OSTO
USE THIS SIDE FOR CHANGED DATA TRANSACTION 7 ONLY
'•CARD TYPE:
1. C REGULAR 1-551 2. Zj COMPUTER 1-551 i. [I* MEXICAN S-586 4. E CANADIAN 1-586
0 CLOORCl I I
aecovt^EDl I I
VES NC CABO FACILITV ust ONLY
E NAME (LAST riHST M OD'.l' ON C1"0
LLLIJ
P NAVE CHANGE CODE
K OCLA'M OO'-'v^N ZAf-r L OTHER FP
DtSlGNATCI
STATE j c i> COOt
O OffiCtH S SIGNATURE
0 C^NiGE COC'E OLO PAT
B CHANGE CODE
4/1/81
TM 805
ADMINISTRATIVE MANUAL
Appendix 1
I-89A
INSTR
(
READ ACROSS TO
CARD A
TYPE™
TRANSACTION
CODE
UCTION SHEET FOR COMPLETION OF 1-89
1-551 OR 1-586 CARD DATA COLLECTION FORM)
P FOR CARD TYPE AND DOWN FIRST COLUMN FOR APPROPRIATE TRANSACTION
1
REGULAR
1-551
2
COMMUTER
1-551
3 4
MEXICAN CANADIAN
1-586 1-586
Initial
1-551/1-586
1
Complete side i of 1-89 only
Do NOT fill in items 4 and 5
See NOTE t
Complete Side 1 ol I-89 only Do NOT Ml in
items 3*5 13 14 16 and 21 through 25
item 3 will be assigned by COREC
Send to COREC. Data Input Un<i-8CC.
for master index search and
card number assignment
Lost or
Stolen I-S51/
1-586 to be
replaceo
2
Complete side ' of 1-89
569 and 19 through
30 See NOTE 1
26 through 30
Mutilated
I-55M-586 to
be replaced
3
Complete side 1 of 1-89
only Fill in items 1 2 3
569 and 19 through
30 See NOTE 1 Altacn
old 1-551 1-586
Complete side 1 ol 1-89 only Fill m items 1 2 3. 5 6 9 18. 20 and
26 through 30
1-551.1-586 to
be replaced
lor administra-
tive reasons
related to pic-
, ture signature
*T or fingerprint
Complex side 1 of 1-89
only Fill in items 1 2 3.
569 and 19 through
30 See NOTE 1 Attach
old 1-551 1-586
Complete side 1 of 1-89 only Fill m items 123 5 6918 20 and
26 through 30
Previously reported
as lost/stolen
1-551/1-586 has
been recovered
No new card
C to be issued
Corrpiete side 1 of 1-89 only
Fill m items 1 23456. 9. 20 and 30
Altacn oid I-55W-S86
1-551/1-586 has
been htled No
new card to be
issued. Examples
revocation o' 1-586
privilege abandon-
ment of status
61 NOT used lor deatr.
or naturalization)
Cor-aiete side 1 of 1-89 only
Fill m items 1 2. 3 5. 6 9 20 and 30
Attach o'd 1-55 M-586
1-551 1-586
replacement
for change in
card data
7
Complete side 2 of 1-89
If card is less than I year
submission of new fmgc
ind items 2. 26. 27 28. 29 and 30 on side 1 Attach old 1-551/1-586
rprmt. signature and photo i$ NOT required See NOTE 1
NOTE 1 - AMC [Alternate Mail Cctlei .3 REQUIRED FOR
al Curd Tyoe 1 it in* card
ii to oe muled to in INS office instead ol to me ilien
- ., * , c. .*,..«
JTORM NO.
I-89A
EDITION TITLE
REV. 1-1-81 INSTRUCTION SHEET FOR COMPLETION OF FORM 1-89
SIZE
& X 10 1/2
INSTRUCTION REFERENCE
USE
TO AID IN COMPLETING FORM 1-89
PRIOR EDITIONS MAY NOT BE USED J SCHEDUUC A
4/1/81
ir\i £.0
I. GENERAL:
STATUS INQUIRIES ARE INTER-REACTIVE ON EVERY OPERATING BRANCH
WITHIN THE DISTRICT. IF NOT HANDLED PROMPTLY WITH A SATISFACTORY
RESPONSE, THEY STIMULATE REQUESTORS TO SEEK INTERCEDENCE IN THEIR
BEHALF FROM DISTRICT DIRECTOR, REGIONAL, CENTRAL OFFICE, CIVIL
GOVERNMENT, NEWS MEDIA, AND CONGRESSIONAL LEVELS. THIS RECOURSE
IS SELF DEFEATING TO THE SERVICE AND RESULTS IN UNPRODUCTIVE TIME
LOST IN ALL OFFICES INVOLVED.
REFERALS: ROUTINE INQUIRIES SHOULD BE RESOLVED BY THE CONTACT
REPRESENTATIVE. SOME INSTANCES WHERE REFERAL TO OPERATING BRANCHES
WOULD BE JUSTIFIED INCLUDE, BUT ARE NOT LIMITED TO:
a. ADJUDICATIVE TIME-FRAMES HAVE BEEN EXCEEDED, OR
b. THE INQUIRER IS HOSTILE AND WILL NOT ACCEPT THE EXPLANATION
OF THE CONTACT REPRESENTATIVE, AND DEMANDS TO SEE AN OFFICER,
OR,
c. THE INQUIRER IS LODGING A COMPLAINT REGARDING POSSIBLE FRAUD, OR
d. THE INQUIRER IS REQUESTING WITHDRAWAL OF A PENDING PETITION OR
APPLICATION.
ADJUDICATIVE TIME-FRAMES:
a. PROJECTED TIME-FRAMES TO ADJUDICATE EACH TYPE OF PETITION OR
APPLICATION IS AN AID TO THE CONTACT REPRESENTATIVE IN ANSWERING
GENERAL INQUIRIES.
b. ALLOWANCES FOR CLERICAL, MAILING AND DELIVERY SHOULD BE ADDED
TO THE ADJUDICATIVE TIME-FRAME BEFORE ACCEPTING STATUS INQUIRIES
FOR RESPONSE TO A SPECIFIC APPLICATION.
REPLACEMENT PETITIONS AND APPLICATIONS:
a. WHEN PETITIONS OR APPLICATIONS HAVE BEEN LOST OR MISPLACED BY
THE SERVICE OR CONSULAR OFFICERS, REPLACEMENTS MAY BE ACCEPTED,
WITHOUT PAYMENT OF FEE, FOR EXPEDITIOUS HANDLING.
10/1/80
b. FULLY COMPLETED FORMS ARE REQUIRED— XEROX COPIES OF THE PETITION
OR APPLICATION PREVIOUSLY SUBMITTED ARE NOT ACCEPTABLE.
c. THE REPLACEMENT PETITION OR APPLICATION MUST HAVE ALL THE REQUIRED
SUPPORTING DOCUMENTS.
d. MUST PRESENT EVIDENCE OF HAVING PAID THE FILING FEE UNLESS VERIFICA-
TION CAN BE MADE FROM SERVICE FILES. (NOTE: THIS DETERMINES
PRIORITY DATES.)
II. CLASSIFICATIONS:
1. RELATIVE VISA PETITIONS:
a. DETERMINE CATEGORY TO FACILITATE LOCATING PETITION:
(1) UNDOCUMENTED CHINESE;
(2) UNDOCUMENTED YEMEN;
(3) SUSPECT FRAUD SPOUSE;
(4) ROUTINE BENEFICIARIES;
(5) FILED IN CONJUNCTION WITH FORM 1-485, APPLICATION FOR
ADJUSTMENT OF STATUS.
b. ADJUDICATION OF THE PETITION MAY HAVE BEEN TERMINATED UNDER
01 103.2(o) FOR LACK OF COMMUNICATION WITH THE PETITIONER. IN
SUCH CASES, THE PETITION IS PLACED IN AN "A" FILE AND NO FURTHER
ACTION IS TAKEN UNTIL PETITION IS REACTIVATED THROUGH STATUS
• INQUIRY FROM THE PETITIONER.
2. ADJUSTMENT OF STATUS AS A LPR:
a. VERIFY ADMISSION FROM PASSPORT TO ESTABLISH ELIGIBILITY TO FILE;
b. OBTAIN "A" FILE NUMBER, IF KNOWN;
c. IF "A" NUMBER UNKNOWN, OBTAIN COMPLETE NAME, DATE AND PLACE OF
BIRTH TO RUN INDEX CHECK;
d. ASCERTAIN DATE OF FILING AND BASIS OF ELIGIBILITY TO DETERMINE
POSSIBLE REASONS WHY APPLICATION IS PENDING; i.e., AVAILABILITY
OF QUOTA NUMBERS;
10/1/80
e. REVIEW FEE RECEIPT IF POSSESSED BY INQUIRER TO CONFIRM FILINI
OF APPLICATION;
f . ADJUDICATION MAY HAVE BEEN TERMINATED FOR "LACK OF PROSECUTK
IF UNABLE TO COMMUNICATE BY MAIL WITH APPLICANT. PROCESSING
MAY BE REACTIVATED BY A SERVICE MOTION TO REOPEN WITHOUT PAYf
OF FEE UPON VERIFICATION OF APPLICANT'S CURRENT ADDRESS.
3. REPLACEMENT OF ALIEN REGISTRATION RECEIPT CARD:
a. DETERMINE FILING DATE;
b. HAS APPLICANT MOVED? MAILING OF 1-551 CANNOT BE FORWARDED,
RETURNED TO SERVICE AND CARD DESTROYED AFTER 90 DAYS;
c. HAS PROCESSING TIME-FRAME FOR THE SERVICE OFFICE AND TEXAS CJ
FACILITY ELAPSED?
4. OTHER APPLICATIONS:
a. DETERMINE DATE OF FILING;
b. HAS APPLICANT'S ADDRESS CHANGED?
c. WHAT IS THE LOCAL ADJUDICATIVE TIME-FRAME FOR THE BENEFIT BE
REQUESTED.
I. REQUESTS WHICH MAY BE GRANTED BY STAMPING 1-94 "EMPLOYMENT AUTHORIZED":
1. 1-485 APPLICANTS:
a. A CONTACT REPRESENTATIVE HAS THE AUTHORITY TO GRANT EMPLOYMENT
AUTHORIZED TO REQUESTERS WHO HAVE AN 1-485 PROPERLY FILED AND
PENDING WITH THE SERVICE;
b. CONTACT REPRESENTATIVE MUST VERIFY APPLICATION HAS BEEN FILED
AND IS PENDING.
2. ASYLUM APPLICANTS:
a. APPLICATION FOR ASYLUM MUST HAVE BEEN FILED;
b. REFER EMPLOYMENT REQUEST TO EXAMINATIONS.
3. ALIENS PAROLED INTO THE UNITED STATES:
a. REFER EMPLOYMENT REQUEST TO EXAMINATIONS.
4. NONIMMIGRANT STUDENTS:
a. MUST APPLY ON FORM 1-538;
b. REQUEST WILL BE ADJUDICATED BY EXAMINATIONS.
5. K-l NONIMMIGRANTS:
a. 1-94 SHOULD HAVE BEEN ENDORSED "EMPLOYMENT AUTHORIZED" AT THE
TIME OF ADMISSION INTO THE UNITED STATES;
b. IF ADMITTING OFFICER NEGLECTED TO ENDORSE 1-94 "EMPLOYMENT
AUTHORIZED", CONTACT REPRESENTATIVE MAY DO SO PROVIDING ALIEN
HAS .NOT BEEN IN THE UNITED STATES MORE THAN 90 DAYS.
6. J-2 NONIMMIGRANTS:
a. MUST MAKE REQUEST FOR AUTHORIZATION BUT IT NEED NOT BE IN
WRITING;
b. REQUEST WILL BE ADJUDICATED BY EXAMINATIONS.
10/1/80
7. DEPENDENTS OF G-4 NONIMMIGRANTS:
a. IT IS AN INVOLVED PROCEDURE. REFER TO 8 CFR 214.2(g)(2)
OF THE I&N ACT FOR INSTRUCTIONS AND REQUIREMENTS.
8. ALIENS UNDER DOCKET CONTROL:
a. AN ALIEN IS GENERALLY UNDER DOCKET CONTROL IF HE:
(1) HAS BEEN ISSUED FORM 1-210;
(2) HAD AN APPLICATION DENIED AND HAS BEEN GIVEN A DATE TO
DEPART THE UNITED STATES;
(3) HAS BEEN GRANTED INDEFINITE VOLUNTARY DEPARTURE;
(4) IS UNDER DEPORTATION PROCEEDINGS.
(NOTE: REFER CATEGORY 8 CASES TO DEPORTATION BRANCH.)
9. SPECIAL REQUESTS:
a. REFER TO AN OFFICER FOR DETERMINATION. (NOTE: ALL EMPLOYMENT REQUESTS
MUST BE ACCOMPANIED BY THE ALIEN'S FORM 1-94).
II. ALIENS WHO MAY ENGAGE IN EMPLOYMENT, WITHOUT BEING CONSIDERED IN VIOLATION
OF THEIR NONIMMIGRANT STATUS, FOR WHOM WRITTEN "EMPLOYMENT AUTHORIZED" FROM
INS WILL NOT BE GIVEN:
1. THE SERVICE IS NOT IN A POSITION TO ACT ON REQUESTS BY FOREIGN QI
GOVERNMENT OFFICIALS AND MEMBERS OF THEIR IMMEDIATE FAMILIES 214. 2(a)
FOR PERMISSION TO ACCEPT EMPLOYMENT UNLESS A FORMAL REQUEST
FOR CHANGE OF STATUS TO THAT OF A PERMANENT RESIDENT OR TO
ANOTHER NONIMMIGRANT CLASSIFICATION IS MADE. THE SERVICE IS
ALSO NOT IN A POSITION TO CONSIDER FOREIGN GOVERNMENT OFFICIALS
AND MEMBERS OF THEIR FAMILIES OR THEIR SERVANTS OR PERSONAL
EMPLOYEES WHO, WITHOUT HAVING BEEN GRANTED CHANGE IN STATUS,
ENGAGE IN EMPLOYMENT WITHOUT PERMISSION AS BEING IN VIOLATION
OF STATUS SO LONG AS THEY CONTINUE TO BE ACCEPTED BY THE
SECRETARY OF STATE AS HAVING AN OFFICIAL STATUS.
10/1/80
WHILE THE SERVICE IS NOT IN A POSITION TO AUTHORIZE THE Q
NONIMMIGRANT E SPOUSE AND CHILDREN OF A TREATY TRADER OR 214^2(6)
TREATER INVESTOR TO ACCEPT EMPLOYMENT, THEY SHALL NOT BE
DEEMED TO HAVE VIOLATED STATUS IF THEY DO SO; AND SO LONG
AS THE PRINCIPAL E NONIMMIGRANT IS MAINTAINING STATUS, NO
ACTION SHALL BE TAKEN TO REQUIRE THEIR DEPARTURE.
10/1/80
2. INFORMATION AIDS
Obtaining Birth And Death Records In The United States And
Outlying Areas
Obtaining Birth And Death Records Of United States Citizens
Born Or Deceased Abroad Or Birth Certifications For Alien
Children Adopted Abroad By United States Citizens *'i
Obtaining Marriage Records In The United States And
Outlyi ng Areas
Obtaining Divorce Records In The United States And Outlying
Areas
2-13
2-23
2-31
American Diplomatic And Consular Offices Issuing Visas
Regional and District Office Areas and Addresses 2-41
NOTE: FOR INFORMATION ON HOW TO OBTAIN FOREIGN DOCUMENTS AND THEIR
AVAILABILITY, REFER TO VOLUME 9 OF THE FOREIGN AFFAIRS MANUAL
10/1/80
BIRTH AND DEATH RECORDS
United States and Outlying Areas
U S DEPARTMENT OF
HLALTH. EDUCATION. AND WELFARE
PUBLIC HEALTH SERVICE
10/1
Where To Write for Mnrriagc Recorth (I)HEW Pvih. No. (PUS)
78-1144, revised 1978) and Where To Write for Divorce Records
(DIIKW Pub. No. (PUS) 78-1145, revised 1978 may be obtained
from the Superintendent of Documents, I'.S. Government Printing
OITic-c, Washington, D.C. 20402.
SuK£csiions arc invited toward improvement of the text and format of future
editions. Please address the Division of Vital Statistics, National Center for
Health Statistics, Public Health Service, D1IEW, Hyattsville, Md. 20782.
DHEW PUBLICATION NO. (PHS) 78-1142
Revised 1978
Kor sale by the Su^nntenJ.'nt of Documents, V.S. tun-err.^!/, I'rinv.np Or.'ue, Wisuj
Slock No. OJT-O^
,,.-!. D.C. 2
10/1/80
ei»e to
I
p
' O»*
BIRTH AND DEATH RECORDS
United States and Outlyins Area;
For every birth and death, and offical certificate should be on
file in the place where the event occurs. These certificates are
prepared by physicians, funeral directors, other professional at-
tendents, or hospital authorities. The Federal Government does
not maintain files or indexes of these records. They are perma-
nently Filed in the central vital statistics office of the State,
independent city, or outlying area where the event occurred.
To obtain a certified copy of a certificate, write or go to the vital
statistics office in the State or area where the birth or death
occurred. The offices are listed below.
In writing for a certified copy, it is suggested that a money order
or certified check be enclosed since the office cannot refun
cash lost in transit. Fees listed are subject to change.
The letter should give the following facts (type or print- all nam<
and addresses):
1. Full name of the parson whose record is being request*
2. Sex and race.
3. Parents' names, including maiden name of mother.
4. Month, day, and year of the birth or death.
5. Place of birth or death (city or town, county, and Stat
and name of hospital, if any).
6. Purpose for which copy is needed.
7. Relationship to person whose record is being requested.
I
Place of birth or
death
Cost of
full
copy
Cost of
short form
Address of vital sratfstics office
Remarks
Alabama $3.00
Not Bureau of Vital Statistics
issued State Department of Public Health
Montgomery, Alabama 36104.
Additional copies at same time are $1.00eacl
State office has records since January 1, 190;
Fee for special searches is $3.00 per hour.
Alaska $3.00
$3.00 Bureau of Vita) Statistics
Department of Health and Welfare
Pouch "H"
Juneau, Alaska 99801
State office has records since 1913.
American Samoa $1.00
Not Office of the Territorial Registrar
issued Government of American Samoa
Pago Pago
American Samoa 96799
Registrar has records on file since before 190
Arizona $2.00
$2.00 Division of Vital Records
State Department of Health
P.O. Box 3887
Phoenix, Arizona 85030
State office has records since July 1 , 1909, ai
abstracts of records filed in the counties befc
that date.
NOTE: Births occurring before birth registration was required or births not registered when they occurred may have been filed
"delayed birth registrations." Keep this in mind when seeking a copy of a record.
" i
Cost of
Place of birth or
full
Cost of
Address of vital statistics office
Remarks
death
copy
short form
Arkansas
Birth..,
Death
California
-anal Zone
Division of Vital Records
Arkansas Department of Health
$2.00 $2.00 4815 West Markham Street
$3.00 Little Rock, Arkansas 72201
$3.00 $3.00 Vital Statistics Section
State Department of Health
410 N Street
Sacramento, California 95814
Not $2.00 Vital Statistics Clerk
issued Health Bureau
Balboa Heights, Canal Zone
State office has records since February 1, 1914,
as well as some original Little Rock and Fort
Smith records from 1881.
State office has records since July 1, 1905. For
records before that date, write to County
Recorder in county of event.
Central office has records since May 1904.
Colorado
Connecticut
$2.00 $2.00
$2.00 $1.00
Records and Statistics Section
Colorado Department of.Health
4210 East Tith Avenue
Denver, Colorado 80220
Public Health Statistics Section
State Department of Health
79 Elm Street
Hartford, Connecticut 061 15
State office has death records since 1900 and
birth records since 1910. State office also has
birth records for some counties for years prior
to 1910. $2.00 fee is for search of files and one
copy of record if found.
State office has records since July 1, 1897. For
records before that date write to Registrar of
Vital Statistics in town or city where birth or
death occured.
Delaware
$2.50 $2.50 Bureau of Vital Statistics
Division of Public Health
Department of Health and Social
Services
Jesse S. Cooper Memorial Building
Dover, Delaware 19901
State office has records for 1861 to 1863 and
since 1881 but no records f or. 1 864 through
1880.
District of Columbia.
$1.00 $1.00 Department of Human Resources
Vital Records Section Rm 1022
300 Indiana Avenue, NW.
Washington, D.C. 20001
Death records on file beginning with 1855 and
birth records beginning with 1 871 , but no death
records were filed during the Civil War.
Florida
$2.00 $2.00
Department of Health and
Rehabilitative Services
Division of Health
Bureau of Vital Statistics
P.O. Box 210
Jacksonville, Florida 32201
State office has some birth records since April
1865 and some death records since August
1877. The majority of records date from
January 1917. (If the exact date is unknown
and more that 1 year has to be searched, the fee
is $2.00 for the first year searched and $1.00
for each additional year searched up to a maxi-
mum of $25.00. Fee includes a copy of the
record if found.)
Georgia
$3.00 $3.00
Vital Records Unit
State Department of
Human Resources
Room 217-H
47 Trinity Avenue, SW.
Atlanta, Georgia 30334
The State office has records since January 1 ,
1919. For records before that date in Atlanta
or Savannah, write to the County Health De-
partment in place where birth or death oc-
curred. Additional copies of same record
ordered at same time are $1 .00 each.
NOTE: Births occurring before birth registration was required or births not registered when they occurred may have been filed as
'delayed birth registrations." Keep this in mind when seeking a copy of a record.
2 WHERE TO WRITE FOR
10/1/80
Place of birth oc
death
Cost of
full
copy
Cost of
short form
Address of vital statistics office
Remarks
Guam
$1.00 $1.00
Hawaii.
Idaho
$2.00 $2.00
$2.00 $2.00
Office of Vital Statistics
Department of Public Health and
Social Services
Government of Guam
P.O. Box2816
Agana, Guam, M.I. 96910
Research and Statistics Office
State Department of Health
P.O. Box 3378
Honolulu. Hawaii 96801
Bureau of Vital Statistics
State Department of Health
and Welfare
Statehouse
Boise, Idaho 83720
Office has records on file since October 26.
1901.
State office has records since 1 853.
State office has records since 1911. For records
from 1907 to 1911. write to County Recorder
in county where birth or death occurred.
Illinois
$3.00 $3.00 Office of Vital Records
State Department of Public Health
535 W. Jefferson Street
Springfield, Illinois 62761
State office has records filed since January 1,
1916. For records filed before that date and for
copies of State records since January 1. 1916,
write to the County Clerk in county where
birth or death occurred. ($3.00 fee is for search
of files and one copy of the record if found.
Additional copies, of the same record ordered at
the same time are $2.00 each.)
Indiana
$3.00 Not Division of Vita! Records
issued State Board of Health
1330 West Michigan Street
Indianapolis, Indiana 46206
State office has birth records since October 1 ,
1907. and death records since 1900. For
records before that date, write to Health Of-
ficer in city or county where birth or death
occurred. Additonal copies of same record
ordered at same time are $1 .00 each.
$2.00 $2.00
Division of Records and Statistics
State Department of Health
Des Moines. Iowa 50319
State office has records since July 1 , 1880.
Kansas.
$2.00 $2.00 Bureau of Registration and Health
Statistics
6700 S. Topeka Avenue
Topeka, Kansas 66620
State office has records since July 1 , 191 1. For
records before that date, write to County clerk
in county where birth or death occurred.
Kentucky
$2.00 $2.00
Office of Vital Statistics
State Department of Health
275 East Main Street
Frankfort, Kentucky 40601
State office has records since January 1. 1911
and for Louisville and Lexington before that
datt. If birth or death occurred in Covington
before 1911. write to City Health Department.
Louisiana
$2.00 $2.00
Office of Vital Records
State Department of Health
P.O. Box 60630
New Orleans. Louisana 70160
State office has records since July 1, 1914.
Birth records available for City of New Orleans
from 1790, and death records from 1803.
NOTE: Births occurring before birth registration was required or births not registered when they occurred may have been filed u
"delayed birth registrations." Keep this in mind when seeking a copy of a record.
BIRTH AND DEATH RECORDS 3
in /i
Place of birth or
death
Cost of
full
copy
Cost of
short form
Address of vital $tatistics office
Remarks
Maine
$2.00 $2.00
Office of Vital Records
State Department of Health and
Welfare
State House
Augusta, Maine 04333
State Office has records since 1892. For records
before that year write to the municipality
where event occurred.
Maryland
$2.00 S2.00
Division of Vital Records
State Deparment of Health
State Office Building
201 West Preston Street
P.O.Box 13146
Baltimore, Maryland 21203
State office has records since 1898. Records for
the City of Baltimore are available from
January 1 , 1875.
Massachusetts.
$2.00 Free Registrar of Vital Statistics
Rm. 103 McCormaek Bldg.
1 Ashburton Place
Boston. Massachusetts 02108
State office has records since 1841. For records
prior to that year, write to the City or Town
Clerk in place where birth or death occurred.
Earliest Boston records available in this office
are for 1848.
Michigan
$2.00 $2.00
Office of Vital and Health
Statistics
Michigan Department of Public
Health
3500 North Logan Street
Lansing, Michigan 48914
State office has records since 1867. Copies of
records since 1867 may also be obtained from
County Clerk. Detroit records may be obtained
from the City Health Department for births oc-
curing since 1893 and for deaths since 1897.
Minnesota.
$2.00 S2.00
Minnesota Department of Health
Section of Vital Statistics
717 Delaware Street, S.E.
Minneapolis, Minnesota 55440
State office has records since January 1908.
Copies of records prior to 1908 may be obtained
from Clerk of District Court in county where
oirth or death occurred or from the Minneapolis
or St. Paul City Health Department if the event
occurred in either city.
Mississippi.
$2.00 $2.00
Vital Records Registration Unit
State Boarc of Health
P.O. Box 1700
Jackson, Mississippi 39205
Missouri .
$1.00 $1.00 Bureau of Vital Records
Division Of Health
State Department of Public Health
and Welfare
Jefferson Ciry, Missouri 65101
State office has records beginning with January
1910. If birth or death occurred in St. Louis
(city), St. Louis County, or Kansas City before
1910, write to .the City or County Health De-
partment; copies of these records are $2.00
each.
Montana.
$2.00 $2.00
Bureau of Records and Statistics
State Department of Health and
Environmental Sciences
Helena, Montana 59601
State office has records since late 1907.
NOTE: Births occurring before birth registration was required or births not registered when they occurred may have been filed
"delayed birth registrations." Keep this in mind when seeking a copy of a record.
WHERE TO WRITE FOR
Placa of birth or
death
Cost of
full
copy
Cost of
short form
Address of vital statistics office
Remarks
Nebraska
Nevada
New Hampshire
$3.00 $3.00 Bureau of Vital Statistics
State Department of Health
Lincoln Building
1003 "0" Street
Lincoln. Nebraska 68508
$2.00 $1.00 Department of Human Resources
Division of Health • Vital
Statistics
Office of Vital Records
Capitol Complex
Carson City, Nevada 89710
$3.00 $3.00 Department of Health and Welfare
Division of Public Health
Bureau of Vital Statistics
61 South Spring Street
Concord, New Hampshire 03301
State office has records since late 1904. M bif
occurred before that date, write th« State of fi
for information.
State office has records sine* July 1, 1911. F
earlier records, write to County Record**
county where birth or death occurred.
Copies of records may be obtained from St;
office or from City or Town Clerk where bii
or death occurred. ($2,00 fee is for seareh
files and copy of the record if found.)
New Jersey
$2.00 $2.00
State Department of Health
Bureau of Vital Statistics
Box 1 540
Trenton, New Jersey 08625
State office has records since June 1878. <$2.
fee is for search of files and one copy of t
record if found. Additional copies of sai
record' ordered at same time are $1.00 ea<
When the exact date is unknown the fee is
additional $0.50 per year searched.)
Archives and History Bureau
State Library Division
State Department of Education
Trenton, New Jersey 08625
For records from May 1848 through May 181
write State Department of Education.
New Mexico
$2.00 $2.00
Vital Statistics Bureau
New Mexico Health Services
Division
P.O. Box 968
Santa Fe, New Mexico 87503
State office has records since 1980 ($2.00
is for search of files and one copy of the rec
is found).
New York (except
New York City)
$2.00 $2.00
Bureau of Vital Records
State Department of Health
Empire State Plaza
Tower Building
Albany, New York 12237
State office has records since 1880. fir race
prior to 1914 in Albany. Buffalo, and YonV
or before 1880 in any oth»r city, write
Registrar of Vital. Statistics in th* city vrt>
birth or death occurred. For tt*rf r«st of
State, except New York City, writs to 6<
office.
New York, (all
boroughs) ..
Birth
Death
$3.00
$2.50
$3.00
Bureau of Records and Statistics
Department of Health of
New York City
125 Worth Street
New York. New York 10013
Records on file since 1898. Additional co
of birth records ordered at sam« time »re $1
'each. For Old City of New York (Manhai
and part of the Bronx) birth and death recc
from 1865-1897, write to the Munic
Archives and Records Retention Center of I
York, 23 Park Row. New York, New \
10038.
NOTE: Births occurring before birth registration was required or births not registered when they occurred may have been fi
"delayed birth registrations." Keep this in mind when seeking a copy of a record.
BIRTH AND DEATH RECORDS
Place of birth or
desth
Cost of
full
copy
Cost of
short form
Addre$$ of vital statistics office
Remarks
North Carolina
North Dakota
Ohio,
$3.00 $3.00
$2.00 $2.00
$2.00 $2.00
Department of Human Resources
Division of Health Services
Vital Records Branch
P.O. Box 2091
Raleigh. North Carolina 27602
Division of Vita! Records
Office of Statistical Services
State Department of Health
Bismarck, North Dakota 58505
Division of Vital Statistics
Ohio Department of Health
G-20 Ohio Departments Building
65 S. Front Street
Columbus. Ohio 4321 5
State office has records since October 1, 1913,
and some deSayed records prior to that date.
State efface has some records from July 1,
1893; years fronn 1894 to 1920 are incomplete.
State office has records since December 20,
1908. For records before that date; write to
Probate Court in county where birth or death
occurred.
Oklahoma
Oregon
$2.00 $2.00 Vital Records Section
State Department of Health
Northeast 10th' Street & Stonewall
P.O. BOK 53551
Oklahoma City, Oklahoma 73105
$3.00 $3.00 Vital Statistics Section
Oregon State Health Division
P.O. Box 231
Portland, Oregon 97207
State office hss records since October 1908.
State office has records since July 1903. State
office has some earlier records for the City of
Portland dating from approxiamtely 1880.
Additional copies of the same record ordered at
the same time are $2.00 each.
Pennsylvania
$2.00 $1.00
Puerto Rico.
$0.50 $0.50
Rhode Island
$2.00 $2.00
Division of Vital Statistics
State Department of Health
Central Building
101 South Mercer Street
P.O.Box 1528
Newcastle. Pennsylvania 16103
Division of Demographic Registry
and Vital Statistics
Department of Health
San Juan, Puerto Rico 00908
Division of Vital Statistics
State Department of Health
Room 101 Health Building
Davis Street
Providence. Rhode Island 02908
State office has records since January 1. 1906.
For records before that date, write to Register
of Wills, Orphans Court, county seat where
birth or death occurred. Persons born in
Pittsburgh from 1870 to 1905 or in Allegheny
City, now part of Pittsburgh, from 1882 to
1305 should write to the Office of Biostatistics,
Pttsburgh Health Department, City-County
Building, Pittsburgh. Pennsylvania 15219. For
births and deaths occurring in the City of
Philadephia from 1860 to 1915. apply to Vital
Statistics. Philadelphia Department of Public
Health, City Hall Annex. Philadelphia.
Pennsylvania 19107.
Centra! office has. records since July 22, 1 931 .
Copies of records prior to that date may be
obtained by writing to local Registrar
(Registrador Demografico) in municipality
where birth or death occurred or to central
office.
State office has records since 1853. For records
before that year, write to Town Clerk in town
where birth or death occurred.
NOTE: Birthi occurring before birth registration was required or births not registered when they occurred may have been filed as
'delayed birth registrations." Keep this in mind when seeking a copy of a record.
6 " ~~~ ~"~ ' WHERE TO WRITE FOR
10/1/80
Cost of
Place of birth or
full
Cost of
Address of vital statistics office
Remarks
death
copy
short form
South Carolina
$2.00 $2.00
Division of Vital Records
Bureau of Health Measurement
S.C. Department of Health and
Analysis Environmental Control
2600 Bull Street
Columbia, South Carolina 29201
State office has records since January 1, 191
City of Charleston births from 1877 and deal)
from 1821 on file at Charleston County Head
Department. Ledger entries of Florence Cii
births and death from 1895 to 1914 on file
Florence County Health Department. Ledg
entries of Newsberry City births and deatl
from late 1800's on file at Newberry Coun1
Health Department. Early records are obtai
able only from County Health Departmen
listed.
South Dakota.
$2.00 $2.00
Division of Public Health
Statistics
State Department of Health
Pierre, South Dakota 57501
State office has records since July 1, 1905, ar
access to other records for some births at
deaths which occurred before that date.
Tennessee .
$2.00 $2.00
Division of Vital Statistics
State Department of Public
Health
Cordell Hull Building
Nashville, Tennessee 37219
State office has birth records for entire Sta
from January 1, 1914, to date and records fro
June 1881 for Nashville, July 1881 for Knc
ville, and January 1882 for Chattanooga. Sta
office has death records for entire State fro
January 1, 1914, to date and records from Ju
1874 for Nashville, March 6. 1872, for Crn
tanooga, and July 1, 1887, for Knoxville. Bir
and death enumeration records by school d
triers from July 1, 1908, through June 3
1912. Memphis birth records are from April
1874, through December 1887, records co
tinue November 1, 1898, to January 1, 191
Death records date from May 1, 1848, to Jan
ary 1, 1914. Apply to Memphis-Shelby Coun
Health Department, Division of Vital Statistii
Memphis, Tennessee.
Texas
$3.00 $3.00
Trust Territory
of the Pacific
Islands
$0.25
plus
$0.10
per
100
words
$0.25
plus
$0.10
per
100
words
Bureau of Vital Statistics
Texas Department of
Health Resources
410 East 5th Street
Austin, Texas 78701
Clerk of Court of district where
event occurred. (If not sure of
the district in which event
occurred, write to the Director
of Medical Services, Department
of Medical Services, Saipan,
Mariana Islands 96950, to have
the inquiry referred to the
correct district.)
State office has records since 1903.
Courts have records since November 21, 19!
Beginning 1950 a few records for various
lands are temporally filed with the Hawaii E
reau of Vital Statistics.
Utah
$3.00 $3.00
Division of Vital Statistics
Utah State Department of Health
554 South Third East
Salt Lake City, Utah 841 13
State office has records since 1905. If birth
death occurred from 1890 through 1904 in £
Lake City or Ogden, write to City Board
Health. For records elsewhere in the State fr
1898 through 1904. write to County Clerk
county where birth or death occurred.
NOTE: Birth* occurring before birth registration was required or births not registered when they occurred may have been fiU
"delayed birth registrations." Keep this in mind when seeking a copy of a record.
BIRTH AND DEATH RECORDS
Cost of
Place of birth cr
full
Cost of
Address of vital statistics office
Remarks
death
short form
copy
Vermont
$2.00 $2.00 Town or City Clerk of town where
birth or death occurred.
$1.50 S1.50
Secretary of State
Vital Records Department
State House
Montpelier, Vermont 05602
Public Health Statistics Division
Department of Health
Burlington, Vermont 05401
For information on vita! statistics laws, how to
correct a record, etc., write to Department of
Health.
Virginia
S2.00 $2.00
Bureau of Vital Records and
Health Statistics
State Department of Health
James Madison Building
Box 1000
Richmond, Virginia 23 208
State office has records from January 1853
through December 1896 and since June 4.
1912. For records between those dates, write to
the Health Department in the city where birth
or death occurred.
Virgin Islands (U.S.)
St. Thomas
Not
$2.00 issued
Registrar of Vital Statistics
Charlotte Amalie
St. Thomas, Virgin Islands 00802
Registrar has birth records on file since July 1,
1906, and death records since January 1 , 1906.
St. Croix
$2.00 Not
issued
Registrar ot Vital Statistics
Charles Harwood Memorial
Hospital
St. Croix, Virgin Islands
Registrar has birth and death records on file
since 1840.
Washington
S3. 00 S3.00
Bureau of Vital Statistics
Health Services Division
Department of Social and
Health Services
P.O. Box 709
Olympia, Washington 98504
State office has records since July 1, 1907. In
Seattle, Spokane, and Tacoma a copy may also
be obtained from the City Health Department.
For records before July 1. 1907, write to Audi-
tor in county where birth or death occurred.
West Virginia
$2.00
Not
issued
Division of Vital Statistics
State Department of Health
State Office Building No. 3
Charleston, West Virginia 25305
State office has records since January 1917.
For records prior to that year, write to Clerk of
County Court in the county where birth or
death occurred.
Wisconsin
$4.00 $4.00
Bureau of Health Statistics
Wisconsin Division of Health
P.O. Box 309
Madison, Wisconsin 53701
State office has some records since 1814; early
years are incomplete.
Wyoming $2.00 $2.00 Vital Records Services State office has records since July 1909.
Division of Health and Medical
Services
State Office Building West
Cheyenne, Wyoming 82002
NOTE: Births occurring before birth registration was required or births not registered when they occurred may have been filed as
"delayed birth registrations." Keep this in mind when seeking a copy of a record.
to
AND DEATH OF U.S.
who were born or died outside of the United States and
RTH CERTIFICATIONS FOR ALIEN CHILDREN ADOPTED BY U.S. CITIZENS
Records of Births
of Persons Born in
Foreign Countries Who
Are U.S. Citizens at Birth
Reports of births of U.S. citizens who are
born in foreign countries are to be made to the
nearest U.S. consular office as soon after the
birth as possible. The report should be prepared
and filed by one of the parents; however, the
physician or midwife attending the birth or any
other person having knowledge of the facts can
prepare the report. The report is made on Form
FS-240, Reports of Birth Abroad of a Citizen of
the United States of America, familiarly known
as the "Consular Report of Birth." The original
of the Report is sent to the Department of State
at Washington, D.C., for retention in its files.
The parents may purchase a copy of the report
for SI. 50 at the time it is prepared.
When the Consular Report of Birth is com-
pleted the post issues the parents, free o£ charge,
a Certification of Birth (Form FS-545). The
Certification of Birth is similar in appearance
and content to the short form birth certificates
issued by the civil authorities in the United
States.
Reports of birth should be made to the con-
sular office as soon as possible after the child's
birth. Except under very unusual circumstances
the Department of State will not permit consular
offices to prepare Consular Reports of Birth
for children who are five years of age or over.
Copies of reports of births of American citi-
zens born in foreign countries, whose births
were reported to an American Consular, may be
obtained by writing to Authentication Officer,
U.S. Department of State, Washington, D.C.
20520. To obtain a copy, the Privacy Act of
1974 requires the applicant, a parent, or an au-
thorized agent to submit a signed statement
which fully "identifies the subject file. The fee
for a copy is $3.00 (check or money order).
The Department of State issues two types of
copies taken from the Consular Report of Birth
(Form FS-240).
a. A full copy of Form FS-240 as it was
filed
b. A short form, Certification of Birth,
Form DS-1350, which sets forth only
the name and sex of the child and the
date and place of birth ($3.00)
Either form is fully valid with respect to the
information it contains. The Certification of
Birth may be obtained in a name subsequently
acquired by adoption or legitimation when
proof is submitted to establish that such an ac-
tion has legally taken place.
Records of Alien Children
Adopted by U.S. Citizens
Birth certifications for alien children who
have been adopted by U.S. citizens and lawfully
admitted to the United States may be obtained
-from the Immigration and Naturalization Service
(INS), U.S. Department of Justice, Washington,
D.C. 20536, if the birth information is on file.
Certification may be issued for any child
under 21 years of age who was born in a foreign
country, but requests must be submitted on INS
Form G-641, which can be obtained from any
INS office. Address of nearest INS office may be
obtained from a telephone directory. The $5.00
fee for INS certification-Form G350, Certification
of Birth Data from Immigration and Naturaliza-
tion Records should be paid by check or money
order.
The certification can be issued in the new
name of an adopted or legitimated child in in-
stances where satisfactory proof of adoption or
legitimation has been furnished to INS. This
certification (Form G-350) docs not serve as
proof of U.S. nationality, however, since it may
be issued for a child who has not yet become a
citizen of the United States.
10/1/80
mf Births
on or Aircraft
A person who acquired citizc.Tishm of the
a a a
United States through birth abroad of a United
States citizen parent or parents or by subsequent
derivative naturalization nsay apply for a certifi-
cate of d.iizeiiship pursuant to the provision? of
Section 341 of the fa-m'
Act. Application for "d
made in the United Stai
of the Immigration xA
Upon satisfactory prcof
child acquired citizenshi
cate of citizenship will •:
the child,, 'but only K such p
United States., The '.jsr.esdoi
Nationality
"vociimeiit may be
i-.; *hi nearest office
a.'Lualization Service.
the Service that the
as claimed, a ceraf?.-
hsv..i,-rJ in the name of
erson Is within >;h«;i
ia of the ce
of citizenship Is not ?r^JKir.tory, and the decisior
whether to apply for h h ontirely optional.
Records ofi U.S. Citizens
Who Die in
Reports of deaths of U.S. citizens who die in
foreign countries are made to the nearest U.S.
consular office, which forwards them to the U.5.
Department of State, Washington,, D.C. 20520,
where they are permanently filed. (See excep-
tion given below.)
Copies of these rrports saay be obtained by
writing to the Office of Special Consular Serv-
ices, U.S. Department of State, Washington,
D.C. 20520. The fee fo:r a copy is $3.00.
Exception: Report.? of deaths of members of
th<c Armed Forces of the United
States are made only to the branch
of the service to which the person
was attached at. the time of death-
Array;. Navy, Air Force, or Coast
Guard. In these cases, requests for
copies of records should be directed
as follows:
For members of the Army, Navy, or
Air Force:
Secretary of Defense,
Washington, D.C. 20301
For members of the Coast Guard:
Commandant, P.S
U.S. Coast Guard
Washington, D.C. 20226
?n a birth or death occurs on the high
s«r-»ai, whether in an aircraft or on a vessel, the
de termination of where the record is filed is
decided in terms of the direction in which the
vessel or aircraft w^-is headed at the time the
event occurred.
a. If the vessel or aircraft was outbound or
docked or landed at a foreign port, re-
quests for copies of the record should be
made to the U.S. Department of State,
c.
If the vessel or aircraft was inbound and
the first port of entry was in the United
States, write to the registration authority
in the city where the vessel or aircraft
docked or landed in the United States.
If the vessel was of U.S. registry, contact
the U.S. Coast Guard facility at the port
of entry.
Cases in which aircraft or vessels were lost at
sea arc so complex that they cannot be discussed
in detail in this publication. Direct inquiries on
such cases to the address shown on the front of
this leaflet.
Records Maintained by
Foreign Countries
Most, but not all, foreign countries record
births and deaths. It is not feasible to list all
foreign vital record offices in this publication,
the charges they make for copies of records, or
the information they may require to locate a
record. Certifications may be obtained from
most foreign countries for births and deaths oc-
curring within their boundaries, however.
U.S. citizens who need a copy of a foreign
birth or death record may obtain assistance by
writing to the Office of Special Consular Serv-
ices, U.S. Department of State, Washington,
D.C. 20520.
Aliens residing in the United States who seek
records of these events should contact their
nearest consular office.
SHRA) 77-1143
April 1977
I
ere to \\inite toi*
f
TC
MARRIAGE RECORDS
United States and Outlying Areas
U.S. DEPARTMENT OF
HEALTH, EDUCATION, AND WELFARE
PUBLIC HEALTH SERVICE
10/1/80
Where To Write for Birth and Death Records (PHS) 78-1142, revised
1978, and Where To Write for Divorce Records (PHS) 78-1145,
revised 1978, may be obtained from the Superintendent of Docu-
ments, U.S. Government Printing Office, Washington, B.C. 20402.
Suggestions are invited toward improvement of the text and format of future
editions. Plcaie address the Division of VitaJ Statistics, National Center for
Health Statistics, Public Health Service, DHEW, Hyattsviile, Md. 20782.
DHEW Publication No. (PHS) 78-1144
Revised 1978
10/1/I
fa twfo /or
MARRIAGE RECORDS
An official record of every marriage should be available in the
place where the event occurred. These records may be filed per-
manetly either in a State vital statistics office or in a city,
county, or other local office.
A copy may be obtained by writing to the appropriate office
listed below. Fees listed are subject to change.
When writing for a copy, it is suggested that a money order or
certified check be enclosed since the office cannot refund cash
lost in transit. The following information will also be needed
(type or print all names and addresses):
1. Full names of bride and groom (including nicknames).
2. Residence addresses at time of marriage.
3. Ages at time of marriage (or dates of birth).
4. Dete and place of marriage.
5. Purpose for which copy u needed.
6. Relationship to person whose record U on file.
Place of marriage
Coir
of COPY
Addreu and nmarkt
Alabama
$2.00
Records since August 1936: Bureau of Vital Statistics, State Department of
Public Health, Montgomery, Alabama 36104. Fee includes search and
report, or copy of record if found.
Alaska
$1.00 Probate Judge in county where license was issued.
$3.00 Records since 1913: Bureajj of Vital Statistics, Department of Health and
Welfare, Pouch H, Juneau, Alaska 99801 .
American Samoa
Arizona
$1.00 Registrar of Vital Statistics, Pago Pago, American Samoa 96799.
Varies Clerk of Superior Court in county where license was issued.
Arkansas
$2.00 Records since 1917: Division of Vital Records, Arkansas Department of
Health, 4815 W. Markham, Little Rock, Arkansas 72201.
$2.00
Full certified copy may be obtained from county clerk in county where
license was issued.
California
$3.00
Vital Statistics Section, State Department of Public Health, 410 N Street,
Sacramento. California 95814.
Canal Zone
Colorado .
License Section, Civil Affairs Bureau. Box "L", Balboa Heights, Canal Zone/
Statewide index of records for all years except 1940-1967: Records and
Statistics Section, Colorado Department of Health, 4210 East 11th Avenue,
Denver, Colorado 80220. Inquiries will be forwarded to appropriate county
office.
Varies
County Clerk in county where license was issued.
* Apply to county where license was issued if it is known. Certified copies not available from State health department.
10/1/80
Place of marriage
Cost
of copy
Connecticut
Delaware
Address &nd rsmtrks
$2.00 Records since July 1. 1897: Public Health Statistics Section, State Depart-
ment of Health, 79 Elm Street, Hartford, Connecticut 081 15.
$2.00 Registrar of Visa! Statistics in town where license was issued.
$2.50 Bureau of Vita! Statistics, Division of Public Health, Department of Health
and Social Services, Jesse S. Cooper Memoris! Bldg., Dover, Delaware 19901.
District of Columbia
$2.00 Marriage Bureau. 440 G Street, N.W., Room 337, Washington, D.C. 20001.
Fee for proof of marricge, $1.00. Fee for application only, $1.00. Complete
record. $2.00.
Florida
$2.00 Records since June 6, J927: Bureau of Vital Statistics, State Division of
Health, P.O. Sox 210, Jacksonville, Florida 32201. If year is unknown, the
fee is $2.00 for 'Jie first year searched and $1.00 for each addtional year up
to a maKimum of $25.00. Fee includes a copy of the record if found.
Georgia
Guam
$2.00 C!erk of Circuit Court in county where Hcwse was 'issued.
Centralized State records since June 9. 1952: Vital Records Unit, State
Department of Human Resources, Room 217-H, 47 Trinity Avenue, S.W.,
Atlanta, Georgia 20334. (Inquiries will be forwarded to appropriate office.
$2.00 County Ordinary in county where license was issusd.
$1.00 Office of Vital Statistics, Department of Public Health and Social Services,
Government of Gu®m. P.O. box 2816. Ag0na, Guam, M.I. 96910.
Hawaii
$2.00
Research and Statistics Office. State Department of Health, P.O. Box 3378,
Honolulu, Hawaii 96801 .
Idaho
$2.00
Records since 1947: Bureau of Vital Statistics. State Department of Health
and Welfare. Stsdehouse, Boise. Idaho 83720.
Varies
County Recorder in county where license was issued.
Illinois
Records since January 1, 1962 Office of Vital Records. State Department of
Public Health, Springfield, Illinois 62761. All items may be verified (fee
$2.00).
Indiana
$2.00 County Clerk in county where license was issued.
Records since 1358: Division of Vital Records. State Board of Health. 1330
West Michigan Street, Indianapolis, Indiana 42606 No certification, inquiries
will be forwarded to appropriate office.
Varies
Clerk of Circuit Court, or Clerk of Superior Court, in county where license
was issued.
Iowa
$2.00
Division of Records and Statistics, State Department of Health. Des Moines.
Iowa 503 19.
Kansas
$2.00 Records since May 1913: Bureau of Registration and Health Statistics,
Kansas State Department of Health and Environment. 6700 S. Topeka Ave..
Topeka. Kansas 66620.
Varies
Probate Judge in county where license was issued.
•Apply to county where license was usucd if il h known. Certified copies not available from State health department.
WHERE TO WRITE FOR
WRO TO/
Place of marriage
Cott
of copy
Address and remarks
Kentucky
Louisiana
Maina
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
$2.00 Records since July 1, 1958: Office of Vital Statistics, State Department ol
Health 275 East Main Street. Frankfort. Kentucky 40601.
Varies Clerk of County Court in county where license was issued.
Records since 1946: Bureau of Vital Statistics. State Department of Health
P.O. Box 60630, New Orleans, Louisana 701 60. -Inquiries will be forwarder
to appropriate office.
$2.00 Certified copies are issued by the Clerk of Court in parish where license was
issued.
$2.00 Office of Vital Records, State Department of Health and Welfare. Stati
House, Augusta. Maine 04333.
$2.00 Town Cleric in town where license was issued.
$2.00 Records since June 1. 1951 : Divsiion of Vital Records, State Department o
Health and Mental Hygiene. State Office Building, P.O. Box 13146. 201
West Preston Street, Baltimore, Maryland 21203.
Varies Clerk of Circuit Court in county where license was issued or Clerk of Court
of Common Pleas of Baltimore.
$2.00 Records since 1841: Registrar of Vital Statistics, Room 103 McCormacJ
Bldg., 1 Ashburton Place, Boston, Massachusetts 02108. Earliest Bostot
records are for the year 1848.
$2.00 Records since April 1867: Office of Vital and Health Statistics, Michigac
Department of Public Health, 3500 North Logan Street, Lansing. Michigai
48914.
$2.00 County Clerk in county where license was issued.
Statewide index since January 1958: Section of Vital Statistics, State D<
partment of Health, 717 Delaware Street, S.E., Minneapolis, Minnesot
55440. Inquiries will be forwarded to appropriate office.
$2.00 Clerk in District Court in county where license was issued.
$2.00 Statistical Record only from January 1926 to July 1, 1938, and from Jam
ary 1. 1942 to present: Vital Records Registration Unit, State Board c
Health, P.O. Box 1700. Jackson. Mississippi 39205.
$2.00 Circuit Clerk in county where license was issued.
Free Indexes since July 1948. Division of Health, Bureau of Vital Record;
Jefferson City, Missouri 65101. Correspondent will be referred to apprc
priate Recorder of Deeds of the county where the license was issued.
Varies Recorder of Deeds in county where license was issued.
Records since July 1943: Bureau of Records and Statistics. State Depar
ment of Health and Environmental Sciences, Helena, Montana 59601. li
quiries will be forwarded to appropriate office.
Varies Clerk of District Court in county where license was issued.
$3.00 Records since January 1909: Bureau of Vital Statistics, State Department <
Health, Lincoln Bldg., 1003 0 Street, Lincoln, Nebraska 68508.
Varies County Court in county where license was issued.
* Apply 10 county where license was issued if it is known. Certified copies not available from State health department.
MARRIAGE RECORDS
10
Plac® of rmrrisge
Cost
of eopy
Nevada
New Hampshire
New Jersey
Mexico
Varies
$3,00
§1.00
$2.00
No fee
Varies
New York (except New York City) $2.00
Varies
$2.00
New York City
$4.00
Bronx Borough
Brooklyn Borough .
Manhattan Borough
Queens Borough . . .
Richmond Borough
siur.e January 1, 1SSB: Depcfrmer.. of L- lumen R^ources. Division
of Health • Vita! Statistics, Capitol Complsx, O-'fice of Vital Racords, Carson
City. Mttvedw 3D? "JO. inquiries '.vis; be fovv-ravsJecl tc appropriate office.
County Recorder in coii.".ty w.:>ere license '.vsi i'.:su«,'^,
Records since 1640: Departcvien: of Health arid Welfare. Division of Public
Health, Bureau of Vital Stinistics, £1 South Spring Street, Concord, New
Hampshire 03301 .
Town C!erk i« town where !!a«. :;a was iwsed.
Stale Registrar. Stats Department of Health, P.O. Box 1540. Trenton, New
Jer&ey OS62S. 83 year in unknown, the fee it an additional S0.50 for each
calendar v w to f.-ss seas-died.
For records, from Wiay 1848 -tiru May 1E78 write to the Archives and
History Bureau, State Library Division, State Department of Education,
Trenion, New Jersey 08625.
Couniy Clerk in county v:here marriage was ij&r
Records from January 1880 ?.n December 'J?)07 and since May 1915: Bureau
of Vital Records, Stafe Department of H«»Uh. Empire State Plaza. Tower
Building, Atoany, Ww York 12237.
Records from January 1908 to April 1915: County Clerk in county where
license was issued.
Records from January 1880 to December 1907: Write to City Clerk in
Albany or Buffalo and Registrar of Vital Statistics in Yonkers, if marriage
occurred in shese cities.
Records from 1847 to 1865: Municipal Archives, and Records Retention
Center, New York Public Library, 23 Park Rosw, New York, New York
10038, exceps Brooklyn records for thi* period, which are filed with County
Cierk'j Office, Kings County. Supreme Court Building. Brooklyn. New York
11201. Additions! copies of the same record ordered at the same time all
$2.00 each.
Records from 1866 to 1907: City Clerk's Office in borough in which mar-
riage wfes perf txmed.
Records from 1908 to May 12. 1943:Residents-City Clerk's Office in
borough of bride's residence; non-residents-City Clerk's Office in borough in
which license was obtained.
Records from May 13. 1943, to date: City Clerk's Office in borough in
which license was issued.
Office of City Clerk. 1780 Grand Concourse, Bronx, New York 10457.
Records for 1908-1913 for Bronx are on the file in Manhattan Office.
Office of City Clerk. 208 Jora!@mon Street, Brooklyn, New York 11201 .
Office of City Clerk, Chambers and Centre Streets, New York. N.Y. 10007.
Of fie® of CUy Clerk, 120-55 Que«ns Boulevard, Borough Hall Station, Ja-
maica, New York 11424.
Office of City Clark, Borough Hall, St. George, Staten Island. New York
10301.
"Apply to county where license was issued if it is known. Certified copies not available from State health department.
e*$4.00 when asset year of marriage is submitted. (Add $0.50 for the 2d year of search and $0.25 for each additional year). Certifi
cate will show names, ages, dates of birth, and dsu& and pbc« of marriage. For additional information-names and countries of birth o
parents, matrimonial history, etc.-express request must b« roads. Ms 52 requests must also include the cost of return postage.
WHERE TO WRITE FOR
Place of mtrriag*
Cost
of copy
Addrets and remarks
North Carolina $3.00 Department of Human Resources, Division of Health Services, Vital Records
Branch. P.O. Box 2091, Raleigh, North Carolina 27602.
Varies Registrar of Deeds in county where marriage was performed.
North Dakota $1.00 Records since July 1, 1925: Division of Vital Records, State Department of
Health, Bismarck, North Dakota 58505. Inquiries will be forwarded to ap-
propriate office.
Varies County Judge in county where license was issued.
Ohio • Records since September 1949: Division of Vital Statistics, Ohio Depart-
ment of Health, G-20 Ohio Departments Building, 65 S. Front Street, Co-
lumbus. Ohio 43215. Inquiries will be forwarded to appropriate office. All
items may be verified.
Varies Probate Judge in county where license was issued.
Oklahoma Varies Clerk of Court in county where license was issued.
Oregon $3.00 Records since January 1907: Vital Statistics Section. State Health Division.
State Board of Health, P.O. Box 231, Portland, Oregon 97207. Fee includes
search and first copy. Additional copies of the same record ordered at the
same time are $2.00 each.
Varies County Clerk of county where license was issued.
Pennsylvania • Record* since January 1941 : Division of Vital Statistics, State Department
of Health, Central Building. 101 South Mercer Street, P.O. Box 1528, New
Castle, Pennsylvania 16103. Inquiries will be "forwarded to appropriate of-
fice.
Varies Marriage License Clerks, County Court House in county seat where license
was issued.
$0.50 Division of Demographic Registry and Vital Statistics, Department of
Health, San Juan. Puerto Rico 00908.
$2.00 Records since January 1853: Division of Vital Statistics, Rhode Island De-
partment of Health, Room 101, Health Building. Davis Street, Providence.
Rhode Island 02908.
$1 .00 Town Clerk in town, or City Clerk in city, where marriage was performed.
South Carolina $2.00 Records since July 1, 1950: Division of Vital Records, Department of
Health and Environmental Control, 2600 Bull Street, Columbia, South
Carolina 29201.
Varies Records since July 1, 1911: Probate Judge in county where license was
issued.
South Dakota $2.00 Records since July 1. 1905: Division of Public Health Statistics, State De-
partment of Health. Pierre, South Dakota 57501.
$2.00 County Treasurer in county where license was issued.
Tennessee $2.00 Records since July 1945: Division of Vital Records, State Department of
Public Health, Cordell Hull Building, Nashville, Tennessee 37219.
Varies County Court Clerk in county where license was issued.
Puerto Rico .
Rhode Island-
* Apply to county where license was issued if it is known. Certified copies not available from State health department.
MARRIAGE RECORDS
Plac* of marriage
Cost
of copy
Addrest and remarks
Texas
$1.00 Records since January 1966: Bureau of Vital Statistic*, Texas Departrne.it
of Health, 1100 West 49th Street, Austin, Texas, 78756.
Varies County Clerk in county where license was issued.
Trust Territory of the Pacific
Islands
Varies Clerk of Court in district where marriage was performed.
Utah
Varies County Clerk in county where license was issued.
Vermont
$1.50 Records since 1857: Secretary of State, Vital Records Department,
Montpelier, Vermont 05602.
$2.00
Town Clerk in town where license was issued.
For information on vital statistics laws, how to correct a record, etc., write
to: Public Health Statistics Division, Department of Health, Buriirtgton, Ver-
mont 05401.
Virginia
$2.00 Records since January 1853: Bureau of Vital Records and Health Statistics.
State Department of Health. James Madison Building, P.O. Box 1000,
Richmond, Virginia 23208.
Virgin Island (U.S.)
St. Crolx
Varies Court Clerk in county or city where license was issued.
• Bureau of Vital Records and Statistical Services, Virgin Islands Department
of Health, Charlotte Amaiie. St. Thomas, Virgin Islands 00801 . Inquiries will
be forwarded to appropriate office.
$1.00 Clerk of Municipal Court, Municipal Court of the Virgin Islands, Christian*
•ted. St. Croix. Virgin Islands 00820.
St. Thomas and St. John
$1.00 Clerk of Municipal Court, Municipal Court of the Virgin islands, Charoltte
Amaiie, St. Thomas, Virgin Islands OO801 .
Washington
$3.00 Records line* January 1, 1968: Bureau of Vital Statistics, Health Services
Division, Department of Social and Health Services, P.O. Box 709. Olympia,
Washington 98504.
West Virginia
Wisconsin
$2.00 County Auditor in county where license we* issued.
$2.00 Records since 1921: Division of Vital Statistics, State Department of
Health, Charleston. West Virginia, 25305. Certified copies available from
1964. Other inquiries wilt be forwarded to appropriate orfice.
Varies County Clerk in county where license was issued.
$4.00 Records since April 1835: Bureau of Health Statistics, Wisconsin Oiv'n'on of
Health, P.O. Box 309, Madison, Wisconsin 53701.
•Apply to county where license was issued if it is known. Certified copies not available from State health department.
Place of marriage
of copy
Address and remarks
Wyoming
$2.00
Records since May 1941: Vital Records Services, Division of Health and
Medical Services. State Office Building. West Cheyenne, Wyoming 82002.
Varies
County Clerk in county where license was issued.
* Apply to county where license was issued if it is known. Certified copies not available from State health department.
10/1/80
TOI*
DIVORCE RECORDS t
United States and Outlying Areas
U.S. DEPARTMENT OF
HEALTH, EDUCATION, AND WELFARE
PUBLIC HEALTH SERVICE
2-24
Where To Write for Birth and Death Records (PHS) 78-1142, revised
1978, and Where To Write for Marriage Records (PHS) 78-1144,
revised 1978, may be obtained from the Superintendent of Docu-
ments, U.S. Government Printing Office, Washington, D.C. 20402.
Suggestions are invited toward improvement of the text and format of future
editions. Please address the Division of Vital Statistics, National Center for
Health Statistics, Public Health Service, DHEW, Hyattcville, Md. 20782
DHEW PUBLICATION NO. (PHS) 78-1 145
Revised 1978
Far uto by th« Superintendent of Docomenti, U.S. Government Printtnc Office, Washington, D.C. 30402
WRO 10/1/80
I
0i»
DIVORCE RECORDS
official record of every divorce or annulment of marriage
ild be available in the place where the event took place,
se records may be filed permanently either in a State vital
sties office or in a city, county, or other local office.
opy may be obtained by writing to the appropriate office
d below. Fees listed are subject to change.
m writing (or a copy, it is suggested that a money order or
if led check be enclosed since the office cannot refund cash
lost in transit. The following information will also be needed
(type or print all names and addresses):
1. Full names of husband and wife (including nicknames).
2. Present residence address.
3. For mar addresses (as in court records).
4. Ages at time of divorce (or dates of birth).
5. Date and place of divorce or annulment of marriage.
6. Type of final decree.
7. Purpose for which copy is needed.
8. Relationship to persons whose record is on file.
Place of divorce
Cott of copy
Address and remarks
banrta
iska
Samoa
kansas
lifornia
nel Zone
ilorado
$3.00 Records since January 1950: Bureau of Vital Statistics, State Department
of Public Health. Montgomery, Alabama 36104. Fee includes search and
report, or copy of record if found.
$1.50 Clerk or Registrar of Court of Equity in county where divorce was granted.
$3.00 Records since 1950: Bureau of Vital Statistics, Department of Health and
Welfare. Pouch "H", Juneeu, Alaska 99801 .
Varies Clerk of the Superior Court in judicial district where divorce was granted:
Juneau and Ketch ikan (First District). Nome (Second District), Anchorage
(Third District), Fairbanks (Fourth District). Alaska.
$0.50 Registrar of Vital Statistics, Pago Pago, American Samoa 96799.
Varies Clerk of Superior Court in county where divorce was granted.
$2.00 Coupons since 1923: Division of Vital Records, Arkansas Department of
Health, 4815 W. Markham, Little Rock, Arkansas 72201.
Varies Full certified copy may be obtained from circuit or chancery clerk in
county where divorce was granted.
$3.00 For final decree entered since January 1, 1962 or initial complaint filed
since January 1. 1966: Vital Statistics Section, Department of Health, 410
N Street, Sacramento, California 95814.
Varies Clerk of Superior Court in county where divorce was granted.
$2.00 License section, Box "L", Balboa Heights. Canal Zone.
Cristobal Division (Atlantic Area). Clerk, U.S. District Court, Box 1175,
Cristobal. Canal Zone.
• Statewide index of records for all years except 1940-1967: Records and
Statistics Section. Colorado Department of Health, 4210 East 11th Ave-
nue. Denver, Colorado 80220. Inquiries will be forwarded to appropriate
county office.
Varies Clerk of District Court in county where divorce was granted.
•Certified copies not available.
10/1/80
Pl»ce of divorce
Cost of copy
Address and remarks
onnecttcut
$3.00
Index of records since June 1, 1947: Public Health Statistics Section, State
Department of Health, 79 Elm Street. Hartford. Connecticut 061 15. In-
quiries will be forwarded to appropriate office.
Clerk of Superior Court in county where divorce was granted.
telaware
Record* since March 1932: Bureau of Vital Statistics, Division of Public
Health, Department of Health and Social Services, State Health Building,
Dover. Delaware 19901. Inquiries will be forwarded to appropriate office.
Search made and essential facts of divorce verified {fee $2.50).
District of Columbia
Morida
jeorgia
$2.00 Prothonotary in county where divorce was granted.
Varies Records since September 16. 1956: Clerk, Superior Court for the District
of Columbia, Family Division, 451 Indiana Ave., Washington, D.C. 20001.
Records prior to September 16, 1956: Clerk. U.S. District Court for the
District of Columbia, Washington, D.C. 20001.
$2.00 Records since June 6. 1927: Bureau of Vital Statistics, State Division o1
Health, P.O. Box 210. Jacksonville. Florida 32201. If year is unknown. tt»
fee Is $2.00 for the first year searched and $1 .00 for each additional year
to a maximum of $25.00. Fee includes a copy of the record found.
Varies Clerk of Circuit Court in county where divorce was granted.
. Centralized State records since June 9. 1952: Vital Records Unit. State
Department of Human Resources, Room 217-H, 47 Trinity Avenue, S.W.,
Atlanta, Georgia 30334. Inquiries will be forwarded to appropriate office.
Varies
Clerk of Superior Court in county where divorce was granted.
juem .
Hawaii
Idaho
Uinois
Indiana
Iowa .
Kansas
Varies Clerk, Superior Court of Guam, Agana. Guam, M.I.. 96910
$2.00 Records since July 1, 1951: Research and Statistics Office. State Depart-
ment of Health. P.O. Box 3378, Honolulu, Hawaii 96801 .
Varies Circuit Court in county where divorce was granted.
$2.00 Records since January 1947: Bureau of Vital Statistics. State Department
of Health and Welfare, Boise Idaho 83720.
Varies County Recorder in county where divorce was granted.
• Records since January 1, 1962: Office of Vital Records. State Department
of Public Health, Springfield, Illinois 62761. Some items may be verified
(fee $2.00).
Varies Clerk of Circuit Court in county where divorce was granted.
Varies County Clerk in county where divorce was granted.
. Brief statistical record only since 1906: Division of Records and Statistics,
State Department of Health, Des Moines, Iowa 50319. Inquiries will be
forwarded to appropriate office.
Varies County Clerk in county where divorce was granted.
$2.00 Records since July 1951: Bureau of Registration and Health Statistics.
6700 S. Topeka Ave.. Topeka. Kansas 66620
Varies Clerk of District Court where divorce was granted.
•Certified copies not available.
WHERE TO WRITE FOR
Place of divorc®
$.2.00 Records *inc® July 1-. 195S: Office of Vital Statistics, S«r,«e Oopartmeivi
Hwlth'. 275 East Main Strait, Frankfort , Kentucky 40S01 .
Varies
Clerk of Circuit Court In county where divorce was granted.
Louisana
Maine
, Record* sines 1§46: .Division of Public Health Statistics. Stene Board o
Health, P.O.. Box 60830. New Orleans, Louisana 701 SO. Inquiries will bi
fo«w&rd®d to appropriate office. All items may be verified.
Varies Clerk of Court in perish wheats divorce wes granted.
$2.60 Records since January 1 . 18S2: Office of Vttsf Statistics. State Dgpartman
of Health and Welfare, State House. Augusts, Maine M333.
Marv land
Massachusetts
$1.00 Clerk of District Court 'm the judicial division wher« divorce tva$ gran sec
• Records since January 1961: Division of Vital Records, State Departmen
of Health and Mental Hygiene. State Office Building. 201 Wnst Prestoi
Street, P.O. BOK 13148, iWtinw®. ywvland 21203. Inquiries will b
forwarded to appropriate office. Soms items may be verified.
$2.00 Clerk of the Circuit Court in <soynty where divorce was granted.
$150 Index only from 1952: State Registrar of Vital Statistics, Room 103
McCormack Building. 1 Ashburton Place. Boston, Massachusetts 02108
tnquiror will te directed where to forward request.
Michigan
Minnesota
$1.50 Registrar of Protwte Court i't county where divorce was granted.
$2.00 Records since 1897: Off let of Vital and Health Statiitics, Michigan Dapan
iront of Health, 3500 North Logan Strees, Laming, Michigan 4891 4.
Varies County Clerk in county where divorce was granted.
• Index since January 1. 1970: Minnesota Department of Health. Section o
Vital Statistics. 717 Oelavwr« Street. S.E., Mmraapolis, Minnesota 5544'
Varies Clerk of District Court in county where divorce m$ granted.
• Records sines January 1, 1926: Division of PubSic Health Statistics. Stat
Board of Health, $*.O. Sort 1 700, Jackson, Mississippi 39205. Inquiries wi
be forwarded, to appsopri&M office.
$2.00
Chancery Clerk in county w9w@ divorce w@s granted.
Missouri
indexes gince July 1048. Division of Health. Bureau of Vital Record
Jefferson City, Missouri 65101. Inquiries will b« referred to apprpriat
Circuit Cterk of lh« county in which the decree was granted.
Vartoe
Clark of Circuit Court in county whsre divorce MM granted.
Montana
Varies
"Certified copies not available.
R«cords since Juiy 1943: Oivfetors of Records and Statistics, State Depai
mertt of Health, Helena, Montana 590)1. inquiries will be forwarded
appropriate office. Some item may b* wHM.
Clerk of District Court in county whera divorce was granted. .
DIVORCE RECORDS
10
Piece of divorce
Cost of copy
Nebraska
Nevada
New Hampshire
New Jersey .
New Mexico
Nsw York . .
North Carolina
North Dakota
Ohio
$3,00 Records since January 1909: Bureau of Vital Statistics, State Department
of Health, Lincoln Building, 1003 'O' Street, Lincoln, Nebraska 68508.
Varies Clerk of District Court where dlivorcs was granted.
« Indexed since January 1, 1968. Department of Human Resources, Division
of Health • Vital Statistics, Capitol Complex, Office of Vital Records,
Carson City, Nevada 89710. inquiries will be forwarded to appropriate
office.
Vans* County Clsrk in county where divorce was granted.
$3.00 Records since 1880: Department of Health and Welfare, Division of Public
Health, Bureau of Vital Statistics, 61 South Spring Street, Concord, New
Hampshire 03301 . Fee includes search and one copy,
Varies Clerk of the Superior Court which issued the decree.
$2.00 Superior Court, Chancery Division, State House Annex, Room 320
Trenton, New Jersey 08625.
Varies Clerk of District Court in county where divorce was granted.
$2.00 Records since January 1. 1963: Bureau of Vital Records, State Department
of Health, Empire Stata Plaza, Tower Building, Albany, N0w York 12237.
Varies County Clerk In county where divorced was granted.
$3.00 Department of Human Resources, Division of Health Services, Vital
Records Branch, P.O. Box 2091 /Raleigh, North Carolina 27602.
Varies Clerk of Superior Court where divorce was granted.
• Index of records since July 1, 1949: Division of Vital Records, State
Department of Health, Bismarck, North Dakota 58505. Inquiries will be
forwarded to appropriate office. Some items may be verified.
Varies Clerk of District Court in county where divorce was granted.
• Records since 1948: Division of Vital Statistics, Ohio Department of
Haalth, G-20 Ohio Departments Building, 65 S. Front Street, Columbus,
Ohio 43215. Inquiries will b® forwarded to appropriate office. All items
may be verified.
Oklahoma
Oragon . .
Pennsylvania
Varies Clark of Court of Common PJess in county where divorce was granted.
Varies Court Clerk in county where divorce was gran tad.
$3.00 Records since May 1925: Vital Statistics Section. State Health Division
P.O. Box 231, Portland, Oregon 97207. Fee includes search and first copy.
Additional copies of the same record ordered at the same time are $2.00
each.
Varies County Clerk in county where divorce was granted.
• Records since January 1946: Division of Vital Statistics, State Department
of Health, Central Building, 101 South Mercer Street, P.O. Box 1528, New
Castle, Pennsylvania 16103. inquiries will be forwarded to appropriate
office.
Varies Prothonotary, Court House, in county seat where divorce was granted.
•Certified copies not available.
WHERE TO WRITE FOR
10/1/
Plaa of divorce
Cost of copy
Aeltfreu and remarks
Puerto Rico ,
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Trust Territory of the
Pacific Islands ....
Utah . . .
Vermont
Virginia
Virgin Islanes (U.S.)
St. Croix
St. Thorn*,* and St. John
Washington
West Virginia
$0.60 Superior Court whsre divorce was granted.
« Records since January 1962: Division of Vital Statistics, Rhode Island
Department of Health, Room 101, Davis Street, Providence. Rhode Island
02908. Inquiries will be forwarded to appropriate office.
$1 .00 Clerk of Family Court in county where divorce was granted.
$2.00 Records since July 1, 1962: Division of Vital Records, Department of
Health and Environmental Control, 2600 Bull Street, Columbia, South
Carolina 29201.
Varies Records since April 1949: Clerk of county where petition filed.
$2.00 Records since July 1, 1905: Division of Publice Health Statistics. State
Department of Health, Pierre, South Dakota 57501 .
Varies Clerk of Court in county where divorce was granted.
$2.00 Records since July 1945: Division of Vital Statistics, State Department of
Public Health, Cordeil Hull Building, Nashville, Tennessee 37219.
Varies Clerk of Court where divorce was granted.
$1.00 Records since January 1968: Bureau of Vital Statistics, Texas Department
of Health. 1 100 West 49th Street, Austin, Texas, 78756.
Varies Clerk of District Court in county where divorce was granted.
Varies Clerk of Court in District where divorce was granted.
Varies County Clerk in county where decree was granted.
$1.50 Records since January 1860: Secretary of State, Vital Records Depart-
ment, State House, Montpelier, Vermont. 05602.
$3.00 Clerk of County Court where divorce was granted.
$2.00 Records since January 1918: Bureau of Vital Records and Health Statis-
tics, State Department of Health, Jamas Madison Building, P.O. Box 1000,
Richmond, Virginia 23208.
Varies Clerk of Court in county or city where divorce was granted.
$2.40 Deputy Clerk of District Court. Christiansted. St. Croix, Virgin Islands
008^0.
$2.40 Clerk of District Court, Charlotte Amalie, St. Thomas, Virgin Islands
00802
$3.00 Records since January 1, 1968: Bureau of Vital Statistics, Health Services
Division, Department of Social and Health Services, P.O. Box 709, Olym-
pia, Washington 98504.
Varies County Clerk in county where divorce was granted.
* Index from 1968: Division of Vital Statistics, State Department of Health,
Charleston. West Virginia, 25305. Inquiries will be forwarded to appro-
priate office. Some items may be verified (fee $2.00).
Clerk of Circuit Court, Chancery Side, in county where divorce was
Varies granted.
'•Certified copiei not available.
DIVORCE RECORDS
Place of divurce
Cost of copy
Address and remarks
Wiscontin
Wyoming
$4.00 Records since October 1, 1907: Bureau of Health Statistics. Wisconsin
Division of Health. P.O. Box 309. Madison Wisconsin 53701.
$2.00 Records since May 1941: Vital Records Services. Division of Health and
Medical Services. State Office Building West, Cheyenne, Wyoming 82002.
Varies Clerk of District Court in county where divorce was granted.
'Certified copies not available.
10/'
LIST OF AMERICAN DIPLOMATIC AND CONSULAR OFFICES
ISSUING VISAS
In! ess otherwise indicated, American diplomatic and consular offices listed below
>oth immigrant and nonimmigrant visas. However, diplomatic visas are issued
ibroad at American Embassies only; consulates may issue such visas only if
specifically so authorized. The insertion of "NIV" after a diplomatic or consular
iff ice indicates that the particular offices issues nonimmi grant visas only.
'IR" indicates that only "Immediate Relative" type immigrant visas are issued
it the post.
"he following symbols are used to indicate the status of each office: (E) for
imbassy?(CG) for Consulate General, (C) for Consulate, and (M) for Mission.
IDEN
(See YEMEN)
\FARS and ISSAS
(See DJIBOUTI)
AFGHANISTAN
Kabul (EJ
\LGERIA
Algiers (E)
Oran (C) - NIV
\MERICAN SAMOA
(See SAMOA, AMERICAN)
\MINDIVI ISLANDS
(See INDIA)
WSTtRi.'AM ISLAND
(See Madagascar)
ANDAMAN ISLANDS
(See India - Calcutta)
ANDORRA
(See SPAIN, NIV Barcelona
IV Madrid)
ANGOLA
(Luanda - closed)
(See PORTUGAL, Lisbon)
UNGUILLA
(See BARBADOS)
ANABAON ISLAND
(S^e CAMEROON)
ANTIGUA
(See BARBADOS)
ARGENTINA
Buenos Aires (E)
ARUBA
(See Netherlands Antilles)
AUSTRALIA
Canberra (E) - dipl. and official or
Brisbane (C) - NIV
Melbourne(CG)- NIV
Perth (C)
Sydney (CG)
AUSTRIA
Vienna (E)
AZORES ISLANDS
(See PORTUGAL - Ponta Delgada (C))
BAHAMAS
Nassau (E)
BAHRAIN, State Of
Manama (E)
BALEARIC ISLANDS
(See SPAIN - IV Madrid
NIV - Barcelona)
BANGLADESH
Dacca (E)
BARBADOS
Bridgetown (E)
BASSAS DA INDIA
(See MADAGASCAR)
BASUTOLAND
(See LESOTHO)
10/1/80
2-32
B/P/E
o/ \*/ u.
Exhibit
BELGIUM
Brussels (E)
Antwerp (CG) • NIV (except dip.)
Belize City (CG)
BENIN
Cotonou (E)
Hamilton (CG)
BHUTAN
(Sae INDIA - New Delhi)
BOLIVIA
La Paz (E)
BONAIRE
(See NETHERLANDS ANTILLES)
BOPHUTHATSWANA
(See SOUTH AFRICA)
Gaborone (E)
BRAZIL
Brasilia (E) - NIV
Porto Alegre (C) - NIV
Recife (CG) - NIV
Rio de Janeiro (CG)
Salvador (C) - NIV
Sao Paulo (CG) - NIV
BRUNEI
(See MALAYSIA)
BULGARIA
Sofia (E)
BURMA
Rangoon (£}
BURUNDI, Republic of
Bujumbura (E)
CAMBODIA
(Closed)
CAMEROON, United Republic of
Yaounde (E), Douala (C) ~ NIV
CANADA
Ottawa (E) - NIV
Calgary (CG)
Halifax (CG)
Montreal (CG)
Balboa (Ths F^ec-Jtive Secretary
Ca^ial Zone Is authorized to isss
types of visas until October ls
CANARY 13LAMRC
(See SPA«! - fedrid)
Praia (E)
CAROLINE ISLANDS, Eastern Trust T«
of the Pacific Islands
Ponape, District Administrator
Tr u k , District Adm i n 1 s t r a tor
CAROLINE ISLANDS, Western Trust T<
Koror (Palau District) District
rinistrator., Yap^ District Adr
CAYMAN ISLANDS
(See JAHA1CA)
CELEBES
(See INDONESIA - IV Jakarta
NIV - Svesbaya)
CENTRAL AFRICA
Banqui (E)
CEUTA
(See MOROCCO - Tangier)
CHAD, Republic Of
M8Djamena (E)
CHANNEL ISLANDS
(See UNITED KINGDOM, London)
CHATAH ISLANDS
(See NEW ZEALAMD - Wellington)
CHICHI-JIMA (Bonin Volcano Island]
(See MARIANA ISLANDS)
CHILE
Santiago (E)
CHINA
Beijing (E)
CHRISTIANS ISLANDS
AUSTRALIA - Perth)
COCOS ISLANDS
(See AUSTRALIA - Perth)
DJIBOUTI
Djibouti (E)
COLOMBIA
Bogota (E)
Barranguilla (C) - NIV
Call (C) - NIV
Medellin (C) - NIV
COMOROS
(See MADAGASCAR)
CONGO (Kinshasa)
(See Zaire)
CONGO, PEOPLE'S REPUBLIC
Brazzaville (E)
COOK ISLAND
(See NEW ZEALAND - Wellington)
CORSICO ISLANDS (Part of Equatorial Guinea)
(See CAMEROON)
CORSICA
(See FRANCE - IV Paris, NIV Nice)
COSTA RICA
San Jose (E)
CRETE
(See GREECE - Athens)
CROZET ISLANDS (Indian Ocean) (French)
(See MADAGASCAR)
CYPRUS
Nicosia (E)
CZECHOSLOVAKIA
Prague (E)
DAMAO
(See INDIA _ Bombay)
DENMARK
Copenhagen (E)
DHOFAR
(See YEMEN - Sana)
DOMINICA
(See BARBADOS)
DOMINICAN REPUBLIC
Santo Domingo (E)
EASTER ISLANDS
(See CHILE)
EQUADOR
Quito (E) NIV
Guayaquil (CG)
EGYPT
Cairo (E)
Alexandria (CG) - NIV
Port Said (C) - NIV
EIRE
(See IRELAND)
EL SALVADOR
San Salvador (E)
DIU
(See INDIA - Bombay)
ELOBEY ISLANDS, GREAT AND LITTLE
(Part of Equatorial Guinea)
ENGLAND
(See UNITED KINGDOM)
ERITREA
(See ETHIOPIA)
EQUATORIAL GUINEA, Republic of
(See CAMEROON - Yaounde)
ESTONIA
(See SOVIET UNION - Moscow)
ETHIOPIA
Addis Ababa (E)
EUROPA ISLAND (He Europa (French)
(See MADAGASCAR)
FAEROE ISLANDS '
(See DENMARK)
FALKLAND ISLANDS
(See ARGENTINA)
10/1/80
2-34
FERNANDO DE NORNKA ISL
(See BRAZIL - Recife)
(See CAMEROON)
I
Suva (E)
LAND
Helsinki (E)
Paris (E)
Bordeaux (CG) ••» NIV
Port-de-France
Lyon (CG) - NIV
Marseille (CG) -• NIV
Nice (C) - NIV
Strasbourg (CR) - HI
Libreville (E)
GALAPAGOS ISLANDS
(See Equador - Guayaquil)
GAMBIA, The
Banjul (E)
GERMANY, Democratic People's Republic
Berlin (E)
GERMANY, Federal Republic of
Bonn (E) - NIV
Berlin (M) (CG)
Bremen (CG) - r^iV
Duesseldorf (CG) - NIV
Frankfurt (CG)
Hambourg (CG) - NIV
Munich (CG) ~ NIV
Stuttgart (CG) - NIV
GHANA
Accra (E)
GIBRALTAR
(See MOROCCO
GILBERT ISLANDS
(See FIJI)
Tangier)
GLORIEUSES ISLES
(See MADAGASCAR)
GOA
(See INDIA - Bombay)
GREAT BRITAIN AND NORTHERN IRELAND
(See UNITED KINGDOM)
G nfiTT'
*< P" ?™ a B*
IKt,t.UL,
tthe
"hessaloniki (03)
APPENDIX B/C/E
Exhibit 1
(See BARBADOS)
GUADELOUPE
(See FRANCE - Port-de-France)
Guatemala City (E)
GUERNSEY (Channel Islands)
(See UNITED KINGDOM - London)
GUINEA-BISSAU
Bissau (E)
GUINEA, REPUBLIC OF
Conakry (E)
Port-au-Prince (E)
HONDURAS, REPUBLIC OF
Tegucigalpa (E)
HONDURAS - (BRITISH)
(See BELIZE)
HONG KONG, B.C.C.
Hong Kong (CG)
HUNGARY
BUDAPEST (E)
ICELAND
Reykjavik (E)
IFNI
(See MOROCCO - Casablanca)
INDIA
New Delhi (E)
Bombay (CG)
Calcutta (CG)
Madras (CG)
INDONESIA
Jakarta (E)
Medan (C) - NIV
Surabaya (C) - NIV
IRAN
Tehran (E)
/f
Exhibit 1
IRAQ
Baghdad (-USINT)
IRELAND (EIRE)
Dublin (E)
IRELAND, NORTHERN
(See UNITED KINGDOM)
ISRAEL
Tel Aviv (E)
ITALY
Rome (E) - NIV
Florence (C) - NIV
Genoa (CG)
Milan (CG)
Naples (CG)
Palermo (CG)
Trieste (C) - NIV
Turin (C) - NIV
IVORY COAST
Abidjan (E)
JAMAICA
Kingston (E)
JAMMU
(See INDIA - New Delhi
PAKISTAN - Islamabad)
JAN MAYEN ISLAND
(See NORWAY)
JAPAN
Tokyo (E)
Fukuoka (C)
Naha, Okinawa (CG)
Osaka-Kobe (CG)
Sapporo (C)
JERUSALEM
Jerusalem (CG)
JORDAN
Amman (E)
JUAN DE NOVA
(See MADAGASCAR - Antananarivo)
KAMARIN ISLAND
(See YEMEN - Sana)
KASHMIR
(Part under control of India,
See INDIA - New Delhi; Part
under control of Pakistan,
See PAKISTAN - Islamabad)
KENYA
Nairobi (E)
KENNER REPUBLIC (CAMBODIA)
(Closed)
KOREA
Seoul (E)
KUWAIT
Kuwait (E)
LACCADIVE ISLANDS
(See INDIA - Madras)
LAOS
Ventiane (E)
LATVIA
(See SOVIET UNION)
LEBANON
Beirut (E)
LESOTHO
Maseru (E) - NIV
LIBERIA
Monrovia (E)
LIBYA
Tripoli (E)
LIECHTENSTEIN
(See SWITZERLAND - IV Bern, NIV
LITHUANIA
(See SOVIET UNION)
LUXEMBOURG
Luxembourg City (E) - NIV
MACAO
(See HONG KONG)
MACIAS NGUEMA BIYAGO
(See CAMEROON)
MADAGASCAR (MALAGASY REPUBLIC)
Antananarivo (E)
MADEIRA ISLANDS
(See PORTUGAL - Lisbon)
MALAGASY REPUBLIC
(See MADAGASCAR)
10/1/80
2-36
C -tJ VJ
APPENDIX B/C/E
Exhibit 1
Valletta
(See INDONESIA - Jakar
MAN, ISLE OF
(see U'lii
HAIL ISLANDS
Flajuroy District Administrator
MARTINIQUE (FRENCH WEST INDIES)
MATS!) ISLAND
(See HQHG rtONG)
TTIK
(See MOROCCO - Tangier)
jxico, i).F. (E)
Ciuiiad. Juarez (C)
Guadalajara (CG) - NIV
HennosiTJo (CG) - NIV
Matamoros (C) - NIV
Ida (C)
Monterrey (CG)
Neuvfv Laredo (C)
Tijuana (CG)
MOLUCCA ISLANDS
(See INDONESIA - Jakarta)
ANCE - IV Paris, NIV Nice)
(See CHIMA, Beijing)
ibat (E) • f
Casablanca (CG)
Maputo (E)
- Cape Town)
REPUBLIC OF
(See AUSTRALIA - Sydney|
NEPAL, KINGDOM OF
Kathmafidu (E)
NETHERLANDS
The Hague (E) Dip!, and official
Amsterdam (CG) - NIV except "K"
Rotterdam (CG)
NETHERLANDS ANTILLES
Curacao (CG)
NETHERLANDS GUIANA
(See SURINAM)
NEW CALEDONIA
(See FIJI)
NEW HEBRIDES
(See FIJI)
NEW ZEALAND
Wellington (E)
Auckland (CG)
NICARAGUA
Managua (E)
NICOBAR ISLANDS
(See INDIA » CalcuttaJ
NIGER
Niamey (E)
10
APPENDIX B/C/
Exhibit 1
NIGERIA
Lagos (E)
Kaduna (C) - NIV except "K" category
NIVE
(See NEW ZEALAND - Wellington)
NORFOLK ISLAND
(See AUSTRALIA - Sydney)
NORTHERN IRELAND
(See UNITED KINGDOM - London)
NORWAY
Oslo (E)
OKINAWA
(See JAPAN - Naha)
OMAN
Muscat (E)
PAKISTAN
Islamabad (E)
Karachi (CG)
Lahore (CG)
Peshawar (C) - NIV
PALAU ISLANDS
(See CAROLINE ISLANDS)
PALESTINE
(See JORDAN)
PANAMA
Panama City (E)
PAPUA, NEW GUINEA
Port Moresby (E) - NIV
(See AUSTRALIA - Sydney - IV)
PARAGUAY
Asuncion (E)
PEMBIA ISLAND
(See TANZANIA - IV Dar es Salaam,
NIV Zanzibar)
PENGHU (Pescadores)
(See HONG KONG)
PERU
Lima (E)
PHILIPPINES
Manila (E)
Cebu (C) - NIV (except "K" visas)
PITCAIRN
(See NEW ZEALAND - Wellington
POLAND
Warsaw (E)
Krakow (C) - NIV (except "K"
Poznan (C) - NIV (except "K"
PONAPE DISTRICT
(See CAROLINE ISLANDS - EASTE
PORTUGAL
Lisbon (E)
Oporto (C)
Ponta Delgada (C)
PORTUGUESE EAST AFRICA
(See MOZAMBIQUE)
PORTUGUESE GUINEA
(See GUINEA BISSAU)
PORTUGUESE TIMOR - Part of Ind
(See INDONESIA - IV Jakarta,
Surabaya
QATAR
Doha (E)
QUEMOY ISLANDS
(See HONG KONG)
REUNION ISLAND (Overseas Depar
of France)
(See MADAGASCAR)
RHODESIA, SOUTHERN
. (See ZIMBABWE)
ROMANIA
Bucharest (E)
ROTA ISLANDS
(See MARI Am ISLANDS)
RWANDA
Kigali (E)
RYUKYU ISLANDS (Okinawa)
(See JAPAN - Naha
SABA
(See Netherlands Antilles)
ST. BARTHELEMY
(See FRANCE:- Fort-de-Francc
3-38
APPENDIX B/C/E
ExWblt 1
ST. CHRISTOPHER - MEVIS, STATE OF
(See BARBADOS)
>> jjaa
GAL, REPUBLIC OF
(See NETHERLANDS ANTILLES)
(See SOUTH AFRICA - Cape Town)
ST KITTS
'(See ST. CHRISTOPHER - NEVIS)
ST. LUCIA
(See BARBADOS)
ST, MARTIN (St. Maartins)
(See NETHERLANDS ANTILLES FOR BUTCH
area and MARTINIQUE FOR FRENCH AREA)
ST* PAUL (Indian Ocean) (French)
(See
ST. PIERRE & MIQUELON
(Overseas territory of France)
(See Canada - Halifax for visa issuance)
(France for schedule of reciprocity fees)
ST. VINCENT
(See BARBADOS)
SAIPAN
(See MARIANA ISLANDS)
SAMOA, AMERICAN
Pago* Pago* Tutuila - Office of
the Governor
SAN MARINO
(See Italy - IV Genoa , NIV Florence)
SAN TOME AND PRINCIPE
(See GABON - Libreville)
SARDINIA
(See ITALY - IV Naples, NIV Rome)
SAUDI ARABIA
Jidda (E)
Dhahran (CG)
SCILLY ISLANDS
(See UNITED KINGDOM - London)
SCOTLAND
(See UNITED KINGDOM - IV London,
NIV Edinburgh)
e Island (E)
Freetown (E)
SIKKIM
(See INDIA - New Delhi)
SINGAPORE, REPUBLIC OF
Singapore (E)
SOLOMON ISLANDS
(Port Moresby NIV,
Sidney IV)
SOMALIA
Mogadiscio (E)
SOMALILAND
(See Djibouti)
SOUTH AFRICA9 REPUBLIC OF
Pretoria (E) Dip!, and official
Cape Town (CG)
Durban (CG)
Johannesburg (CG)
SOUTH yEST AFRICA
(See SOUTH AFRICA - Cape Town)
SOUTHERN RHODESIA
(See ZIMBABWE)
SOVIET UNION
Moscow (E)
Leningrad (CG) - NIV
SPAIN
Madrid (E)
Barcelona (CG) - NIV
Bilboa (C) - NIV
Seville (CG) - NIV and IV not
to numerical limitations(IR, SB,
SC9 SD, SE only)
SPANISH SAHARA
(See SPAIN - Madrid)
SRI LANKA (CEYLON)
Colombo (E)
STEWART" ISLAND
(See NEW ZEALAND
Wellington)
Exhibit 1
SUDAN
Khartoum (E)
SURINAM
Paramaribo (E)
SVALBARD
(See NORWAY)
SWAZILAND, KINGDOM OF
Mbabane (E) «- NIV
SOUTH AFRICA - Johannesburg IV
SWEDEN
Stockholm (E)
Goteburg (CG) - NIV
SWITZERLAND
Bern (E)
Geneva (BRANCH OFFICE) Dip!, and
official NIV)
Zurich (CG) - NIV
SYRIA
Damascus (E)
TAIWAN
(See HONG KONG)
TANZANIA, United Republic of
Dar»es-Salaam (E)
Zanzibar (C) - NIV
TASMANIA
(See AUSTRALIA - IV Sidney,
NIV Melbourne)
THAILAND
Bangkok (E)
TIMOR
(See INDONESIA - IV Jakarta,
NIV Surabaya)
TINIAN ISLANDS
(See MARIANNA ISLANDS)
TOGO
Lome (E)
TOKELAU ISLANDS
(See NEW ZEALAND - Wellington)
TONGA
(See FIJI)
TRINIDAD AND TABAGO
Port-of-Spain (E)
TRISTAN DA CUNHA (Dependency of
St. Helena)
(See SOUTH AFRICA - Cape Town)
TROMELIN ISLAND
(Indian Ocean - French)
(See MADAGASCAR)
TRUCIAL STATES
(See UNITED ARAB EMIRATES)
TRUK DISTRICT - Trust Territory
of the Pacific Islands
(See CAROLINE ISLANDS, EASTERN)
TUNISIA
Tunis (E)
TURKEY
Ankara (E)
Istanbul (CG)
Izmir (CG) - NIV
TANGANYIKA
(See TANZANIA)
TURKS AND CAICOS ISLANDS
(See The BAHAMAS - Nassau)
TUVALU
(See FIJI - Suva)
UGANDA
Kampala - (E)
UNION ISLANDS - Takelau
(See NEW ZEALAND - Wellington)
UNION OF SOVIET SOCIALIST REPUBLICS
(See SOVIET UNION)
UNITED ARAB EMIRATES
Abu Dhabi (E)
UNITED ARAB REPUBLIC
(See EGYPT)
UNITED KINGDOM
London (England) (E)
Belfast (Northern Ireland) (CG)
Edinburgh (Scotland) (CG) - NIV
UPPER VOLTA
Ouagadougou (E)
URAGUAY
Montevideo (E)
10/1/80
Exhibit 1
VATICAN CITY
(See ITALY - IV Naples, NIV Rome)
VENEZUELA
Caracas (E)
Maracaibo (C) - NIV
VIETNAM
(Closed)
VIRGIN ISLANDS - (British)
(See BARBADOS)
WALES
(See UNITED KINGDOM)
WALL IS AND FUTUNA ISLANDS
(See FIJI - Suva)
WESTERN SAMOA
(See NEW ZEALAND - Wellington)
WEST INDIES, FRENCH
(See MARTINIQUE)
WEST INDIES, NETHERLANDS
(See NETHERLANDS, ANTILLES)
WIGHT, ISLE OF
(See UNITED KINGDOM - London)
YAP DISTRICT (Trust territory of the
Pacific Islands)
(See CAROLINE ISLANDS, WESTERN)
YEMEN, ADEN
Sana (E)
YUGOSLAVIA
Belgrade (E)
Zagreb (CG)
ZAIRE (Former Congo-Kinshasa)
Kinshasa (E)
Bukavu (C) - NIV
Lubumbashi (C) - NIV
ZAMBIA (Formerly Northern Rhodesia)
Lusaka (E)
ZANZIBAR
(See TANZANIA)
ZIMBABWE
(See SOUTH AFRICA - Johannesburg)
AMERICAN INSTITUTE IN TAIWAN
Taipei
YEMEN, SANA
Sana (E)
FORM NO.
M-6
EDITION
REV. 10-15-80
TITLE
REGIONAL AND DISTRICT AREAS
size
8 1/2 X 11
INSTRUCTION REFERENCE
AM 2107.02, 2482 Ex. 1, P. 7
USE
INFORMATIONAL CHART SHOWING REGIONAL
AND DISTRICT AREAS AND LOCATIONS
PRIOR EDITIONS MAY NOT BE USED
| SCHJCDUIX A
4/1/81
Page 2
Appendix 1
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4/1/81
-5-T
CHAPTER 3.
3. PETITIONS AND APPLICATIONS PERTAINING TO NONIMMIGRANTS
Form 1-17 Petition For Approval Of School For Attendance By
Nonimmi grant Students ........................................... ^
Form 1-20 A & B - Certificate Of Eligibility For
Nonimmigrant F-l Student Status ............ , ..................... 3-1 C
Form 1-102 - Application By Nonimmigrant Alien For
Replacement Of Arrival Document .................. ............ .... 3-1?
Form 1-126 - Report Of Status By Treaty Trader Or Investor ....... 3-21
Form I-129B - Petition To Classify Nonimmigrant As
Temporary Worker Or Trainee ...................................... 3-2
Form I-129F - Petition To Classify Status Of Alien Fiance
Or Fiancee For Issuance Of Nonimmigrant Visa ..................... 3-3
Form 1-190 - Application For nonresident Alien Border
Crossing Card .................................................... 3-'A
Form 1-506 - Application For Change Of Nonimmigrant Status
And Requests For Change Of Nonimmigrant Status Not Requiring
A Fee Or Application ............................................. 3-4
Form 1-515 - Notice To Student Or Exchange Visitor ................ 3-5
Form 1-538 - Application By Nonimmigrant Student (F-l) For
Extension Of Stay, School Transfer, Or. Permission To Accept
Or Continue Employment ............................................ 3-6
Form 1-539 - Application To Extend Time Of Temporary Stay ........ 3-6
Form IAP-66 - Certificate Of Eligibility For Exchange Visitor
Status ........................................................... 3-i7
Documentary Requirements Necessary To Apply For A New Or
Revali dated Nonimmigrant Visa For Aliens Returning Abroad ........ 3-!7
FORMJ-17
I. USE;
USED BY A SCHOOL OR -SCHOOL SYSTEM TO PETITION FOR APPROVAL FOR
ATTENDANCE BY NONIMMIGRANT STUDENT.
II- gUGIBiyTY:.
1. MUST BE A BONA FIDE SCHOOL OR SCHOOL SYSTEM, PUBLIC OR PRIVATE,
LOCATED WITHIN THE JURISDICTION OF THE DISTRICT OFFICE WHERE
THE PETITION IS TO BE FILED,
2. MUST BE AN ESTABLISHED INSTITUTION OF LEARNING OR PLACE OF STUDY.
3. MUST BE A SCHOOL OR INSTITUTION IN POSSESSION OF THE NECESSARY
FACILITIES, PERSONNEL, AND FINANCES TO CONDUCT INSTRUCTION.
HI- REQUIREMENTS:
1. ALL PETITIONS ARE FILED IN DUPLICATE.
a. PUBLIC SCHOOLS COMPLETE QUESTIONS 1,2,6, AND 7.
b. PRIVATE OR PAROCHIAL SCHOOL MUST COMPLETE ALL QUESTIONS.
2. PROPER FILING FEE.
a. NO FEE IS REQUIRED IF THE SCHOOL IS A STATE OR FEDERAL PUBLIC
EDUCATIONAL INSTITUTION.
b. NO FEE IS REQUIRED IF THIS IS A PETITION FOR A CONTINUATION OF
APPROVAL OF A SCHOOL PREVIOUSLY GRANTED APPROVAL.
3. PETITION MUST BE SIGNED BY AUTHORIZED SCHOOL OFFICIAL. (8 C!
4. SUPPORTING DOCUMENTATION:
a. PUBLIC EDUCATIONAL INSTITUTIONS OF THE STATE OR FEDERAL
GOVERNMENT.
1. MUST SUBMIT A CERTIFICATION ATTESTING TO THE FACT THAT THE
SCHOOL IS A PUBLIC EDUCATIONAL INSTITUTION OF THE STATE OR
FEDERAL GOVERNMENT.
2. ABOVE CERTIFICATION MUST BE SIGNED BY THE APPROPRIATE PUBLIC
»s ^^ OFFICIAL AND CERTIFIED THAT HE IS AUTHORIZED TO SIGN SAME.
b. PRIVATE OR PAROCHIAL ELEMENTARY OR SECONDARY SCHOOL SYSTEM.
1. MUST SUBMIT A CERTIFICATION STATING THE SCHOOL OR SCHOOL
SYSTEM MEETS STATE OR LOCAL PUBLIC EDUCATIONAL SYSTEM
REQUIREMENTS.
2. ABOVE CERTIFICATION MUST BE SIGNED BY THE APPROPRIATE PUBLIC
OFFICIAL AMD CERTIFIED THAT HE IS AUTHORIZED TO SIGN SAME.
c. OTHER SCHOOLS, SCHOOL SYSTEMS, OR INSTITUTIONS NOT INCLUDED IN a.
OR b. ABOVE, MUST SUBMIT:
1, A CERTIFICATION BY THE APPROPRIATF LICENSING, APPROVING, OR
ACCREDITING OFFICIAL THAT IS LICENSED, APPROVED8 OR ACCREDITED
OR A STATEMENT OF RECOGNITION SIGNED BY THE APPROPRIATE OFFICIAL
OF THE STATE APPROVING AGENCY,
d. ADDITIONAL DOCUMENTATION IS REQUIRED TO BE SUBMITTED BY ALL SCHOOLS
EXCEPT:
1 . PUBLIC EDUCATIONAL INSTITUTIONS OF THE STATE OR FEDERAL
GOVERNMENT;
2. SCHOOLS LISTED IN "ACCREDITED POSTSECONDARY INSTITUTIONS AND
PROGRAMS", OR "EDUCATION DIRECTORY, HIGHER EDUCATION.11; OR
3. ANY SECONDARY SCHOOL OPERATED BY OR AS A PART OF AN INSTITU-
TION OF HIGHER LEARNING LISTED IN *2 ABOVE.
e. ADDITIONAL DOCUMENTATION REQUIRED OF ALL SCHOOLS NOT LISTED IN d.
ABOVE .
1. SCHOOL CATALOG,
2. IF NO SCHOOL CATALOG IS AVAILABLE, THE FOLLOWING INFORMATION
MUST BE PROVIDED:
a, SIZE OF PHYSICAL PLANT.
b, NATURE OF FACILITIES FOR STUDY AND TRAINING.
c, EDUCATIONAL, VOCATIONAL, OR PROFESSIONAL QUALIFICATIONS
OF TEACHING STAFF,
d, SALARIES OF TEACHERS,
e, ATTENDANCE AND SCHOLASTIC GRAOING POLICIES.
f. THE AMOUNT AND CHARACTER OF SUPERVISORY AND CONSULTATIVE
SERVICES AVAILABLE TO STUDENTS AND TRAINEES.
g. CERTIFIED COPY OF ACCOUNTANT'S LAST STATEMENT CONCERNING
SCHOOL'S FINANCES, NET WORTH, INCOME, AND EXPENSES.
f. ADDITIONAL DOCUMENTATION REQUIRED BY CERTAIN SCHOOL'S NOT
LISTED IN d. ABOVE.
1. INSTITUTIONS OF HIGHER EDUCATION.
a. EVIDENCE THAT IT CONFERS RECOGNIZED DEGREES, OR IF NO
DEGREE IS CONFERRED, THAT CREDIT IS ACCEPTABLE TO OTHER
INSTITUTIONS.
b. IF UNABLE TO SUBMIT EVIDENCE OF UNCONDITIONAL ACCEPTANCE
OF ITS CREDIT PETITIONER MUST SUBMIT A STATEMENT THAT THE
INSTITUTION IS RECOGNIZED AS A "CORRESPONDENT" OR "CANDI-
DATE FOR ACCREDITATION" FROM A NATIONALLY RECOGNIZED
REGIONAL ASSOCIATION.
2. ANY ELEMENTARY OR SECONDARY SCHOOL MUST SUBMIT EVIDENCE THAT
IT QUALIFIES GRADUATES FOR ACCEPTANCE BY OTHER ACCREDITED
SCHOOLS.
3. VOCATIONAL OR BUSINESS SCHOOLS, OR AMERICAN INSTITUTIONS OF
RESEARCH RECOGNIZED AS SUCH BY THE ATTORNEY GENERAL MUST
SUBMIT EVIDENCE THAT ITS 'COURSES OF STUDY ARE NOT A VOCATIONAL
OR RECREATIONAL IN CHARACTER.
f
PETITION FOR APPROVAL OF
SCHOOL FOR ATTENDANCE (rleas^ tear off thts pase before suhmitltng petition)
1Y NOIMMIGRANT STUDENTS
INSTRUCTIONS
1. r :'.m,> of Petition: This petition (Form 1-17) shall be filed in duplicate with the District Director or Officer-
s-Charge of the Immigration and Naturalization Service having administrative jurisdiction over the place in
-ruch the school or school system is located. One petition may be filed for an entire school system if all
schools of the system are located in the same immigruion district. Separate petitions are required of school-
system schools located within the jurisdiction of different district directors, [f the petition is for a school
s '.stem, attach a list identifying by name and location those schools included in this petition.
2. A fee of twenty dollars ((20) muse be paid (or filing this petition. It cannot be refunded regardless of the action taken on
-.he petition. DO NOT MAIL CASH. ALL FEES MUST BE SUBMITTED IN THE EXACT AMOUNT. Payment
by check or money order must be drawn on a bank or other institution located in the United States and be payable in
L'nited States currency. If petitioner resides in Guam, check or money order must be payable to the "Treasurer, Guam." If
petitioner resides in the Virgin Islands, check or money order must be payable to the "Commissioner of Finance of the
Virgin Islands." All other petitioners must make the check or money order payable to the "Immigration and Naturalization
Service." When check is drawn on account of a person other than the petitioner, the name of the petitioner must be entered
;n the face of the check. If petition is submitted from outside the United States, remittance may be made by bank
:.iternational money order or foreign draft drawn on a financial institution in the United States and payable to the
Immigration and Naturalization Service in United States currency. Personal checks are accepted subject to collectibility. An
uncollectible check will render the petition and any document issued pursuant thereto invalid. A charge of $5.00 will be
imposed if a check in payment of a fee is not honored by the bank on which it is drawn. A fee is not required if the
petitioner is a school or school system owned or operated as a public educational institution or system by the United States
->r a State or a political subdivision thereof. Also, a fee is not required if the petition is for continuation of approval
previously granted by the Immigration and Naturalization Service. (See Instruction No. 9.)
3 Execution of Petition This form must be executed by the principal officer of the school authorized to ex-
ecute contracts. A petition in behalf of a public school must be made by the School Board and signed by
its president or chairman. In the case of a petition in behalf of a public school, only questions 1, 2, 6,
and 7 must be completed.
4. SupportinR Documents, (a) General, Except in the case of a petition bv aschool within category (11. (2) or
(3) of paragraph No. S below, a school catalogue, if one is issued, must be submitted, [f not included in the
catalogue or if a catalogue is not issued, the school must furnish a written statement containing information
concerning: (1) the size of its physical plant; (2) the nature of its facilities for study and training; (3) the
educational, vocational, or professional qualifications of the teaching staff; (4) salaries of teachers; (S) at-
tendance and scholastic grading policy; (6) the amount and character of supervisory and consultative services
available to students and trainees; (7) finances (including certified copy of accountant's last statement of
school's net worth, income, and expenses):
Unless the petitioner is within categories (i) or(ii) of paragraph (b) below, it must submit a certification by
the appropriate licensing, approving, or accrediting official that it is licensed, approved, or accredited. In
lieu of such certification, a school which is recognized by a state approving agency as an "educational
institution" for study for veterans under the provisions of P.L. 550 (82nd Congress) may submit a statement
of recognition signed by the appropriate official of the state approving agency. A charter is not considered
a license, approval or accreditation.
(b) Additional Documents Required.
I'i) School or school system owned or operated as a public educational institution by the United States
or a state or political subdivision thereof - must submit a certification to that effect signed bv the
appropriate public official.
Hi) Private or parochial elementary or secondary school or school system • must submit a certification
signed by the appropriate public official that it meets the requirements of the state or local public
educational system.
(iii) Institution of higher education not included within category 11) 01 (2) of paragraph No. 5 below -
must submit evidence that it confers upon its graduates recognized bachelor's, master's, doctor's,
professional, or divinity degrees, or if it does not confer such degrees that its credits have been and
are accepted unconditionally by at least three institutions of higher learning within category (1)
Or (21 If unable to submit evidence of such unconditional acceptance of its credits, the petitioner
creduation" from a nationally recognized regional association which has jurisdiction over accredita-
tion of institutions of higher education in the geographical area where the petitioner is located.
fOflM 1-17 (R«v 6-JO-OO) N "
FORM NO.
1-17
EDITION
REV. 6-20-80
TITLE
PETITION FOR APPROVAL OF SCHOOL FOR ATTENDANCE
BY NONIMMIGRANT STUDENTS
SIZE
a 1/2 x n
INSTRUCTION REFERENCE Q CFR 214. 3(a), (e), (h), 299.1; 01 214. 2(f) (7), 3-
AM 2301.07, 2482 Ex. 1. P. 5, 2984 Ex. 2, Ex. 4, P. 3, II Hbk 9-8, -24, -25, -26 -26 1-
GIB A-6 ' '
USE
FILED BV INSTITUTION OR PLACE OF STUDY WITH DO OR QIC TO OBTAIN APPROVAL
REQUIRE: BY SECTION im(a) (15) (F) OF THE i & N ACT
PRIOR E:ITIONS MAY NOT BE USED
| SCHEDULE A
4/1/81
- 2-
(iv) Elementary or secondary school not included within category (1) or (3") of paragraph No. 5 below -
must submit evidence that it qualifies graduates for acceptance by schools of higher educational
level within category (1 ) (2) ot (3) of said paragraph.
(v) Vocational School, business school, or American institution of research recognized -as such by the
Attorney General - must submit evidence that its courses of study are accepted as fulfilling the
requirements for the attainment of an educational, professional, or vocational objective and are not
avocational or recreational in character.
5. Consultation by the Immigration and Naturalization Service with the United States Office of Education. Before
a decision is made on the petition, the District Director of the Service will consult the United States Office
of Education by transmitting to that Office the petition, supporting documents and any report of interviews or
other inquiry conducted by the Service, with a request for advice as to whether the petitioner is an estab-
lished institution of learning or other recognized place of study, is operating a bona fide school, and has the
necessary facilities, personnel and finances to instruct in recognized courses. .However, since the United
States Office of Education has advised that each of the following is so considered, consultation with that
Office is not required if the school is within one of the following categories:
(1) Any school or school system owned or operated as a public educational institution by the United States or
a state or political subdivision thereof;
(2) Any school listed in the current United States Office of Education publication, "Accredited Postsecondary
Institutions and Programs", or "Education Directory, Higher Education";
(3) Any secondary school operated by or as part of an institution of higher learning listed in the current United
States Office of Education publication, "Accredited Postsecondary Institutions and Programs", or "Educa-
tion Directory, Higher Education".
6. Interview of Petitioner. An authorized representative of the petitioner will be requested to appear in person
before an Immigration officer prior to adjudication of the petition, to be interviewed under oath concerning
eligibility of the school for approval unless the school is within category (1), (2) or (3) of tne preceding
paragraph.
7. Eligibility for Approval. To be eligible for approval the petitioner must establish that it is a bona fide school,
that it is an established institution of learning or other recognized place of study, and that it possesses the
necessary facilities, personnel, and finances to conduct instruction in recognized courses and that it is, in
fact, engaged in instruction of students in said courses.
8. Notification of Approval of Petition. Upon approval of petition, the petitioner will be notified by the return
of a copy of the Form 1-17, approved and signed by the District Director.
9. Review of School Approval. The district director of the Immigration and Naturalization Service is required to
review the approval accorded to schools in his district from time to time. The review is made to determine
whether the school has complied with the reporting requirements concerning students, and continues to be
eligible for approval. Each school whose approval is reviewed may be required to furnish a currently exe-
cuted Form 1-17 as a petition for continuation of approval, without fee, together with the supporting docu-
ments specified in that form. The review may include interview of the school's authorized representatives
and consultation with the United States Office of Education. If upon completion of the review the district
director finds that the approval should be continued, he will so notify the school in any case in which
Form 1-17 was submitted as a petition for continuation of approval; otherwise, he will institute proceedings
to withdraw its approval.
4/1/81
FORM APPROVED
OMB NO 43-RO 467
UNITED STA.TFS DKP ARTMF.NT Of JUSTICE , , .
Immigration and Naturalization Servics
PETITION FOR APPROVAL OF
SCHOOL FOR ATTENDANCE
BY NONIMMIGRANT STUDENTS
(Please read instructions before filling in form. If you need more space to answer fully any items on this form, use •
a separate sheet; identify each answer with the number of the corresponding item; and' sign and date each sheet.}
TO THE IMMIGRATION AND NATURALIZATION SERVICE:
Petition is made for approval, or continuation of approval, of this institution as a school for attendance by
nonimmigrant alien students under Section 101(aX15XF) of the Immigration and Nationality Act, and the following
statement of facts is submitted:
1. Name of School
7 T. oration
(Sttaat and Number) (Citr) (County) (St»t») (Zip Codt)
Mailing Address (if different from above)
3. Petition is for |~~] initial approval [~~| continuation of approval (See Instruction No. 9)
4. Date school established
S Name and address of owner
(Street and Ntmbar) (City) (County) (Statt) (Zip Codt)
6. This school is a [~~| public | | private institution.
7. The school operates under the followingFederal, State, local, or other authorization: (If none, write "none".)
8. The school has been approved by the following national, regional, or State accrediting association or agency:
(If none, write "none".)
9. The school is engaged in: (Check appropriate blocks and explain further if necessary.)
| ] Elementary or Secondary Education. It | | does |~~1 does not qualify its graduates for acceptance by
accredited schools of higher educational level.
I | Higher Education. It [^] does [ | does not confer recognized bachelor's, master's, doctor's, professional, or
divinity degrees. Its credits [~~| are f""1 are not recognized by and transferable to institutions of study
which confer degrees.
I | Vocational or Technical Education. It [ | does | | does not qualify its graduates for employment in the
occupations for which preparation is offered.
(R«v. 8-20-60) N * 3 "
4/1/8
-4-
10, Calendar of school year, including terms or semesters: „
11. Sessions: Q Day only [3 Night only Q Day and Night
12. Requirements for admission:
13. Courses of study and time necessary to complete each:
14. Requirements for graduation:
15. Causes for expulsion:
16 Average »nnii«»1 mincer nt: Classes Teachers or Instructors
Students Non-teaching employees
17, Approximate annual total cost of room, board, tuition, etc. per student S
If the school is approved, THE PETITIONER AGREES:
(1) Upon acceptance of any nonimmigrant alien student, to furnish such student a Certificate of Eligibility (Im-
migration and Naturalization Service Form 1-20)
(2) After receiving notice of arrival in the United States of a nonimmigrant alien student destined to this insti-
tution, to submit immediately to the office of the Immigration and Naturalization Service having jurisdiction over the
area in which the institution is located, reports in writing (Service Form J-20B), whenever such student:
A. Fails to register personally at the school within 60 days of the time he is expected to do so; or
B. Fails to carry a full course of study; or
C. Fails to attend classes to the extent normally required; or
D. Terminates his attendance at this institution.
(3) That in any advertisement, catalog, brochure, pamphlet, literature, or other material hereafter printed or
reprinted by or for this school, any statement which may appear in such material concerning approval for attend-
ance by nonimmigrant alien students shall be limited solely to the following:
"This school is authorized under Federal law to enroll nonimmigrant alien students".
Dated at . this day of , IP,
I certify that I am authorized to execute this petition.
(CORPORATE 'SEAL
OF INSTITUTION! (Signitun)
TO PETITIONER! DO NOT FIUL IN BLANKS BELOW THIS LINE. (Title)
File Number
APPROVED , 1Q DAOTFE
ACTION
DD
District Director
OFFICE
At
IF THE AGREEMENT IS NOT COMPLIED WITH. APPROVAL MAY BE WITHDRAWN.
U,S, GOVERNMENT PRINTING OFFICE : 19BO 0 - 3JM-17
4/1/81
3-10
FORM 1-20 A & B
!• USE:
USED BY A NONIMMIGRANT ALIEN TO SHOW ACCEPTANCE AT A UNITED STATES
SCHOOL IN ORDER TO APPLY FOR NONIMMIGRANT STUDENT STATUS,
II. ELIGIBILITY:
DETERMINED BY THE SCHOOL.
HI- REQUIREMENTS:
1. ISSUING SCHOOL MUST BE APPROVED FOR ACCEPTANCE OF NONIMMIGRANT
STUDENTS BY THIS SERVICE,
2. ITEM #7 I-20A MUST BE COMPLETED BY SCHOOL SHOWING SCHOOL IS APPROVED,
3. MUST BE SIGNED BY SCHOOL OFFICIAL ON FRONT OF I-20A.
4. FORM MUST BE OBTAINED FROM THE SCHOOL AUTHORIZING ACCEPTANCE, MAY
NOT BE OBTAINED FROM IMMIGRATION & NATURALIZATION SERVICE.
5. REVERSE OF I-20A MUST BE COMPLETED AND SIGNED BY ALIEN
PROSPECTIVE STUDENT.
6. IF ALIEN IS INSIDE THE UNITED STATES AND SEEKING A CHANGE OF
STATUS, COMPLETED I-20A&B MUST ACCOMPANY 1^506 APPLICATION.
7. IF ALIEN WILL APPLY FOR STUDENT STATUS ABROAD, COMPLETED I-20A&B
MUST BE HANDCARRIED TO THE CONSULAR OFFICE,
8. IF A NONIMMIGRANT STUDENT WITH A VALID NONIMMIGRANT VISA IN HIS
PASSPORT WISHES TO PROCEED ABROAD TEMPORARILY AND RETURN TO
' THE UNITED STATES TO CONTINUE STUDYING, HE MUST TAKE A COMPLETED
FORM I-20A WITH HIM FOR PRESENTATION TO AN IMMIGRATION OFFICER
UPON HIS RETURN TO THE UNITED STATES. (ALIEN STUDENTS EXEMPT VISAS,
SUCH AS CANADIANS, MUST DO THE SAME,)
TM 76*.
Appendix \
Paga 1
READ CABimjULY THE INSTRUCTIONS OW PAOf 4
*e. MO. 4»-MMT
CERTIFICATE
OP
ELIGIBILITY
VtVMNT BTATUB)
L n>» antna wawl ftoeui mt Men mucud h» a ma «rarae o mM» u Ma BMHUK «
O M
KMM I.KM (K(V. 4-1-rVI N UMITBO STATO* OapAJKTMBMT O* JUSTICa lilimlmilHHM MM I
REN/. (2-15-75
EDITION
fttv. ii 1 K
FORM NO.
I-20AB
CERTIFICATE OF ELIGIBILITY
(For Noniwnigr»nt "F-t" Student Status)
SIZX
8X10 1/2
ADO. S-A; Inv. Hbk 21
FROM ONE SCHOOL TO AHOTHER
1
PRIOR EDITIONS MAY NOT BE USED
I.-20AB
Page 2
ADMINISTRATIVE MANUAL
Appendix 1
CfBTIPOTi BY NONIMMIGRANT STUDENT UNDER SECTION 101 (a) (15) (f) (i)
OF THE IMMIGRATION AND NATIONALITY ACT
Page 2
1. I saek la antar or remain in tha united States temoararily and solely lor th» purposa of pursuing a full course of study at tho school nar-ed on
page 1 of this form.
2.
Pteat* print name in full
4.
My educational oowctive is
a.
I am financially ibl« to support myself for tha entire period of my stay in the United States while pursuing a full course of study. (State source
and amount of support:) (Documentary evidence o> means of actual support must be attached to this form)
a
I last attended (Nona of School) JCily) (State) (Country)
7.
My maiof field ol studies was
8. I completed such stuaias on (Data)
9.
The oersnn moat closriv related to ma who lives outside cne United Slates >a:
(Name) (Ralution»hip)
(Add raw)
10.
(Name) (Relationship)
n the Unitad Slates, give tha name cf a friend.)
(Address)
11 I understand tha following:
a. A nonimmigrant student applying lor admission to the United Stales for tha fir'! time af'er bain? issued an F-i (sludont's) visa, will not h« admitted
unleu ha intends to attend in« school ipecitiod .n that visa. Therefore, it before he departs for the United f. tat as tna student decides to .mend some
ot.'-.er school. r;o should communicate with the issuing American consular office tor tha purpose of having such order scnool specified in fin visa. Any
other nonimmigrant student will nor btf admitted to tha United Stales unless he intend? to attend (M* v:*ooi «c«ofied m the Form 1-20 or Form 1-94
which ha presents to tha immigration officer at the port of entry.
b A nonimmigrant student is not jerm ttec to work alf-oamgus for a waga or salary cr engaga in business *•".!; in tfte UrtiHW States unltss permission
U do so h.is (irtt b«cn -iftntod by tno im:,ngrjt,on and Naturaliiatie-n Service A •t-.ir'.Tit wno requires emolcymonf '1 • Sncause of economic nocessity
due to unforcs^ten circumstances arising after admission, or (2) to obtain practicnl training, rnjy apply to the Immigration and Naturalization Service on
Form 1-538 for parrmsjion to accept luch employment. Additional information cocr.atr.:r<j employment if cat forth in Form 1-533. The alien SI?OL".>» or
child accompanying or following to |om a nonunmigrant student is not permitted to wor* in tha United Sla'es
c A nonimmigrant student Is permitted to remain In tha U"
the
id S'ltos only whilo nslnfi'ninc nonimrr.:grant studont j:?*us. and in any «v.-i" not longer
st...-1'tnt clasoil'-ati-.- ••'. uniesu u« aopitr.s to tho lrnmi;r:'..jn and Naturi'ir ;i: n Sarvica on
balw.an i 5 and .to C.v.'i, ,?.ior *a :-.c oxcirailci c? da uariod of his ai'thcru:.-! stay and
rorm 1-336 la rrcvrdance with tha instructions en that lorm balwr.en 13 »no 30 cayi i?.ior'a t~.c oxcirailci c
obtains an extension of hi> slay.
d iach y*ar. e<«ry nonimmigrant student in :no United Stales on tha first day of J.inunry m .*t submit by the ,1l-;t cf January a written notice of his
address *o the Immigration and Naturalization Service In adoption a notice mu^t bo -, .:t v;>:r-.i 10 days after ?v.-.-y rMange of ade*r>'>». n^ga'dlas^ c.l
whether n* mouea. «ach nonimmicj'»nt sti>d*r<l is require*! to file written noi>ce of h-« address wary 3 moni.ii ?nnl«-1 form* obtmnkbla at tna United
SIJ
addrau report.
e. At the time J nonimmigrant jtuctont leoatts from the l.'nftcd States, nis temocnrv r.-'ry c^i^""' 'Form t-941 is ..i Co rirrenderod! to a r«ir«sentative
ol thealeamsRia oratrlir.eif hd lu.-ve* via a ser.;;rt or airport, to a Canadian in- -nigraticn ctflr.cr if ne leaves furors the Canadian border. ;r to a United
Stttas immioralion officer if no leaves across the Maxican border
f A neniri""' <rar.t -ti.dAut may r?ma>n in tr.it United Stales lemporartly only for trte ;:'jrpo-o of piirsr'tn I ful( cc-i«^ ol study at a T.D'.-cifJo-i school.
17. attar being adiritttid. the iturtent di>«irns to tr;r.cfTto another school, ha must m-^o ,..-i;:cn ac3i:;jticr. on rorm !-."3" for permission to m.iko s;:ch n
transfer Th« j-pi'>c??on m\,st bo sutsmutp? f> C.a r'"<r9 of the Imr'i!3r3ti.5n and Natura.'Jrarlon Service hav!.:3 jui.s.'Ic:.-':.'' over th.i -re-v in wnien the
scnool from wr>'v.h r.a w>shes to transfer ii '.(wraterf. Th^ aoolicaticn must be accomsnnied by Form l-,?0 c.'.rncletcd by fhi» school to which h» vii«h^i to
transfor. Ha may not iransfer until his application is aaprovad. The application will ba denied if tne student t~ Ic j to Actually take a fuil cc .r.-.-i ol itjdy
at t^e school he was last authorized by the Sar/ic<( to i:tci)d, uiitaas fi-a establishes trtut '••' * fnilura to do so v,~z J.ie t.i CnCumstances beyond Mis control
or was otnarwiao lustllied.
9 A studani who icciu. :a re-enter the United Slates as j nonimmigrant student after a temporary amonca -nuat be in possession of tha following
documnnti: li) A jiliJ unexpireU student u.sa !ur.:»sj exainpi frcm visa '»qu>rerrcnts) !ii' A passport vtl'-l for six months beyond the s«nod of raad-
mmion (unless exempt from passport requirement* V. (ili) A current copy of Firm (-7.0 (A arid 8). However only tho'A'copy of Form I-IO Is required
in the case o« I nc.itmmigrant student raturnmr; from temporary aMrance c^tsida tha United States to cantlnuo a"«ndanc» at the seme jrr.ooi v/hich
the Immigration and Naturalization Service last authorized him In <nend: In mch cn"~ ^orm I-20A may be retainer) by the student and JSS'J by him for
any number ul recnlnaa within twelve oonths from lha date of issuance, the carti(<caia on page 2 of Form I-20A need.not be eomoleMirl. and Form
1-208 should be destroyed.
h. A nonimmigrant student who does not register at the school specified in his temporary gntry permit 'Form 1-94). or whose school attendance is termi-
nated, or who takes le*is than a full course of study, or who accents unauthorized employment, thereby fails to maintain his status and must depart from
the United States immediately.
I CERTIFY THAT THE ABOVE IS CORRECT. I hereby agre* to comply with the above and any other terms and conditions of my admission and any
extonsion of stay. I hereby authorise the named school and any school to which I may subsequently trana.'ar to release to the Immigration and Natural-
ization Service any information from my education records wmch tna Service needs to knew in order to dalermina If I am maintaining the lawful non-
immigrant status in which I was admitted to the United States under tha immigration law. Mora specifically. I authorize the school to report. In writing,
to the immigration and Naturalization Service if I fail to register within 6O days of the time expected, if I fail to carry a lull course of study, if I full to attend
classes to the extant normally required, if I am failing courses, if I becoma employed or if I terminate attendance at tha named school and to provide) tha
Service upon demand with my latest address.
Signature of Student
Address (City) (State or Province) (Country)
(Signature of Parent or Guardian if Student is Under 18 Yeara of Age)
[Relationship) (Date)
appendix i
NOTICE AND REPORT CONCERNING
NONIMMIGRANT T-1" STUDENT
UNITED STATES DEPARTMENT OF JUSTICE
end NatawaUaaflmi Servtoo
Name o( Student— Family Name (Capital tetter*)
Date of Birth (Mo., day. yaar) Country of Birth
Country ol NettonaMy
READ CAREFULLY THE INSTRUCTIONS ON PAGE 4
Name ol School
School Official To Ba Notified of Student B Arrival Ml U.S.
Adereu o< School (include Zip Cod*)
Via
aheumgPoot
PART II-MOTICB TO BCMOOL CONCIRNINO f.1- BTUMNT
A* Indicated herein, the above named «iu4«nt we* admlnvd to or authoruM) to remain m Ina UnMcd
SUrtat lor • temporary p*nod •» t norummlprmnl ituOanL
3V»B TOUB aCMOQL
N*TUHALI2»TION StBVlCi Of IT« *PI»BOVAL OF TOUR KMQQL f QH ATTBNPANCB BY HONIMMinBAHT
«TUP«NT«.
TO: til
1.
•mtoratton and NaturaUttben Aenrk
The atudent (Check on*,):
(A) Q DM not reglMer paraonair
(B) D l» carrying lew man a lull
(C) Q Terminated attendance oi
PART HI-REPORT 0Y SCHOOL CONCBRNINO l^f BTUMNT
oe
/ at mil aehool within 60 day* of the data expected
lflii«« munn tar MrmlnolMMi m Aamartu.)
(TemunaUon data)
* (°) O Terminated attendance at thu aehool u»on commotion of the aameatar.
(r}t-» r*MO" iv «*n«l«Ml}»« In Itamarta.)
(Termination data)
• Do not report temporary ditcontinuanee of attendance during a vlelt abroad, or beceuae of acute Illnaoi or tntury. However. H (iudent talli to reeume attendanoi
triii report mud be tubmltted A atudent who. on the ban* ol the recommendation ol your achool, ha* been authorized 10 accept employment lor practical training
In a field related to hit eouree of (tudlet it conalderod to be In attendance at your tchool during me authortied period of ouch employment. Plaaaa ba gukted
accordingly In eubmrrttng report! concerning atuoenti who have been permitted to engage m practical training.
2 Theatudent'ilastreiioeneeeddreulntheU.S war (Apt. number and/or In care ofXNumber and tweet) (City or town) (Slate)
(Zip Code)
3 The
4. Refl
tollowing Inlormalion it lurnithed concerning the atudenfi departure or planned oepanure from the UnllaO State*:
Data ol departure
Port of departure Name ol (hip, airline, or transportation company
Add rea* abroad
Mrtu):
Signature ol achool off Mual
Title Data
FORM I.20B (REV. 4-1-70) H
Pagas
10/1/80
I-20AB
Page 4
ADMINISTRATIVE MANUAL
Appendix 1
TM 764
INSTRUCTIONS TO SCHOOL OFFICIALS
This certificate may be signed and issued only by an authorized school official in the United States
after he has determined that the student is eligible. A faise certification or improper issuance of this
certificate to a student may result in revocation of the approval of your school for attendance by
foreign students.
1. Before issuing this certificate you rr>ay wish to arrange to have the stu'.'srt tested for Ensiibh language proficiency. If you wish
to use a test of your own selection you may have it administered abroad by any person or agency you care to designate or by an
American consular officer. Alternatively, if you wish to use a test which lias been furnished to American consular officers by the
Deoartment of State, you should instruct the student to arrange with the consular officer to take the Department's English
language examination. The results of any test administered by the consular officer will be forwarded direct to you.
You should not issue this certification unless you are satisfied that Ihe student meets the language and scholastic requirements
to pursue the proposed course of study at your school, and that he is able to pay his expenses (including those of any accom-
panying spouse and children) during his stay in the United States. A copy of the evidence submitted by the student concerning
scholastic preparation and ability to pay expenses must be retained by the scnool for the duration of the student's attendance
there.
2. Complete page 1, and PART 1 of page 3. of this form for.
a. Every nonimmigrant student whom you accept for admission to your school and who will apply for a visa and/or admission
to the United States under Section 101 (a) (15] (F) (i) of the Immigration and Nationality Act;
b. Every nonimmigrant student in the United States whom you accept for transfer to your school;
c. Every alien in the United States who applies for a change to nonimmigrant student status and has been accepted to attend
your school. (An alien who has been admitted or seeks admission to the United States. for permanent residence is not clas-
sifiable as a nonimmigrant student. Forms I-20A andB should not be issued to any such alien.)
Remove cartoon interleaf and furnish I-20A and 1-208 to the student. The Immigration and Naturalization Service, after authorizing
admission (except in the case of a student returning from a temporary absence outside the United States to continue attendance
at the same school), transfer, or change m status, will endorse and mail Form I-20B to the school. For procedure applicable in the
case of a nonimmigrant student returning from a temporary absence outside the United States to continue attendance at the same
school, see item 1 1 g. page 2, of Form I-20A.
3. A student's spouse and minor children following to join him are not eligible for admission into the United States unless they
present Form I-20A from the school in whicn the student is enrolled, stating that he is taking a full course of study, and the
form is noted by the school to indicate the date of expiration of his authorized stay in the United States as shown on the stu-
dent's Form 1-94. When issuing Form I-20A for the use of his spouse and minor children, the school should fill in only the block
giving the name and personal data relating to the student, the block giving name and address of the school, item 7 relating to
school approval, and item 3, "Remarks", showing the date of expiration of the student's stay as, "Student's authorized stay
In United States anoiraa ....." in this instance. Form 1-208 and the carbon interleaf should be destroyed.
(date)
4. If the student fails to register, does not carry a full course of study, or does not attend classes as required, or if his attend-
ance is terminated, fill in PART III of Form 1-208 (page 3) and mail immediatery to th« office of the Immigration and Natural-
ization Service having jurisdiction over the area in which your school is located. (Pleas* read PART II of Form I-20B for further
instructions.)
INSTRUCTIONS FOR NONIMMIGRANT STUDENTS
1. Fill in page 2 of Form I-20A and complete and retain page 5 for your records. Do not fill in any other pages of the form.
2. If you are an applicant for admission to the United States, present bom I-20A and I-20B to the American consular officer at the
time of your visa application (unless you are exempt from visa requirements) and to the immigration officer upon your arrival in
the United States. If you are exempt from visa requirements and are applying for admission to the U.S. for the first time as an F-1
student, present to the immigration officer documentary evidence of your ability to support yourself while pursuing a full courr.3 of
study (see item 5. page 2 of I-20A). For procedure applicable in the case of a student returning from a temporary absence outside
the United States to continue attendance at the same school, see item 11g. page 2. of I-20A,
3. If you are an applicant for permission to transfer to another school (or for transfer and extension of stay), mail or bring Form 1-538
and both I-20A and 1-208 to the office of the Immigration and Naturalization Service having jurisdiction over the area in which
the school from which you wish to transfer is located, together with your temporary entry permit (Form 1-94 ARRIVAL-DEPARTURE
RECORD]. (If your temporary entry permit is attached to your passport, the permit should be removed for this purpose.)
DO NOT SEND IN YOUR PASSPORT.
4. If you are an applicant for change to nonimmigrant student status, apply on Form 1-506 and attach both I-20A and 1-208. Apply
at the office of the Immigration and Naturalization Service having jurisdiction over the area in which you are temporarily residing.
Severe penalties are provided by law for knowingly and wilfully
falsifying or concealing a material fact in filling out this form.
Appendix 1
Page 5
CERTIFICATE BY NONIMMIGRANT STUDENT UNDER SECTION 101 (o) (15) (F) 0)
OF THE IMMIGRATION AND NATIONALITY ACT
Page 6
1 . I a«*tc to enter or remain In the United Statea temporarily and ootely lor the purpose of pursuing a full course of study at the school named on
page 1 of this form.
2.
Ptoaoa print name in (uil
3. My maximum anticipatedatayislMonthtorYaara)
4.
My •ducalional obiectivg la
8.
1 am financially able to support myself tor the entire period of my (lay in tha United States while pursuing a full course of study. (Stal* source
and amount of support:) (Documentary evidence of moans of actual support muit bo attscnaa to this form)
a.
1 last attended (Name of School) (City) (State) (Country)
7.
My major field of studios was
6. I completed such studies on (Data)
0.
Tho parson mod closely related to ma who Hvas outside the United States i*.
(Name) (Relationship)
(Addraea)
10.
The parson most closely related to ma who lives in the United Stales is: (If you have no relative i
(Name) (Relationship)
n the United States, give the name of a friend.)
(Address)
11. I understand the following •.
a. A nonimmigrant student applying for admission to the Unlted'States for the first time after being issued an F-1 (student s) vlss. will not be sdmtned
unless he intends to attend the school specified in that visa Therefore, it betor* he departs lor the United States the student decides to attend some
other school, he should communicate with the issuing American consular office tor tne purpose of hsvmg such other school specified in the viss. Any
other nonimmigrant student will not be admitted to I ho United States unless he inlands to attend the school specified in the Form 1-20 or form 1-04
which he presents to the immigration officer at the port of entry.
b. A nonimmigrant student is not permitted to work off-campus for a wage or salary or engage in business while in the United States unless permission
to do to has first been granted by the Immigration and Naturalization Service A itudam who reouires employment (1) because of economic necetsity
due to unforeseen circumstances arising after admission, or (2) to-obtam practical training, may apply to the Immigration and Naturalization Service on
Form 1-538 lor permission to accept such employment. Additional Information concerning employment is set forth in Form 1-538 The alien spouse or
child accompanying or following to loin a nonimmigrant student is not permitted to work In the United States.
c A nonimmigrant student is permitted to remain in the United States only while maintaining nonimmigrant student status, and in any event not longer
than the period fixeo at the time of admission (or change to student classification) unless he applies to the Immigration and Naturalization Service on
Form 1-538 in accordance wilh the instructions on that form between 15 and 30 days prior to the expiration of the period of his authorized itay and
obtains an extension of his stay
d. Each year, every nonimmigrant student m the United States on the first day of January must submit by the 3 1st of January a written notice of his
address to the Immigration and Naturalization Service In addition, a notice must be sent within 10 oays alter every change of address Regaidless ol
whether he moves, each nonimmigrant student is required to tile written notice of hit address every 3 months Printed forms obtainable it the United
States immigration office or post office should be used in making tha annual address report, the change ol address report, and tha 3-month address report
e. At tne time a nonimmigrant student departs from the United Slates, hia temporary entry permit (Form 1-94) is to be surrendered to a reoresentative
of the sleamshio or airline if he leaves via a seaport or airport, to a Canadian immigration officer it he leaves across the Canadian border, or to a united
S'.ates immigration officer if he leaves across the Mexican border
f A nonimmigrant student may remain In the United States temporarily only for the purpose of pursuing a full course of study at a specified school
II. artrr being admitted, tne student desires to transfer to another school, he must make written application on Form I-S3S for permission to make such a
transfer The application must t>e submitted to the office of the Immigration and Naturalization Service having jurisdiction over the area in which the
school trom which he wishes to transfer is located The application must be accompanied by Form 1-20 completed by the school to which fie wishes to
transfer He may not transfer until his apolication is approved The application will be denied If the student tailed to actually take a lull course ol stuoy
at tne school he was last authorized by tne Service to attend, unless he establjshes that his failure lo do so was due to circumstances beyond his control
or was otherwise lustified
g A student who se«k. lo re-e-i er the United States as a nonimmigrant student after a temporary absence must be in possession of the following
documents: (i; A valid unexpired student visa (unless exempt trom visa requirements!. (II) A passport valid for six months beyond the ptmod of resd-
misaion (unless exempt trom passport requirements). <'ni| A current copy of Form 1-20 (A and B! However, only the "A" copy of Form 1-20 is required
m the case ol a nonimmigrant student returning from temporary absence outsida the United States to continue attendance at the same school which
the Immigration and Naturalization Service last authorized him to attend, in such case. Form i-20A may be retained by the student and used by him tor
any number ol reentries within twelve months from the data of issuance, the certificate on page 2 of Form I-20A need not be completed, and Form
I-20B should be destroyed
h A nonimmigrant student who does not register at the school specified in his temporary entry permit (Form 1-94). or whose school attendance Is termi-
nated or who takes less than a full course ol study, or who accepts unauthorized employment, thereby falls to maintain his status and rnust a>p»rt Irom
lh» United States immediately ~
I CERTIFY THAT THE ABOVE IS CORRECT I hereby agree to comply with the above and any other terms and conditions of my admission and any
on and Natural-
immigrant status in which I was admitted to the United States under the immigration law More specifically. I authorize the school to report, in writing,
to the immigration and Naturalization Service if I fail to register within OOdays ot the time expected, if I fail lo carry a full epuria of study, it I fill to attend
classes to the extent normally reouired. it I am tailing courses, it I become employed or if I terminate anenoance at the named school and to provioe the
Service upon demand with my latest address.
Signature of Student
Address (City) (Slate or Province! (Country)
(Date)
(Signature ol Parent or Guardian it Student is Unoer 18 Years of Age)
(Relationship) (Date)
THIS PACE IS TO BE COMPLETED AND RETAINED BY THE STUDENT FOR HIS RECORDS
FORM 1-102
I • USE;
USED BY A NON-IMMIGRANT ALIEN TO REPLACE:
1. A LOST, MUTILATED OR DESTROYED ARRIVAL-DEPARTURE RECORD,
FORM 1-94 OR 1-95.
2. AN INCORRECT ARRIVAL-DEPARTURE RECORD, FORM 1-94 OR 1-95.
II. ELIGIBILITY:
1. MUST HAVE ENTERED THE UNITED STATES AS A NON-IMMIGRANT.
2. MUST HAVE BEEN ISSUED FORM 1-94 OR 1-95 WHEN ADMITTED INTO
THE UNITED STATES, OR WHEN GRANTED AN EXTENSION OF STAY.
III. REQUIREMENTS:
1. FILING FEE IS REQUIRED UNLESS APPLICATION IS FOR REPLACEMENT
OF AN INCORRECT ARRIVAL-DEPARTURE RECORD.
2. IF DOCUMENT HAS BEEN MUTILATED, ATTACH IT TO THE APPLICATION
FOR REPLACEMENT,
3. IF REPLACEMENT OF AN INCORRECT RECORD, ATTACH THE INACCURATE
DOCUMENT TO THE APPLICATION. ALSO ATTACH A SIGNED AND DATED
STATEMENT FROM THE APPLICANT CITING SPECIFIC INFORMATION TO
BE CORRECTED AND REASON WHY SUCH INFORMATION IS INCORRECT.
10/1/80
UNITED STATES DEPARTMENT OF JUSTICE
APPLICATION 8V NONIMMIGRANT ALIEN
FOR REPLACEMENT Of ARRIVAL DOCUMENT
READ INSTRUCTIONS ON REVERSE]
• by oeoly <>r: (OiosU *0
A ^ REPLACEMENT OF LOST. MUTILATED. OH DESTROYED A«RI VAL-OEP ARTU Kt PECORO fFORM !-».!
3 ~; REPLACEMENT OP LOST. MUTILATED. OR DESTROYED CREWMAN'S LANDING PERMIT (FORM 1-93)
C ~ REPLACEMENT OF IMCO'RRECT ARRIVAL-DEPARTURE RECORD {FORM 1-941 OR CREWMAN'S LANDING PERMIT (FORM I.5S)
Ji TOUR
FAMILY NAME (Coo.iai L<
rtot.l FIRST MIDDLE t
1
1
1
^5
4. Country al C>i>»n>hip
•'MAILING
ADDRESS
IN U. i.
Numl>*r and S»<« U»l. No.) 5
6
Ct»
Slan ZIP C>4« 6
E
1
&
MtMko) ISlr»«t> (C.r/) iP.ovme. 0. 5lo,.l (CMntiy)
7.Uoi« •( Sir* [M«tfti)(b«yJ(YMr)
10. Caunny •< Biiih
1
I.PIac. VI >« U.w.d (Cllyl (Country)
i2. D.I. v.,o li»uod lM««*|(0«vHY««r|
11. La.t Muirmi n U.S. « iCityl (St.i
•1
14. D«l. L«lt A4«ill«d M U.S.,Monrh)(Oorl(Y.«.)
1 5. N«»o U»d Whm L».r Aiont.«i M *« U. i. (II »o~o at iwn "2" . •«« "Sow."
14. SKIUI «r T.«i« o( A4n.ii, on
'— Cr..««» CD Oll>"' (SMCiM
17. Oo» '• Which S'av Hai 8<«n AuHorfi.d (Mo**!lD.r l(r.«rl
FILL IN THISALOCKIF YOU ARE APPLYING FOR REPLACEMENT OF YOU* ARRIVAL-DEPARTURE RECORD 0» CREWMAN'S LANDING PERMIT
U. My A.nvai-O.IMXxKi fl.cr,-d M Cxoooa'l L««4>i<« P.mH ..c». P] !••> CI """''"'•^ d «»"»T-^
(D«W (Plcc*l
II -y Joeo-oo. ., ..to. .rod or 1 .ic.ttun Kt -•••rMktt.f.. 1 .ill lur.«naoi> ,1 or r.M,l .ho ioc.t I. rho lm,i<r.lrM or.4 N.rur.l, tol.on S.r.ic..
SICNA'UREOF PERSON PREPARING FORM. IF OTHER THAN APPLICANT
SIGNATURE OF APPLICANT
\-}. < » gl , J4i u<«.o ^. ""^•^ w • "** * i ^
.1 my kno«.U4V <rl. «.!..(.
Ca«if>l«t« «ttr)4lM«r* »f 40plie«Mtt
Si4n««wr»i
A^drox DM*
0«ro ,ione4i
Fon> 1-102 (R.».12-l»-7»)M
FORM NO.
I-IO?
EDITION
WEV. I'M!-?*
TIT IX
APPLICATION
DOCUMENT
3T NONIMMICRAKT
ALIEN
FOR REPLACEMENT OF ARRIVAL
S1ZJC
a X 10 I/'
INSTRUCTION RJUrCRJENCX 8 CTR 103.700 (I), "64
•>45.8(d), "'fit. 6: AM '414 Ex 1, ''787.04, ''794.01, .0"»,
8-14.4, -14.5, -'5, -''6, -'7, 9-5; GIB o.^, Aop. «,
.05,
Aop.
,(c). "99.1: 01 '14.'l(h)C')(v),
^984 Ex ', '984 Ex 4: II Hbk 8-1"
30, App. S 7
OSJB
APPLICATION TO REPLACE LOST, MOrTILATZD 0» OTSTROOED ARRIVAL-DEPARTURE RECORD AND CREWMAN 3 LAUDING PERMIT
(Carbon- inc«rl<M.v«d - Original and Addra'i Label) - Al«o printed In ^ingl* copy
PRIOR EDITIONS MAT HOT BE USED
| SCHEDULE A * B
10/1/80
Appendix I
ADDRESS LABEL
A»H.ICAMTi 00 MOT «<HT«E BBUOW TMIS LIMB
DATE
OF
ACTION
00
ouTmcr
HOW TO PREPARE
in ink.
INSTRUCTIONS
Fill in, io single copy only, by typewriter, or print in block letters
2. WHERE TO SUBMIT THIS APPLICATION . You may mail this application or submit it in
person to (he Immigration office having jurisdiction over the place where you are residing
tn the United States.
3. MUTILATED OR INACCURATE DOCUMENTS • (f you have a mutilated or inaccurate
document ia your possession, it mast be attached to this application. If you checked Box
"C" of item 1, there must be attached to this application i statement dated and signed by
yoe, citing specifically the information on your Fons 1-94 or 1-95 that requires correction
and the reason why such information is incorrect.
4 FEE • If you checked box "A" or "B" of iten 1. a fee of five dollars (S5) must be paid for
filing this application. It caaaot be refunded regardless of the action taken on the application
00 NOT MAIL CASH. Payment by check or money order must be drawn on a bank or other
insctncion located ia toe United States and be payable ia United States currency. If applicant
resides ia the Virgin Islands, check or money order must be payable to the "Comnussioner of
Finance of the Virgin Islands." If applicant resides in Guam, check or money order must be
payable to the "Treasurer, Guam." All other applicants must make the check or money order
payable to the "Immigration and Naturalization Service." When check is drawn on an account
of a person other than the applicant, the name ef the applicant must be entered on the face of
the check. Personal checks are accepted subject to collectibility. An uncollectible check
will render the application and any documents issued pursuant thereto invalid. A charge of
13-00 will be imposed if a check ia paymeat of a fee is not honored by the bank on which it is
drawn.
3. PENALTIES - Severe penalties are provided by law for knowingly and willfully falsifying
or concealing a material fact or using any false document ia the submission of this
application. Also, a false representation may result ia the denial of this application and
any other application you may make for any benefit under the immigration laws of the United
States
10/1 /8C
FORM 1-126
II
1. USE;
1. SUBMITTED ANNUALLY BY A TREATY TRADER OR INVESTOR WHO WAS ADMITTED
TO THE UNITED STATES UNDER SECTION 3(6) OF THE IMMIGRATION ACT OF
1924 (NO 1-539 REQUIRED).
2. USED AS AN ADDENDUM TO FORM 1-539 WHEN A NONIMMIGRANT TREATY TRADER
OR TREATY INVESTOR APPLIES FOR AN EXTENSION OF HIS AUTHORIZED STAY
IN THE UNITED STATES TO REPORT APPLICANT'S PRESENT STATUS AS A TREATY
TRADER OR TREATY INVESTOR.
3. USED AS AN ADDENDUM TO FORM 1-506 WHEN AN ALIEN APPLIES TO HAVE HIS
NONIMMIGRANT STATUS CHANGED TO TREATY TRADER OR TREATY INVESTOR IN
ORDER TO REPORT THE INTENDED STATUS TO BE ACQUIRED BY THE APPLICANT
AS A TREATY TRADER OR TREATY INVESTOR.
ELIGIBILITY:
1. MUST PRESENTLY BE- A NONIMMIGRANT TREATY TRADER OR INVESTOR, OR BE
APPLYING FOR A CHANGE OF NONIMMIGRANT STATUS TO THAT OF A TREATY
TRADER OR INVESTOR.
2. MUST BE A NATIONAL OF A COUNTRY WITH WHICH THE UNITED STATES HAS
CONCLUDED A TREATY OF COMMERCE AND NAVIGATION.
a. THE PROVISIONS OF SECTION 101(a)(15)(E)(i) , TREATY TRADER,
APPLY ONLY TO NATIONALS OF:
214. 2(e))
ARGENTINA
AUSTRIA
BELGIUM
BOLIVIA
BORNEO
CHINA
COLOMBIA
COSTA RICA
DENMARK
ESTONIA
FINLAND KOREA
FRANCE LATIVIA
NORTHERN IRELAND
THE FEDERAL REPUBLIC OF GERMANY
GREECE
HONDURAS
IRAN
IRELAND
ISRAEL
ITALY
THE NETHERLANDS
VIETNAM
NICARAGUA
NORWAY
PAKISTAN
PARAGUAY
LIBERIA
LU.XEMBORG
SPAIN
SULTANATE OF MUSCAT
& OMAN
SWITZERLAND
THAILAND
ETHIOPIA
JAPAN
PHILLIPINES
b. THE PROVISIONS OF SECTION 101(a)(15)(E)(H). TREATY INVESTOR
APPLY ONLY TO NATIONALS OF:
ARGENTINA LUXEMBOURG
AUSTRIA NETHERLANDS
BELGIUM . NICARAGUA
CHINA NORWAY
COLOMBIA PAKISTAN
COSTA RICA PARAGUAY
ETHIOPIA PHILIPPINES
214. 2(e}) FRANCE SPAIN
FEDERAL REPUBLIC OF GERMANY SULTANATE OF MUSCAT & OMAN
HONDURAS SWITZERLAND
IRAN THAILAND
ITALY TOGO
JAPAN UNITED KINGDOM OF BRITAIN
KOREA NORTHERN IRELAND
LIBERIA VIETNAM
YUGOSLAVIA
c. THE NATIONALITY OF SPOUSE AND CHILDREN OF A TREATY TRADER OR TREATY
INVESTOR IS NOT MATERIAL.
III. REQUIREMENTS:
1. COMPLETION OF ALL QUESTIONS ON REPORT.
2. SIGNATURE OF TREATY TRADER OR INVESTOR.
3. NO FEE REQUIRED WITH THIS REPORT.
a. FEE IS REQUIRED FOR 1-539.
b. FEE IS REQUIRED FOR 1-506,
4. ARRIVAL-DEPARTURE DOCUMENT U-94) MUST BE SUBMITTED.
a. ARRIVAL-DEPARTURE DOCUMENTS (1-94 'S) OF DEPENDENTS, SPOUSE AND
CHILDREN, SHOULD BE SUBMITTED IF INCLUDED IN APPLICATION/REPORT.
b. ALL PASSPORTS MUST BE VALID FOR SIX MONTHS BEYOND INTENDED STAY IN
THE UNITED STATES.
c.
1-94'S.
5. EACH 1-126 MUST BE ACCOMPANIED BY A LETTER, ON COMPANY LETTERHEAD PRE-
FERABLY, FROM THE EMPLOYER STATING THE PRESENT AND INTENDED POSITION AND DUTIES.
a. THE NAME AND TITLE OR POSITION OF THE PERSON SIGNING THE
LETTER SHOULD BE CLEARLY INDICATED.
b. THE LETTER FROM THE EMPLOYER, IF A PERSON AND NOT AN
ORGANIZATION, SHOULD INDICATE WHETHER HE IS A TREATY TRADER
OR TREATY INVESTOR.
10/1/80
TM 786
ADMINISTRATIVE MANUAL
Appendix I
1-126
Page 1
OHB No. 4J-CO1I?
REPORT OF STATUS
BY TREATY TRADER OR INVESTOR
Read instructions on other side before filling out this report
AUon Rogntroura N-«l»r
fM/*H«J :. D«l» o< Birth
I. Pteco of Birth lC.lt Y <* TotrnJ Itui* *r frviinct}
rCM-BM 4. -~,..« ».u_»_mx
' Uailuif Ad.ni.
6. r«roi(n 'Slro.y (Cur or Tw-v) (i
R«idonc.
I.M ar PrarlnMj (Covltfr)
foni|« oadroto _tM| _o
o-rj 1. 0... .f I.UT ««u^ _,,. ,«„;
8. Port at Cnlrr (CirxJ ttlfl*)
10. Nw_> >i v*..ol or «UMr c««w»y._o.
ll.Vloo looi»d on IMt.. o-x, r.-U Vi»» loouM «l
fCiiw tCftmar)
1J. Poo. »«n Nuimbvr l»i»4 OB «•.. «-r. /Mr; l.o_td 01 (Glirl
(C~**r) l..imUM D.»
• J. _..«~.l-, C^.-^ ,u«_.« _»,..«, _ Pw.-_« ,. T«~ - C__-«. .
_- «,.,__-. -_,*.„-,..»,.,
A. N.__ .1 C^«r, i,.M._-' <• T-,.,, -U UUU. •«- .
.. *___ .- — ... - .-._,... « ««^,, h -... ^M^ » ^_-_.
C. M-M. -^U~... ,«--«-.
M 1IUUM. •-«_]•« • HI«.JI| MB
>* _«_M_ ««IH«d 1MB <HMk III ••!
•• ssr^^cirrnrrr
> UM UMH4 tut.*, 11. 1 OMir WHm.Mlloa >l_»i.
P. TUIo W My Pxuum or Omu|MU««
H. (Ck»«» MB o_rf fill !• kUn- •• «.«j|»r_Mo)
1 1 1 am an employee of the busineas or enterprise named in itei
LJ 1 am an independent developer or director of operation, of tk
1 have penonally invested or am ia the proceoa of investing
a 13B.
• boaioeaa or enterprise named in item 13B, in which
cash or other capital in the amount of 5 .
Lj AnivaWDeparture Record (Form 1-94) LJ Letter £ram Employer
O Application for Extaasion 0f Stay (Form 1-539) Q Application far Change of NonimigiMt Stattta(Fona 1-506)
Fens 1-126 (Rev.6-_6-78)N
FORM
1-126.
NO.
EDITION TITJ-E
REV 6-26-78 REPORT OF STATUS BY TREATY TRADER OR INVESTOR
SXZK
8 X 10
1/2
INSTRUCTION REFERENCE
8 CFR 214. 2(e), 299.1; 01 214. 2(e); AM 2482 Ex. 1; GIB A-6
USE
REPORT SUBMITTED ANNUALLY BY TREATY TRADER OR INVESTOR ON ANNIVERSARY DATE OF THEIR ORISINAL
ADMISSION; SUBMITTED WITH APPLICATION TO ACQUIRE STATUS AS A TREATY TRADER OR INVESTOR;
SUBMITTED WITH APPLICATION FOR EXTENSION OF TEMPORARY STAY BY A TREATY TRADER OR INVESTOR
3-26
1-126
Page 2
ADMINISTRATIVE MANUAL
Appendix I
IS. Marital Statue
Married
I I Divorced
D
Widowed
I J Never Married
aoM at Spouee
Nationality of Spouao
Paaaport taaued Sy (Country)
Expires on (Da««)
Present Addreaa of Spouaa
It. Nam« of Children
D«t« at Birth
Country of Birth
Pass port laaued by ("Country.) and Expires on (Oat»)
Note: If the children for whom you are seeking extension or change of nonimmigrant status do not residue with you,
give their complete address on a separate attachment to this application.
17. I certify thai all infonaatloa fomiahed in this report la OIM and comet.
Date
Signature of Treaty Trader or Inveetor or applicant aaeking auch status
IS. Stfiurur* of p«raoa preparing form. If other than Treaty Trader or tare at or or applicant aaeklnc luch status
1 declare that this document was prepared by me at the request of the Treaty Trader or Investor or applicant seeking
such status and is based upon all information of which I have any knowledge.
Slcnalu
Date
Address
INSTRUCTIONS
If you were admitted to this country as a Treaty Trader prior to December 24, 1952, this report must be submitted
annually, 30 days prior to each anniversary of your entry, to the immigration office having jurisdiction over your place
of residence; and, in that case, no application for extension of temporary stay need be submitted.
If you are seeking to acquire status as a Treaty Trader or Investor, this report must be attached to your Applica-
tion for Change of Nonimmigrant Classification, Form 1-506.
If you acquired status as a Treaty Trader or Investor on or after December 24, 1952, this report must be attached to
your Application for Extension of Temporary Stay (Form 1-539).
Submit with this report your temporary entry permit (Form 1-94, Arrival-Departure Record). If your temporary entry
permit is attached to your passport, the permit should be removed for this purpose. DO NOT SEND IN YOUR PASS-
PORT. However, you must be in possession of a passport valid for at least six (6) months beyond the date to which
your stay may be extended.
If you are employed, submit with this report a letter from youi employer stating your present and intended position
and duties. Name and title or position of person signing the letter should be clearly indicated. If your employer is a per-
son and not an organization, the letter from your employer should indicate whether or not he is an E-l or E-2 nonimmigrant.
A Treaty Trader or Investor may include in this report any alien dependent spouse and unmarried, minor children
who are in the United States. If this application includes your wife and children, their Forms 1-94 must be submitted
with the application. They too must be in possession of passports valid for at least six months beyond the expiration
date of the extensions requested. In all other cases separate reports must be made.
Status maintained
Date
DO NOT WRITE IN THIS SPACE
(For use of Immigration and Naturalization Service Officer)
LJ Statua not maintained LJ See Fora 1-506 for action taken.
OUtrtet Director
SCO » 30.7 14
1. uut.u DI nn triruui tr\ 111 inc uniicu oinico lu Mii^ucoi I rmi
BE CLASSIFIED H OR L NONIMMIGRANTS IN ORDER TO ARRANGE FOR THE
ALIENS TO COME TO OR REMAIN IN THE UNITED STATES TO PERFORM TEMPORARY
SERVICES OR LABOR, OR TO RECEIVE TRAINING.
2. USED BY AN EMPLOYER IN THE UNITED STATES TO REQUEST THE EXTENSION
OF THE AUTHORIZED PERIOD OF STAY OF A GROUP OF "H" NONIMMIGRANT
ALIENS WHO ARE IN THE UNITED STATES PURSUANT TO A PREVIOUSLY
APPROVED I-129B.
II. ELIGIBILITY:
1. ALIENS OF DISTINGUISHED MERIT AND ABILITY (H-l).
a. BENEFICIARY MUST BE NEEDED TO PERFORM SERVICES OF AN EXCEPTIONAL
NATURE REQUIRING A PERSON OF DISTINGUISHED MERIT AND ABILITY.
b. BENEFICIARY MUST BE A PERSON OF DISTINGUISHED MERIT AND ABILITY
(WILL BE DETERMINED BY ADJUDICATOR).
c. PETITIONER MUST DESIRE THE BENEFICIARY'S SERVICES TEMPORARILY.
2. ALIENS COMING TO PERFORM TEMPORARY SERVICES OR LABOR (H-2):
a. THE POSITION TO BE FILLED BY BENEFICIARY MUST BE TEMPORARY.
IT CAN NOT BE A PERMANENT POSITION TO BE FILLED BY THE BENEFICIARY
TEMPORARILY.
b. THE DEPARTMENT OF LABOR MUST EITHER CERTIFY THAT THERE IS A SHORTAGE
OF WORKERS IN THE UNITED STATES AVAILABLE AND WILLING TO DO THE JOB
OR FURNISH WRITTEN NOTICE THAT SUCH CERTIFICATION CAN NOT BE MADE.
3. ALIENS COMING FOR TRAINING IN THE UNITED STATES (H-3).
a. TRAINING MUST NOT BE AVAILABLE IN ALIENS HOME COUNTRY.
b. PETITIONER MUST HAVE A VALID TRAINING PROGRAM THAT IS MORE THAN
ON-THE-JOB TRAINING.
c. TRAINING TO BE RECEIVED MUST BE OF USE TO THE BENEFICIARY IN HIS
COUNTRY OF RESIDENCE.
10/1/80
3-28
4. INTRA-COMPANY TRANSFEREES (L-l)
a. BENEFICIARY MUST BE COMING TO THE UNITED STATES TO BE EMPLOYED
IN A POSITION WHICH IS MANAGERIAL, EXECUTIVE, OR IN A CAPACITY
THAT INVOLVES SPECIALIZED KNOWLEDGE.
b. BENEFICIARY MUST BE COMING TO THE UNITED STATES TO BE EMPLOYED
BY THE SAME COMPANY WITH WHICH HE IS EMPLOYED ABROAD OR AN
AFFILIATE OR SUBSIDIARY THEREOF.
c. BENEFICIARY MUST HAVE BEEN EMPLOYED BY THE COMPANY ABROAD IN A
MANAGERIAL, EXECUTIVE OR SPECIALIZED KNOWLEDGE POSITION FOR
A MINUMUM OF ONE YEAR PRIOR TO THE PETITION BEING SUBMITTED.
III. REQUIREMENTS:
1. GENERAL:
a. PROPER FILING FEE.
b. ALL PETITIONS AND SUPPORTING DOCUMENTS MUST BE FILED IN
DUPLICATE.
(1) ALL DOCUMENTS WHICH ARE SUBMITTED MUST INCLUDE THE ORIGINAL
OR CERTIFIED COPY AND ONE PHOTOCOPY.
(2) ALL FOREIGN LANGUAGE DOCUMENTS MUST BE ACCOMPANIED BY CERTI-
FIED TRANSLATIONS.
c. ALL QUESTIONS MUST BE COMPLETED:
(1) FOR H-l, ALL QUESTIONS EXCEPT #25 - 31.
(2) FOR H-2, ALL QUESTIONS EXCEPT #23 - 26.
(3) FOR H-35 ALL QUESTIONS EXCEPT #26 - 31.
(4) FOR L-l, ALL QUESTIONS EXCEPT #25, and 27-31.
d. PETITION MUST BE SIGNED BY PETITIONER.
2. SPECIFIC:
a. IN THE CASE OF "H" GROUP EXTENSIONS.
(1) THE ORIGINAL ARRIVAL-DEPARTURE DOCUMENTS MUST BE ATTACHED.
(2) NEW LABOR CERTIFICATIONS MUST BE SUBMITTED FOR ALL H-2S.
(3) ALL ALIENS APPLYING FOR EXTENSIONS MUST HAVE PASSPORTS VALID
(1) EVIDENCE THAT BENEFICIARY IS A PERSON OF DISTINGUISHED
MERIT AND ABILITY.
(a) EVIDENCE OF HIGHER EDUCATION OR TECHNICAL TRAINING
MUST BE SUBMITTED.
(i) DIPLOMAS
(ii) SCHOOL CERTIFICATES
(b) OR OTHER SUPPORTING DOCUMENTATION THAT IN FACT INDICATES
THAT THE PERSON IS A PERSON OF DISTINGUISHED MERIT AND
ABILITY.
(i) AWARDS RECEIVED
(ii) MEMBERSHIP IN ELITE SOCIETIES OR CLUBS
(iii) MATERIAL AUTHORED AND PUBLISHED
(iv) EVIDENCE OF BENEFICIARY"S INTERNATIONAL RENOWN
(v) EVIDENCE THAT BENEFICIARY HAS DISTINGUISHED MERIT
AND ABILITY IN HIS FIELD
(c) ADDITIONAL REQUIREMENTS FOR NURSES
(i) EVIDENCE THAT THE BENEFICIARY HAS OBTAINED A FULL AND
UNRESTRICTED LICENSE TO PRACTICE PROFESSIONAL NURSING
IN THE COUNTRY WHERE SHE/HE HAS OBTAINED HER/HIS NURSING
EDUCATION, OR THAT SUCH EDUCATION WAS OBTAINED IN THE
UNITED STATES OR CANADA.
(ii) A STATEMENT FROM THE PETITIONER CERTIFYING WHETHER
TO THE BEST OF PETITIONER'S INFORMATION AND BELIEF
THE BENEFICIARY IS FULLY QUALIFIED UNDER THE LAWS
GOVERNING THE PLACE OF INTENDED EMPLOYMENT TO PER-
FORM THE DESIRED SERVICES, WHETHER UNDER THOSE LAWS THE
PETITIONER IS AUTHORIZED TO EMPLOY THE BENEFICIARY
TO PERFORM SUCH SERVICES, AND WHETHER UNDER THOSE LAWS
THE BENEFICIARY IS PERMITTED TO SUBSTANTIALLY PERFORM
THE SERVICES.
(iii) IF THE LAWS GOVERNING THE PLACE WHERE THE SERVICES WILL
BE PERFORMED PLACE ANY LIMITATIONS ON THE SERVICES TO
BE RENDERED BY THE BENEFICIARY THE STATEMENT SHOULD
CONTAIN DETAILS AS TO THE LIMITATIONS.
(.iv) EVIDENCE THAT NURSE HAS A VALID STATE LICENSE TO
PRACTICE NURSING IN THE UNITED STATES OR EVIDENCE THAT
10/1/80
3-30
(iv) HE/SHE HAS SUCCESSFULLY PASSED THE SCREENING
EXAMINATION GIVEN BY THE COMMISSION ON GRADUATES
OF FOREIGN NURSING SCHOOLS.
(2) COPIES OF WRITTEN CONTRACTS OR SUMMARIES OF ORAL
CONTRACTS MUST BE SUBMITTED.
c. PETITION FOR ALIENS TO PERFORM TEMPORARY SERVICES OR LABOR FOR
WHICH A BONA FIDE NEED EXISTS (H-2).
(1) MUST SUBMIT A UNITED STATES DEPARTMENT OF LABOR CERTIFICATION
ON FORM MA7-50B INDICATING THAT WORKERS ARE NOT AVAILABLE IN T
UNITED STATES.
(2) MUST SUBMIT EVIDENCE TO ESTABLISH THAT THE BENEFICIARY MEETS T
MINIMUM REQUIREMENTS OF THE JOB CERTIFIED BY THE DEPARTMENT OF
LABOR.
(3) MUST SUBMIT EVIDENCE TO ESTABLISH THAT THE JOB TO BE PERFORMED
IS IN ITSELF TEMPORARY IN NATURE.
d. ALIEN TRAINEES (H-3).
(1) EVIDENCE THAT PETITIONER HAS AN ESTABLISHED TRAINING PROGRAM.
12) DESCRIPTIVE STATEMENTS MUST BE ATTACHED DETAILING.
(a) KIND OF TRAINING TO BE GIVEN
(b) PROPORTION OF TIME TO BE DEVOTED TO PRODUCTIVE EMPLOYMENT
(c) THE NUMBER OF HOURS TO BE SPENT IN CLASSROOM INSTRUCTION
IN ON THE JOB TRAINING, AND IN JOB PERFORMANCE WITHOUT
SUPERVISION.
(d) THE POSITION AND DUTIES FOR' WHICH THIS TRAINING WILL
PREPARE THE BENEFICIARY.
(e) THE REASON WHY SUCH TRAINING CANNOT BE OBTAINED IN THE
ALIEN'S COUNTRY.
(f) THE REASON WHY IT IS NECESSARY FOR THE ALIEN TO BE TRAINE
IN THE UNITED STATES.
e. PETITION FOR INTRA-COMPANY TRANSFEREE (L-l).
1. MUST SUBMIT EVIDENCE (COPY OF STOCK CERTIFICATES, ARTICLES
INCORPORATION, MINUTES OF BOARD MEETINGS, ETC.) TO
ESTABLISH BENEFICIARY IS COMING TO THE UNITED STATES TO
WORK FOR THE SAME EMPLOYER WITH WHICH HE WAS EMPLOYED ABROAD,
OR A SUBSIDIARY OR AFFILIATE THEREOF.
BLLIN tF!KLUYtU MBKUMU BY I ML Ft I 1 1 iUINlNb LUWMINY Ur M
SIDIARY OR AFFILIATE THEREOF FOR THE ONE YEAR IMMEDIATELY
PRECEEDING THE FILING OF THE PETITION.
3. PETITION MUST INCLUDE A STATEMENT DESCRIBING:
(a) CAPACITY IN WHICH ALIEN WAS EMPLOYED ABROAD, INCLUDING
HIS JOB DUTIES.
(b) CAPACITY IN WHICH HE IS TO BE EMPLOYED IN THE UNITED
STATES INCLUDING HIS JOB DUTIES.
(c) NATURE OF ALIFN'S SPECIALIZED KNOWLEDGE WHICH MAKES HIS
SERVICES NECESSARY, IF HE IS OTHER THAN MANAGERIAL OR
EXECUTIVE.
4. MUST SUBMIT EVIDENCE THAT BENEFICIARY IS AN "EMPLOYEE" OF
THE PETITIONER.
5. IF BENEFICIARY IS COMING TO NEW ESTABLISHMENT, INCLUDE
INFORMATION CONCERNING NEW ESTABLISHMENT.
(a) ITS NATURE
(b) RELATIONSHIP TO THE PETITIONING FIRM OR CORPORATION
(c) ITS NAME AND ADDRESS
(d) WHEN AND WHERE ESTABLISHMENT TO BE OPENED
(e) PROOF OF PURCHASE, LEASE, OR RENTAL OF PHYSICAL PREMISES
TO BE OCCUPIED.
4/1/81
UNITES fft
DEPARTMENT 0
Immtgrataa out M
PETITIC
TO CIAS,
NONIMMIG
AS TEMPO
WORKE
OH THAN
(T« to Mtmttttd In
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toxJ to lnsavdiMM. u ite EMnrid Dtn
1 bt «»!>toiw) "• miwali
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ams BLOCK NOT TO ae FILLED our BY rermoNESi
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n- UUfctr tor «6td> » k»« Bda es»i «d,
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a faxa oiKpterw! CTxMt»s»aaty r«r aw
torw «r ato*sfcltar7 v iffBtott Vane
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NdtooStr AO. hr UM Mawtoj: (Ox* mo.)
nte. (Oso "fan ta la iwthrn dona %fe><* m ttmwOwi
gctiiatea. nnn. «r «dMr BraJBtr hr lh> !>• num rf r*.
< IB • aaxm&rut v MMMM nfattr «r ta » Ofo^T
MM»K. (Our »b> mfal » «at
*tag inaMBj to «">T **• •* «
ifMwy Inu^eraa. (0*M «&• k<
r kta csa-rtao M tttt oeaB <m|i
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t. AOOMCM (MUMMA. tTMntT, CJTT, ITATS. ZK> COM)
4. DCWfUmOM O» rCTTOOHUni MJWMSMk UKUXIIHO ITS MATUnC. MUMMD OP 01
UWUJTBaB. AND <MOM AMHUAL tHOQOt
L LOCATION Of AH(R«AH COMtULATU AT Wt5»CM
AUOM(»| WILL AfVLY HMI V1SWB):
IGBf to t>WW8r> Cc
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ItakJ.C^ri
(N laHlftxn M ro b« «w
mud M utoMnwi lor
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•aobcttiwn* wtll Iw maa«u l««areu putftinJt Hu»t IM ni«4 tor «ecn L*1 M«A.|
t. T«a Auawui WILL ranrama «D«v»caa on LAMM ran cm nuictiva TRAIMMM mi
tU THS rOUOWMW QSTABLOMMMT:
NMM «M MMmM> (C», m, TOM)
««««» O*C«M|
T. MBUOD MOUHUI
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tenvien ootnAMiiHa
d. w»oas fen wai
IK M. HOU!«
• MII wow >. ovwrrmi KATE
1C. OTMSM OOammaATIOM <Ba»t>te|
18A. VALMUt AT 1 11. BY
t tngnaYl
WHOM MUOt
C~.J IB »»•
NECCIVEO
TtANC. IN
AfTO'TKAMS OUT CXXW.mo
FORM NO.
I-129B
EDITION
REV. 2-25-76
TITJ-C
PETITION TO CLASSIFY
TRAINEE
NONIMMIGRANT AS TEMPORARY WORKER OR
B X 10 1/2
1WSTROCTION RXrEJUCNOC 8 CFR 2Hi.2(h) (1) , (3»)
282.1. 299.1. .2; 01 2Ct.2(h) (1), .2(h)(2)(l), (II),
II Hbk 5-M. -kS, -53, 9-1, -3. 10-56.1
. (l|)(l), 2)*.2(L)(U. C«), 2'»8.3(b),
.2(h)(2)(v); M 2301.07. 2384 Ex. 2,
.It.
P. 2
OTE
REQUEST 8Y EMPLOYEE TO BRING HOW IMM! GRANT ALIENS TO THE U.S. FOR
TEMPORARY SERVICES, LABOR OR TRAININ6
PRIOR EDITIONS MAY NOT BE USED
8CHXOOUB
A
10/1/80
3-34
•I -1298
Page 2
AOH ! N I STRAY ! V E MANUAL
Appendix 5
TM
( Page 2
AU, PermONSM COaWLETE HEMS 12A THROUGH 23. II petition 13 tot more) (Ran oca H aliun. rjivo requirsd information lor each additional alien in
icaca provided on pago 3. !• tn« idantisy of tno H aliono >& r.at !:tvowi: at preheat, you must tufnisn in!er.statlon concerning tnam as soon as that information
became® noa«m to you.
1JA. AUSN'S NA6SE (Pomlly »8ms bfl esptet letlaimj (Flrel n®m<j> (MkWto nanw)
118. OTHSfl MAWS (Show all olticf isiszu vat pr®!»« nareaM. incluJing meadstn tium® if fiwmod woman.) 12G. MUhtBIR OP ALIENS IMCUIOfB
IN THIS permoM
IX ADOHBSS TO WHICH AUEN WtU. nen.^i:i lSJfot'8 end NuratWTj (City) (Put.itosoJ (Country)
14. PRSSSNT AOQRESS , W. P8C3POSIO PORT Of EMTKY
18. DATE OP BlRTVi 1?. PUCE OP aiBTH 1t ?HSSIMT NATIOMMIIY OH 18. miSeNT 06CUPATION
CITIZENSHIP
S3. HAS AN IMSaiGRftMT VtSA FC7TYIOM CV£S OEgM FILES SM THE AUSK'S HEilAU1? Q VSS Q MO
1! "Yea", srtsre «wt I: ^Ksd?
21. HAS WE AHEM EVER AWH.I6B FCS1 AH IMKItJRfii-S? VI8& OH PRBfc3AfJgMT SEBIOEMCK IM TMK U.S.? QvSS QMO
If "Yffls", nntera did tio up^ty?
22. TO VOUB KMOWLKDQE. HAS AMV VISA PSllTZOfa FIUO 8V YOU OH ANV OTHER PSRSOM OB OROa«l2ATIOM PO8 TMg NAMiO AUSW(8)
3E2W OSNISD? Q VE* G N£>
«i«aiio4«Bnfl oSenaft dSKisis: psi:a«Sfl (clfyf,. ,„ „ ,.,,, „,_ T^m_, .^m
TO YOUB KNOWLEDGE. HAVE ANY OF THE NAMED ALIEN(S) D/ER 8EE-N !PJ TOG U.S.? Q YES nNO '" ">••" W«"«l'y 8>»cl1 °" PW 3)
23. NONTECHWICAI. OCSd^lPTIOM OP SERVICES TO fct 1'EH^OaMEO BY OR TWAIMIMG TO Eg P.ECEIVCO 8V AUEK(S1 (THIS BLOCK HSSO NOT
BE COMP»1£TRO IF PeTlTIOM 19 FOR M-2 WOB«?^flS5
24. (II you ara petitioning Icr 911 H-l pnv-i<cian cf uuree. coiopielo tnis blunlt.)
0023 THE LAW GOWRMINQ H4£ PLACE V«:-KF,Z TAH AUEM'3 GCIHVICE2S Wtt.1. BS PgRPOPiMSe l-JESTRiCT HIM FROM PgRFOfTOlHG ANY
OF THE DESIRED SERViCES? Q YES LjNO if th« JUIBVINK is >«a '. «ttaeH atawmens listing tha rsstrictatl ssrvicas and salting tortrt in®
njason lor ins reilrictian. (Sea in^frucliona lor Pnysicizns and Nursoa.)
23. (II you are petitioning tot a trainee. cour.Ma inis bioct; 1
A. IS SIMItAS TRAINING AVAILABLE IM ALIEN'S COUWTOVT Q YES Q MO
8. WOULD ALIENS TBAININQ RSiULT IM DISPLACEMSOT OP UMITSO STATES WOPWEB? [j YSS Q NO
20. (it you ua petitioning Icr sn U-< alien. oir«pietf> '.ins block.) (Chisel: approtinn'Q ttonoa.)
a. Th« aUoo Has frsafl omp.'cjwd In en Q] o^scuthra; Q frtssiegfcvlal ca«@dtv; Q h9 a caeseeKp wt)M) Iniroltfee soaelatfssd hnoKksrfge
Iw .., . - , , . - - i «I«M:«» . ._ . .
(riGiaa end is..:r-jos of sinpt<»foi| (daU)
». Tha paltUsMior la Q tha oame «m)>te7« Q auibahjtarv Q an •HIKtW OH th« o«»el«v«J aOread.
FILL IN ITEMS 27 THROUGH 31 INCLUSIVE ONLY IF PETITION IS FOR H-2 ALIENS)
27. OESCmPTTV! JOB TTYLE W S^ORK TO BE PEUPORMGD QV /Cl£N(3t (Use till® nhicn corfMt/fitvdE to that used in |Ob ord«r olacsd v»m 3I3SQ
Emoloywwm Sarvica or Agarvsy nv ixitition«r lor Mme typ« c) ijttor. Vihorc work in mure than ena job classuficznon is to 6s parformad by aliana,
state mjftiosf to ba employe in c«n |<;i! ctacailicaiioti.)
is. is (A«e) ALiewisi SKILLED IN WORK TO m cgRPOafciEOT Q ves rjw0 Q UWKWGWM
a. IS AMV LABOW ORGANI2AT10M ACTIV8 IM THS LA80K MEJ.P(3) SPSCIHTO IH'lTEM m Q VM Q NO
(It "y«3". ao^ciry organiuuonU) and I.j8uf fia(d(s|.)
30. IS TOB PZTTTiOMgR INVOLVES IN, OH A^K HlfiRe THSlEAriNEO. AMY LASOR fteWTIOWS DIPFfCULTIES, IWCLUOIWO STRIKES OR LOCK-
OUTS? (Specify)
31. 1 HAVE NOT 8tEH ABLE TO UNO IK THS UNtT'JD STATES ANV UMIMPLOtED 8>6HSON(S) CAPABLE OP PEBFOHMINQ TH8 DUTIES OF THS
coamoM(S) TO as FILUD. i"Hg FOU.OWIKO, KF PORTS HAVS SEEK MAOS TO HMO SUCH PEMOM(S): (Comoiaio only ii isoor c«rtiiicaiion
not »tucnoa.|
ALL 9>ermOM£R9 RU. IM ITEM® 32 TWRSUffila 3«.
U. UST OOCUMEMTS SUQMITTSO IN SUPMKir 0? THIS PCTT8TOM.
in /i
(Page 3)
M. THE DOCUMENTS SUBMITTED HEREWITH ABE HEREBY MADE A PART Of THIS CETnTION.
I am willing (unwilling) to DOOI any bond roouirud aa a condition to tha aooroval 01 thia petition
I aarw mat at toon a> known I enali lumun tn« Omtnct Director to wnont ihi» paiiiion n txunq luomittaa wrtti trw ntmoa on inea* cn«n(i) not named harun.
H th« petition it lor temDorjry wotnerts). I certify tnat I have a aorta (KM noed of aucfi wofk«r(sj.
It IK* iwtiiion n lor trunoMsl. I canity rws t» coming u> th* UmUKt sutaa lo pariicip«ta m a Don* (KM training program.
I oartiry nun IX* gtaunwnu ant rootMonutiora maoo m ihra pwn>on are in* ang cornet to ma MM ol my tnowMde* and tafart
MA, SIGNATURE OF PCTITIONCR
DATE
MB. TITLE (Mult tM peliliorwr or outnonzod agent ol
StGNATURE OF PERSON PREPARING FORM. IF OTHER THAN PETITIONER
M. I d«cJ»»B mat «Ma decunrant was praparM by ma at lha »«ju*«i o< |)M (MtHtonsf and to baa«l on >J| intormaikn of vMch I h«»» any tuMMrtoilloi.
(Acbtreac)
If (hit cxMlUcn M lor moni Irum on« ali»n trf dl«inoui«Md merit and ability (H-1) or trainee (K-3). uws upaeao tMtow to gh* requtrad inlomtatlOA. U addi-
tion*.! ap»c* n nt«<ta(l. uucfl caparei* «neat anocuuM in tamo general manna*..
DATE OF sierra
PLACE Of BIRTH
MATIONAIJTV
OCCUPATION
PMESCNT AODflBM
AOOHES9 TO WHICH AUEN WILL METUHN
HOrfTECHNICAL DEftCRIITtOM OF StKVICES TO Btt PERFORMED BV OH TRAIMIHO TO BE RECEIVED BT ALIEN
DATE OF aiRTH
PLACE Of BMTM
PRESENT ADDRESS
ADDNESS TO WHICH ALIEN WILL RETURN
NONTECHNICAL OSeCRIPTtOM OF 8EAVICES TO BE PERfORMEO BY OR THAIMINQ TO BE RECEIVED BY AUEN
DATE Of BIRTH
PLACE OF fflWTW
rtABONAUTY
OCCUPATIOM
PAESENT AOORE9S
AtHDReU TO WHICH AUEM WILL RETURN
NONTECHNICAL DESCRIPTION OF SERVICE* TO BE PCHPORUED 8V OR TRAINING TO BE RBCEIVKD BY AUEN
It ltw» pajtitlan >t tor ITKKV than on* (H-31 alxn to puletm tomporary wnrte* or labor, uso MMOM batoto to give recjuirad mtormation. II BddHraiul MMC*
t* rM«o«d, atucfi Mparau w>««i macutad in tamo gtmrml mwwtax. Identify wcri olkwi wno hu tm*n in Vru> U.S.. by placing an "X" in MM lot oMurnn.
NATIONALITY
DATE AND PLAC8 Of BIRTH
PRESENT ADOREM
10/1/80
3-36
I-I29B
Page 4
A DM i M I STRAT 1 Vf; MANUAL
Append i x 1
REAtt INSTRUCTIONS CAH2FULLY. FEE WILL NOT BE REFUNDED.
Fai'ure to eemply v/i(h inatmetiona may make is neses«ry to reject yctir ptEitian.
This petition mini Its eseeuied in duplicate. iTfce alien spo«s« ami miner children of ike henendary of M i^pm-ied pxtitiun •"£ au'omuiieally entitled to ihc
tame nonimmigrant clas&ificaiiosa frs h;..3 Been accofeewj if accompanying hir.i or following to jiMn fttm. No psti'ijfis iiw: t^sm yr® required)
AU supporting documenta must tt lubmiitcu' in encinal ar.d on» cosy. If :hi; return Sf the anginal ii issircJ. sii'j.-nii i»o cr<pies v»nh the onginal ar.d request
that (Ffeg original o? returned to yoy after an ir.".;.ti|^^:ion oilicer hrts compared it will) (fts copisre. CoP'-s i'"1 duplicate? unaccompanied by (he Of3gmai rruy feg ac-
cepted if ona of Ih«t copses b-tufs a cei'i'Katr..: tiy ia ic.j.-.irfEtsjji c..- consular cuTice? er an aitiv.iey tii.u tl:: copy w;« compared witfl ih« original and found 10 be
identical.
A foreign documm mu<& be Mcompaiucd by a traislraan «rtifi«l Ijy the transistor as 10 tiic accuracy irf the cramkuicn and as to his competency lo translate.
*W A fee of ten dollars (S 10) must b® paki fix- Wine this person. !t cannot b: refunded regardless of the action takeia on the petition. CO NOT MAIL CASH.
Payment by ch-sck or rnoncv onto mint M drawn on P. bark cr other institution locate*! in the United Siatt.i sni< be payanle in United Siaiss currency. If peti-
tioner resides in the Virgin Ijluria. check orptoney oracr ouiii b» payabts to the ••Cdtnmuasone; of Finar"-.<: nf ins Virgin li. arias" If petitioner resides in Guam,
check or monsv order RHMI fcs payable tu> tta "Trea'.crer. Guam". All oliurr psutussm inu«.t ja-Ms tf.s c.'iecl: or inonty order payable to tha "Immigraitonard
NaturalizM-on Service". When check is drswa en an *ccc««n£ ci1 j PCT-.CB sther than itii r-Ju'icit-.r. sfca nuiij of 1112 petitioner mum b* entered on the facet of (ha
checlr. Personal checU &w .*-£::ptc<l subject to coikcti&Iiiy. An u:KVll«ci!bls c.'.cci-. unil fe.Mlc- 1; . ;:-::, iioa and any uooimcnu issued putaujutt tnercto iuvalid.
A chants of $5.00 wll be imv-med if a cft-wS IQ iay;i:sat 01 c feo is iiui .:;tnnre>lby if;s banU en wftir.h it ixirav^n. if piyresniismiuieby the typ« of international
moruy order that cannot ha nial«U, ;'..i: mnney ort^r ti;uni ba £ravm ore thv p">i'ni««ier uf lha city ::: ch»i U rut«d Sa Jwa o whreh the petitioa «UI b« mailed, aaa that
city, tiw RHKKy aider nui.*d>s:. and ll:z <)sie itKiat bs sixim ebr:1 y ca ite up rtsarcin of ih." ;->:Mirrj id r.i.
WSwra to fite petition
The peltubn mult ttj filed vislh it>a officji cf Ihc lttiiRic.-jiu>« snd N jttirjliisiion Service having jur:sL'ict:uri ci»«r th® area id which lh« sanices will r» per-
formed or trie tnininj receives! Where tha isrvices will ^zpcTformidarthcirainicijiaillbircceivM in rsore ttar. csa arsa. tha pctitiofi must ea tiled m a» office
of (his Service having junsiiicn.is over at teas! or.: rf tl-.i.'ie ;:!•<;:».
More then one H bCTat'iciaT f.ay S-a includwS in ^::'.a FBII'M:. '*fccre ths bcneficiancs n'lli ail (32^;n"ominasari*ce3ii)aiinslepperauottOTreeei«rirrgthe3»ma
type of training and. if '.1143 are required. v>i(j ill ts ip; ivr,:;; to: tncir -waa at ths same Anienc^n Conwlntn ;:r,<l will M! be pcrfotrminf the lervicn of receiving the
training within the same immif^ra^iun riistnct. Sepsroie ^.'tit!^::!! >T.U?I ^ filed where the ^ncilciar^^ w?tl b£ rcrfomiiny services in different operations or will no<
be receiving the same type of traiuing or. if vuai ars required, \viil ba applying Tor vius cr. f :ftcvcv<« AU«:IUQ CotuuLues or w!l pe-n'orm the servrees or receive
tbe uaiuina in different irnniigrasuii disuicta.
A separate petition must be fiktl (o& @£cb L*l aben.
Pttfgktsm aeui nursa
In the case of an H- 1 ar H-l pein&a for a physKi-irj or nurse. :her« muM he ^tt£'-..i"d ths f.i>l»«>ii:,-j ir- 3i?iiit:an 10 its', documents required in ih« instructions
below for H-l or H-3 peinwni:
1. Evidence thai the beneficiary 'i,--; nbtntuti a full and weitnct^d licence to sr^rj-o mcdi-.ic-; or n*j7smg in tlic country where hs obtained his medical
of nursing education {Sucn evit}em:«i is ntM required if gviiisncg ,3 tubmiUfid itii..uiin^ trui th£ b«.'neiK*iiti'>'s education was obtained in the Uftite^a Stales
orCanndaor thai he is i physician &ho p-^si-a me s::-.,-.r;r..::iio« given 6v the Eiiu.: ..uo,-t.i! Council for Foreign Medical Crnuuatcs. I and
2. A itaiemeni from ilw netinn.-w cenifying that, ic the t<tat of th« petiitonrr's minrmwon and belief, (at the fwiieficiary is fully qualified under the la\ws
Eovcrning ihs place ol intcndeiJ empiayiT'erii to pertarm tat *MirerJ ?er«i«'! 10? receive the desired irami.til and mat tni under inosa latos the petitioner
is authorized to employ the rxtmi~iciury to snl^-ljiiiinllv perform tucfi Krvicn lor to pve the taflefioary the d<tiired trumsnRi: If the Uw novernine the
place where the services will fre i-.-nicu.iKt f.&-~/i any IIKIS j:nv>i on the scrj.ccs to t<: centered by tiii tencficiavy. the statement must contain detuns as
to the limitation.
H-l Pttltloa for stasis) c^ cbsiK,si-ie!»«s mtrii sod abiJiCy to [isrfoyra service of M ennftitoosi ftaeure
Allega'ions of high educatioe) 'ir lecftnifaJ irajmiuj itul! be iu,ip4j/;c:i by dip'omos. icftool cenificates. or equivalent document: or aflldavits. anestms 10 tuch
education or technical training and executed by iha person in cf.ir^e of the iscorda of the educational of other institution, firm, or tatoolishinirtt wherein such
tduCAiion or (raiding was acquire, irripro.^d. or pcrfect<7;'j.
Allegations of specialized eiiwnancc or SSL'CPI oiial ability -hal-i IK tupponed by a/fidavits ^:W5l!fiB to an4 dsjcnbing the degree and extent of the «*cwn-
cnctf or ability, executed by ite apprrjpriaie oJTicer •:! lha f/rra, weaniuiusn. tjidoiisiitntni. or otlier iniiiiuttun wnereui IBS juemii dctjuireil or penecteU sued
etpenmce or ability.
Copm of written cootmcti r:,' summcrm of ore) co..irect» roiwccn psiiuosef and b^r«fid^J^^M rm»s! bs aiiashcrt.
H-2 Pelilkm for afeafal la faafiitm temp^rsry SOT-JSCS oi' lolsJi'
If petition 11 for an alien t" jftsn* it? perform urnrKinirv ncrvice'i or Ubor. the lolloping suriplemental 'Joctiff^ntu rr.u^t be attached:
A certification from the Departmeni jf I ar»w indicj-.i^E thai qualified applicants in ihs L niisil Stales are r.« available for refemal 10 the employer and thai
tmplovmeni 04 the jiicnttl v,ill 1101 idveriely iiTect w^ei .".id working conditions of markers in tte United Stales simiUrly employed, or a notice from the De-
partment uf Labor that luch certification CEtinot be made-, lha. a statement containing a full and complete and detniled description of the situations or conditions
*hich make it necesa^ry lo bring the align or alums to tha Unueti States, whether ih« necessity is 'emncxmry. iaijsotiai.or permanent and. if temporary at seasonal,
whether it is evpttctcd to recur
To apply fur the certification, the petitioner must place a job order with the !oc«l offkie ot the state Enpioymen! Service serving the area of proposed em-
ployment. In order that th« Department DS Labrr/ may raaltc a deurrninaiKiii as to ths avgilafahly of qualified applicants in lira United Stales, the order must ac-
curately rtpon the occupational requirements o. the jot) If local and inttr-area racfwimicni of qualified workers i« the United Stales proves unsuccessful, copiea
of the certification are 'furnished to the tuiuioncr itirounh ins local Emplaymeni Service olfite .vlrare the job orcter was filed
If more than one cenificauun is isjuuJ by iiis Oepanment of Labor, a scimnts [ ctuion mu^t bs filed for the aliens covered by each unification.
H-3 PHItltxa for alwn Irainertjl
If (Rrtuion is for one or mor« alwn trautrcj. ttxsce muss Bs atuwrxi] a Malermnt daicn&ir.g the kind of training to be given the alien and seltim] out the propor-
tion of his time thai will rx dgvoud u> p»oduciu--3 empluymeM; tne numixr i :" hount tfai will l»; speiu respectwely in his cUsaroom insirucnon. in on-the-joe train*
ing. and in his performance without uipsnuioti: id-.- p<niuon o>r duties for v>hich (his training will prepare him; the reason why such training cannot be obtained
in the aiKn's country: and. if you amwered "yet" to n«m 23A. why u 19 ne:;fnarv for alien to taue mining in the United Slates,
If this petition is approvrt. the approvtl does, not SiRnrfy that th« wages shown in item.* of the pennon meet the minimum wage requir*fnems of any state or
federal laws. Any questions regvfling ;i r.iiihdc.':^ M'i:li tltoH requirenKnta s'lsiild IK addressed lo like appropriate s(a!?of federal bibor authorities:.
L-l Ptlltlon for intfa-corayiimy trsmteiw
tt peiiiiun i« Tor an L-l alien, ait.tch a iiaienvent dtncribing the capuitv in which Its v>«s employed ubraud and tlK: capacity in which he is to be employed in
the US. If trie alien's services involve socialized knowledge, descnbe bnelly tJvj natuiv; of the spncwIJTed knowledge whict) msfcen his services heret necessary
If the beneficiary is coming to b* Em^iuyed IR an esublt'.hmeni tMiinr. iv-jwly O'-i-fKd in !IM Untied Slum by rm <mi ln»«r, or by the p«rem company, a subsidiary,
or an affiliate of his employer. m« 'iiatewtur, tjull •HtlciVi i \far-nianon co.icstninB the t»vj esublisliment tuch M its nature, rslaliotuhip to Ihs petitioning firm or
corporation, its nama and address, -arisn it <a«a ur will ;« opsr.cd al tiios address, when And where it was incarpcraisd uf it is a corporation), and tlw toukl number
of <mplovecs wno »MI be employed there. Evidence rvuut alto be iubmitteti that physical p.-siniscs for ita n»w esubuihmmt have been acquiriid by purchaa*.
lease, or rental and will be occupied by that esualishweiit,
Extension of Key
m* penuon form sMtl be us«d as an appltca*itjn f.r i ;rc»if extension of stay for H aiwsna who ara ia ihe L'm'tcd Statas punusnt to tJie approval of a previous
pctiuon by the sam« petitioner. This petition fono slutll also te ussd ai an application for tin eitension (if stay when tiled on behalf of ores or mora H alien* who
are in the Untied Stales pursuant to the approval of a petition by sreiriher pemiooar and are maintaining Hams. When the petition '« being fil«d M an application for
extension of stay tha Form 1-941 Amval-O«panvru R»un» o! e'i.;t! beneftcurv must bm attac'wd and, if HE: re IB rnwe iMnona iwrnsliciary. an ad&uona! sheet
mu« be attached, noted to show the country of rzucncc P.I:."! data Q{ expiration of sKh beneficiary '9 iwupon.
iffl a nuteriai faa or miina any falsa document in ita subrnjsiioo of ihii
Severs penajtiea ara proviikd by law for kuinngl) t-.i v/ti'.i'ully falsifying cw c
petitioit.
I. USE:
CLASSIFIES AN ALIEN AS A FIANCE OR FIANCEE OF A UNITED STATES
CITIZEN IN ORDER FOR THE BENEFICIARY TO APPLY FOR THE ISSUANCE
OF A VISA TO ENTER THE UNITED STATES TO MARRY THE PETITIONER.
(NOTE: A LAWFUL PERMANENT RESIDENT CANNOT PETITION ON THIS FORM,)
II. ELIGIBILITY:
1. PETITIONER MUST BE A UNITED STATES CITIZEN;
2. BENEFICIARY CANNOT BE PHYSICALLY PRESENT IN THE UNITED STATES;
3. PETITIONER AND BENEFICIARY MUST BOTH BE LEGALLY FREE TO MARRY
AT THE TIME THE PETITION IS FILED.
III. REQUIREMENTS:
1. PROPER FILING FEE;
2. EVIDENCE TO ESTABLISH THAT PETITIONER IS A UNITED STATES
CITIZEN;
3. EVIDENCE OF TERMINATION OF ALL PRIOR MARRIAGES FOR BOTH
PETITIONER AND BENEFICIARY;
4. BIRTH CERTIFICATES OF ANY CHILDREN OF BENEFICIARY;
5. PETITION MUST BE SIGNED UNDER OATH AND NOTARIZED;
6. ADDITIONAL INFORMATION TO BE RELAYED TO PETITIONER:
a. PETITIONER AND BENEFICIARY MUST MARRY WITHIN 90 DAYS OF
BENEFICIARY'S ENTRY INTO THE UNITED STATES.
b. A SEPARATE PETITION IS NOT NECESSARY FOR THE BENEFICIARY'S
UNMARRIED MINOR CHILDREN. THEY MAY BE ISSUED A VISA BASED
ON THE PETITION APPROVED FOR THEIR PARENT,
c. BENEFICIARY AND CHILDREN MUST MAKE SEPARATE APPLICATIONS
FOR PERMANENT RESIDENT STATUS AFTER THE MARRIAGE IS COMPLETED.
IV. EVIDENCE:
1. UNITED STATES CITIZENSHIP:
a. PRIMARY EVIDENCE:
(1) CERTIFICATE OF NATURALIZATION;
(2) CERTIFICATE OF CITIZENSHIP;
(3) CERTIFIED COPY OF BIRTH CERTIFICATE SHOWING BIRTH IN THE
UNITED STATES AND REGISTERED AT THE TIME OF BIRTH.
(4) STATE DEPARTMENT CERTIFICATE OF UNITED STATES CITIZEN BORN
ABROAD (FORM FS-240) ,
4/1/81
3-38
b. SECONDARY EVIDENCE:
(1) CERTIFIED COPY OF DELAYED BIRTH CERTIFICATE (NOT
REGISTERED AT THE TIME OF BIRTH) SHOWING BIRTH IN THE
UNITED STATES;
(2) BAPTISMAL CERTIFICATE:
(a) MUST CONTAIN SEAL OF CHURCH WHERE BAPTISM OCCURRED,
(b) MUST SHOW DATE AND PLACE OF BIRTH, DATE OF BAPTISM,
AND PARENTAGE.
(3) SCHOOL RECORD--A LETTER FROM THE SCHOOL AUTHORITIES
SHOWING:
(a) DATE OF ADMISSION TO SCHOOL;
(b) DATE OF BIRTH;
(c) PLACE OF BIRTH;
(d) NAMES OF PARENTS;
(e) PARENTS PLACES OF BIRTH, IF SHOWN ON SCHOOL RECORD.
(4) STATE OR FEDERAL CENSUS RECORD SHOWING:
(a) NAME;
(b) PLACE OF BIRTH;
(c) DATE OF BIRTH.
(5) NOTARIZED AFFIDAVITS FROM TWO PERSONS WHO HAVE PERSONAL
(FIRST HAND) KNOWLEDGE OF THE EVENT TO BE PROVEN, MUST
INCLUDE:
(a) AFFIANT'S FULL NAME, ADDRESS, DATE AND PLACE OF BIRTH,
AND RELATIONSHIP TO PETITIONER OR BENEFICIARY j
(b) COMPLETE DETAILS OF EVENT TO BE PROVEN;
(c) COMPLETE DETAILS OF HOW AFFIANT ACQUIRED KNOWLEDGE OF
THE EVENT.
(NOTE: IF PETITIONER IS BORN ABROAD AND CLAIMS UNITED STA
CITIZENSHIP THROUGH PARENT, SEE FORM N-600 FOR ADDITIONAL
DOCUMENTARY EVIDENCE NECESSARY,)
2. PROOF THAT PETITIONER AND BENEFICIARY ARE LEGALLY FREE TO MARRY:
a. PARENTAL CONSENT (IF APPLICABLE);
b. EVIDENCE OF TERMINATION OF ALL PRIOR MARRIAGES?
(1) CERTIFIED COPY OF ALL DIVORCE DECREES;
(2) CERTIFIED COPIES OF ALL APPLICABLE DEATH CERTIFICATES;
(3) IF SECONDARY EVIDENCE NECESSARY, AFFIDAVITS (.SEE bf(5
ABOVE).
(NOTE: SECOND EVIDENCE CANNOT BE ACCEPTED UNLESS EVIDENC
IS SUBMITTED TO ESTABLISH PRIMARY EVIDENCE IS NOT AVAILAB
(a) EVIDENCE THAT PRIMARY DOCUMENTS ARE NOT AVAILABLE
MUST BE OBTAINED FROM THE CIVIL OFFICE THAT WOULD
ISSUE THE PRIMARY EVIDENCE;
(b) MORE THAN ONE TYPE OF SECONDARY EVIDENCE IS GENERJ
REQUIRED; THEREFORE, THE PETITIONER SHOULD SUBMIT
MUST SECONDARY EVIDENCE AS POSSIBLE,
(NOTE: ALL FOREIGN DOCUMENTS MUST BE ACCOMPANIED BY I
CERTIFIED ENGLISH TRANSLATION.)
PETITION TO CLASSIFY STATUS OF ALIEN FIANCE OR FIANCEE FOR ISSUANCE OF NONIMMIGRANT VISA
INSTRUCTIONS
READ INSTRUCTIONS CAREFULLY. FEE WILL NOT BE REFUNDED.
Pleaie read carefully. Failure to follow instructions may require return of your petition and delay final action.
1. A petition may be filed only by an unmarried citizen of the United States to classify the status of the alien beneficiary at a
nonimmigrant fiancee or fiance who seeks to enter the United States solely to conclude a valid marriage with the petitioner within
ninety days after entry into the United States. The beneficiary must also be unmarried and free to validly marry the petitioner. Do
not file this petition for an alien fiancao or fiance who i> physically present in the United States. Petitions are not required for the
children of the beneficiary. They will be permitted to accompany the beneficiary provided their names are listed in item 3 of the
petition.
2. Supporting documents. The following documents must be submitted with the petition.
a. To prove United States citizenship of petitioner
(1) If you are a citizen by reason of birth in the United States, submit your birth certificate. If your birth certificate is unob-
tainable, see "Secondary evidence" below for submission of document in place of birth certificate.
(2) If you were born outside the United States and became of citizen through the naturalization or citizenship of a parent or
husband, and have not been issued a certificate of citizenship in your own name, submit evidence of the citizenship and
marriage of such parent or husband, as well as termination of any prior marriages. Also, if you claim citizenship through
a parent, submit your birth certificate and a separate statement showing the date, port, and means of all your arrivals and
departures into and out of the United States. (Do not make or submit a photostat of a certificate of citizenship. See In-
struction No. 8).
(3) If your naturalization occurred within 90 days immediately preceding the filing of this petition, or if it occured prior to
September 27, 1906, the naturalization certificate must accompany the petition. Do not make or submit a photostat of
such certificate (see Instruction No. 8).
b. To prove that petition and beneficiary are free to con tract a valid marriage with each other:
(1) If either party is of an age which requires special consent or permission for the parties to legally contract a valid marriage
in the jurisdiction in which their marriage will occur, proof of such consent or permission must be submitted.
(2) If either has been previously married, submit proof of legal termination of each marriage.
c. Secondary evidence.
If if is not possible to obtain any one of the required documents or records shown above, the following may be submitted for
consideration:
(1) Baptismal certificate.— A certificate under the seal of the church whera the baptism occurred, showing date and place of the
child's birth, date of baptism, the names of the child's parent, and names of the godparents, if shown:
(2) School record.— A letter from the school authorities having jurisdiction over school attended (preferably the first school),
-howing the date of admission to the school, child's date of birth or age at that time, place of birth, and the names and
places of birth of parents, if shown in the school records.
(3) Census record. -Slate or Federal census record showing the name(s) and placets) of birth, and date(s) of birth or age(s) of
the person(s) listed.
(4) Affidavits.— Notarized affidavits of two persons who were living at the time and who have personal knowledge of the event
you are trying to prove— for example, the date and place of a birth, marriage, or death. The persons making the affidavits
may be relatives and need not be citizens of the United States. Each affidavit should contain the following information re-
garding the person making the affidavit: His (Her) full name and address: date and place of birth, relationship to you, if
any; full information concerning the event; and complete details concerning how he (she) acquired knowledge of the event.
d. Documents previously submitted.
If your birth abroad was registered with an American consul on Form FS-240, submit that form with this petition. If any re-
quired documents relating to your claim of citizenship were submitted to and retained by the American consul who issued FS-
240 and you wish to use them in connection with this petition instead of submitting new documents, list such documents in
in an attachment to this petition and show the location of the consulate. If you wish to make simitar use of required documents
contained in any Immigration and Naturalization Service file, list them in an attachment to this petition and identify the file
by name and number. Otherwise the documents required in support of this petition must he submitted.
e. Documents in general.
All supporting documents must be submitted in original. If the return of the original is desired, submit a copy with the original
and request that the original be returned to you after an immigration officer has compared it with the copy. A copy unaccom-
panied by the original may be accepted if it bears a certification by an immigration or consular officer that the copy was com-
pared with the original and found to be identical. Any document in a foreign language must be accompanied by a summary
translation in English. A summary translation is a condensation or abstract of the document's text. The translator must certify
that he is competent to translate and that the translation is accurate.
Form 1-1 29F
<R«v. 2-28-80IN
FORM NO.
I-129F
EDITION
REV. 2-28-80
TITLE
PETITION TO CLASSIFY STATUS OF ALIEN FIANCE OR
FIANCEE FOR ISSUANCE OF A NONIMMIGRANT VISA
SIZE
8 1/2 X 11
o. n.T . ,
Hbk 5-63. 64, 65, 66. 67, 68, 10-68, 10-70, 16-32, App 5-M; GIB P. 11. App-6, -31
. «,
USE
USED TO APPLY FOR SECTION 101 (a) (15) (k) CLASSIFICATION FOR FIANCE OR FIANCEE OF U.S. CITIZEN
PRIOR EDITIONS MAY NOT BE USED
SCHEDULE
4/1/81
3-42
I-129F
Page 2
ADMINISTRATIVE MANUAL
Appendix 1
TM 803
3. Preparation of petition. The petition must be typewritten or printed legibly with pen and ink. and be submitted in single copy. (If
you need more space to answer fully any questions on this form use a separate sheet, identify each answer with the number of the
corresponding question, and date and sign each sheet.)
A. Execution of petition. You must sign 'the petition in your full, true, and correct name and affirm or make it under oath.
a. In the United States the petition may be sworn to or affirmed before an immigration officer without the payment of fee, or be-
fore a notary public or other officer authorized to administer oaths for general purposes, in which case the official seal or cer-
tificate of authority to administer oaths must be affixed.
b. Outside the United States the petition must be sworn to or affirmed before a United States immigration or consular officer.
c. A member of the Armed Forces of the United States, either in the United States or abroad, may swear to or affirm the petition
before an officer of the Armed Forces authorized to perform notarial acts under Article 136, Uniform Code of Military Justice.
d. Important: Failure to follow these instructions may result in rejection of the petition. All information and documents request-
ed must be furnished. It is important that you answer all questions fully and accurately. If an item does not apply to you or if
there is not information to be given, please write the letter "N.A." for "Not Applicable."
5. Submission of petition. Send the completed petition to the office of the Immigration and Naturalization Service having jurisdiction
over your place of residence in the United States.
6. A fee of fifteen dollars ($15) must be paid for filing this petition. It cannot be refunded regardless of the action taken on the peti-
tion. DO NOT MAIL CASH. ALL FEES MUST BE SUBMITTED IN THE EXACT AMOUNT. Payment by check or money order
must be drawn on a bank or other institution located in the United States and be payable in United States currency. If petitioner
resides in Guam, check or money order must be payable to the "Treasurer, Guam." If petitioner resides in the Virgin Islands, check
or money order must be payable to the "Commissioner of Finance of the Virgin Islands." All other petitioners must make the
check or money order payable to the "Immigration and Naturalization Service." When check is drawn on account of a person
other than the petitioner, the name of the petitioner must be entered on the face of the check. If petition is submitted from out-
side the United States, remittance may be made by bank international money order or foreign draft drawn on a financial institu-
tion in the United States and payable to the Immigration and Natrualization Service in United States currency. Personal checks are
accepted subject to collectibility. An uncollectible check will render the petition and any document issued pursuant thereto invalid.
A charge of S5.00 will be imposed if a check in payment of a fee is not honored by the bank on which it is drawn.
7. Application for status as permanent resident. A beneficiary who concludes a valid marriage with the petitioner within 90 days of
arrival in the United States will be considered an immediate relative and exempt from the numerical limitation on immigration. Up-
on concluding such marriage, the beneficiary becomes eligible and should apply promptly to the Immigration and Naturalization Ser-
vice for status as a permanent resident on Form 1-485 submitted in accordance with the instructions thereon.
8. Penalties. Title 18, United States Code, section 1546, provides: "Whoever knowingly makes under oath any false statement with
respect to a material fact in any application, affidavit, or other document required by the immigration laws or regulations prescribed
thereunder, or knowingly presents any such application, affidavit, or other document containing any such false statements, shall
be fined not more than 52,000 or imprisoned not more than 5 years, or both."
Title 18, United States Code, section 1426(h) provides: "Whoever, without lawful authority, prints, photographs, makes or
executes any print or impression in the likeness of a ***certificate of naturalization or citizenship, or any part thereof, shall be
fined not more than $5,000 or imprisoned not more than 5 years, or both."
9. Authority. The authority for collecting the information requested on this form is contained in 8 U.S.C. 1184(d). The principal
purpose for which the information is solicited is to determine the eligibility of the beneficiary for the benefits sought. The infor-
mation solicited may also, as a matter of routine use, be disclosed to other federal, state, local, and foreign law enforcement and re-
gulartory agencies, the Department of Defense including any component thereof (if either the beneficiary or petitioner has served,
or is serving in the Armed Forces of the United States), the Department of State, Central Intelligence Agency, Interpol, and indi-
viduals and organizations, during the course of investigation to elicit further information required by the Service to carry out its
functions. Failure to provide the solicited information may result in the denial of the petition.
TM 803
ADMINISTRATIVE MANUAL
Appendix 1
I-129F
Page 3
3-
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
READ INSTRUCTIONS CAREFULLY
FEE WILL NOT BE REFUNDED
Form approved
OMB No. 43-RO473
PETITION TO
CLASSIFY STATUS OF
ALIEN FIANCE OR FIANCEE
FOR ISSUANCE OF
NONIMMIGRATION VISA
PLEASE NOTE
YOU ARE THE PETITIONER
AND YOUR FIANCE OR
FIANCEE IS THE
BENEFICIARY
Fee Stamp
1 . Name of beneficiary (Uil. in CAPS! (pint) (Middle!
4. Olftw nimn uted: Including maiden n«nw if formerly married)
5. Country of b«n*ficiwv'i birth
2. Beneficiary's file
number
6. Date of beneficiary's birth (Month. d»v. yur)
'. My name ii: (tail, in CAPS) (Fintl (Middle
9. Other names uud (including maiden name if formerly married)
8. My phone number
3. Names, txrindates end countries of birth o<
beneficiary'i children:
Q
11.1 w.i born: (Month) (Day) (year)
in: (Town or City)
(State or Province)
I am a citizen of the United States
a. Dtinnihip was acquired: (Check one)
D through birth in the U.S. Q through pa/tntt
Q through marriage D through naturalization
(1 1 If acquired through naturalization, gin name undar which naturaliud. numbar of naturalization certificate and data and plac* of
naturalisation: _______________________________________^^_____^_____
(2) If acouirad through parentage or marriaga. hava you obuinad a cartificata of citizenship in your own nama baaad on luch acquisition?
__— -— _ — — (a) If 10, give numbar of cartificata and data and placa of issuance: •
(bl If not, lubmit avidanca ol citizanthip in accordance with initruction 2a. (2).
If 10, attach detailed explanation on leparate ihaat.
13. My marital itatui: Namai of my prior ipouut Namai of taanaficiary's prior spouses
D Married D Widowed D Divorced D Single
14. Beneficiary's marital status:
D Marnad D Widowed D Divorced D Single
15. Hat thu beneficiary ever been in the US.'
D Vat D No
16. IQ am Q am not related to the beneficiary.
(Place an "X" in the appropriate box. Alto, if related, state th« naturi and degree of relationthip. «.g. third coutin or rrwtarnal uncle, etc.)
CONTINUE WITH ITEMS ON REVERSE) OATH OR AFFIRMATION OF PETITIONER
I am legally able to and intend to conclude a valid marriage with the beneficiary within 90 days of the
beneficiary's arrival in the United States.
I iwear (affirm) that I know the content! of thii petition signed by me and that the statement! herein are true and correct.
Signature of petitioner (See Initruction No. 4)_____ — — — ___ — _
Subscribed and sworn to (affirmed) before me thii day of — . 19 , at__ ___ _ —
(SEAL) My comminion expires
(Signature of officer administering oath) (Title)
— Signature of Person Preparing Form, if Other Than Petitioner -
j declare that this document was prepared by me at the request of the petitioner and is based on all information of which I have
any knowledge.
" isigna't'u'reT " (Addrenl I0»tel ^
Form I-129F I Received I Tran«. In I Ret'd-Trani. Out | Completed
(Rev. 2-28-80IN
I-129F
Page 4
ADMINISTRATIVE MANUAL
Appendix 1
TM 803
TO THE SECRETARY OF STATE
The petition is approved for status
under Section 101 (a) (15) (K) on
the condition that the beneficiary
submit to the. American Consul a
statement of ability and intent to
conclude a valid marriage with the
petitioner within 90 days after ar-
rival in the United States. It is
valid for four months from date
of action.
THE PETITION WAS FILED ON
Remarks
D APPROVAL PREVIOUSLY FORWARDED
n DOCUMENT CHECK ONLY
DPERSONAL INTERVIEW CONDUCTED
Beneficiary's file number
A
DATE
OF
ACTION
DD
DISTRICT
REMARKS (Con r/»uedj
-
|
i
I
(PETITIONER IS NOT TO WRITE ABOVE THIS LINE}
' 17. Beneficiary will apply lor t viu abroad >t the American Consulate in (City in foreign country) (Foreign country)
18. (Dhsv« Qhave not personally met and «aan the benef iciary
• by which the relationship was established between the beneficiary and yourself. If nacauary. uca a separata sheet of paper th i size and Identify the answer with the
corresponding question)."
i
1
IS. Hive you evir filed a pennon for mil or any other alien fia
i and data of filing and mult.)
|
nee or finawe before? QYei Qnlo (Place an "X" in the appropriate box. Alto, If "y««" hat been checked, give name ot alien, place
20. 1 reside m the United Sum at (Apt. Mo.)
(Number and street! (Town or City) (State) (Zip Code)
2V If v«u are serving overseas in the Armed Forces ol the United Stales, pleasa provide the following:
22. Adams in the United States where beneficiary mil ratide
(City)
(Sute)
23. Address at which beneficiary is presently residing
(Apt. No.) (Number and street)
(Town or City) (Province or State)
24. Names and addresses ol beneficiary1! children
25. Have you attached all required documents (see instruction
No. 21 QYes
/P
TM 803 ADMINISTRATIVE MANUAL I-129F
Appendix 1 Page 5
UNITED STATES DEPARTMENT OF JUSTICE READ INS"
MMIGHATION AND NATURALIZATION SERVICE
FEEWII
PETITION TO CLASSIFY STATUS OF ALIEN Fl/
FOR ISSUANCE OF IMMIGRANT VISA
Reviewing Office Location: Date:
Please Forward This Form 1-1 29F(a) To:
Central Office, Immigration and Naturalization S
425 Eye Street, N.W. Attn: CO ADP
Washington, D.C. 20536
FRUCTIONS CAREFULLY
.L NOT BE REFUNDED
Form appr
OMB No. 43-RC
\NUb Fee Stamp
ervice
1 . Name of beneficiary (Lut. in CAPS) (First) (Middle)
2. Beneficiary's file 3. Names, birthdates and countries of birth of
nurnb<r beneficiary's children:
4. Other names used; Including maiden name if formerly married)
5. Country of beneficiary's birth 6. Date of beneficiary's birtf
(Month, day, year)
7. My name is: (Last, in CAPS) (Fint) (Middle)
8. My phone number is:
9. Other names used (including maiden name if formerly married)
10.1am: Qj Male Q Female
1 1 . 1 was born: (Month) (Oay) (year) in: (Town or City)
1
(State or Province) (Country)
' 1 am a citizen of the United States
a. Citizenship wes acquired: (Check one)
D through birth in the U.S. Q through parents
D through marriage D through naturalization
(1 ) If acquired through naturalization, give name under which naturalized, number of naturalization certificate and date and place of
n«..r>li»flnn-
(2) If acquired through parentage or marriage, have you obtained a certificate of citizenship in your own name based on such acquisition?
— —la) If so, give number of certificate and date apd place of issuance:
(bill not, submit evidence of citizenship in accordance with instruction 2a. (21.
b. Have you or any person through whom you claim citizensh p ever lost United Stetes cltlzenshlp?____— — — .—
If so, attach detailed explanation on separate sheet.
1 3. My marital status: Names of my pric
O Married D Widowed D Divorced D Single
r spouses Names of beneficiary's prior spouses
14. Beneficiary's marital status:
D Married Q Widowed D Divorced D Single
15. Has this beneficiary ever been in the U.S.?
D Yei D No
16. ID am D am not related to the beneficiary.
(Place an "X" in the appropriate box. Aljo. if related, state the nature and degree of relationship, e.g. third cousin or maternal uncle, etc.)
(CONTINUE WITH ITEMS ON REVERSE) OATH OR AFFIRMATION OF PETITIONER
I am legally able to and intend to conclude a valid marriage with the beneficiary within 90 days of the
beneficiary's arrival in the United States.
I swear (affirm) that 1 know the content! of this petition signed by me and that the statements herein are true and correct.
Signature of petitioner ISM Instruction No, 4).,.
_, 19 at. . ..-
(Signature of officer administering oath) (Title)
— Signature of Person Preparing Form, if Other Than Petitioner —
1 declare that this document was prepared by me at the request of the petitioner and is based on all information of which 1 have
any knowledge.
(Signature)
(Address) (Date)
FormI-129F(a)
deceived Trans. In Ret'd-Trans. Out
Completed
Rev. 2-28-80) N
3-46
FORM 1-190
I. USE;
USED BY A CITIZEN OF MEXICO TO APPLY FOR A NONRESIDENT ALIEN BORDER
CROSSING CARD (1-586), FORM 1-586 IS USED IN LIEU OF A B-2 OR B-1
NONIMMIGRANT VISA. (U.S., CONSULAR OFFICERS IN MEXICO ARE STILL ISSUING
FORM 1-586,)
II. ELIGIBILITY:
1, MUST BE A CITIZEN OF MEXICO.
2. MUST HAVE A PERMANENT RESIDENCE IN MEXICO.
III. REQUIREMENTS:
1, NO FEE REQUIRED.
2, MUST BE SUBMITTED IN PERSON.
3, EACH ALIEN, REGARDLESS OF AGE, MUST SUBMIT AN APPLICATION,
4, MUST BE SUBMITTED TO AN IMMIGRATION OFFICER AT A MEXICAN BORDER PORT
OF ENTRY, OR TO AN AMERICAN CONSULAR OFFICER IN MEXICO,
(NOTE: MAY NOT BE SUBMITTED TO A CONSULAR OFFICER ADJACENT TO THE
BORDER BETWEEN MEXICO AND THE UNITED STATES,)
5, MUST PRESENT A VALID MEXICAN PASSPORT OR VALID MEXICAN FORM 13.
6, MUST SUBMIT EVIDENCE THAT APPLICANT IS A CITIZEN OF MEXICO,
7, MUST SUBMIT EVIDENCE THAT APPLICANT HAS A PERMANENT RESIDENCE IN MEXI
8, MUST SUBMIT EVIDENCE THAT APPLICANT IS CURRENTLY EMPLOYED IN MEXICO,
9, MUST SUBMIT (1) ADIT-TYPE PICTURE.
10. ADIT FORM 1-89 MUST BE EXECUTED WHEN APPLICATION IS SUBMITTED.
11. MUST OBTAIN FIRST NAME OF APPLICANT'S PARENTS (INFORMATION NECESSARY
BUT NOT REQUESTED ON APPLICATION) , •
12. ALL COPIES OF APPLICATION MUST BE LEGIBLE.
4/1/81
Appendix I
MANUAL
1-190
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ADVCRTCNCIA IMK3RTANTI
NCIA IMPOR7ANTE
1-190
MV. 3-1-75 A?PLIC
ATIOK FOB. KOKRESIDEKT AUEK BOKDEK CBXJSSIKC CARS
size
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INSTRUCTION R£r£X£NCX
8 Cm 212. 6(b), 264.1U), .l(c), 299
Jtt_22al^7._2799.03: 11 Hbk 6-16. .1
.1; 22 CFK 41.128(b)j 01 212.6(«)(1) thnj .6(«)(5):
DSE
PILED BI ELIGIBLE ALIEH AS DEFINED IN 8 CFBL 212
(C«rbon-inttrl««v«d, orij & 2 copici) (Al«o printed
in tingle copy)
PRIOR EDITIOKS MAY MOT BE USED
SCKCDDLC B
FORM 1-506
I. USE:
USED BY A NONIMMIGRANT ALIEN LAWFULLY ADMITTED TO THE UNITED STATES TO
REQUEST TO HAVE HIS/HER NONIMMIGRANT STATUS CHANGED TO ANOTHER NONIMMIGRANT
CLASSIFICATION.
II. ELIGIBILITY:
1. GENERAL:
a. MUST BE LAWFULLY ADMITTED TO THE UNITED STATES AS NONIMMIGRANT.
b. MUST BE MAINTAINING NONIMMIGRANT STATUS WHEN THE APPLICATION IS
FILED.
(NOTE: THE ADJUDICATOR WILL MAKE THE DETERMINATION ON THE APPLICAN'
MAINTENANCE OF STATUS AFTER THE APPLICATION IS FILED.)
2. INELIGIBLE NONIMMIGRANTS:
a. NONIMMIGRANTS WHO ARE INELIGIBLE TO CHANGE TO ANY, OTHER NON-
IMMIGRANT CLASSIFICATION ARE:
(1) TRANSITS WITHOUT VISAS . . . TWOV'S.
(2) FIANCES AND FIANCEES OF UNITED STATES CITIZENS . . . K-l;
AND THEIR DEPENDENTS ... K-2'S.
(3) CREWMAN... D-l AND D-2.
3. ELIGIBILITY LIMITED:
a. ALIENS IN TRANSIT THRU THE UNITED STATES ("C" CLASSIFICATION ARE NO'
ELIGIBLE FOR ANY CHANGE OF NONIMMIGRANT CLASSIFICATION OTHER THAN
TO CLASSIFICATION AS AN A OR G NONIMMIGRANT (REPRESENTATIVES OF
FOREIGN GOVERNMENTS RECOGNIZED BY THE UNITED STATES GOVERNMENT).
b. ALIENS CLASSIFIED AS J NONIMMIGRANTS (EXCHANGE VISITORS) MAY CHANGE
TO AN A OR G CLASSIFICATION, OR IF NOT SUBJECT TO THE TWO-YEAR
FOREIGN RESIDENCY REQUIREMENT, OR HAVE HAD IT WAIVED, MAY CHANGE
TO A CLASSIFICATION AS AN H OR L NONIMMIGRANT. (IAP-66
WILL SHOW IF ALIEN IS OR IS NOT SUBJECT TO THE TWO YEAR FOREIGN
RESIDENCE REQUIREMENT.)
4/1/81
III. REQUIREMENTS:
1. GENERAL:
a. PROPER FILING FEE.
(1) NO FILING FEE IS REQUIRED.
(a) TO CHANGE FROM ANY NONIMMIGRANT CLASSIFICATION TO A
NONIMMIGRANT CLASSIFICATION UNDER SECTIONS. 101(a) (15) (
AND/OR G. (A OR G NONIMMIGRANT CLASSES.)
(b) TO CHANGE WITHIN ANY CLASSIFICATION, FOR EXAMPLE:
(1) B-2 TO B-l
(ii) F-l TO F-2
(111) L-2 TO L-l
(2) NO FEE OR APPLICATION IS REQUIRED FOR RECLASSIFICATION WITH
THE SAME CLASSIFICATION, BUT AN APPLICATION SHOULD BE REQUE
TO HAVE A RECORD OF THE CHANGE THAT TAKES PLACE. . .WITHOUT F
(3) NO FEE IS REQUIRED WHEN A CHANGE TO AN EXCHANGE VISITOR (J)
HAS BEEN REQUESTED BY AN AGENCY OF THE UNITED STATES GOVERN
b. ALL QUESTIONS MUST BE COMPLETED BY APPLICANT.
c. APPLICATION MUST BE SIGNED BY APPLICANT (IF CHILD IS APPLICANT,
GUARDIAN MAY SIGN).
d. ARRIVAL-DEPARTURE DOCUMENTS (FORMS' 1-94) OF PRINCIPAL AND DEPEND
MUST BE SUBMITTED WITH APPLICATION.
e. PRINCIPAL APPLICANT AND DEPENDENTS MUST BE IN POSSESSION OF PASS
THAT IS VALID FOR SIX MONTHS BEYOND THEIR INTENDED STAY IN THE
UNITED STATES.
f. ALL APPLICATIONS SHALL BE ACCOMPANIED BY THE DOCUMENTARY EVIDENC
NECESSARY TO ESTABLISH ELIGIBILITY FOR THE CHANGE OF NONIMMIGRAN
STATUS BEING REQUESTED.
2. SPECIFIC:
a. APPLICATION FOR CHANGE OF NONIMMIGRANT STATUS TO SECTION:
in/i
3-50
(1) 101 (a) (15) (A) OR (G),.. REPRESENTATIVES OF FOREIGN
GOVERNMENTS IN THE UNITED STATES RECOGNIZED "DEFACTO" OR
"DEJURE."
(a) NO FEE
(b) STATUS OF THE ALIEN MUST BE VERIFIED FROM THE STATE
DEPARTMENT ON FORM 1-88.
(c) NEITHER AN 1-88 OR FORM 1-506 ARE REQUIRED WHEN THE
CHANGE OF NONIMMIGRANT STATUS WAS AT THE REQUEST OF OR
THRU THE STATE DEPARTMENT,
(2) 101(a)(15)(H) OR (L)... ALIENS OF DISTINGUISHED MERIT AND
ABILITY COMING TO PERFORM TEMPORARY SERVICES, ALIENS COMING
TO PERFORM TEMPORARY SERVICES FOR WHICH A NEED EXISTS:
TRAINEES AND INTRA-COMPANY TRANSFEREES,
(a) FORM I-129B SHOULD BE SUBMITTED BEFORE, OR IN CONJUNCTION
WITH, THE REQUEST FOR A CHANGE OF NONIMMIGRANT STATUS.
(b) SUPPORTING DOCUMENTS NECESSARY TO ESTABLISH ELIGIBILITY
MUST BE SUBMITTED.
(3) 101 (a) (15) (J).,. EXCHANGE VISITORS.
(a) FORM IAP-66 SHOULD BE SUBMITTED IN CONJUNCTION WITH THE
REQUEST FOR CHANGE.
(4) 101(a)(15)(F),.. STUDENTS
(a) FORM 1-20 SHOULD BE SUBMITTED IN CONJUNCTION WITH THE
REQUEST FOR CHANGE OF STATUS.
(b) AN AFFIDAVIT OF SUPPORT (1-134) OR PROOF OF ECONOMIC
SOLVENCY MUST ACCOMPANY APPLICATION,
(5) 101(a)(15)(E)... TREATY TRADERS AND INVESTORS.
(a) FORM 1-126 IS SUBMITTED IN CONJUNCTION WITH THE REQUEST
FOR CHANGE OF STATUS.
(b) SUPPORTING DOCUMENTATION NECESSARY TO ESTABLISH
ELIGIBILITY MUST BE SUBMITTED,
7M 800
ADMINISTRATIVE MANUAL
Appendix 1
1-506
Paqe 1
«»IICATION)
UNITED STAT8S DEPARTMENT OF JUSTICE ICLEASS
Immigration and Maturation Servtee JU
APPLICATION FOR CHANGE OF NONIMMIGRANT STATUS
(Uneto Section 249 ff» the ImmferMlon and Nationality Act)
INSTRUCTIONS TO THE APPLICANT
READ INSTRUCTIONS CAREFULLY. FEE WILL NOT BE REFUNDED.
Failure to comply with instructions may maka it nscatsary to reject your application.
1. This application thould be taken or moiled to tha offiea of tha Immigration and Naturalization Sarvica nearest your place of residence In tha
Unil«d Statai. A separate application must b* executed (or each parson applying lor a change of nonimmigrant clinsification, with tha following
exceptions:
la) You m«y include your spouse and unmarriad. minor children in your applieation. without additional application or f»e. if thay ait in the
United Siataa at nonimmigrants end you are leaking e change of status under paragraph 11 5)(A) (foreign aownment official or his employee)
I1SIIE) (treaty treder or Investor). (15XF) (student). (15HGI (representative to or employes of international organization, or hii employee).
(15IIH) (temporary worker or trainee), (151(1) (foreign information medium repreientative). I15IIJ) (exchange visitor) or (1SHLI (intra-conv
pany transferee) of lection 101 (a) of the Immigration and Nationality Act. a amended.
(b) Neither en application nor fee ii required if you ere leaking reclanification from the ttatui of a viiitor for pleasure (B-21 to that of a visitor
for business IB-1 ); from the status of a student IF-1 ). exchange visitor (J-1 1. or intre-company transferee (L-1 ) to that of an accompanying
spouse or unmarried minor child of a student, exchange visitor or imra-company transferee (F-2. >2 or L-2 raspectivalyt. or vice vena; or
from any category within (action 101 la) (15KH) of the Act (H-1, H-2, H-3, or H-4 tamporary worker or trainee or accompanying spouse or
unmarried minor child) to another, provided that any requisite Form I-129B patition has been approved.
(e) No fee is required if you are seeking a change of nonimmigrant status to that of a foreign government official (or his/her employee), or to that
of e representative to. or employee of, an international organiiation (or his/her employee) under paragraphs (1 SKA) or 11 SHG) of section 101 (a)
of the Immigration and Nationality Act, as amended. No fee is required if a change to exchange visitor status under paragraph I1SKJI of
that section is requested by an agency of the U.S. Government, and Form IAP-66, Certificate of Eligibility for Exchange-Visitor Status, sub-
mitted by that agency with its request will be accepted in lieu of an application for the change.
The burden is upon you to establish your eligibility for the change of status you are seeking. If you fail to supply tha information and documents
required by the application and tha instructions attached to it. your application will not be approved.
2. Except at indicated above, a fee of ten dollers ($101 must be paid for filing this application. It cannot be refunded regardless of the action taken
on the application. DO NOT MAIL CASH. ALL FEES MUST BE SUBMITTED IN THE EXACT AMOUNT. Payment by check or money order
must be drawn on e bank or other institution located in the United States end be payable in United States currency. If applicant resides in Guam,
check or money order must be payable to the "Treasurer. Guam." II applicant resides in the Virgin Islends. check or money order must be payable
to the "Commissioner of Finence of the Virgin Islands." All other applicants must make the check or money order payable to the "Immigration
and Naturalisation Service." When a check if drawn on an account ol e person other than the applicant, the name of the applicant must be entered
on the face of the check. If the application is submitted from ouuide the United States, remittance may be made by bank international money
order or foreign dreft drawn on a financial institution in the United States and payable to the Immigration and Naturalization Service In United
States currency. Personel checks are accepted subject to collectibillty. An uncollectible check will render the application end any document issued
pursuant thereto invalid. A eharae ol JS.OO will be imposed If a check In payment of a fee Is not honored by the bank on which It is drawn.
3- PQ NOT SEND IN YOUR PASSPORT. When you submit your application you must alto send in your temporary entry permit (Form 1-94,
ARRIVAL-DEPARTURE RECORD). (If your temporary entry permit is attached to your patspon. the permit should be removed for this pur-
pose). However, you mutt be in pcesession of a passport valid for at least six (6) months beyond the expiration dele of the extension requested.
4. If you era applying for e change from your present lawful nonimmigrant classification to that of a student, you need not answer item 20 of this
application. Instead, you must submit tha following:
A completed Form 1-20, Certificate of Eligibility, i
(page 2) of tha Form 1-20.
ued by the school you are attending or wish to attend. You mutt complete the reverse
(bl A statement showing that sufficient funds will be eveilable to you for your support and all costs of attending school, giving the source of your
sunport *nd the amount recilved from each source. If you are not self-supporting, you must submit a Form 1-134, Affidavit of Support,
executed by each parson from whom you will receive support together with tha evidence suggested on the reverse of that form.
5. If you are applying for a change from vour present lawful nonimmigrant classification to that of en exchange visitor, you must submit a com-
pleted Form IAP-66, Certificate of Eligibility for Exchange-Visitor Status, from the sponsor of the exchange-visitor program you wish to partici-
pate in. You must complete the reverse of Form IAP-66.
6. If you ere applying for a change from your present lawful nonimmigrant classification to perform temporary services in the United States or to
be a trainee, your application must be accompanied by Form I-129B, Petition to Claasify Nonimmigrant as TemporeryWorkerorTrainec.com.
plated in duplicate by the person or firm desiring your services or offering the training; or, If such a petition hat already been approved in your be-
helf. your application must be accompanied by the Form 1-1 7 1C, Notice of Approval of Nonimmigrant Visa Petition, which was sent to your pro-
spective employer or treiner upon approval of tha Form 1-1 298.
istor, you must submit a com-
7. II you are applying for a change from your present lewful nonlmmigrent status to that of a treaty trader or In
plated Form 1-1 26. Report of Status by Treaty Trader or Investor,
8. If you are applying for a change Irom your lawful nonimmigrant classification to one of the nonimmigrant classifications not discussed In instruc-
tions 4. 5, 6, or 7 above, you must submit with your application appropriete evidence of your eligibility for the clarification you seek.
8. PENALTIES. Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact or using any falsa docu-
ment In the submission of this application. Also, a falsa representation may result In the denial of this application and any other application you
may maka for any benefit under the immigration laws of tha United States. Any statement submitted with this application Is considered part of
the applieation.
I4oe IMV. 1033 7
Slock Xumtxr OJI-OB-aoajw
. oowjWKon ntnnme omct i
FORM NO.
1-506
EDITION
Rev. 10-22-79
TITLE
APPLICATION POR CHANGE OF NONIMMIGRANT STATUS
SIZE
* x 104
INSTRUCTION REFERENCE
.5; AM 2301.07, 2482 Ex. 2.
8 CFR 214.2(j)(2), 248. 3{a), (b), 299.1; 01 248. l(b),
2790.08, .13, .14, 2984 Ex.2, Ex. 4; II Hbk 8-14.4, 10
(c)
•51,
52 "
-56, -57. -58, -58.
2, 13-2.
2 ADD 9-A. 10-J: GTB APP.6
DSE
SUBMITTED BY AN ALIEN LAWFULLY ADMITTED TO THE U.S. AS A NONIMMIGRANT TO HAVE STATUS
CHANGED TO ANY OTHER NONIMMIGRANT CLASSIFICATION FOR WHICH HE MAY BE ELIGIBLE
PRIOR EDITION MAY NOT BE USED
SCHEDUJJE
3-52
ADMINISTRATIVE MANUAL
Appendix 1
TM 80
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
APPLICATION FOR CHANGE
OF NONIMMIGRANT STATUS
(Under Section 248 of the Immigration and Nationality Act)
•"•»• PIMM read trva instructions on the first page
I hereby apply to have my status in the United States changed to that of a nonimmigrant.
I wish to remain in the United States in that new status until
Form Approved
OMBNo.43-R0342
Fee Stamp
(Month. D»y. Y«ar)
This application is submitted together with the required documents which are made a part hereof and. if applicable, the fee of $10.
MAILING
ADDRESS
NAME ICtpial Lttnrjl
FILE NUMBER IH Known)
NUMBER ANUSTREET (Apt. No.l
DATE ON WHICH AUTHORIZED STAV EXPIRES
Reclassification
tO
FOR GOVERNMENT USE ONLY
DATE
r—jSTAY GRANTED TO (D««)
f— 1 APP|icat'°n DENIED. V.D. TO (DSM>
6. I AM IN POSSESSION OF PASSPORT
NUMBER:*
ISSUED BY (Country)
WHICH EXPIRES ON: (Month, Day. Year)
7. MY 1-94 IS ATTACHED Q YES Q NO
If "No", It was OLott D Stolen Q Destroyed
QOther (Specify)
8. I ENTERED WITH NONIMMIGRANT VISA NO.
9. MY NONIMMIGRANT STATUS IN THE UNITED
STATES D HAS D HAS NOT BEEN CHANGED
SINCE MY ENTRY (If changed, give details)
107 MY PERMANENT ADDRESS OUTSIDE THE UNITEDSTATES IS: (Street) (City or Town) (County. District, Province or State) (Country)
11. I RESIDED ATTHE ADDRESS IN ITEM 10 FROM: (Month, Day, Year)
TO: (Month, Day. Yaar)
12. SINCE MY ENTRY INTO THE UNITED STATES. I HAVE RESIDED AT THE FOLLOWING PLACES:
(Streat and No.) (City or Town) (State) FROM: (Month. Day, Year) TO: (Month. Day. Yaar)
Present Tim*
13. I DESIRE TO HAVE MY NONIMMIGRANT STATUS CHANGED FOR THE FOLLOWING REASONS:
14. I DID NOT APPLY TO THE AMERICAN CONSUL FOR A VISA IN THE NONIMMIGRANT STATUS WHICH
I AM NOW SEEKING FOR THE FOLLOWING REASONS:
15. I SUBMIT THE FOLLOWING DOCUMENTARY EVIDENCE TO ESTABLISH THAT I WILL MAINTAIN THE NONIMMIGRANT
CLASSIFICATION TO WHICH I WISH TO BE CHANGED:
ATTACH YOUR FOHM-l-94 -*DQ NOT SEND YOUR PASSPORT)
FORM I -MB INEV. 10-22-7*)
RETO -TRANS OUT
COMPLETED
TM 800 ADMINISTRATIVE MANUAL
Appendix 1
I-
Pa
16. (COMPLETE THIS BLOCK ONLY IF YOU ARE APPLYING FOR CHANGE TO STUDENT ST ATI
THE COUNTRY IN WHICH 1 INTEND TO LIVE AND WORK AFTER 1 COMPLETE MY SCHOOL
JS.)
NG IN THE UNITED STATES IS . .
(IF YOU ARE SEEKING TO ATTEND A VOCATIONAL OR BUSINESS SCHOOL. COMPLETE THE FOLLOWING ADDITIONAL STATEMEN"
BY CHECKING THE APPROPRIATE BOXES.)
THE SCHOOLING 1 AM SEEKING Q IS Q IS NOT AVAILABLE IN MY COUNTRY.
1 Q INTEND D DO NOT INTEND TO ENGAGE IN THE OCCUPATION FOR WHICH THAT SCHOOLING WILL PREPARE ME.
17. MY OCCUPATION IS:
18. SOCIAL SECURITY NO.
(If none, state "none")
19. 1 D HAVE D HAVE NOT BEEN EMPLOYED OR ENGAGED IN BUSINESS SINCE ENTERING THE UNITED STATES. IF ANSWER IS II
AFFIRMATIVE. COMPLETE THE FOLLOWING:
NATURE OF OCCUPATION OR BUSINESS IN WHICH 1 Q]AM DWAS EMPLOYED:
NAME OF EMPLOYER OR BUSINESS FIRM
ADDRESS
MY EMPLOYMENT OR ENGAGEMENT IN BUSINESS BEGAN ON: (Month. Dav. Ywr) AND ENDED ON: (Month. Day. Year)
MY MONTHLY INCOME FROM EMPLOYMENT OR BUSINESS Q IS QWAS: t
20. IF NOT EMPLOYED OR ENGAGED IN BUSINESS IN THE UNITED STATES. DESCRIBE FULLY THE SOURCE AND AMOUNT OF YOUR
INCOME ABROAD AND HOW SUPPORTED WHILE IN THE UNITED STATES: (If applying for change to student status, saa Instruction # 4.)
21. i QAM QAM NOT MARRIED
Name of Spousa Present addraii of Spout*
Citizenship (Country) of Spouse
22. I HAVE (Number) CHILDREN: (Li«t children below)
Name Age
Place of Birth
Present Address
23. I HAVE (Number) RELATIVES IN THE UNITED STATES OTHER THAN MY SPOUSE AND/OR CHILDREN: (Lilt ralatives ban
Name Ralationihlp
Immigration Status
Present Address
24. 1 n HAVE n HAVE NOT SUBMITTED THE ADDRESS REPORTS REQUI RED By THE ALIEN REGISTRATION ACT OF 1940, .
AS AMENDED. AND BY SECTION 265 OF THE IMMIGRATION AND NATIONALITY ACT.
25. I Q HAVE QHAVE NOT BEEN ARRESTED OR CONVICTED OF ANY CRIMINAL OFFENSE IN THE UNITEOSTATES OR IN ANY
FOREIGN COUNTRY. IF ANSWER is IN THE AFFIRMATIVE. GIVE DETAILS:
26. I certify that the above I* true and correct to th« best of my knowledge and belief. (If form prepared by other than applicant, that person must
execute item 27.)
(Signature of Applicant)
(Data)
SIGNATURE OF PERSON PREPARING FORM. IF OTHER THAN APPLICANT
27. I declare that this document was prepared by me at the raqu«
have any knowledge.
it of the applicant and Is based on all information of which I
(Signature)
(Address)
(Data)
1-506
Page 4
ADMINISTRATIVE MANUAL
Appendix 1
TM 800
ADDRESS LABEL
PLEASE SEE ENDORSEMENT
ON ATTACHED FORM 1-94
REGARDING ACTION TAKEN
ON YOUR APPLICATION
4/1/81
TM 800
ADMINISTRATIVE MANUAL
Appendix 1
[ PORM I-S08A IHEV. 1O.27.7S1 AWtlCATIONCHAXCf NONIMMIGRANT STATUS I
1 FAMILY NAME {CttHOl LtOtnl OIVEN
YOUR NAME
MIOOLE
C/O
IN CARE Of
FILE
NUMBER IHKna**)
MAILING
IN U.S
ZIP CODE
COUNTRY OF CITIZENSHIP
STATES
Of LAST ARRIVAL IN U
s.
Rectification FOR GOVERN*^
to
JT USE ONLY
DATE
or
ACTION
OO
OR
OIC
OfftCt
r— jSTAY GRANTED TO (D.t.)
j— -j Application DENIED. V.D. TO (D.t.)
.REQUESTS FOR A CHANGE OF NONIMMIGRANT STATUS
31™ NjQEMRIWLAIELM^
I. GENERAL;
1. APPLICATION MUST BE MADE IN WRITING; A LETTER WILL SUFFICE;
2. FORM 1-94 MUST ACCOMPANY APPLICATION;
3. APPLICANT HAS THE RIGHT TO APPEAL IF APPLICATION IS DENIED.
II. ELIGIBLE CLASSES:
1. AN ALIEN WHOSE STATUS HAS BEEN CHANGED TO A CLASSIFICATION UNDE!
SECTION 101(a)(15)(A) OR (G) OF THE ACT HAS IN THE UNITED STATE!
AN "IMMEDIATE FAMILY" MEMBER AS DEFINED IN 22 CFR 41.1, THE STA'
OF THE "IMMEDIATE FAMILY" MEMBER MAY BE CHANGED TO THE CLASS IF 1 1
TION OF THE PRINCIPAL ALIEN WITHOUT AN APPLICATION OR FEE.
2. AN ALIEN WHOSE STATUS HAS BEEN CHANGED TO A CLASSIFICATION UNDEI
SECTION 101(a)(15)(E), (F), (H), (I), (J), OR (L) OF THE ACT HA!
A NONIMMIGRANT SPOUSE OR NONIMMIGRANT CHILD IN THE UNITED STATE!
THE STATUS OF THE SPOUSE OR CHILD MAY BE CHANGED TO THE APPROPR
NONIMMIGRANT CLASSIFICATION WITHOUT AN APPLICATION OR FEE.
3. NEITHER AN APPLICATION NOLfM. IS REQUIRED OF AN ALIEN WHO SEEK:
RECLASSIFICATION^
a. FROM THAT OF A VISITOR FOR. PLEASURE UNDER SECTION 101(a)(15
OF THE ACT TO THAT OF A VISITOR .FOR BUSINESS UNDER THE SAME
SECTION;
b. FROM CLASSIFICATION AS A STUDENT UNDER SECTION 101(a)(15)(F
OF THE ACT TO CLASSIFICATION AS AN ACCOMPANYING SPOUSE OR M
CHILD UNDER SECTION lOl(a)(l5)(F)(11) OF THE ACT OR VICE VE
c. FROM ANY CLASSIFICATION WITHIN SECTION 101(a)(15) (H) OF THE
TO ANY OTHER CLASSIFICATION WITHIN SECTION 101(a) (15)(H) PR
VIDEO REQUISITE FORM I-129B VISA PETITION HAS BEEN FILED AN
APPROVED;
d. FROM CLASSIFICATION AS A PARTICIPANT UNDER SECTION
10l(a)(15)(J) OF THE ACT TO CLASSIFICATION AS AN ACCOMPANY-
ING SPOUSE OR MINOR CHILD UNDER THAT SECTION, OR VICE VERSA;
e. FROM CLASSIFICATION AS AN ' MTRACOMPANY TRANSFEREE UNDER
SECTION 101(a)(15)(L) OF T';F An TO CLASSIFICATION AS AN
ACCOMPANYING SPOUSE OR MINOR CHILD UNDER THAT SECTION, OR
VICE VERSA;
f . WHEN A CHANGE TO EXCHANGE ALIEN STATUS UNDER SECTION
101(a)(15)(J) OF THE ACT IS REQUESTED BY AN AGENCY OF THE
U.S. GOVERNMENT; FORM DSP-66, CERTIFICATE OF ELIGIBILITY FOR
EXCHANGE-VISITOR STATUS, SUBMITTED BY SUCH AGENCY TOGETHER
WITH ITS REQUEST WILL BE ACCEPTED IN LIEU OF FORM 1-506.
NOTE: AN ALIEN CLASSIFIED AS A VISITOR FOR BUSINESS UNDER
SECTION 101(a)(15)(B) OF THE ACT NEED NOT REQUEST A
CHANGE OF CLASSIFICATION TO REMAIN IN THE UNITED STATES
TEMPORARILY AS A VISITOR FOR PLEASURE.
NOTE: AN ALIEN CLASSIFIED UNDER SECTION 101(a)(15)(A) OR (G)
OF THE ACT AS A MEMBER OF THE IMMEDIATE FAMILY OF A
PRINCIPAL ALIEN WHO IS CLASSIFIED UNDER THE SAME SECTION,
OR AN ALIEN CLASSIFIED UNDER SECTION 101 (a) (15) (E), (F)s
(H), (I), (J), OR (L) OF THE ACT AS THE SPOUSE OR CHILD
WHO ACCOMPANIED OR FOLLOWED TO JOIN A PRINCIPAL ALIEN WHO
IS CLASSIFIED UNDER THE SAME SECTION, NEED NOT REQUEST A
CHANGE OF CLASSIFICATION TO ATTEND SCHOOL IN THE UNITED
STATES, AS LONG AS SUCH IMMEDIATE FAMILY MEMBER OR SPOUSE
OR CHILD CONTINUES TO BE QUALIFIED FOR AND MAINTAINS THE
STATUS UNDER WHICH HE IS CLASSIFIED.
10/1/80
TM 656
ADMINISTRATIVE MANUAL
1
1-515
t
NOTICE TO STUOIMT OR iXCHAMGi VIS1TDH
Your admission to the United States has been LIMITED TO 30 DAYS because you do not have the document checked
below.
P"1 Fora I- 2MB from the school to which you are destined.
Q2 Form DSP-66 from the exchange program sponwjr to which you ®r« destined.
You must obtain the required form end submit it to the United States Immigration and Naturalisation Service office
at the location and before the date shown below. If the first box above is checked, you roust complete the reverse of
Form 1-20A. If the second box above is cheeked, you must complete the reverse of Form DSP-66. You must also 'submit
the immigration document (Form 1-94) given to you on entry in the United Steles. If yoa sre aceouipaniffd by your spouse
and children, you should also submit the Forms 1-94 issued to them. (If your temporary entry permit is attached to your
passport, the peimit'should b® removed for this purpose). DO NOT SENDJN YOUR .PASSPORT.
YOU MUST ALSO COMPLETE THE BLOCK BELOW BEFORE SUBMITTING THE FORM TO THE IMMIGRATION
AND NATURALIZATION SERVJCE.
U» mm* la: fL<»O f 'pireO fMraflo)
ttr A«cS«>o« w Ota U.S. vtU to: t*r pcaiven 10 «»11<! tg
ro<Ho>.-
Ttso otsmi ol erf ogc»rat>iEiyliim etasuao f/( smzl te:
EaoKoo'o poocpon lo icin) to:
U7 x>«Mn>n;ti>a oSalOKOT'o ocaoo mt:
Ttaoi< nooaono <ra osJld to:
THIS FORM. FULLY EXECUTED. AND REQUIRED DOCUMENTS MUST BE SUBMITTED BEFORE
to the UNITED STATES IMMIGRATION AND
NATURALIZATION SERVICE OFFICE LOCATED AT:
Pom l-s:s
:Rm. 10-1-69)
UNITED STATES DIEPARTMIMT Of JUSTICE - I
lM «M) M«vroll.o«t«i SvrvlM
FORM NO.
1-515
SIZE
8 X 10f
USE
EDITION
REV. 10-1-69
TITIJE
NOTICE TO^SOTDDffi CK EXCEAHCE VISITOR
OR DSP-66
WrffiOUT 1-20
INSTRUCTION REFERENCE
oi
TO "F1 AMD "J" AUCffl
WXTHQW POfM 1-20 OR
SCHEDULE
1-538
i- USE-
USED BY NONIMMIGRANT STUDENT (F-l) TO REQUEST EXTENSION OF STAY,
SCHOOL TRANSFER OF PERMISSION TO ACCEPT OR CONTINUE EMPLOYMENT.
II. ELIGIBILITY:
MUST BE IN THE UNITED STATES AS A NONIMMIGRANT STUDENT (F-l) OR
DEPENDENT THEREOF (F-2).
III. REQUIREMENTS:
1. GENERAL:
a. APPLICATION MUST BE FILED BY MAIL OR IN PERSON AT THE OFFICE
OF THE IMMIGRATION SERVICE HAVING JURISDICTION OVER THE SCHOOL
THAT STUDENT WAS LAST AUTHORIZED TO ATTEND (NO FEE REQUIRED).
b. SPOUSE AND CHILDREN (F-2) MAY BE INCLUDED ON APPLICATION.
c. FORM 1-94 MUST ACCOMPANY APPLICATION, INCLUDING I-94'S FOR
SPOUSE AND CHILDREN IF APPLICABLE.
d. APPLICATION MUST BE COMPLETED IN ENTIRETY WITH PART IV
COMPLETED BY LAST AUTHORIZED SCHOOL OF ATTENDANCE* ALL COPIES
OF THE FORM KJSJ BE LEGIBLE,
e. MUST PASSPORT VALID FOR 6 MONTHS BEYOND PERIOD OF STAY
REQUESTED, UNLESS EXEMPT FROM PASSPORT REQUIREMENT.
2. REQUEST FOR TRANSFER:
a. A FORM 1-20 EXECUTED BY THE SCHOOL WERE APPLICANT WISHES TO
STUDY MUST ACCOMPANY APPLICATION.
b. APPLICANT MUST EXPLAIN, IN WRITING, WHY A TRANSFER IS REQUESTED
3. REQUEST FOR PERMISSION TO ACCEPT EMPLOYMENT BECAUSE OF ECONOMIC
NECESSITY:
a. MUST SUBMIT EVIDENCE TO ESTABLISH THAT THE ECONOMIC CONDITIONS,
CREATING SUCH NEED, WERE UNFORESEEN AND HAVE ARISEN SINCE
APPLICANT'S ATTAINMENT OF NONIMMIGRANT STUDENT STATUS.
-1-
b. WHEN REQUESTING PERMISSION TO CONTINUE IN PREVIOUSLY
AUTHORIZED EMPLOYMENT , MUST SUBMIT EVIDENCE TO ESTABLISH
TJ..-T CONDITIONS WHICH WARRANTED INITIAL GRANT STILL EXIST.
4. REQUEST FOR PERMISSION TO ENGAGE IN EMPLOYMENT FOR PRACTICAL
TRAINING:
a. MUST SUBMIT EVIDENCE TO ESTABLISH THE TYPE OF TRAINING
APPLICANT WILL RECEIVE.
b. MUST SUBMIT EVIDENCE TO ESTABLISH THAT SUCH TRAINING IS
NOT AVAILABLE IN THE APPLICANT'S COUNTRY OF ~OREIGN RESIDENCE.
c. IF APPLICANT HAS ENGAGED IN A "WORK/STUDY" PROGRAM, THE
FOLLOWING MUST BE SUBMITTED:
(1) A LETTER FROM THE SCHOOL STATING:
(a) THE NUMBER OF HOURS THE APPLICANT HAS PARTICIPATED
IN OFF-CAMPUS EMPLOYMENT UNDER THE WORK/STUDY PROGRAM.
(b) A DESCRIPTION OF THE APPLICANT'S DUTIES WHILE SO EMPLOYED.
(c) THE NAME AND ADDRESS OF THE EMPLOYER.
d. WHEN REQUESTING PERMISSION TO CONTINUE IN PREVIOUSLY AUTHORIZED
EMPLOYMENT FOR PRACTICAL TRAINING, MUST SUBMIT A LETTER FROM
(NOTE: THE F-2 SPOUSE AND CHILDREN MAY N3T ENGAGE IN EMPLOYMENT.)
10/1/80
ADMINISTRATIVE MANUAL
Appendix I
APPLICATION BY NONIMMIGRANT STUDENT |F-1) FOR EXTENSION OF STAY,
SCHOOL TRANSFER OR PERMISSION TO ACCEPT OR CONTINUE EMPLOYMENT
INSTRUCTIONS
1. GENERAL Complete this application If you are months beyond the expiration date of the extension ro-
an alien admitted to the United Siaiei !or > temporary queawd.
! aT'eitens'ion o°nv™rr'Vuih'orFtte'd '^'"so'^a^tou^mav 3- ^PLICATION FuK EXTENSION OF STAY.
I conunuentyour0stud"el /Also 'co'mpie'e^ this app;ica'tio'n">L' (a) WHEN TO SUBMIT APPLICATION. Submit ap-
i you desire permission lo transfer to another scnool or to plication lor extension of stay not lefle than 15 nor
acrepi or continue employment previously authorized. more than 60 days before your authoruad stay
| In^m'^oT^exTe'niion ""eVp'orary"^"' 'and" permfsTion (b) WHERE TO Sl'DMIT APPLICATION. Take or
lo transfer to another icnool. or for eaieniion ol tern- mail your application to the office of the Immi-
I ronun'ue previously autnorueo employment Jurisdiction over the pmce where your school Is
' K-nool" and Tso^de^^o''^^0 pe?mi'."on'0|ot sccrpt * APPLICATION FOR PERMISSION TO TRANS-
employment or to continue previously authorizes em- FER TO ANOTHER SCHOOL. You may not Iramfer
ployment. you must firn luomit the application for to another scnool unlni permission to do so hai firm
permission lo transfer land extension il neeoed I in been granted by the Immigration and Naturalization
: accordance with Inilruction number I In luch case Service Therefore, before you transfer submit with
' PART iV of tne application should be eiecuied by an this application Form I-!0 ereculed by the »chool to
! aulhorued olT>cial of the school Irom which you wish which you wish to tranifer Submit the apolication to
lo transfer, and the completed application should be the a/dot df the Immigration and Naturalization Ser-
lubmtned lo Ihc Immigration and Naturaluauon Ser- vice having jurisdiction over the school vou were last
vice office whicb hai lunsdiction over th» place »here authorized by the Service to attend. Permission to '
ihai school it located II the application lor permission transfer may be granted only to a boon Qo« nonim-
in transfer II granted and you desire permission to migrant student wiio intends id take ft full course of I
• srrrpl or continue prevtouiiv aulhorued employment. study at the school lo which he toifthes to transfer.
vou may then submit a separate application on Form In addition, a tranifer applicant must establish thai he
I-53S Idr mat purpose, in such ease PART IV of the wa> a full-time student at the school which be was last
1 of the school lo which your transfer nas been author- commence or conunue full-time attendance at that school
ized. and me completed application should be submitted was due to circumstances beyond his control or was other-
id the Immigration and Naturalisation Service office wise justifed. If you did not anend the ichool you were
, having Jurisdiction over that ichool last aulhorued 10 attend or die not punue a full counw
in each case, exc.pl a. specified ,n Intttruction 4 be- ot"»°? <"««• """VS,* 'i? «•'«»«*«>' «Pl«<«"on
' IT.,"" m*™nbe"0mn.dT'b:.1n 'author* Jed ^'a,"',,', £ "^ M* .7u"'«±., frJSF& £*££>&
; %XUS?£ .T^ton-r. ^nec^r^ £- e^d - -„ Sft^™J^V-£
A separate application must be completed by each ap- also, instead of submitting lot application to the o(Ace
pncant However, an F.I student wno aeoirei an es- of the Immigration and Naturalization Service having
( lennon ol temporary <tay lor his spouse and children at Jurisdiction over that school, you may submit It to the
F-2 nonimmigrants thould Include them m his appli- office of the Service having jurisdiction over the school
I cation | block 1 6 1 to which you wish to transfer.
I A incuse or child who desires an extension of stay In s APPLICATION FOR PERMISSION TO ACCEPT
omer lhan an F-. cia.su-icaiion mu.t man. a separate OR CONTINL'E EMPLOYMENT.
: jpplrr^n.tr'on^ ft.*?.;1)!. ^«?z '"^jg""-^ ^T^ns^tM:
! n" 'P°nx>r in a businets while In the L'nued Suies unleas per-
! _ mission to do so has fUtt been granted by the Immt-
I The application must be lyjwwrmro or printed lejlbly jranon and Naturalization Service. Permission which
: in ink witn block leneri IK YflL NEhO MORE SFACE ,, .ranu<) to a student to engage m any employment
TO ANSWER FULLY ANM QUESTION ON THIS .hall n" receedmedateofo^rsltonofL aulnoJuSi
FORM. UbE. A SEPARATE SHEET AND IDENTIFY awv The F-S spouse or chUd o( a nonlmntsrafll
| EACH ANSWER WITH THE NUMBER OF THE .tuden. may no. apply fof or be granted perm^on
| CORRESPONDING QUESTION. atorpt employment
If you are carrying less lhan a full schedule of claae- (b) ECONOMIC NECESSITY. (1) If you are a nonSn-
example. a graduate itudent may Indicate in such eut«- continue part-time employment because of economic
a'lhes""00"' h°Ur* " th*' *" " tnsa89d ta wrthn* (I) Enabllsh that the nscaaslry It due to unloMseendr.
j 2 FCHM 194. ARRIVAL-DEPARTURE RECORD. o^*^^nBlB8<rf^c^"wu«O|om»iUmV*ra«
I When you submit your application you muat alao Btend etudettt:
DEr'ARVLRrrKEyconRS'^Ptlfroyour'tmporBry entry p«." <u> ob<«'» eertUkatlon. In Pan IV of thio application,
mil is attach.d 10 your passport the permit should** °( M «u'honMd scnool oflteal that pan-ume em-
removed for this purpose). DO NOT SEND IN YOUR nloymtm will not interfere with youi abUlly to e»ny
PASSPURT However, you mult be In poee*aaw>n of a succesafully a fuU eoune ol atudy.
f;pT.0uonVd.t 'of Sta'-U^'^T^? Tlu it W S.ud«u, penn.^ to ac«p, «npU,y»« due,, aco-
pl«,,on include, vour spouse .mlcnlldren their For£ «>«?* '>£!*?'«"« l!^M" >Uch ""P"""""1 " •<>»»
T»4 must be submitted with the application. They, too, «» the need .therefore ceMes.
must be In Dosaoaaton ol paespom valid lor at ka»« eu (3) Pornlaaton tc acoept employmeni beeAuaeof economic
For Sale by the Aui
tits, imv nj mv
UMrustendoiil of Doctiaeenu. US Government Pnmu
.D.C. lOtOI - <?,, 1001-itoitt No. OI1XW3-001
FORM NO.
I-S38
SIZE
8 X 10 1/2
use
REV.
M
EDIT10N
TXTJUE
APPLICATION BY NONIMMIGRANT STUDENT FOR EXTENSION OF STAY,
SCHOOL TRANSFER, OR PERMISSION1 TO ACCEPT OR CONTINUE EMPLOYMENT
INSTRUCTION REFEJRLENCJE 8 CFR 214.2(5), (3) . (6), 299.1; 01 214. 2(f], 235. 4(h); AM 2301.07,
2482 Ex. 2, 2790.02, .02.03, .08. .09, .12, .14; II Hbk 9-1, -3, -4, -13, 9-10.2, -14.1, -16, -18
-20. -22, 13-2.1, App. 9-A; GIB P. 30. App. -8. App. .59 e,-r^~^-r,—-^anan-.n.,.mmmma«.
SUBMITTED BY A NONIMMIGRANT STUDENT AS AN APPLICATION FOR EXTENSION OF STAY, SCHOOL TRANSFER,
OR PERMISSION TO ACCEPT OR CONTINUE EMPLOYMENT
PRIOR EDITION OF REV. 6-1-74 MAY BE USED
SCHEDULE
1Q/1/80
ADMINISTRATIVE MANUAL
Appendix I
TM 784
necessity y b« granted In lacr«m«nt» of not more than
12 mom: . tich. Curing the period for which part-ltme
eroploytv ... •' j authorized, a student may work of! campus
tip to 20 hours per week while school i* In session, and
full time during vacation or recess periods when he Is not
required to attend school.
(c) PRACTICAL TRAINING, f I ) rfet more than sixty
daya_ mriof to and not lat-aythaaT thirty _days_atter
completion of studies or graduation, you may r<>
quest permission to aeceps or continue employment
in otrdsf to obtain practical training in your field of
study. Such application may to mad« more than
sixty days prior to completion of studies only if you
are attending * college, uniwwiity or seminary which
«*tifi«a tltat it require* practical training (or all de-
gree candidates in a specified professional field, and
that you are a caadidat* for a degree in that field. An
autaoriawi school official must: certify in Part IV of
this form that tha employment is recommended for
pra«tical training in year field of study. That official
must also certify that h« b*liey*» that practical brain-
ing is not available to you ia your country of foreign
r«aad«ne«.
(2) Permission to accept or continue temporary employ-
ment to obtain practical training may b« granted In Incre-
ment* of not m or* than 6 months «ach, not to exceed 12
months ia th« aggregate.
(3) Students carolled in a college, university, or seminary
hcivicg alternate work-study courses as a part of its regular
prescribed curriculum may participate in such, courses with-
out change of status and without filing an application for
permission to accept employment, provided such periods
of actual employment shall be conaidared as practical train-
ing. Th« work must b« in a field related to your course of
study. For students who have engaged in off -campus work-
study programs, a letter from his school must be submitted
witte th« application stating tha number of hours tb« stu-
dent has patticigpatad in off-eaiuptu employment, a descrip-
tion of toe duties, and tbo MOT* and address of the «mploy-
(e) WHERE TO SUBMIT APPLICATION FOR PER-
MISSION TO Accsrr OR CONTINUE EMPLOY-
MENT. (1) After cti:tiftcation by the appropriats
official of ycur school, (he applksttoit .should bi sub-
milled to the office of the (inmigration and Naturali-
zation Service Having Jurisdiction over the area in
which your school li located, unlesa ihe application
Is for permission to extend practical Staining-.
(2) If the application is for practical training, the applica-
tion for the first patioc: of practical tramm^ shall b* sub-
mitted to the office of the borvice having jucisdiction over
the school recommending practical training. An application
for permission to continue practical training must b* sub-
mitted to the office of th« Serfice having jurisdiction over
th« actual place of employment. An application co con-
tjiBue practical training must contain the recommendation
ottne) school the student wim last authorized by INS to at-
tend. That recommendation must be in sufficient detail in
otdar to determine whether th-e position is r^laUsd to the
student's field of ;tud;- . "n .\.ldition, there rnusr. b« attached
a letter from the stud:n;'i employer aur-.cj; the student's
occupation and describicg the duties ha is performing.
(f) LABOR DISPUTES. ?enr.ia»Um granted you to en-
gage in any employment ii automatically suspended
while a strike or other labor dispute involving a work
stoppage or lay off of employees is in progress in
the occupation and at the place in which you are em-
ployed. YOU MUST SUSPEND EMPLOYMENT
IMMEDIATELY IF SUCH A SITUATION ARISES
AT YOUR PLACE OK EMPLOYMENT.
6. PENALTIES. Severe penalties are provided by law
for knowingly ind willfully falsifying or con-baling a ma-
terial fact or using any false document la th£ submission
of this application. Also, a 'ali« representation may re-
sult in denial of this application and any other applica-
tion you may rnaka for any benefit under the Immigra-
tion laws of the United States Any jtatem«nt submitted
with this application is considered part of the application.
(d) ON-CAMPUS EMPLOYMENT. On-campua employ-
ment pursuant to th« terms of a scholarship, fellow-
ship, or asuiut ant ship te deemed to be a pun of th«
academic program of a stu cleat otherwise taking a
full coun« of study, if related thereto. If the school
offers y-ou this kind of employment or any other on.
campus employment which will not displaca a United
States resident, you ant not required to apply for
to this Servke to accept such employment.
10/1/80
TM 784
ADMINISTRATIVE MANUAL
Appendix I
1-538
Page j
i-orm Approved
OMB No. i2-00i\7
UNITED STATES DEPARTMENT Of JUSTICE
IMMlGSAtlCN AND NAIURALI2A1ION SERVICE
APPLICATION BY NONIMMIGRANT STUDENT (F-l)
FOR EXTENSION OF STAY, SCHOOL TRANSFER
OR PERMISSION TO ACCEPT OR CONTINUE EMPLOYMENT
PART 1- TO BE FILLED IN BY ALL APPLICANTS !
1 AM APPLYING FOR (CHECK AND COMPLETE AS APPROPRM
r~) 6NTENSION Of TEMPORARY STAY UNTIL iSPECIFY DAT
', £3 PERMISSION TO TRANSFER TO ANOTHER SCHOOt
, CD PERMISSION TO ACCEPT EMPLOYMENT OR TO CO
T£)
E,
NTiNUE PREVIOUSLY AUTHORIZED EMPLOYMENT
1 YOUR NAk
(FAMILY NAME (Capital Lctitn) rmST
MIDDLE •)
IN CAHC OP
C/0
!
. iGAMUAM NOT IN POSSSSSlON O' A
2.
MAILING
ADDRESS
IN U.S
CITY STATE
ZIP COOt S
. pAsa«3RT hUMaiB •
J. D*Tt Of
S1RTM 1 Month. Day. Ytor) I COUNTRY Of B1RTM
COUMTav O' QTlZKKaHIP
1
STATM
Of LAST AH
RIVAL IN U.S.
,,T NUM8CK ON MY PORM ,-W IS; I I
f I |
I— j EXTENSION aaANTSO TO fDau) THIS SEC
ITION FOR GOVERNMENT
USE ONLY
D EXTENSION OINISO V.D. TO (DaUJ DATE
OP
ACTION
EMPLOYMENT QOSANTID Qoiwito
SCHOOL. CITY. STATE. o"c
OFFICE
TRANSFER Q CSANTID Q Diwiio
11. Hoi on ir
1*. Hovi y
ov «v«r oppli«d tor on immiQronr vi«o or p«r
mon.nl romance in th« U. S.? D ^«« D^o. If 'Yei', «h«re did you opply?
X Of GIRTH COUNTRY OP 3IHT
H PASEPOKT ISSUED BY (Country) AND EXPIRES ON (DaU)
IS. OCCUPATION
7. SOCIAL EKCURITY WUMBSLK (If noiU, USLlt "nont'J
IS. (liwrt -Haut'ar "Ham Not')
BISM tMPLnveD OR EMOA(»KD IN BUBINKSS IM TMffi UNrTOO 8TATES. If YOU HAVE
»0. (COMPLETE IHIS ITEM ONLY IF YOU ARE APPLYING FOR
A SCHOOL TRANSFER)
FORM l-iM IREV H2 77IY
ADMINISTRATIVE MANUA'
Arroendlx I
TM 784
•jtyiim far a transfer tu Inttrvstior. No. 4.)
K-W'50 ««• fH£ iMMl'iitA.ION AND NAfURAHlAflON
OOU <f ANSWER 1$ "WAS NO!-. AIUCH A StAIEwENI
>fJ OP llif SCHCOl YOU WME USI AUINOmjEO to
1 AftE-NOMC fHAt SCHCOL.
JOV luAlEEX^CVliO IO COMPLETE
vi OR LA jr MAJOR PIELD OF JTUDy
•?
SNf
(COMMfiNOiO 4V FHE SCHOOL.
CH AROSE
tsptoin in 6(oeA 23. J
ortv kKMia My v««rly muMo
> <rf Initial currently In
£
-to*.
.... »>»^,w_«»
i,*i BBnia Tn
CAU TUAIH1NI9.
IAMTCO (_] DENIED j
n Praparing lh« Form It Qih«r Than Applicant
• application wo< pr«oar«d by ma ol lha r«qu««t
id la bated an all Information of wh.ch 1 Kav«
'
'••"*""""''
niil ,J^i<i 5,<jnwi
KTURS ?.iCOROj |S«« In3tirv«tion«>2)
B l™™,.8,0)i(.,. en-l Wfflf.,™liI«4i<,« 3«rvi«a ta attend)
f..> ir, '. » 'Utj M! «fvi<jy. to IK? boil uf
it wf.Jor*. a&^n change In the shtdfiie's
:>•/ '>, .i?rv nwe<:«at<wlly a full court*
, tehoal dUtrkt UKdar which It op«rot*< or
Oi ippto^.J lor oH«ndd<<c« by Mon-immi^roni
> rir-e
.1 m.ra M» ,»,„ „ . M,,U. „ ,. .... .«!_„ ,
PABT i~
~ TO 88
z i . .-.ween ITS*! (Ai <5« (9) A«o sc»H^urre TM« irsaj ijHsosro j'Ssf Ixttntcitaa Sio. I; «/so. i/r^o« ii/-« <ipj
i O WAS O WAS wor .'.ym-w ;o
VAJOfl fIBO OF SIUOV
^.CfU'r naPt-dvuaaNT few vi- o rou^>aj,-jo BOASON:
TO CSUIM os coNVSiitc, i>aAc:ricM IRAEJ»-IC IN A f\oo MUTED TO w COURSE OP STUDY AMD ,
'" CJ Id CMAIN OH COMllNUEP'l'Rf-riA«£twiPl.Oyi»SNT NEEDED BECAUSE O' ECONOMIC NECESSITY WHICH AROSE
Ai A HESUIT O? UNFOBESEEN fHANCE IN P1NANCU4. ClSCUMSTANCSS. fjlTjiou c/UK:A«i idis u<«. tuptoin in 6(oeA 23.)
My sw.r<¥
at r<n« <M
l-l ««ir»
* V
1:14 urvforjoj*i» <.H?^o in V'3v» hrMUKtal nrcun. DMncea v/hl* ui-ata dw your
-hu Ciii^ ^:uMg ontl whv 'Kiraitt. rr.l(Xh>«. oirganUiMko «r clliar ttuBtsM Is
lurntjh v&u -^a (BtidtfiaatMsl Guilds [%0*^4«J (9 eovor «&poAfl«fl.
Annual taoMQv $_™
*
".HECKtD <Ai IN '.'ttW 3S ABOVO. CM&CX ANO FILL IM THS APPUCABV.lt STATKMSNT SilOW.J
. i«{!isvioijsi,ir «EBW <3R»wrai PERMISSION VQ aMoAftg IN SMPUOVMSNT ran
'. P«!VIO«JSLV PA'STS.-IPATEl.l IN AN Of F-'-.AMI"US WOBK-5TUOV PBOORAM
.
nation abavs la true ttml tasput
by
iQ-d ellk.'al of H>«
ta>)
(ci thd txint c4 roy Info/matlon and h«li«( !h« facts M tins ti^plkallort am Inja
th« r.fv^l.cani: (Ch:>cii on a; ti Ham (OJ la diocbad. compluls that Ham.)
{A} O is tahin'! «i full courts of alutilas 4! lhi> eehoal.
^Vf [^J It; tu&in^ (cias th^n a /ot£ cou/etf a^ sfudise 4( Ihlt ich^aL
{C! ^; compm^l o' «vi!i joimMaia his coufSB o? «tu») si !ho iCSool on .
[01 [[_'] did not cu.-i'i!j'.o!u his courtu ol »imf!.ii but t«rmlnaled bin attanoaocD o«™
oii':oi')i:it<>, IHD LJ wag U >"Oo nnt (a«Mg tt full uuraa of Jh; dies,
it ! vpl&aiian Islor pejrn^iooBan ier accept or cct»llnua ««*ploym «KS«T (Chacfe 6t*&\
[Ai r*j lite proQoiad BWpiarmuni it r«som.*!i4in<l«<l (or practical training Ci
• ball*} Mich Irqlnlnfl will fit ba avnliofeta la him In H>* country of hl«
oj Bt^tdy.
t) b«<c»ftae{«{onoffitCR*<:««iil-y i!vi> to •
will net lriterfar« vuilh ih« tilucwn!'- ail
j KAMI cc sCHoai.
stOMArunii. Of *c»t%x. urrio*
10/1/80
TM 784
ADMINISTRATIVE MANUAL
Appendix I
I-S38
Page S
ADDRESS IABE1
PLEASE SEE ENDORSEMENT
ON ATTACHED FORM 1-94
REGARDING ACTION TAKEN
ON YOUR APPLICATION
10/1/80
ADMINISTRATIVE MANUAL
Appendix I
TM 784
i. vcwn NA*sg
FAMILY NAM8 fCa.OUO/ LtOSr3> PI«ST MIOOLK
IN CAMS Q9
cvo lj'it.a.NUM9«wcy^floi»(i; ^
Z.
MAH.INQ
. ODRSS3
IN U.S.
Mi;«ssa AMO trncrr r^M. WoJ '
arc STATB IIP COOK u
. ,_.. . ,„ , „ _T.^_ J
3. OATS Of «l»l
fH AWoniA. Day, r«ir; COUNTRY OF »I»TM JCOUNTHV of OTIISNUM* -
4. f>(S«4«NT NONIMUIGAAMT GlAftSIPICATION
OATS ON »MlCH AUTHOMIZtO STAY OCPIKSS ?
1 TAT as
Of LAJ1T AMHIWAL IN U.S. ;
S TWK C8RMIT
MUMASM ON MV fQHM !•»* 13: 1 I | 3
P"™! tSTSNBlON SSAMtaO TO (IllUtl
FOR OOVlDNMfNTUll ONIV H
5i
OATI >
OC Q
ACTION s
OC Z
ON i
OIC
OPFICB
g«r««
N D1NM9 V.O. TO K7<u*^
If TRAMAfKR GKAMTUCO SHOW NSW
t,CMOOl_ CITY. STATK.
10/1/80
FORM 1-539
I. USE;
USED TO REQUEST EXTENSION OF AUTHORIZED TEMPORARY STAY OF CERTAIN
NONIMMIGRANT ALIENS IN THE UNITED STATES.
II. ELIGIBILITY:
1. ANY NtfNIMMIGRANT ALIEN LAWFULLY ADMITTED INTO THE UNITED STATES
MAY APPLY EXCEPT THOSE LISTED IN III. BELOW.
III. NONIMMIGRANTS WHO CAN NOT USE FORM 1-539;
1. ALIENS ADMITTED IN TRANSIT (CLASS C-l, C-3, OR TWOV).
2. ALIEN CREWMEN (CLASS D-l OR D-2).
3. ALIEN STUDENTS AND THEIR DEPENDENTS (CLASS F-l AND F-2).
4. ALIEN EXCHANGE VISITORS AND THEIR DEPENDENTS (CLASS J-l AND J-2).
5. ALIEN FIANCE(E) AND HIS/HER MINOR CHILDREN (CLASS K-l AND K-8) .
IV. REQUIREMENTS;
1. GENERAL:
a. PROPER FILING FEE (NO FEE IS REQUIRED FOR APPLICANTS CLASSIFIED
A-3 OR G-5).
b. MUST BE FILED IN i THE IMMIGRATION OFFICE HAVING JURISDICTION OVER
THE PLACE WHERE THE- ALIEN IS STAYING IN THE UNITED STATES.
NONIMMIGRANT CLASSIFICATION AS THE PRINCIPLE ALIEN. THEY
SHOULD BE INCLUDED ON THE PRINCIPLE'S APPLICATION.
d. FORMS 1-94 OR 1-494 MUST ACCOMPANY APPLICATION, INCLUDING
THOSE FOR SPOUSE AND CHILDREN IF APPLICABLE.
e. MUST INCLUDE A GOOD MAILING ADDRESS FOR APPLICANT.
f- ALL COPIES MUST BE LEGIBLE.
g. MUST POSSESS PASSPORT VALID FOR SIX MONTHS BEYOND INTENDED STAY IN
UNITED STATES.
10/1/80
ALIENS CUSSIF_IED_AS_A^3_OB_g!!5'
ATTENDANT, SERVANT, OR PERSONAL EMPLOYEE (INCLUDING MEMBERS OF
HIS FAMILY) OF CERTAIN FOREIGN GOVERNMENT OFFICIALS, MUST SUBMIT
A STATEMENT FROM EMPLOYING OFFICIAL DESCRIBING THE CURRENT AND
INTENDED EMPLOYMENT.
ALIENS CLASSIFIED AS E-l TREATY TRADERJ3R E-2 TREATY LIWESIQR;
MUST SUBMIT A PROPERLY EXECUTED FORM 1-126 WITH A LETTER
FROM EMPLOYER STATING APPLICANT'S PRESENT POSITION AND DUTIES.
THE NAME AND TITLE OR POSITION OF PERSON SIGNING MUST BE CLEARLY
INDICATED, THESE REQUIREMENTS ALSO MUST BE COMPLETED FOR WIFE
AMD CHILDREN.
ALIENS CLASSIFIED AS
MUST SUBMIT A STATEMENT FROM EMPLOYER ESTABLISHING THAT THE
APPLICANT IS A REPRESENTATIVE OF SUCH MEDIUM IN THE UNITED STATES
AND SETTING FORTH CURRENT AND INTENDED ACTIVITIES AND THE REASON
FOR EXTENSION,
SlH-3> OR L-l :
MUST SUBMIT A STATEMENT FROM EMPLOYER OR TRAINER DESCRIBING CURRENT
AND INTENDED EMPLOYMENT OR TRAINING AND THE REASON FOR THE EXTENSION.
AN H-2 APPLICANT MUST ALSO SUBMIT A NEW LABOR CERTIFICATION FROM
THE DEPARTMENT OF LABOR UNLESS THE EXTENSION OF TIME REQUESTED WILL
MOT EXCEED THE PERIOD OF VALIDITY OF THE CERTIFICATION PREVIOUSLY
SUBMITTED BY EMPLOYER.
(NOTE: FORM I-129B IS USED FOR GROUP EXTENSIONS OF STAY - H-l,
H-2 OR H-3. IN THESE CASES BE SURE TO NOTE ON I-129B THE WORD
"EXTENSION", SO RECORDS AND INFORMATION WILL NOT CREATE A NEW FILE.)
10/1/80
APPLICATION TO EXTEND
TIME OF TEMPORARY STAY
INSTRUCTIONS. READ CARIiFULI.Y. FEE WILL NOT BU REFUNDED
Failure to comply with instructions may make is necessary to reject your applications
(Please tear off this sheet belo
submitting application!
1. GENERAL An alien admitted in transit U'ass C- 1, C-2.
C-3 or TWOV); or as a crewman (dass D-l orO-2): uris the
fiance(e) of a United States citutn ar.d his or her children (class
K-! or K-l) is ineligible lor an extension of temporary stay
A student (class F- 1 ) must apply for extension of temporary
stay on Form 1-5 iH An exchange alien iclass J-li must apply
for extension of temporary stay on form 1AP-6G executed by
his her sponsor. Spouses and children of students and
exchange aliens may be included in tlieir applications.
Any other nonimmigrant admitted tor a temporary period of
time may apply for an extension uf temporary scay by
completing this form.
A separate application must be completed by each applicant
for an' extension of temporary stay with the following
exception
A nonimmigrant v. ho desires an extension of temporary stay
for his her spouse and unmarried children under age ^ I who
have the same nonimmigrant classification as the applicant
shoulj mdu<!c the spi use .inj children in the application
i Block 10) A spouse or chiid having a different nonimmigrant
classification than the- applicant must make a separate
application. (See instruction under -I for payment of tee. I
2. WHEN TO sL'BMIT THIS APPLICATION. You
shoulj submit this application n.it less than liitren nor more
than sixty davs before ; ,n.r authorized stay expires, except that
you may submit rh.s application at any time prior to the
expiiatinn in jour authorized s;j) if you were issued a Form I-
-4-1 1 when you wete admitted to the L'niicJ States.
3. WHERE 1O SI.'BMIT APPLICATION. Take or
mail your completed application :o the office at the
Immigration and Naturalisation Service having jurisdiction
over the place where you ate staying.
When yju submit your application you must also send in
your temporary entty permit. |Form I-'M ARRIVAL-
DKPAR.tX:K.L ULCORO or Form I-w 1 ,!t jout tempu'irv
entry permit is attached to your passport, the permit should be
removed tor tins purpose i DO SOT i/:\O J.V YOUR
MSSPOKT However, you must be in possession ot a passport
valid lor at least six 101 months beyond the expiration date of
the extension requested. It this applicition includes your
spouse or children their Forms !•'' I must be submitted with the
application. They, tun. must be in possession ot passports valid
fur at least six months beyond the expiration date ot the
extension requested.
•i. FEE. A tec of live dollars <S5) must be paid for tiling
this application It c..nnut be relui.deil regardless of the acnon
taken on the application DO NOT MAIL CASH ALL fl-l'S
MUST Bl: SUHMITTl'D IN THI: -LXAC.T AMOUNT.
Payments by clieik or money order must be drawn .in a bank or
other institution located in the Limed States and be payable in
United States currency. II applicant resides in (.num. check or
money order must he p^.ttviv 10 the "Treasurer, tiuam." If
applicant resides in the Virgin Islands, check or money order
must be payable to th(:"C.omini«ionerol l-'inanceot the Virgin
Mauds." All other applicants must make the check or money
order payable to the 'Immigration and Naturalization
Service" When check, isdrawnonaccountnl person other than
the applicant, the name of the applicant must be entered on the
faie ol the check It application is submitted tnun outside the
United States, remittance m.u be' made by hank ititiTnati'in.H
money older or lomgndralt drawn on a (manual institution in
the United States and payanle to the Immigration and
Naturalization Service in Unind States currency Personal
checks are accepted subject to collecnbility. An uncollectible
check will render tne application and any documents issued
pursuant theteto invalid. A charge of $5.00 will be imposed if a
check in payment of a lee is not honored by the bank on which it
is drawn.
However, no fee is required for A-3 employees of
government officials and their immediate families. G-5
employees of representatives to tn international organization
and their immediate families, and the spouse and all unmarried
children under »ge of 21 if they are properly included in one
application.
V NONIMMIGRANT CLASSIFICATION (BLOCK
-i). Indicate in this block the classification symbol shown in the
admission stamp on your Form I-'J4 immediately after the
word 'class", for example B-l.l-M. etc. or whatevet if maybe.
6. ATTENDANT, SERVANT. OR PERSONAL
EMPLOYEE (INCLUDING MEMBERS OF HIS
FAMILY) OF CEP.TAIN FOREIGN GOVERNMENT
OFFICIALS (A-3 or G-5). II you are in the United States
under an A-3 or Co nonimmigrant classification, you must
submit with this application a statement trom the employing
official describing the current and intended employment of the
attendant, servant nf person.)! employee.
f. TREATY TRADER OR INVESTOR (E-l or £-.!). If
you arc in the United Statei under an li- 1 or f.-l nonimmigrant
classification, you must submit with this application a Form I-
126 properly executed, with such additional documents as ire
required by that form
8. REPRESENTATIVE OF FOREIG»N PRESS.
RADIO, FILM, OR OTHER INFORMATION MEDH'M
("I"). It you are in the United States under an "I"
nonimmigrant classification. jou must submit with this
application a statement from your employer establishini; that
yim are the representative of such medium in the United States
and setting forth your current and intended activities and the
reason fc>r the extension.
'). ALIEN ADMITTED TO PERFORM
TEMPORARY SERVICE OR LAHOR, OR AS A
TRAINEE OR INTRA-COMPANY TRANSFEREE iH-l,
K-l, H-3. or L-l ). It you aie in the United States under an H- 1.
H-l. H-5 or L-l nonimmigrant classification, you must submit
with (his application a statement from your employer or
trainer describing your current and intended employment or
craini '.gand the reason for the extension. In. iddition, if you are
an H-. applicant, you must submit a certification from the
Department ot l.ibor c mcernmg availability of workers
domestically and effect on wages and working conditions ol
persons similarly cmpl.it ed in the United States, unless the
extension of time requested will not exceed the period of
validity of the certification previously submitted by your
employer. For a group extension of stay of H-l, H-^ or H->
nonimmigrants. Form I-IJ'JU shall be used
10. PENALTIES- Severe penalties are provided hv law
tor knowingly uml willfully falsifying or concealing a m.ucrial
tact or using any false document in the submission nt this
application. Also, a lalse representation may roult in denial ol
:lns application und or any other .ipplicatiol. you m.iy make for
any bent-tit under the immigration laws ol the United States.
Any statement submitted wi:h this application is considered
part of (he application.
For s,ik by the Superintendent of [\icumenti, U.S. (iovernment Printing Office
Washington, U. C 20-IO-1 (per 1001
FORM NO.
1-539 5 A
EDITION
T1TUE
APPLICATION TO EXTEND
TIME
OF TEMPORARY STAY
SIZE
8 X 10 1/2
INSTRUCTION
103.2(o), 214
.02.03. .08,
REFERENCE 8 CFR 214. 1 (c)
.2(a), (e). (gj, (h), 235. 400;
.09. .12, .15, 2798.03, 2984 Ex.
-2.3 Apt). 9-A; GIB P. 29. ADO.
. .2(«0, .2
AM 2301.07.
2, 2984 Ex
8, 31. 58
00(1). .200(11), .2(1)(3), 299.1
.09, 2482 Ex. 2, 2787.03, 2790.02
. 4; II Hbk 8-14.4, 9-1, -3, -11,
; oi
,
-16,
osa i — --t •- -
USED BY
ALL
NONIMMIGRANTS EXCEPT
"F" OR "J"
ALIENS TO APPLY
FOR EXTENSION OF STAY
PRIOR EDITION OF REV 4-1-76
MAY
BE USED
SCHEDULE »
4/1/81
39 § A
ADMINISTRATIVE MANUAL
Appendix I
•JWTKO STATES DEPARTMENT OF JUSTICE KtAO INSTRUCTIONS CARKFUU.Y ft.,m ABpr,»«l
wnmunoNMioiuniHAuzAnoN SERVICE FEE WILL NOT BE REFUNDED OMB II.RO.WI
APPLICATION TO EXTEND
TIME OF TEMPORARY STAY
ftr STAMr
1 HEREBY APPLY TO EXTEND MY
TEMPORARY STAY IN THE UNITED STATES
"ftESS flflMLY -LEGIBLE COPY REQUIRED PRINT OR TYPE YOUR NAME EXACTLY AS IT
APPEARS ON YOUR ARRIVAL - DEPARTURE BECOf 0 fORM 1-94 IF VQUR MAILING AOOR6SS
IN THE U S S WITH SOMEONE WHOSE FAMILY NAME IS DIFFERENT FROM YOURS. INSEf.7
THAT PERSON'S NAME IN THE C'O BLOCK.
• «0*NA»< »*"H.VNAMtltA«IAL«nKJ, , RSr M.OOLE $%%$%
! rif.AS-J*fO««EOu£SI1hG!.-<r[KilCm
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J OATI 0* WITMjMO DAr Y«t PQUNrPv 0* PJfl TH COu^THV Of ClH^MShlP
1 1
i
LAST ARRIVAL IN U S
t MAiON fOII COMING TO tut U S
FOR GOVERNMENT USE ONLY
[j EXTENSION GRANTED TO .DATE) °2f'
» HAS AN IMMICKANI VISA PJTII.CN CYt<t 8t[1 tll.EP IN
= «S .".NO IflES WHf«tWASITflL£0>
J": EXTEMS ON DENIED V 0 TO (DATE) DD
o«
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IS 30CIA1. SECURITY MO {If NONE. STATE NON{ 1
1 . _._.._
WOT£ tQ tw,.j A.ffc'OA'iO^
iN fH€ u«MTXa Sf *t*5 COMPiCTg -Ng RtST Of litf 8I.OC1 1
NAME AND AQDAtiSS i> tMW O»6« OH lltSINFSS INCOME P
ER W(|K DATES EMPLOVMEhT OR 3USIhkSSi 8CGAN & iMOEO
1 cer,,(y th.. me ahovc » iru. and cor«« 7/M////!!///M////M///W//^^
l.G»AfU»f Of A«M.IC*«T UAtu
SIGNATURE OF PERSON PREPARING FORM. IF OTHER THAN APPLICANT
SiKAAruMi. ^ AODHCSS
Dill
ArTACH YOUR FORM 1 94 OR 1 144 -'00 NOT SKNO YOIIH PASSPORT.] j RI.IIVTO
K „..„ tmtv I
4/1/81
ADMINISTRATIVE MANUAL
Appendix 1
1-539 5 A
Page 3
4/1/81
I-SS9 4 A.
Pags 4
ADMINISTRATIVE MANUAL
Appendix I
ADDRESS UBEl
ENDORSEMENT
ON ATTACHED FORM 1-94
5«°*A-f!PING ACTION TAKEN
ON YOUR APPLICATION
4/1/81
ADMINISTRATIVE MANUAL
Appendix I
1-539 & A
Page 5
I
1 VOOd NAMt '*"*•» "**•' *»"'*«.
"""* '"" "***
MCAMOT C °
m^^M
I MA.UNO *««M«0««W1'
wt NO i 1 ru H
UUOIB
MUt CITY
,«n »co« ^^
1 e*n o» •"«•« IMO OA» rti
COUKTin 0» I*IM COOSTKV 0*
cnuaMM»
4. mUNTNOMUMIGIUNtClAUtflCATIOM 0*U 0*VHMCMMlTH«lUlOlUr <>«|M>
ft MUMO'VltUl.A«UM.O*OTM(*MtAllSO'
LAIIAMUVALWU*
fOR qpyt|l<^MENT USE ONLY
(3 EXTENSION GRANTED TO IOJ
£
Q EXTENSION OCNIEO V.O. TO
DATE) oo
M
FORM IAP-66 (FORMERLY DSP-66)
USE;
USED BY NONIMMIGRANT EXCHANGE VISITOR TO REQUEST EXTENSION OF AUTHORIZED
STAY OR PROGRAM TRANSFER.
MUST BE IN THE UNITED STATES AS AN. EXCHANGE VISITOR (J-l) OR DEPENDENT
THEREOF (J-2).
REQUIREMENTS:
1. NO FEE REQUIRED.
2. APPLICATION MUST BE FILED AT THE IMMIGRATION OFFICE HAVING JURSID1CTION
OVER THE LOCATION OF THE PROGRAM IN WHICH THE EXCHANGE VISITOR WAS
LAST AUTHORIZED TO PARTICIPATE.
3. FORMS 1-94 MUST ACCOMPANY APPLICATION, INCLUDING 1-94 'S FOR SPOUSE
AND CHILDREN IF APPLICABLE.
4. FORM MUST BE PROPERLY EXECUTED, SIGNED BY APPLICANT AND ENDORSED,
WITH CERTIFICATION OF SPONSOR.
5. MUST HAVE A PASSPORT VALID FOR SIX MONTHS BEYOND THE PERIOD OF STAY
REQUESTED.
6. IF APPLICANT IS REQUESTING A PROGRAM TRANSFER, PART III OF THE FORM
MUST BE COMPLETED.
10/1/80
3-77
DOCUMENTS NEEDED TO APPLY
FOR A NEW OR REVALIOATED NONIMMIGRANT VISA
I. GENERAL:
INTEND TO TEMPORARILY DEPART THE UNITED STATES AND NEED A NEW OR
REVALIDATED NIV TO RETURN, SHOULD HAVE THE FOLLOWING DOCUMENTS
TO PRESENT TO THE AMERICAN CONSUL:
(a) STUDENTS AND THEIR DEPENDENTS (F)
(1) PASSPORT VALID FOR 6 MONTHS BEYOND
INTENDED STAY IN THE U. S.
(2) CURRENT FORM 1-20 FROM THE SCHOOL
INTENDING TO ATTEND UPON RETURN;
(3) EVIDENCE OF FINANCIAL ABILITY TO
MAINTAIN STUDENT STATUS.
(b) FOREIGN EXCHANGE VISITORS AND THEIR DEPENDENTS (J)
(1) CURRENT IAP-66 PROPERLY ENDORSED
BY THE PROGRAM SPONSOR;
(2) PASSPORT VALID FOR 6 MONTHS BEYOND
INTENDED STAY IN THE U..S.
(c) TEMPORARY WORKER OR TRAINEE AND THEIR DEPENDENTS (H)
(1) ORIGINAL FORM I-171C;
(NOTE: THE SERVICE MAY ISSUE AN ORIGINAL
FORM I-171C, UPON WRITTEN REQUEST BY
THE EMPLOYER OR TRAINER, FOR INDIVIDUAL
BENEFICIARIES. FORM I-171C SHOULD
REFLECT AUTHORIZED EXTENSION OF STAY.);
(2) PASSPORT VALID FOR 6 MONTHS BEYOND
INTENDED STAY IN THE U. S.
- 1 -
(d) INTRA-COMPANY TRANSFEREES AND THEIR DEPENDENTS (L)
0) ORIGINAL. FORM I-171C;
(NOTE: THE SERVICE MAY ISSUE AN ORIGINAL
FORM I-171C, UPON URITTEN REQUEST OF THE
EMPLOYER, FOR INDIVIDUAL BENEFICIARIES.
FORM 1-1 71 C SHOULD REFLECT AUTHORIZED
EXTENSIONS OF STAY.);
(2) PASSPORT VALID FOR 6 MONTHS BEYOND
INTENDED STAY IN THE U. S.
I. EXCEPTIONS:
TRAVEL TO ADJACENT ISLANDS OR CONTIGUOUS TERRITORIES:
(a) "F" OR "J" NONIMMIGRANTS APPLYING FOR READMISSION
FROM THE ABOVE AREAS AND THAT DO NOT HAVE A VALID
NIV - MAY BE READMITTED PROVIDED:
(1) ABSENCE DID NOT EXCEED 30 DAYS;
(2) ONLY VISITED CONTIGUOUS TERRITORIES
AND/OR ADJACENT ISLANDS;
(3) HAS A VALID PASSPORT;
(4) PRINCIPAL (OR ACCOMPANYING SPOUSE
OR CHILD) PRESENTS A CURRENT 1-20
OR IDP-66 AND FORM 1-94 ISSUED TO
HIM IN CONNECTION WITH HIS PREVIOUS
ADMISSION OR STAY. THESE DOCUMENTS
MUST SHOW THE UNEXPIRED PERIOD OF
THE ALIEN'S STAY PROPERLY ENDORSED
BY THE SERVICE AND SCHOOL OFFICIAL,
OR EXCHANGE PROGRAM DIRECTOR.
CANADIAN NATIONALS;
A VISA IS NOT REQUIRED OF A CANADIAN NATIONAL, AND A
PASSPORT IS NOT REQUIRED OF SUCH A NATIONAL EXCEPT
AFTER A VISIT OUTSIDE OF THE WESTERN HEMISPHERE.
10/1/80
- 2 -
4-1
CHAPTER 4
4. PETITIONS AND APPLICATIONS PERTAINING TO IMMIGRANTS AND LAWFUL
PERMANENT RESIDENTS
Form 1-90 - Application by a Lawful Permanent Resident for
an Alien Registration Receipt Card - Form 1-551 4-1
Form 1-130 - Petition to Classify Status of Alien Relative
for Issuance of an Immigrant Visa 4-5
Revalidation of Relative Visa Petition Upon Death
of Petitioner 4-17
Form I-130E/I-485H - Petition to Classify Status of Alien
Relative for Issuance of Immigrant Visa and Application for
Status as Permanent Resident 4-18
Form 1-131 - Application for Issuance of Extension of Permit
to Reenter the United States 4-26
Form 1-140 - Petition to Classify Preference Status of
Aliens on Basis of Profession or Occupation 4-33
Form 1-407 - Abandonment by Alien of Status as Lawful
Permanent Resident 4-41
Form 1-485 - Application for Status as Permanent Resident 4-43
Form I-485A - Application by Cuban Refugee for Permanent
Residence 4-51
Form I-485C - Application for Creation of Record of
Lawful Admission for an Indochinese Refugee 4-59
Form 1-526 - Request for Determination that Prospective
Immigrant is an Investor 4-67
Form 1-570 - Application for Issuance or Extension of
Refugee Travel Document 4-72
Form 1-600 - Petition to Classify Orphan as an
Immedi ate Rel ati ve 4-81
Form ETA 750 - Application for Alien Employment Certification .. 4-91
4-1
FORM 1-90
I- USE:
. USED BY AN ALIEN TO OBTAIN REPLACEMENT OF ALIEN REGISTRATION
RECEIPT CARD.
II. ELIGIBILITY:
MUST HAVE BEEN GRANTED LAWFUL PERMANENT RESIDENT STATUS.
III. REQUIREMENTS:
1. ADIT INFORMATION:
EVERY APPLICANT MUST APPEAR IN PERSON REGARDLESS OF AGE TO COMPLY
WITH ADIT PROCESSING. THIS REQUIREMENT MAY BE WAIVED AT THE
DISCRETION OF THE DISTRICT DIRECTOR BECAUSE OF CONFINEMENT DUE TO
AGE, PHYSICAL INFIRMITY, ILLITERACY OR OTHER COMPELLING REASONS.
2. PROPER FEE WHEN:
a. ALIEN REGISTRATION RECEIPT CARD HAS BEEN LOST, STOLEN.
DESTROYED, OR MUTILATED;
b. ALIEN'S NAME HAS BEEN CHANGED.
(NOTE: APPLICATIONS NOT WITH a OR b ABOVE ARE EXEMPT FROM FEE.)
3. ATTACH OLD CARD IN ALL CASES UNLESS CARD HAS BEEN LOST, STOLEN,
OR NEVER RECEIVED.
(NOTE: 1-151 CARDS ATTACHED TO APPLICATIONS WILL BE
INVALIDATED BY CLIPPING OFF THE LOWER RIGHT HAND CORNER
WITHOUT DESTROYING INFORMATION. ANY CARD ISSUED UNDER
THE ADIT PROGRAM WILL NOT BE INVALIDATED IN ANY MANNER.)
4. IF NAME HAS CHANGED, ATTACH LEGAL DOCUMENT EFFECTING CHANGE.
5. FINGERPRINTS MUST BE TAKEN ON FORM FD-258 AND SUBMITTED WHEN
REGISTERING UPON REACHING AGE 14.
AM
2782.0
6. PHOTOGRAPHS :
ATTACH TWO PHOTOGRAPHS AS DESCRIBED IN THE GENERAL
INSTRUCTIONS.
7. TEMPORARY CARDS:
a. MUST FILE, OR HAVE EVIDENCE OF FILING, FORM 1-90;
b. LAWFUL PERMANENT RESIDENT STATUS MUST BE VERIFIED;
c. REFER TO DIEXM FOR ADJUDICATION.
EVIDENCE:
ADMISSION AS A LAWFUL PERMANENT RESIDENT MAY BE ESTABLISHED
THROUGH THE FOLLOWING EVIDENCE FOR THE ISSUANCE OF A TEMPORARY
CARD:
1. ALIEN REGISTRATION RECEIPT CARD;
2. ADMISSION STAMP IN PASSPORT;
3. PROCESSING STAMP FOR 1-551 IN PASSPORT;
4. RELATING FILE;
5. INDEX CHECK.
4/1/81
Appendix !
1-90
Pag* 1
IfWl^pr
I Immigration and Naturalitatian Sarvlc
Farai Aaaraved
OMB No. 4I.R0040
ttBElHIttttlCTtONSON ReveRSS)
APPLICATION BY A LAWFUL PERMANENT RESIDENT FOR
AN ALIEN REGISTRATION RECEIPT CARD, FORM 1-551
(TYPE OR PRINT IN BLOCK LETTERS WITH BALLPOINT PEN)
FeaStomc
t. Femlly Norn. (Cwital Letter.) First
Middle 2. Allan RagltlfaMan Nuxber
A-
1 Mailinaaddra.ainU. S. c/o (Number & Streat) (City)
(State) (ZIP Cede)
4. Name used when 1 became a permonent raiidontt (If jama a* ereient. write "Son*"}
!L Country a' ciriianihip
1 Dot* at Birth (Mo./Doy/Yr.) 7. Place of birth (Dry or to««XProvince « State) (Count,
ry) 3. My phone number U (Include Area Code)
9. Originally odWttad to U.S. at (Cty and Slate) 10. Data of oemi.sion as Permanent Reaieent or a^iv.ted to .talus as PanwHnl Resident
(Me/Day/Yr)
11. Destination in U.S. at time of original admission 12. My
II* it at the INS office in (City and State)
13. Lilt the dele. »l all absences Irom the U. S. o( 1 yaar or longer. sinca admission for pannanoi
it residence
14. City o/ residence whan 1 applied for on immigrant visa or odiujrment to parmanant ratidanca i
latui
15. Coniulota wfiare my viio wot i««uod (or INS alllca vihara 1 <*« od jut tod to parmanant railoan
ca itotu*)
16. Mtthar'a Firtt r4oota O Living Q Oacaatad 17. FotrMf'a
Flnt Nama Q Uvina Q Oeceated
IB. 1 NEED AORD BEOUS&
(A) Q K- alien ragUtratlon racalal card «o> last, aeinoved. or mitilelwl. (ArMeh remainder of conl) (FEE REQUIRED. SEE INSTRUCTION 3.)
Explain hew card wai lott. d*>treyed. or mutilated.
(B) D My nam. has been changed. (Attach the decree af the court or the marriage certificate and oM card.) (FEE REQUIRED. SEE
INSTRUCTION 3)
(C) CD 1 am rewired M be regiitered and (Inqorprintod after mv 14tfi MrthdW. (Attack cit Cord.) (You MUST we if. Anaercrlnt card Farm FD.238
which you can pot from any United Stata> Con «u lor or Inmiaration and Naluralliatian Service office.)
(0) 1 1 I am an alien commuter taklnq up actual permanent raiidenca in the U. S. (Attach eld card.)
(E) O 1 received an incorrect card. (Attach old cord.)
(B\r~| 1 never received my cord.
* "— ' XM.
(G)Q OTHER (Exelain) *
19. Slanalure and date of oerion nreaarlng the form if other than applicant 20. Signature
of applicant and date
DO NOT WWTE BELOW THIS LINE
ACTION BLOCK (For uvtby Immigration w Contulof officer) Thi» applicant wat inlervle.
., (Dry)
»ed bv me under oath an
(Data)
REMARKS:
(Signature and Title)
D GRANTED DDEN'E° C
DATE OF ACTION
DO Q
DISTRICT —
| Fingerprint card forwarded la the FBI to comely with
Section oil b u (Initials and Dale)
1 149 ta Immigration Card Facility (Date)
•
iSlanatura of lirmigratlon Officer)
R>
:tlVltl | TRANS IN Drill 1 HANS <>r! COM Pl.t I H)
FOk'*I-90 (R«v. 4-X-80)N
' 1
9
1-90
U-y APPLICATION BY LAWFUL PERMANENT RESIDENT ALIEN FOR
**' ALIEN REGISTRATION RECEIPT CARD
8 X 10
1/2
?OQ 1 * fll 5T1 ^ jt 9*IC 1 / 1 \ 1*4 •* §* »*»"*• fcll*l\u7\».f»\fc.l| 4*V«j
.02! 2794.01.'.64.'.05.'2984'Ex. 2,*Ex ^^^HbM-lS1'.!-'!!248?.*03'?'
1. 264.1(b).(c),(f),(9)l
. Ex. 2. 2740.01. 2741.01,
1. -14.).. -14. 2. -14.3.
DSC
USED BY AN ALIEN IN OBTAINING REPLACEMENT OF ALIEN REGISTRATION RECEIPT DOCUMENT
(Also printed In Spanish;
PRIOR EDITIONS MAY NOT BE USED
INSTRUCTIONS - -
•RE TO SUBMIT THIS APPLICATION- If you art In the United Stot*«. TAKE nSl. application IN PERSON
« Immigration and Naturalisation Service office having jurisdiction over your place of residence^. If you are
ao the United States, TAKE thlc application IN PERSON to the United State* Conflate or Immigration and
nlliatlon Service office having jurisdiction over id* place where yaw or* now residing.
IOTE: YOU MUST RLE THIS APPLICATION IN PERSON. DO NOT MAIL IN.
rOCRAPHS - Submit two color photographs of yourself token within 30 days of the date of thii application. These
>» mutt have a white background, photos must be glossy, un.ratouched, and not mounted; dimension of me facial
i should be about 1 Inch from chin to top of hair; subject should be shown In 3/4 frontal view showing right side of
rilh right ear visible; using pencil or f«lt pen, lightly print nonte(and Alien Registration Receipt Number, if known)
> back of each photograph. Failure to comply with the above instructions will delay die processing of your appli-
• - If you checked (A) or (B) of Item 18. a fee of fifteen dollars (SIS) must be paid for filing this application,
rwlse, no fee Is required. THE FEE CANNOT BE REFUNDED REGARDLESS OF THE ACTION TAKEN ON
APPLICATION. ALL FEES MUST BE SUBMITTED IN THE EXACT AMOUNT. Payment by check or money
r must bo drawn en a bank or other institution located in the United States and b« payable in United State*
Hicy. If applicant resides in Guam, check or money order must be payable to the "Treasurer. Guam." If
leant resides in the Virgin Islands, check or money order must be payable to the "Commissioner of Finance
o Virgin Islands." All other applicants must make the check or money order payable to the "Immig-ation
Naturalization Service." If the check is drawn on an account of a person other than the applicant, the name
e applicant must be entered on the (ace of the check. If the application is submitted outside the United
r», remittance may be made by bank international money order or foreign draft drawn on a financial Institution
e United States and payable to the " Immigration and Naturalisation Service" in United States Currency. .
onal checks are accepted subiect to collectlbillty. An uncollectible check will render the application and
locument Issued pursuant thereto invalid. A choroe of $5.00 will be imposed if a check In payment of a
* net honored by the bank on which it It drawn.
HORITY - B U.S.C. 1302 and 1304. Routine uses for disclosure under the Privacy Act of 1974 have been
ished in the Federal Regltter and are available on request. The Information will be used by the Service to
ratine eligibility for an alien registration receipt card. Failure to provide all of the Information requested will
It In the denial of this application.
IALTIES
-SEVERE PENALTIES ARE PROVIDED BY LAW FOR KNOWINGLY AND WILLFULLY
FALSIFYING OR CONCEALING A MATERIAL FACT OR USING ANY FALSE DOCUMENT
IN THE SUBMISSION OF THIS APPLICATION.
4/1/81
FORM 1-130
i
USE:
THIS PETITION ONLY ESTABLISHES RELATIONSHIP.
ELIGIBILITY;
1. PETITIONER MUST BE A UNITED STATES CITIZEN OR LAWFUL
PERMANENT RESIDENT.
2. A UNITED STATES CITIZEN MAY ONLY PETITION FOR:
a. SPOUSE;
b. CHILD UNDER 21 YEARS OF AGE;
(1) NATURAL CHILD OF MOTHER PETITIONER;
(2) LEGITIMATE CHILD;
(3) CHILD LEGITIMIZED BY FATHER PETITIONER PRIOR
TO AGE 18;
(4) STEPCHILD, WHETHER OR NOT BORN OUT OF WEDLOCK
(MARRIAGE CREATING RELATIONSHIP MUST HAVE OCCURRED
PRIOR TO CHILD'S 18TH BIRTHDAY);
(5) CHILD ADOPTED PRIOR TO 14TH BIRTHDAY IF CHILD RESIDED
WITH PETITIONER 2 YEARS AND HAS BEEN IN LEGAL CUSTODY
OF PETITIONER 2 YEARS AFTER ADOPTION.
c. PARENTS: f
(1) PETITIONER MUST BE AT LEAST 21 YEARS OF AGE; I
(2) PETITIONER MUST HAVE QUALIFIED AS THE "CHILD" OF THE
BENEFICIARY AS DEFINED IN "b" ABOVE. t
d. UNMARRIED SONS OR DAUGHTERS OVER 21 YEARS OF AGE:
(1) MUST HAVE QUALIFIED AS "CHILD" OF PETITIONER AS
DEFINED IN "b" ABOVE.
-1.
10/1/80
e. MARRIED SON OR DAUGHTER:
(1) MUST HAVE QUALIFIED AS "CHILD" OF PETITIONER AS
DEFINED IN "b" ABOVE.
f. BROTHERS OR SISTERS:
(1) PETITIONER MUST BE AT LEAST 21 YEARS OF AGE;
(2) PETITIONER AND BENEFICIARY MUST HAVE QUALIFIED AS THE
"CHILD" OF A COMMON PARENT AS DEFINED IN "b" ABOVE.
(NOTE: A UNITED STATES CITIZEN CANNOT PETITION FOR GRANDPARENTS,
GRANDCHILDREN, NEPHEWS, NIECES, UNCLES, AUNTS, COUSINS, OR AN
IN- LAW.)
3. A LAWFUL PERMANENT RESIDENT MAY ONLY PETITION FOR:
a. SPOUSE;
b. UNMARRIED SONS OR DAUGHTERS REGARDLESS OF AGE:
(1) BENEFICIARY MUST HAVE QUALIFIED AS "CHILD" OF PETITIONER
AS DEFINED IN 2.b. ABOVE.
(NOTE: A LAWFUL PERMANENT RESIDENT CANNOT PETITION FOR PARENTS,
MARRIED SONS OR DAUGHTERS, BROTHERS OR SISTERS, GRANDPARENTS,
GRANDCHILDREN, NEPHEWS, NIECES, UNCLES, AUNTS, COUSINS, OR AN
IN-LAW.)
REQUIREMENTS:
1. A PETITION MUST BE FILED FOR EACH ELIGIBLE BENEFICIARY.
2. EACH PETITION MUST HAVE SUPPORTING DOCUMENTS AND PAYMENT OF FILING FEE
3. IF ORIGINALS ARE TO BE RETURNED TO THE PETITIONER, COPIES TO SUPPORT
EACH PETITION ARE REQUIRED.
4. DOCUMENTARY REQUIREMENTS:
a. GENERAL:
(1) PETITIONER MUST SUBMIT PROOF OF U.S. CITIZENSHIP OR LAWFUL
PERMANENT RESIDENCE.
(NOTE: PETITION SHOULD BE NOTED 1-151, 1-551, NATURALIZATION
CERTIFICATE, CERTIFICATE OF CITIZENSHIP SEEN AND RETURNED. MAKE
SURE PROPER "A" NUMBER, ETC., IS ON PETITION.)
(2) EVIDENCE OF ANY NAME CHANGE OF PETITIONER OR BENEFICIARY; IF
NOT A LEGAL NAME CHANGE, A STATEMENT OR AFFIDAVIT OF
4/1/81
OF EXPLANATION IF NAME IS DIFFERENT FROM THAT ON
THE BIRTH CERTIFICATE OR OTHER LEGAL DOCUMENT;
(3) IF THE PETITION INVOLVES A FATHER/SON OR DAUGHTER,
EVIDENCE IS NEEDED TO ESTABLISH LEGITIMATION OF THE
RELATIONSHIP;
(4) EXCEPT FOR SPOUSES AND PARENTS, A BIRTH CERTIFICATE
OF EACH BENEFICIARY;
(5) IF THE PETITION INVOLVES A STEP-PARENT/STEP-CHILD,
MARRIAGE CERTIFICATE OF STEP-PARENT AND NATURAL
PARENT AND PROOF OF TERMINATION OF ALL OF THEIR PRIOR
MARRIAGES IS REQUIRED TO ESTABLISH RELATIONSHIP.
b. SPOUSE:
(1) MARRIAGE CERTIFICATE;
(2) EVIDENCE OF TERMINATION OF ALL PRIOR MARRIAGES OF BOTH
PETITIONER AND BENEFICIARY.
c. CHILD:
(1) BIRTH CERTIFICATE OF BENEFICIARY SHOWING PARENTAGE.
(2) IF STEP-PARENT IS THE PETITIONER, SEE NOTE 4. a. (5)
ABOVE;
(3) IF ADOPTIVE PARENT IS THE PETITIONER, ALSO NEED
ADOPTION DECREE;
(4J. IF FATHER IS THE PETITIONER, SEE NOTE 4. a. (3) ABOVE.
d. PARENT:
(1) BIRTH CERTIFICATE OF PETITIONER SHOWING PARENTAGE;
(2) IF FOR A STEP-PARENT, SEE NOTE 4. a. (5) ABOVE.
(3) IF FOR AN ADOPTIVE PARENT, ALSO NEED ADOPTION DECREE;
(4) IF FOR A FATHER, SEE NOTE 4. a. (3) ABOVE.
e. UNMARRIED SON OR DAUGHTER:
(1) BIRTH CERTIFICATE OF BENEFICIARY SHOWING PARENTAGE;
(2) PROOF OF TERMINATION OF BENEFICIARY'S PRIOR MARRIAGES;
(3) IF STEP-PARENT IS THE PETITIONER, SEE NOTE 4. a. (5) ABOVE;
-3-
10/1/80
f.
(4) IF ADOPTIVE PARENT IS THE PETITIONER, ALSO NEED
ADOPTION DECREE;
(5) IF FATHER IS THE PETITIONER, SEE NOTE 4. a. (3).
MARRIED SON OR DAUGHTER:
(1) BIRTH CERTIFICATE OF BENEFICIARY SHOWING PARENTAGE;
(2) IF STEP-PARENT IS THE PETITIONER, SEE NOTE 4.a.(5);
(3) IF ADOPTIVE PARENT IS THE PETITIONER, ALSO NEED
ADOPTION DECREE;
(4) IF FATHER IS THE PETITIONER, SEE NOTE 4. a. (3)-.
BROTHER OR SISTER:
(1) BIRTH CERTIFICATE OF PETITIONER AM BIRTH CERTIFICATE
OF BENEFICIARY SHOWING A COMMON MOTHER;
IF PETITIONER AND BENEFICIARY HAVE A COMMON FATHER AND
.
"""18"
C2I
(3)
DIFFERENT MOTHERS, SEE NOTE 4. a. (3);
IF PETITIONER AND BENEFICIARY RELATIONSHIP CREATED
THROUGH ADOPTION, ALSO NEED ADOPTION DECREE.
INDIVIDUALS WHO DO NOT NEED PETITIONS:
a. SPOUSES AND/OR UNMARRIED DEPENDENTS UNDER 21 YEARS OF AGE,
ACCOMPANYING OR FOLLOWING TO JOIN, WILL AUTOMATICALLY BE
ELIGIBLE FOR THE SAME PREFERENCE STATUS OF THE PRINCIPAL
BENEFICIARY IN THE FOLLOWING CLASSIFICATIONS:
Cl] UNMARRIED SONS OR DAUGHERS OF UNITED STATES CITIZENS
OR LAWFUL PERMANENT RESIDENTS;
(2) MARRIED SONS OR DAUGHTERS OF UNITED STATES CITIZENS;
C3) BROTHERS AND SISTERS OF UNITED STATES CITIZENS.
EXECUTION OF PETITION:
a. THE PETITIONER MUST SIGN HIS/HER FULL, TRUE AND CORRECT
NAME AND AFFIRM OR MAKE IT UNDER OATH;
b. PERSONS AUTHORIZED TO ADMINISTER OATHS:
10/1/80
4-9
(1) INS OFFICER OR EMPLOYEE AUTHORIZED TO ADMINISTER OATHS;
(2) CONSULAR OFFICERS;
(3) MILITARY OFFICERS AUTHORIZED TO ADMINISTER OATHS;
(4) CLERKS OF COURTS;
(5) NOTARY PUBLICS.
IV. EVIDENCE:
1. PRIMARY EVIDENCE:
a. PROOF OF UNITED STATES CITIZENSHIP:
(1) ORIGINAL OR CERTIFIED COPY OF BIRTH CERTIFICATE SHOWING
BIRTH IN THE UNITED STATES;
(2) NATURALIZATION CERTIFICATE;
(3) CERTIFICATE OF CITIZENSHIP;
(4) AN UNEXPIRED U.S. PASSPORT VALID FOR FIVE YEARS.
b. PROOF OF LAWFUL PERMANENT RESIDENCE:
(1) ALIEN REGISTRATION RECEIPT CARD;
(2) ADMISSION STAMP IN PASSPORT AS "ARC" OR PROCESSING STAMP
FOR 1-551;
(3) RELATING FILE;
(4) INDEX CHECK.
G. ORIGINAL OR CERTIFIED COPY OF FOREIGN BIRTH CERTIFICATE.
d. ORIGINAL OR CERTIFIED COPY OF MARRIAGE CERTIFICATE.
e. ORIGINAL OR CERTIFIED COPY OF DIVORCE DECREE SHOWING DATE OF
"FINAL" DISSOLUTION.
- f. ORIGINAL OR CERTIFIED COPY OF ADOPTION DECREE,
g. ORIGINAL OR CERTIFIED COPY OF FAMILY REGISTER,
h. ORIGINAL OR CERTIFIED COPY OF DEATH CERTIFICATE.
2. SECONDARY EVIDENCE:
a. DELAYED BIRTH CERTIFICATE;
b. BAPTISMAL CERTIFICATE;
c. SCHOOL RECORDS
d. FAMILY PHOTOS;
e. FAMILY MEMORABILIA;
f. AFFIDAVITS;
g. BLOOD TESTS;
h. STATE DEPARTMENT CERTIFICATE OF CITIZENSHIP (FORM FS-240) OF
UNITED STATES CITIZEN BORN ABROAD.
3. ALL FOREIGN DOCUMENTS MUST HAVE AN ENGLISH TRANSLATION ATTACHED.
A/1 /Q1
4-11
PETITION TO
CLASSIFY STATUS OF
ALIEN RELATIVE FOR
ISSUANCE OF
IMMIGRANT VISA
(PLEASE TEAR OFF HERE SgFORg SUBMITTING PETITION)
INSTRUCTIOMS
READ INSTRUCTIONS CAREFULLY.
FEE WILL NOT BE REFUNDED.
Not an ol thea* instructions relate to IMS type o> casa <
'•our* return ol your petition and ostay imal action
nan concerns you PKaaa react carefully tnoM wrucn do rotate Faiiuca lo louow instruction* may
A satiuon may DO t,i«a By a ciMsn or a lawful permanent 'wxient of tne united State* to cus»rty Ira Mann ol awn relative* M follow*
a. fly C'ftixi of me unilsta 5'an»: Except u noted in paragraph 2. a cituan of in* United State* may submit a petition on oenaif ol a spouse or son* and
aaughtar* i regerdiea* ol ago or mantel ««u». A UniiM State* citizen at i*a*l 21 yaw* ol ag* may suornrt a petition for a parent, brother or sister. If tho
petition u lor a ton or daughter vino :a mamad or at laaat 21 years ol age. or oom. or lor a brother or sister . 30 not suorrat petitions lor m« beneficiary i
ipouse or unmamed children unoer 21 year* ol age. II in« petition i> approved, me beneficiary > ioout* tna unmarnea children under 21 yunol age. if
accompanying or following to iwn rummer, will automatically M eligioi* lor the um« preference status.
a 3» t HWIUI Mrmwtnt rttatnt Han E»caot as noiad m paraqraon 2 jn auen lawfully aomineo to me United Slam lor permanent reodenc* may sub-
TIII a a«iii>on on o«n«i ol > 3001,1* or an unmarried enua regaraWss ul ag«. However it a lawiui permanent render* awn u mamed to » otixen and
*<sne* to D«ii!ion 'or an unmarried child sucn anen should cansu't ine nearest office ol ine immigration and Naturalization Service IOT advice aa to
«nether >i would 00 preiar aoie or n«c«34j/x 'or ine untied Stales citnan spousa 10 submit the petition instead. II the petition <* for an unmarried son or
caugnter ao not submit pennons tor me twneliciary t unmarried cn.iaran under 2* \atii of aqa if ine patition i* approved, tin D«ne<ioary i unmanwl
children unoer 21 yeara ol aga. it aceornpanymg or following to loin nim/har. will autom«ieaMy o» eligilMe lor irw tame preference stama.
PeUBom anun eenmt be eearowttL Aoorovel cannot be ormn to a osotion on Mfwit of—
a. A parent, oroinw. or atsrar. unleea the petlttonar It a United Slataa citizen and at leaat 2t yeera of age.
a. An Moottvo param. unU«« tne refationsMp to tlw United Swires cillzan oaollorw axian oy virnw ol en adoption wMcn took place wrui* the cfiild wee
under tn« age of 1 4. and ma cnild hai ttwraetter oeen in me legal cuatooy at. and hu reeided witti. tne adapting parent or owtnti tor at leeat 2 yeara.
Wrul* tne legal custody muat M atl»r tna adoption, ruudenee occurring pnor to lira adoption can unify the reeiaenc* requirement.
c. A itepparent. unlaaa Ine mamaoe creating tna Kama ol stepparent occurred bafara tne ctUxsn stepcnlld reached the age of 18 yeera.
a. An aoopied child, uniana ma cnikl weg adapted wnil« under irw age ol U «nd has thereafter Doen in tna legal euaWdy of. and nn reeled with. KM
Mooting parent or oarenta lor u laaat 2 yean. While llw legal cuatody must b« altar ma adoption, reodenea occurring pnor m Uia adopuan can aatlafy
Irw ree«Mnc« requirement.
e A ateoeniW. unteaa ma cMd wa« undar the age ol 18 yaara at the hm« me mamaga) crowing the statua ol atsocnail occurred.
3- A grandparent, grandchild, neanew. rmgce. uncfcs. aunt, cousin, or irUKw.
1. SupporHng decumenn. The following oocumenis muat aa suommed with tna petrlion-
t. To print t/nifM Srarea C'tmnvtio ol petitioner (wnar* petition is for relative ol a en
(2) II vou were Dom outaida tna united Stana ana Mcanw » citizen througn me naiurahtanon or cmMmmo of a param or huaoand. and nova not Dean
isauad a certmcata ol atlzansnio m your own name, iuomn avidanea ol trw crtiientnip and mamage ol sucn parent or nuaoand. aa wen aa termi-
nation ol any prior mamagea. Also, if you claim ciliiensnip mrougn a oarent suemrt your txrm cemlicate ana t separata statement snowing me
ajle. port, and mean* of a« your amva« ana depwturea into ana out at me United State* (Oo not mane or suomit a onotoetai ol a certificate at crn-
lemnip Sae instruction No 9)
(3) II your naturalization occurred wimtn 90 ooys immedlatafy pracadmg me filing of mis petition, or tl it occurred pnor to SexXomBar 27. 1906. tne natu-
raniation canificaia muat accompany tna cwnnon Oo not mane or submit a ofloloatat ol men cartrncaw (See instruction No 9 )
e. To prove /amify manonsnip sermon oennoner ana MnaAoary.
(11 il oeirlnn « auDmittM on Denait ol a wrfe or nuaoand. it muM (w accompanied by * cortmcata ol momaoa to ina poneneiary and proof of teg* term- .
nation ol an prevtoufl mamaaM of both w«la and nuttoffind.
;2) If a petition >a submitted by a mother an oeriaif at a cmtd (regard!*** of aga). irta txrtfi cortrffcare ol me child, ihowng m* name o< ma mother. mu*t
accompany me oontion. II me oatmon « suommed by a lather or slapturant on behail of a cmld 'reoordlna of age), certificate <x mamage ol tna
parent*, proof ot termination of mow pnor marmaoa*. and twin cemticaM of ma child snowing me name* ol ma parent* thereon, muat accompany
me petition.
(31 If oatmon >a suonMMd on nation erf a brother or srMo», your own btrtn cornAccta and rha birth cartDlcaM of the oenenclary, showng a eammon
mother muM accompany itv» patilion II ma wmfon ia on beftaif ol a oromer or «mt*r Having a common father and different mother*, marnage cer-
tificate of your parenta. and prod of termination o) mw poor m«n«gai muat accompany ma petition
(4) II oatmon « *uomitted on DanaM of a mothar. your own birth corttflcaie. snowing in* name of your mother, must accompany the petition If panoon «
suBmitled on banaU o* a father or stepparent, your own twtn cenrncale. inowmg the name* ot In* param* maraon. and marriage cortiAcata ol your
parent* muat accompany fa pennon, aa won a* proof of torminaMn of prior mamooa* of your parent*.
(31 If aimer me peUUoner or m* bmeOciary • a mamad woman, mamaoe cartNlcctafa) muat accompany ma peMton. Howaver. wnan ma rataKonaMp
oatwean m* pentionar and boneficiary n that ol a momer and child (reganKaca ol aga), the motner s mamaoa canMcata nead not be wamnad it
tna motner s praaent mamed nama aopaar* on the b<ntt canrncaM of lha chad.
(8) If tna petitioner end tha benetleiary am mated M aocn otnar by ooapuon. a carWIaa; copy ol ma adoonan dacra* must accampany tna petition,
c. Stcanduy eviavnca.
If It •> not POMIDM lo obtam any oral of tna raoumd documanti or raconta Moon aOowa. me foaexwng may be auoamrtnd lor conortaiaUuri-
nan occurrad. showmg doM and place ol tha cn*ra bvtn. 00** of
(2) Scnoo record. — A i«tter irom tha school aumormea novmg |unsatction avar school attended (preferably ihe tint school). MVMwig, tha oat* of
admnoion to tho acnool. chiW a data ol turtn or ago a that wn*. ptaca ol Ixrtn. andtrwnama*arxlpiacaaolbirmof poi«ma.if anowninttM*af<Ml
'ecord*.
(3) Ceniu* Record. — Stata or fedanl cortaua record showing the narmfM and plcc«< 9) of Mrtn. and dated) of birth or aocfs) of me panon)*) listed.
(4) Affidavit*. - Wrmen statamann sworn to or amnnod by two penon* »ho wara Inrng at the time, and wno nav* paraonal knowladaa. of me *MHtt
you are trying to prove — lor exarfioie. In* dale and place of a pirtn. marriage or dearr* Tha paraons making me artldavil* may be raialrrea and nead
not t>« otutane ot tha United Slum. Each alMavri ahouul conum tha following information regarding tha person making me afffdant: rnuner lull
name and addr***: oat* and place of birth: reunonemp to you. il any: fun information concerning tna avanl: and complate dame) concerning how
he/*na acquired knowledge of tfta evant.
Form M30 (Rev. 10-2*-79t N
FORM NO.
1-130
EDITION^.^ . y-
REV. W*P?77 '
T1T1X
PETITION
OF IMMIG
TO
RANT
CLASSIFY STATUS OF
ALIEN RELATIVE FOR ISSUANCE
size
INSTRUCTION REFERENCE
8
CFR 204.
Hal
, ?a?
.1, 299.1, .2
: 01 Iu3.2fol. 204. Hal. .2fdU21.
8 X 10
1/2
2l4.2(k)(l); AM
2301.07, 2482.
Ex
2, 2761
.01
- .05
, 2771.02, 2790.31. 2984 Ex. 2. Ex. 4: II
Hbk
1-24, 5-26, -27,
-28.1. -36, -
37,
-52, App
. 5-
B i -G
. -M; GIB 7,
8, 10j 12-16. App. 6, 31, 44,
45
use
FILED TO CLASSIFY THE STATUS OF
AN ALIEN FOR
ISSUANCE OF
AN IMMIGRANT VISA AS THE SPOUSE, CHILD fREGARDLESS
OF
AGE), PARENT, BROTHER, OR SISTER OF A U.S. CITIZEN, OR THE SPOUSE
OF UNMARRIED
CHILD CREGARDLESS OF AGE), OF AN
ALIEN LAWFULLY ADMITTED TO THE
U.S. FOR PERMANENT RESIDENCE
PRIOR EDITION OF RtV. 1-1-7
7 MAY
BE USED
| SCHEDULE
8
umems ana seconaery ewoence unamiaoie.
u are unable to submit required evidence of birth, death, marriage, divorce or adoption because the event took place in a f oreign country which does
•ecord such events, and secondary evidence is unavailable, attach a statement to this effect, setting forth the date and place of each of your entries
the United States. Also attach any letters, photographs, remitt®nc®s or similar documents which tend to support the claimed relationship and three
iport type photographs of yourself.
umenfs previously submit d.
ur birth abroad, or the birth abroad of any person through whom citizenship is claimed by you, was registered with an American consul, submit with
petition any registration form that was issued. !f any required documents weresubmitted to and retained by tha American consul in connection with
i registration, or in connection with the issuance of a United States passport or in sny other official matter, and you wish to use such documents in
aort of this petition instead of submitting duplicate copies, merely list such documents in an attachment to this petition and show the location of the
>ulate. If you wish to make similar use of required documents contained in any Immigration and Naturalization Service file, list them In an attachment
tis petition and identify the file by name and number. Otherwise, the documents required in support of this petition must be submttted.
uments m general.
upporting documents must be submitted in the original, if you desire to hav® th@ original returned to you, and if copies we by law permitted to be
«. you may submit photoststic or typewritten copies. Photostatic copies unaccompanied by the original may be accepted if the copy bears a
ification by an immigration or consular officer that the copy was compared with the original and found to b© identical. Any document in a foreign
uage must be accompanied by a summary translation in English. A summary translation i$ a condensation or abstract of the document s text The
slator must certify that he is competent to translate and that the translation is accurate. (Do not matoa a copy of a certificate of naturalization or
enship.) (See Instruction No. 9.)
stion of partition. A separate petition for each beneficiary must be typewritten or printed legibly with p«n and ink.
r?eed more space to answer fully any questions on this form, use a separate shaet(s), identify each answer with the number of the corresponding
n. and date and sign each sheet.)
Ion of petition. You must sign the petition in your full, true, and correct name and affirm or make it under oath.
ie United States the petition may b« sworn to or affirmed before an immigration officer without the payment of fee, or before a notary public or of her
:er authorized to admi nister oaths for general purposes, in which case the official seal or certificate of authority to administer oaths must be affixed.
side the United States the petition must be sworn to or affirmed before a United States immigration or consular officer.
ember of the Armed Forces of the United States, either in the United States or abroad, may swear to or affirm the petition before an officer of the
ed Forces authorized to perform notarial acts under Article 136. Uniform Code of Military Justice. His/her spouse or other dependent, abroad only,
swear to or affirm the petition in like manner.
islon of petition. If you are residing in the United States, send the completed petition to the office of the Immigration and Naturalization Service
jurisdiction over your place of residence. If you are residing outside the United States consult the nearest American consulate as to the consular
r foreign office of the Service designated to act on your petition. If you are a United States citizen petitioning for an immediate relative classification
If of your unmarried child , the petition must be submitted in sufficient time for action to be completed on the petition and for the child to obtain a visa
ich the United States before the date on which he/she will be 21 years of age.
•a! of petition. Upon approval of a petition filed by a United States citizen for his/her alien spouse, unmarried minor child, or parent, an immigrant visa
issued to the alien without regard to the annual limitation on immigrant visa issuance. In the cases of all other aliens for whom immigrant visa
is are approved, an immigrant visa number will be required. Availability of an immigrant visa number depends on the volume of demand by aliens in
ie visa classification who have an earlier priority date on the visa waiting fist.
ee of ten dollars ($10) must be paid for filing this petition. It cannot be refunded regardless of the action taken on the petition. DO NOT MAIL CASH.
ES MUST BE SUBMITTED IN THE EXACT AMOUNT. Payment by check or money order must be drawn on a bank or other institution located in the
States and be payable in United States currency. If petitioner resides in Guam, check or money order must be payable to the "Treasurer, Guam." If
ler resides in the Virgin Islands, check or money order must be payable to the "Commissioner of Finance of the Virgin Islands." All other petitioners
ake the check or money order payable to the "Immigration and Naturalization Service." When check is drawn on an account of a person other than
tioner, the name of the petitioner must be entered on the face of the check. If petition is submitted from outside the United States, remittance may be
>y bank international money order or foreign draft drawn on a financial institution in the United States and payable to the •'Immigration and
tzation Service" in United States currency. Personal checksare accepted subject to cpllectibility. An uncollectible check will render the petition and
;ument issued pursuant thereto invalid. A charge of S5.00 will be imposed If a check in payment of a fee is not honored by the bank on which it is
es. Title 18. United States Code, section 1 546, provides: "Whoever knowingly makes under oath any false statement with respect to a material fact in
jlication. affidavit, or other document required by the immigration laws or regulations prescribed thereunder, or knowingly presents, any such
tion, affidavit, or other document containing any such false statement, shall be fined not more than $2.000 or imprisoned not more than 5 years, or
18. United States Code, section I426(h). provides. "Whoever, without lawful authority, prints, photographs, makes or executes any print or
»ion in the likeneess of a *" certificate of naturalization or citizenship, orany part thereof shall be fined not more than $5.000 or imprisoned not more
years, or both."
ity. The authority for collecting the information requested on this form is contained in 8 U.S.C. 1154(a). Submission of the information solicited is
ry. The principal purpose for which the information is solicited is to determine the eligibility of the beneficiary for the benefits sought The
ition solicited may also, as a matter of routine use. be disclosed to other federal, state, local, and foreign law enforcement and regulatory agencies,
tartment of Defense including any component thereof (if either the beneficiary or petitioner has served, or is serving in the Armed Forces of tne
States), the Department of State. Central Intelligence Agency, Interpol, and individuals and organizations, during the course of investigation to elicit
information required by this Service to carry out its functions. Failure to provide any or all of the solicited information may result in the denial of the
SurK'rinrendent of Documents. U.S Government Printinjr Oflic- \Yasliiupioii. D.C. 20402 (per 100). Stock No. 02T-002-00224-.")
10/1/80
4-13
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization Service
Form Approved
OMB NO. 43-RO 4Q1
PETITION TO
CLASSIFY STATUS OF
ALIEN RELATIVE FOR
ISSUANCE OF
IMMIGRANT VISA
PLEASE NOTE
YOU ARE THE PETITIONER
AND YOUR RELATIVE
IS THE
BENEFICIARY
Fee Stamp'
1 . Name of beneficiary (Last, in CAPS)
(First)
(Middle)
4. Other names used: (including maiden name if married)
2 Do Not Write in This Space
5. Country of beneficiary's birth
6 Date of beneficiary's birth (Month, day. year)
7. My name is: (Last, in CAPS)
(First)
(Middle) B. My phone number is.
3 Names, birthdates and countries of birth of
beneficiary's children:
9 Other names used: (including maiden name if married woman)
11. I was born (Month) (Day) (Year)
in: (Town or city)
(State or Province)
(Country)
1 2. If you are a citizen of the United States, give the following:
a Citizenship was acquired: (Check one)
(H through birth in the U.S. Qj through parents [j through naturalization H through marriage
(1) It acquired through naturalization, give name under which naturalized, number of naturalization certificate, and date and place of naturalization
(2) H known, my former alien registration was A
(3) II acquired through parentage or marriage, have you obtained a certificate of citizenship in your own name?,
(a) If so. give number of certificate and date and place of issuance: ______ ____________________
(b) It not. submit evidence of citizenship in accordance with instruction 3 a (2)
13. If you are a lawful permanent resident alien of the United States, give the following:
a. Alien Registration Number
A
Date, place, and means of admission tor lawful permanent residence
•' 14 Beneficiary s marital status:
j Q Married ;H Widowed r] Divorced Q Single
1 5 Name of beneficiary's spouse, if married, and date and country of birth (Omit this item if petition is
tor your spouse)
1 6 Full address of beneficiary's spouse and children, if any (Omit this item if petition is for your spouse)
1 7. If this petition is for your spouse or child, give the following:
a. Dare and place of your present marriage
18. Has this beneficiary ever been in the U.S.?
QYES 3 NO
19. Are beneficiary and petitioner related by adoption?
C YES
b. Names of my prior spouses
c. Names of spouse 's prior spouses
•(CONTINUE WITH ITEM 20 ON REVERSE)-
OATH OR AFFIRMATION OF PETITIONER-
I swear (affirm) that I know the contents of this petition signed by me and that the statements herein are true and correct.
Signature of petitioner (See Instruction No 5) ;
Subscribed and sworn to (affirmed) before me this dayof . 19 ..at
(SEAL) My commission expires
(SIGNATURE OF OFFICER ADMINISTERING OATH)
(TITLE)
SIGNATURE OF PERSON PREPARING FORM IF OTHER THAN PETITIONER
I declare that this document was prepared by me at the request of tne petitioner and is based on all information of which I have any knowledge.
(SIGNATURE!
(ADDRESS)
(DATE:
FORM I — 130
/Ftov in.9ft.7Qt Kl
RECEIVED
TRANS. IN
RET'D TRANS. OUT
COMPLETED
REMARKS
s filed on
Q PERSONAL INTERVIEW CONDUCTED
appro wed for status under
(2 DOCUMENT CHECK ONLY
OUSE.
[J FIELD INVESTIGATION COMPLETED
:HILD ~. 203 fa; (2)
DATE
OF
Q APPROVAL PREVIOUSLY FORWARDED
ACTION
^ARENT — 203 ra) (4)
DO
1) r] 203 (a) (5)
DISTRICT
Continued)
(PETITIONER IS NOT TO WRITE ABOVE THIS LINE)
ie appropriate box below and furnish trie information required for the box checked:
(ticiary win apply for a visa abroad at the American Consulate in.
(CITY IN FOREIGN COUNTRY) (FOREIGN COUNTRY)
sficiary is in the United States and will apply for adjustment of status to that of a lawful permanent resident in the office of the Immigration and Natural-
jn Service at . .. ... . . _______________________________
(CITY) (STATE)
plication tor adjustment of status is denied, the beneficiary will apply for a visa abroad at the American Consulate in
IITY IN FOREIGN COUNTRY)
(FOREIGN COUNTRY)
lence in the United States is. (C '0. if appropriate) (Apt No ) (Number and Street) (Town or city)
(State)
(ZIP Code)
ess abroad (it any) is (Number and street)
(Town or city)
(Province)
(Country)
Iress at which I and my spouse resided together
r city) (State or Province) (Country)
(Apt. No. ) (Number and street)
From To
(Month) (Year) (Month) (Year)
in the United States where beneficiary will reside
(City)
(State)
at which beneficiary is presently residing (Apt No.)
(Number andstreet)
(Town or city)
(Province or State)
(ZIP Code)
nef iciary's address abroad (// any) is: (Number and Street) (Town or City)
(Province)
(Country)
he beneficiary's native alphabet is other than Roman letters, write his/her name and address in the native alphabet:
imel (Number and Street) (Town or City) (Province)
(Country)
gtition is for a child, (a), is the child married?.
. (b). is the child your adopted child? .
es. dates, and places of birth of all other children adopted by you. It none, .so state
. If so, give
ifition is for a brother or sister, are both your parents the same as the alien's parents? '
nt giving full details as to parentage, dates of marriage of parents, and the number of previous marriages of each parent
He petitions are also being submitted tor other relatives give names of each and relationship to petitioner
If not. submit a separate
u ever died a petition for this alien before'7
. If so give place and date of filing and result
;iarv is m the L'nnec States give the toi'owmg information concerning beneficiary
arrived in U.S. as
jr. student, exchange alien, crewman, stowaway, etc.) on
(h) (Day) (Year)
(b) Date beneficiary's stay expired or will
expire as shown on his Form 1-94 or 1-95.
(Month) (Day) (Year)
(c) Beneficiary's File number
if any
A-
and address ot present employer
•e> Date alien began '.iis employment
... 10/1/80
4-15
UNITED STATES DEPARTMENT OF JUSTICE
immigration and Naturalization Service
Form Approved
OMB N.O 43— RO <01
PETITION TO CLASSIFY STATUS OF ALIEN RELATIVE
FOR ISSUANCE OF IMMIGRANT VISA
EUEWING OFFICE LOCATION
PLEASE FORWARD THIS FORM M30B TO
DATE
CENTRAL OFFICE IMMIGRATION & NATURALIZATION SERVICE
425 EYE STREET N W ATTN CO ADP
\\ASHINGTON D C 20536
Fee Stamp*
• 1 Name ot beneficiary (Last, in CAPS) (First) (Middle)
i
2 Do Not Write in Thit Space
3 Names, birthdates and countries of birth of
beneficiary's children:
i 4 Other names used: (including maiden name it married)
i
[5 Country of beneficiary s birth 6 Date of oeneficary's birth (Month, day. year)
• 7 My name is (Last, in CAPS) (first) (Middle)
8 My phone number is:
9 Other names used (including maiden name it married woman)
1 0 Relationship of Beneficiary ro myself
" ' i was Dorn (Mon'hj (Day) (Year)
in (Town or city)
(State or Province)
(Country)
' 2 If you are a citizen of the United States, give the Following
a Citizenship was acquired (Check one)
~ through birth in the U S ^J through parents Q through naturalization H through marriage
(1) It acquired through naturalization, give name under which naturalized, number of naturalization certificate, and date and place ot naturalization
(2) If known, my former alien registration was A -
'? ) // acquired through parentage or marriage, have, you obtained a certificate of citizenship in your own name9.
taj it so give number ot certificate and date and place of issuance: ...... - -
(0) It not submit evidence ot citizenship in accordance with instruction 3 a (2)
1 3 If you are a lawful permanent resident alien ot the United State*, give the following
a Alien Registration Number
A—
D. Dare, place, and means ot admission for lawful permanent residence
14 Beneficiary s -riarital status
~ Married 3 Widowed ^j Divorced JH Single
15 Name of beneficiary's spouse, if married, and date and country of birth (Omit this item if petition is
tor your spouse)
M6 Full address of beneficiary s spouse and children, if any (Omit this item if petition is for your spouse)
.17 if this petition is for your spouse or child, give the following
; a Date and place of your present marriage
i 18 Has this beneficiary ever been in the U.S "»
i YES
1 9 Are beneficiary and petitioner related by adoption?
— YES 2 NO
b. Names ot my prior spouses
c Names of spouse 's prior soouses
i —(CONTINUE WITH ITEM 20 ON REVERSE)—
OATH OR AFFIRMATION OF PETITIONER
I I swear (affirm) tnai I Know the contents of this petition signed by me and that the statements herein are true and correct
Signature of petitioner (See Instruction No 5)
, Subscnoed and sworn to (affirmed) before me this dayof . 19 .at
' f SEAL) My commission expires
(SIGNATURE OF OFFICE* ADMINISTERING OATH;
(TITLE
SIGNATURE OF PERSON PREPARING FORM IF OTHER THAN PETITIONER
i declare mat this document was prepared by me at the request of the petitioner and is based on all information of which I have any knowledge
(ADDRESS)
I— 130B
RECEIVED j TBANS IN JRET'D TRANS OUT [ COMPLETED
1 , Name of barwficiary (Last, in CAPS)
(Pirat)
(Middte)
4 Othar names us«d: (including matden name if mamad)
5 Country of beneficiary's birth
7 My name ia: (Last, m CAPS)
SNOX Code
6. Date of Baneticiary's Birth (Month, day. year)
(First)
(Middle) I 8. My phone number is:
DATE AND ACTION ON VP
DATE
OP
ACTION
DO
DISTRICT
•Jetttnw Prtfion Card
fwm M30A
(R*v 10-28-79) N
Sent to Consul at:
SECTION
(spousa
[j 201 (t» child)
203<aX1)
Q
DATE PETITION FILED
10/1/80
4-17
VALIDITY OF RELATIVE VISA PETITION UPON
DEATH OF THE PETITIONER
I. NO FORM IS USED.
TO REQUEST HUMANITARIAN CONSIDERATION BY THE ATTORNEY GENERAL 8 CFR
WHEN REVOCATION WOULD BE INAPPROPRIATE. 205.1(a)(3.
II. ELIGIBILITY:
1. A RELATIVE VISA PETITION MUST HAVE BEEN APPROVED PRIOR TO
THE DEATH OF THE PETITIONER;
2. HARDSHIP TO THE BENEFICIARY MUST EXIST.
III. REQUIREMENTS:
1. BENEFICIARY OR HIS/HER REPRESENTATIVE MUST INITIATE THE REQUEST;
2. NO OFFICIAL FORMAT HAS BEEN ESTABLISHED. REQUEST SHOULD BE MADE
IN WRITING;
3. NO FEE REQUIRED;
4. REQUEST MUST DESCRIBE IN DETAIL THE BASIS FOR THE REQUEST.
IV. GENERAL:
1. DECISIONS OF THE ATTORNEY GENERAL ARE DISCRETIONARY AND ARE
BASED ON REVIEW OF SERVICE RECORDS AND THE PRESENTATION MADE
BY THE REQUESTER;
2. REVOCATION UNDER 8 CFR 205.1(a)(3) IS AUTOMATIC, UNLESS
REQUEST IS GRANTED;
3. UNFAVORABLE DECISIONS ON REQUESTS TO RETAIN VALIDITY ARE
APPEALABLE TO THE BIA. IF AN APPEAL IS FILED, REFER IT TO
EXAMINATIONS. NO FEE IS REQUIRED FOR AN APPEAL.
FORM I-130E/I-485H *
USE:
USED TO PETITION TO CLASSIFY STATUS OF ALIEN RELATIVE FOR ISSUANCE
OF IMMIGRANT VISA WHEN THE BENEFICIARY OF THE PETITION IS SIMULTANEOUSLY
MAKING APPLICATION FOR STATUS OF PERMANENT RESIDENT.
ELIGIBILITY:
MUST MEET ELIGIBILITY REQUIREMENTS AS DESCRIBED ON FORM 1-130 AND
FORM 1-485.
(NOTE: SEE DISCUSSIONS PERTAINING TO FORM 1-130 AND 1-485 FOR
FURTHER REFERENCE.)
THIS FORM WAS CANCELLED MARCH 5, 1981, BUT EXISTING FORMS ARE TO
BE USED UNTIL EXHAUSTED.
A ft /O1
TM 782
ADMINISTRATIVE MANUAL
Appendix I
I-130E/1-485H
Page 1
^W^^^
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Hatmakiatton .Service
PETITION TO CLASSIFY STATUS OF ALIEN RELATIVE FOR ISSUANCE OF IMMIGRANT VISA AND
APPLICATION FOR STATUS AS PERMANENT RESIDENT
PACUCS I AMD 1 A«ff TMC VISA OgTITIOM.
1. Only o titmn or lawful Mtmansnt latteant of ine onwea ttaiet mm tuemit mo vita oatHIOA.
A. A CHINA may ma lot a eoovta. w». »' nauoMar. A cltuwi 2 1 yean oto may ano <M for a BMOOI. Mouwf. a» tluar.
aAant rotiaam maf na« la • cltlton tnouM AM*
fla «eugntar(D.
C. A eotitiari cannot M aaenwea lor:
(1) An aaoBtwa MM*!, untatt liu cnucn painionaf wa< M««<M Mfora >uK»ln« 14 ««* «•«• trtaruttaf HI in* »a«ai cuMeoy oi. MM IH*O wit*
a »*raAI lor two y«0n.
(HA
IDA
nerrioaa cresting fn«
> IM CAM w,
W»««« IM <KIM«
<M manum
(S> A «>ai>«»Ma«t. «<a«a«<ute.
ina MoetBBa ttaiut oecurtaa •»«» tna CAM ««M«*« in.
a. unau. aum. cousin or (
2. SyBiwning OMtHnami. O'K)»"m «i« nrauMM. if you vaAi tnam tanumaa, tMa a caey wnA tna •MaMii. A tototan •ocumant HUM ta atcwnM«ia«
Dv a iianilaiion, cannw« «y lira >rcnfflettw at te tna accgiacv »« tna tranuattoA ana >i 10 AH c««Mtan«y ta iranMaia.
tt H uAMoful le nuua a coov of a unrfl«M« of nnuroMuelon or cnuengntt. TIM feNowMa aocvmmu mu«l M luayMttad wfM ma •atrtwrii
A. To B*OM lamny mutitmnia Mtaoi:
( 11 KM A SPOU88. A ma»iao» teritd
ana »n»< of «armt«»iio« a« «>y»nat
«f Mm you aM yo«r l
Ill POfl A CMILO.
a. BV A MOTHER. Tna enua't otrtn eanlfwau. II your nama M offfonrif from tiwt on ttM onificaM. Ml nama tn*H» oocwriMriti lucfi tt
manrlaa* conificaMi, oivorta aacroat. MM coort oraan.
». BY A f ATKIR ON STBPPAfiCMT. Trn cnua'i Bmn cariifKaw.marrlaeatonifttata of tna aoroAn. MM »rao« of lormwailOA of IAOK Driv
manlawt.
(1) FOfl A SNOTMin OR SISTSB. Betn your aA« trtair Bmti canifltatai. it you ara rauto* »v MootMn, • cortina* t«ov of tna afootlon oacraa
If yau MM your ftrotAar or u«ar na»* « common fgtnor an« mfforant motAort WK manUaa canifKaMt of yow MAWU, MM oroof of lafi*Mi«ion o'
tnaH orMr ntMriaaat.
(a) *OM A FATHER OK. STEPPARENT. Vour Mrtn cortliluu ana trw morriaaa caniticMa M «M« at ptool o> larmMuOnx of onor marriatai al
yowt pawAtt.
IDIKM AMOTMKR. vow Mrtn tanHUau.
B. To »TOM unuoc auiat ciiueAaniat
(II It you w«fa torn In MM unMo* ><aM>. »nacA your Mrt* aanif Icata. II Aalutaiuoa. J»«CA y«ur AanramattBO or cmnmnia cortrlltata.
<D If you w»« com outiMa tna Unnoa ttau> n<4 fc«mt» a utuan ttirouen MM AMuraHiailon or cHUOMMo of a annul o> nu«tan«, an« AOM
•M taoit lima • eartlficata of cltuonaM* M your Own name. MIWKK aMoanca of tn« citua*oMa wM nwrruv> of <u«i itaram or nunkana. •» wall al
tarawjiatioA of any orior marriMjai. AIDS. H you eletrn cMUortfAia fnrouoA a &<rani. inttmn your MrtA (ordficMa MM a *Marau naiamaot wowlnf
mo aala. tort, ano moant of MI your Mm<an ano no»Mtu>aa Mto MM out of MM Unite* atMu.
C. To arova lawful i
i aRMIi your AUoA Daomrauefl MoetHH Cwo. ^orm i-Jil «w l-ltl.
O. loco««ary or»««no«. n yaw cannot sn tna ooawncnH or rownii UMWA »o»a, uibmit any.two of IfM fottowMIt
C. Comut rocwo. Staia or *a«orai ta>
o. Aftwavil*. fttatamarm tt»om to or affirmotl by two parcon* vrho wara Iwifif at trta tima, ano WAO nova oaraonai Mnawiaoaa, of tna a«oAt vow
•x lryw« to orova. Caen atf M«rtt «t«uM cemarn ma tooowMt wtomwiMA raoaMMo IMI •onon inaHMa tno atfWwnt HI* (Mar) lull nama MM aoonmt
oaia ana ouco of »ini<iroiaitonaiHo to you. Monyi lu> »Httmqu>n coBoarnma ina a»ontj wt comotata oataUt tancurnlna now (w (tool aownroa iinow-
oovt of KM avoni.
1, bMcutMn of a«|H>ori.
von imui MMar or affMn tna vMa pMlilon IMMJOT oMn. Art MUMorttlOA arftaleiinio «•» aw mai vttMvt eitarat or you KMT IWNO tt «OM* »y a notary
•uMIc or off tmr autnoruao 10 aomtnMtor oatni lor oararal puroooM.
t. PWWHWC. Tna law orovHua tor a fine et tl.ooa arM Mu>rl«MMwnt of fNo y«an for falarlMalWfi 01 tnoat aocurmnu.
Farni J- 1 30E/Mt«.H/3. 1.71 1
rOKM NO.
I-130E/I-48SH
EDITION
3-1-78
TITIX
PETITION TO CLASSIFY STATUS OF ALIEN RELATIVE FOR ISSUANCE OF
IMMIGRANT VISA ANO APPLICATION FOR STATUS AS PERMANENT RESIDENT
SUUB
8 X 10 1/2
INSTRUCTION JtETSJLENCX 8 CFR 204.1(a),24S.lCg), .2(*)(2), 2(d). 249.2, 264. 1(»), 282.1,
299.1, .2; 01 103. 2(o), lOS.lOCb), 204. 1(A), .2(d)(2), 214.2(K)fl), 245. 1(»). ,2(b)(l), -2(c)(l).
.2(d)(6), .3(b); AM 2050.21, 2301.07, 2482 Ex. 2, 2761.01, - OS, 2771.02, 2790.31. 2984 Ex. 2,
USE
Ex. 4; II Hbk 1-18. -24, .5-26, -27, -28.1. -36, -37, -52, 6-24, 8-4.2, -14.1, 10-2.1, -S, -10,
-22, -36. -38. App. 5-B. ADD. 5-G. App. S-F.l, App. 5-F.2, App. S-M, App. 10-A
COMBINED PROCESS VISA PETITION AND ADJUSTMENT APPLICATION - TO BE USED THE FORMS ARE FILED SIMULTANEOUSLY
FOR AN IMMEDIATE INTERVIEW DATE UNDER SECTION 245
| SCHIDOLX B
485H
ADMINISTRATIVE MANUAL
Appendix I
TM 782
PAGE THREE IS THE APPLICATION FOR PERMANENT STATUS AND MUST BE COMPLETED BY YOUR ALIEN RELATIVE.
UK addition* Form I-485H application form* If additional applications are required tor the spousa or child ran of your alien relative.
IMPORTANT • AFTER YOU FILE AND BEFORE A DECISION 15 MADE ON THE APPLICATION, DO NOT LEAVE THE UNITED STATES WITH-
OUT GETTING PERMISSION FROM THE IMMIGRATION ANO NATURALIZATION SERVICE.
1. Eacn applicant mutt luOmlt a separate form. A parent or guardian may file an application far » eft lid 14 or under.
a. The following must B« completed and tuemltted wltn your aopllcaclon:
(1) Record of your birth.
(2) A connotated fingerprint card (form FO-238) must do lubmltted By eacn applicant who It 14 yo»n of age or older. Fingerprint cards with
Instruc
application.
You may have your fingerprints r«cord«d on Form FO-258 at an office of this Service or you may prater to Drawn t Form FD-23B to a police nation Or
sheriff's office and request an officer tn«re to record your flngerprintt on tha card. The card must be signed by you In the presence of tne officer tak-
ing your fingerprints, wno must then sign nil name and enter tna date In tne spaces provided. it It Important to furnish all tne Information called for on
tn« card.
(3) 8lo«raenlc information (Form G-323A). (Nof required If under 14).
(4) A l«tt«r from your present employer mowing employment ol a permanent nature, If you ara amoloyea; or a Form 1-134 (Affidavit of Sup-
port) from a ratpontlbla parton in trie United States, or otnar avidanca to ortaolUfl tntt you ara not llkvly to Become a ouollc enar«e.
b. Suoportlne Ooeumonts. Originals ar« roqulrad. if you want tn«m returned, file a copy wltn tne original. A foraiqn document mutt M aceomp*-
nled oy a translation, cartllled oy the translator 11 to tne accuracy of tne translation and as to fiU competency to tranflate.
2. Three color ohotofraoni complying with mete specification]:
Pnotograpn mutt tfiow tne uielect In a 3/4. frontal portrait.
Rlgnt ear mutt be •xoo«d In pnotograpn tor all applicant!, hats
mult not oe worn.
Photograph mutt oe larger than 1 l/«" X 1 3/8" but head size from
chin to top of hair mult maauira aoout ona Inch.
Photoerapn must oe color with a white Background.
Surface of tne photograph mu*t DO 910 My.
Pnotograpn mutt not Da ttalned. cracked, or mutilated, and mutt
tie flat.
Pnotograpnlc Image mutt B« tnarp and correctly vxpoted, pnoto-
grapn mutt Da un-retoucned.
Pnotograpn mutt not oe patted. on cardi or mounted In any way and mutt
M borderiew.
Tnrve (3) identical pnotograpnt or every ipollcant, regerdleu of age, mutt
be tuomltted.
Photograpna must t3e taken wltnln thirty (30) dayi or appllcatlon Oats.
Snaoihott. group pleturet, or full length oortralti v»H( not Be aeeeotad.
Utlng crayon or felt pen, to avoid mutilation of tn« pnocograotii. ligntty
print your name) (and alkm file numoer If known) on tne oacx of all pnoto-
grapni.
Important nota - failure to submit pnotograpni in compliance with tnew
toeclflcatlona will delay tn« proceitlng of your application.
3. You ihouM not file this appllcatlon If you :
a. Entered the United Statet at a memper of the crew of a v«t*el or aircraft or were dettlned to join a vewel or aircraft In (n* United State* as a
member of tne crew wrten you arrived In this country.
a. Mere not admitted or paroled Into the United States following Inspection by a United Statet Immigration officer.
c. Am sublect to tne exchange visitor two year foreign r«t«J«nc4 reauiroment.
a. Have, on or after January 1. 1977, continued In or accepted unautnorlzed employment, unless- you are a ipoute, oarent or child of a United
Statet citizen.
e. Entered me United States as an alien transit without vita.
PENALTIES. THE LAW PROVIDES FOR A FINE OF »a.ooo AND IMPRISONMENT OF FIVE YEARS FOR FALSIFICATION OF AN APW.ICA.
TION OR AFFIDAVIT.
FEE. A fee of tnirty-tlve (*39) mutt Oe paid for filing tn«te forms. Tan dollars (110) of this f«e Is for filing tne visa petition and twenty-frvo (»«)
It for filing tne appllcatlon for permanent raildant ttatut. If your appllcatlon It rejected oecaute a visa number Is not availaote. fee may »e refunded.
Otherwise, the fee. cannot be refunded regardleu of tne action taken on tne application. DO NOT MAIL CASH. ALL FEES MUST BO SUBMITTED IN
THE EXACT AMOUNT. Payment Oy check or money order must b« drawn on a bank or other Institution located In the United States and be pay*
able In United Statet currency. If you roilde In the virgin Islandt, check or monay order mutt be payaele to tne "Commissioner of Finance; of tne
Virgin It
I check
or money order payable fo the "Immigration and Naturalization Service.'* When check 11 drawn on an account of a person other tnan the applicant,
the name of tne applicant mutt be entered on the face of the check. If payment Is made by tne type of International money order that cannot be mailed,
tne money order must be drawn an the pottrrutter of tne city In the United Statet to w/ilcn tne application will be mailed, and that city, tne money
order number, and the date mutt be thown clearly on tne top margin of the appllcatlon form. Pertonal checks ara accepted uibject to collectlblllty.
An uncollectible cnecK will ronaar the appllcatlon and any documents Ittuaft pursuant tnereto Invalid. A cnarge of SS.OO will bolmpoted If • cneck In
payment of a fee It not honored by the bank on wnicn It <t drawn.
10/1/80
TM 782
ADMINISTRATIVE MANUAL
Appendix I
I-130E/I-48SH
Page 3
UNITED STATES DEPARTMENT OF JUSTICE
Immigrttian and Naturalization Sswies
Form Approved
OMB NO. 49— RO 401
Petition To Classify The Status Of An Allan Relative for The iuuanca Of An immigrant Visa
FEE STAMP
TIM petition HIM fllBd an ..., Oat*
The patltlon It aparovea for status under (Action;
DO
Da03(*>U) Q203(sH2> District
D 201 (b) SPOUSE - CHILD D 203(a)<4)
1 C JOl(b) PARENT Q 203(8)15)
PETITIONER IS NOT TO WRITE ABOVE THIS LINE
I. Name of beneficiary (Family In CAPS) . (First/Given) (Middle)
i. Names, blrthOato* and countries of birth of
beneficiary'* cnlMren:
3. Date of beneficiary's blrtn (Montn. day. year)
4. My name lt> (Family In CAPS) jfrirft/aivefi) (Middle)
S. My pnone number is S. Otlter names uaafl: (include maiden nam« If marrtod)
7. Family raiatlonsnip — tna tMiwflclary II my:
0. twatbomt (Montn) (Day) (Vaar) in: (Town or City) (Slate of Pro*
nee) (Country)
*. It you arc • citizen of the Unltad Slam, aiv* tna following:
a. Cltlnmtnip wat acaulrml: (CnacM oive)
LJ tnrouan Birth In tn« U.S. Q tnrougn Wf«nti O tnrouan naturalization
LJ tnrough marriage
11. My currant aoorau II: (c/o l< approprlata) (Apt. No.) (Numbar & Stratrt)
(Town or City) (State 4. Zip Code)
12. L»tt aadrau at wnicn I and my IOOUM r«»ia»O togatnar FROM TO
(Town or City) (Stata or Province) (Country) (Apt. No.) (Numbar and S treat) {Montn) (Vaar) (Montn) (Year)
14. If tnlt petition l> for your tpoute or cniia. give the following:
A. Date and puce of your pre*ent marriage B. Name* of all my prior ipouMt
C. Namet of all my wlfe/tiuioand'i prior IOOUMS
Are beneficiary and petitioner related by adoption?
D YES D NO
IS. II <nl< petition K far * <•»"<> '« «•>• cftllij vnur ««npt«<« {MM » _ .
If to, a>*e tne names, datei. and placet of blrtn of all otnar children adopted oy you. If none, to itate.
OATH OR AFFIRMATION OF PETITIONER
Signature of petitioner .
SuMerlbad and (worn to (afflrmad) before me thl«__._ _ day af ,.„.... "*..,, »« .......
(5EA1,} My cammlpitQn "«P''»« ,_..
(Signature of Officer Admimttering Oatn)
(Title)
SIGNATURE OF PERSON PREPARING FORM IF OTHER THAN PETITIONER
Thlt document w»i prepared by me at tho request of tne petitioner.
(Signature) (Addreu)
(Date)
Form 1- 130 Ep- 1.78} Received Trans In
Ret'd. Trans Out Completed
ADMINISTRATIVE MANUAL
Appendix I
TM 782
UNITED STATES DEPARTMENT OF JUSTICE
Immigration end Meturaliaation $wic«
Form
OM8 NO. 43— HO 401
irtton To Cteaaify Tha Status Of An Alton Relative fen Th« Issuance Of An Immigrant Vise
IEWINO OFFICE LOCATION:
DATE:
FEE STAMP
PETITIONER IS NOT TO WRITE ABOVE THIS LINE
of txsoefleiary (Family in CAPS)
(Flr»t/Glv«n)
of Mnefldary'* birth (Mantn. day, year)
erne Iti (Family in CAPS]
(First /Given |
(Mlddl«)
iona numaw it
2. Name*, oirtnoate* Add countrlM of Dlrtti of
Deneflclary't enildreni
Other name* ua«d: (IncJuaa maiden n«m« If married)
ly reutlonwtlo — tn« b«n«flcl«ry It my:
(Month I
(0«y) (Vwr>
(To«*n of Clty>
(State or Pfovlnc*)
(Country) '
j art a citlian of tna UnltM Statat, giv« tna following!
<**% acquired: (Ch«CK on«)
rouqft Btrtn In tna U.S.
D tnn
LJ tnrouoft
naturalization
D true
irrvnt addr«*s ic
(c/o If appropriate) (Apt. No.) (Number & Street)
(Town or City)
(SUM & ZIP CO<M)
iaor«wat wnlcn I and my IOOUM r«*ld*4 to«atn«r FROM TO
n or CltyJ (SUta or Pro*lne<i) (Country) (Aot. No.) (Numbw and Str*«t| (Montn) (Yaar) (Month) (Y*ar)
l o«titlon la for your IOOUM or enild, glv* tri« following:
it« ano puco of your presont marrl«g«
imM of all my wifa/nutMnd'i prior tpoutcs
«n«flclary and pvtlllonar rviatM by adoption?
es GNO
B. Nam«« of all my prior SOOUMS
l potltlon l« (or a en lid li tn« enlld your adopted ri\ua*
9lw« th« n«m««, dat«f. and PIMM of blrtfi of ail oth«r cnlldran adoptod by you. if non«, to sut«.
OATH OR AFFIRMATION OF PETITIONER
ir (alTlrm) tn*t I Know tn« ci
Sl«n«tur« of pvtitlenar.
i ana correct.
Wlbsd «nd Mrorn to («fflrm«d) b«for« m« tnls.
(SCAi.) My eommi«ilpn expires .
. aay of.
(Signature of O'fleer Adminltterlng Oath)
(Title)
SIGNATURE OF PERSON PREPARING FORM IF OTHER THAN PETITIONER
ument wet prepared by me at tn* requeit of the petitioner.
ature)
(Addreti)
(Date)
106(3-1-78)
(COADP COPY)
Ret'd. Tram Out
TM 782
ADMINISTRATIVE MANUAL
Appendix I
I-130E/I-485H
Page 5
APPLICATION FOR STATUS
AS PERMANENT RESIDENT
Form Approved
O.M.0. No. 43— RCUOO
^PW|^r
(Family)
(Middle)
2. Other name* ua&ai (including mstMn nama If msrelea woman)
Q Female
4. Oats of Blrtn
S. Telephone Number
6. Place oi Birth (City or Town)
(County. Province, or stm)
(Country)
7. I am a cftlian of (Country) a. PrtMnt A*j?«s (Wtimoar and Straat) (City or Town) (State or Province) (Country)
(Zip Coos)
9. Have you aver aeoUeg! ba*eWW'iiiiiw!riiM' resident status In the U.S.? Q Yes r-j NO (H "Yes", give the data and place of filing and the final
10. My (Ma num&er US:
10. e. I tninh my A «M Is at the immigration Office in
(City)
11. name at apooan on nQtflmmt&tM deeum*m (Form i-®«. l-J@«, ate.) (if different from above)
t last arrives in tne Unites States at the oort of {City and State) on (Month) (Day) (Year) by (N»m« ot vessel or other means of tr«w«i)
•i a (visitor, ttudont, efowman. twotsa. ®tfc«J
12. My nonimmigrant visa,
my l-9« permit number It
LJ was LJ ws» not Inspected.
United statat Consul at jciSyS {Country)
was itwied by tn« on (Montn) (Day) (Year)
Q single
divorced
I4- i nave o«en married
tunas, Including my pregont marriage. If now married, (it you art now married give the following;)
a. Number or timat my
wita use Botn masrtaa
b. Name of huioano or wlf* (Wlfa glv« maiaan ntma)
c. My nuiband or nvila r««iO94 Q wltn me Q aoart from m« »t Aadrets(Apt.No.) (No. i Stract) (Town or City) (Province or Stata] (Country
IS. a. i hav«__to«» or oeufmera at follow*: (comeiata an columns at to eicn ion or daugntar; if living with you state "with ma" in wit column: otrwnwl*
give city ana Mate or country of ton's or oau$nter's residence. (J»« teoarate snaat If nacastary).
Place of Birth
Data of Birth
Now living at
b. I hav«_^n_prothafg and trttanat «ello«i«»i (Cemotata all columns as to each at in 15. a. apove).
Place ot Birth
Data of Birth
NOW living at
c. The following rrwnpeft of my family aro a>«o applying for par manent reticent statut;
16. I lltt below all orasnUations. «ocMtle<, eluBS. and associations, past or present, in wmcn i nave neid mamoennio in tne United States or a foreign cc
ana tno oarlodtaml »tsce* of such me«nD«r*AI:>. (if you nava never aeon a member of any organisation, tt»ta "None".)
17. I [3 •<•«• Q »aw« not IM««I treated tor a n>«ntal dlwd«r, drug addiction or aicohoiitin. (If you have »««n, exoialn on separate snaet).
18. I D ruswa [j flaw* not M«n arr«n«d. canwtetad or confined in a prison, (if you have t»««n, explain on separate stieet).
_. _, havo not Man tM MnaflcUry of a Pardon, amn*ity. r*hablilt«tfon decree, other tct of clemency or similar tctlon. (If you nav« ba«n.
10. I Q rtav« [J twotain on sowtrat* W«m.)
20. i CD have Q hava not received any eualle assistance. (If you riavo, «xplaln on separate sheet.)
21. EXCEPT AS OTHERWISE PROVIDED 8V LAW, ALIENS WITHIN ANY OF THE FOLLOWING CLASSES AWE NOT ADMISSIBLE TO THE UNITED
STATES AND ARE THEREFORE INELIGIBLE FOR STATUS AS PERMANENT RESIDENTS!
Allans who have committed or who have Omn convicted of a crime Involving moral turpitude (does not Include minor traffic violations) ; tllent wno
have bean engaeM In or wno inland to engaee In any commercialized saxual activity! alMnt wno ar« or at any time have been, anarchists, or mam-
ban of or affiliated with any Communist or other totalitarian party, including any subdivision or affiliate thereof; aliens who have advocated or
taught, either by p0rgonei uttefanea, or by m<aan« of any written or printed matter, or tnrougn affiliation with an organization, (I) opposition to
organized government. (H) the ovortttrow of government by force or violence. (Ill) tne assaulting or killing ot government officials Decaute ol tnelr
official character, (IV) toe unlawful destruction of property, (V) rootage, or (Vt) the ooctrlnei of world communism, or the establishment ot •
totalitarian dictatorship In the United States; aliens who Intano to ongaja In prejudicial activities or unlawful activities of t subversive nature;
aliens who have boon convicted of violation of any taw or regulation ranting to narcotic drugs or marmuana, or wno nave been Illicit traffickers
In narcotic drugs or marihuanas silent who have a«en involved In jmutlng anyotnar aliens tp enter the united States in violation of law: alt*n> wno
have applied for examtttion or discharge from training or service In tne Armed Forces ol the unltoo states on tne ground of alienage ana wno nave
been reltoved or <tMcnarg«d from su«h training or service. Allans wno are mentally retarded, Insana. or have suffered one or more attacks of in va-
nity t aliens afflicted with ptycnopethta personality, sexual deviation, mental defect, narcotic drug addiction, chronic alcoholism or any dangerous
contagious dlsoasat aliens who nave B physical defect, disease or disability affecting tnelr ability to earn a living; aliens wno are paupers, pro'esiionai
beggars or veflrantsi aliens wno are poly gam im or advocate polygamy; aliens likely to become a public charge; aliens wno have been excluded from
the united States wltnin the oatt year, or wno at any time nave been deported from the united States, or wno at any time have been ramoved
from th« United States et Government expense; altonswno have attempted to procure a visa by fraud or misrepresentation; aliens who have de-
parted from or remained outtMSe the United States to avoid military service in time of war or national emergency: aliens wno are former excnange
visitors who are subject to but have no* eomplkso with tne two year foreign residence redulramenl.
Do any of the foregoing cM««es aoaly to you? LJ Yes LJ No (if answer is Yes, explain on separate sheet).
22. (Signature of parson preparing form. If oth«r than applicant). I aecur* trim
tnis document was prepared by rne at tna request ot the applicant ana is
bated on all Information on wnlcn I have any Knowledge.
Address o< person preparing form, If otter than applicant
Form |-485H(3-l-78)
UNITED STATES DEPARTMENT OF JUSTICE - lmmiBmion «nd K«ur»!ization Serving
AUPUn.L31KAl.iyC PWVfUMi,
Appendix X
1 1
o M rtenea o«0w until a»«M<8«t »Meera Mfora M offtear of th« iaun&»t\on «M Natur»tUatlo« S«nrtca fof «uiMnati0n)
. . do &&& UHinnt mat i (MOW tM eonnnts of mH MMMC
*, tn«t HM WKM »f« tru« to tM MM of my knowMo^ «<m that MM eorractlont mimooratf [
by m« or M my r*euo*b att4 that tl»ta a»»ilo(lo«i wat ««M*4 by m« wim my full, truo namw
It MMSrifeOd By <»• UWHMlDf
] to ( ) wore mMM1
(ConuMOM «M tnM *t«MMf« of «MMieaitt)
*wom to bafora ma by tit» t
(OayJ <Y«»r)
10/1/80
FORM 1-131
I. USE:
USED BY A PERMANENT RESIDENT ALIEN WHO INTENDS TO TRAVEL
ABROAD, TO APPLY FOR THE ISSUANCE OR EXTENSION OF A REENTRY
PERMIT. THE PERMIT, VALID FOR NOT MORE THAN ONE YEAR, CAN
BE EXTENDED FOR ONE MORE YEAR.
II. ELIGIBILITY:
1. APPLICANT MUST BE A LAWFUL PERMANENT RESIDENT ALIEN;
2. MUST BE DEPARTING TEMPORARILY FROM THE UNITED STATES;
3. MUST BE PHYSICALLY PRESENT IN THE UNITED STATES AT THE
TIME THE APPLICATION FOR ISSUANCE OF A REENTRY PERMIT IS FILED.
MAY BE ABROAD AT THE TIME OF SUBMISSION OF AN APPLICATION FOR
EXTENSION OF A REENTRY PERMIT.
III. REQUIREMENTS:
1. GENERAL:
a. MUST PRESENT VALID ALIEN REGISTRATION RECEIPT CARD
WITH THE APPLICATION. (NOTE APPLICATION: "FORM
1-151 OR 1-551 SEEN AND RETURNED." DATE AND INITIAL
NOTATION AND RETURN CARD TO APPLICANT.)
b. IF APPLICANT'S ALIEN REGISTRATION RECEIPT CARD HAS
BEEN LOST OR DESTROYED, APPLICANT MUST ALSO FILE
FORM 1-90.
c. MUST HAVE A SEPARATE APPLICATION WITH PROPER FEE FOR
EACH MEMBER OF THE FAMILY.
d. IF APPLICANT'S NAME HAS BEEN CHANGED AND HIS/HER IMMIGRATION
DOCUMENTS HAVE NOT BEEN CHANGED, MUST SUBMIT EVIDENCE OF NAME
CHANGE.
e. MUST SUBMIT ANY PREVIOUSLY ISSUED REENTRY PERMIT OR
REFUGEE TRAVEL DOCUMENT.
ISSUANCE:
a. MUST HAVE TWO PHOTOGRAPHS, PER INSTRUCTIONS ON THE APPLICATION;
b. APPLICATION MUST BE SIGNED UNDER OATH AND SIGNATURE NOTARIZED.
EXTENSION:
a. MUST SUBMIT CURRENT UNEXPIRED REENTRY PERMIT.
4/1/81
TM 766
ADMINISTRATIVE MANUAL
Appendix 1
1-131
Page 1
APPLICATION FOB ISSUANCE
OK EXTENSION OF P01MIT
TO Rgiwrea we. UNITED STATES
WgP STATES DEPARTMENT OP JUiTICK
{migration oust NtalttratigMlM Service
INSTRUCTIONS
HEAD INSTRUCTIONS CAREFULLY. FEE WILL MOT BE REFUNDED.
Form MSI (Alien Regatnitiefl Beowpt Cwdt nwy tie ptetonud instead oi a reentry p«rmii ai lima of application for reentry imo th«
United SIMM, eacsei from eornmurwimlomiRwad cour.tnei. otic; in gtmnce of not more Uisn 1 year That 1-year time limitation it
not epdicsbta to ths ssouno or child el o member of tho Arrnad Forcm of trie United SIMM or o« 0 civilian employee of the United
StaiM Qovenwnsnt stafortsd a&<o«d pursuant to otticiel orders. >t iM ipouse or enild prea>m» Form 1-181. did not relinquish lawful
perfficnani reudencit. and it erseadinf or sosamoiiflving m» nwmBar or employee, or u tollattnng to torn th* member or employe* in
the United Sutet within 4 montnt of in* return of trw msmttse or ampioyae. If you RsvtrthglMi prefer to receive a reentry otrmit. sub-
mit the attached application. Form M31. mweordsncs wnn m» instructions in the numbered paragraph! below. D«P«e travel to, in v
through corrunumst-domineiea countries (otiw l*um Cuoa. ana communist oonipni o) Korea or V«t-M«rnl. Form MSI nuy tu utea
instead of a reantrv sarmit for r«£dmiu»on to the United Stiles after an science of not more thsn \ year by on alien who has not retch-
ed ttw «gfi o^ 18 «t the tuna ne ssalpss for issamisnon into me Umteo Stetes. or Ov a cxwmcn on an wreratt or a ««iwl of American
travel WM punuant to his s««(3K)vf»!>m IB « crewman.
. UMJ§R HiHaiaMTION LAW. Qf E»£BS3!7 TO Rg-SNTKrl
A rcentrv onmil lihgll Ka« ma eHtwt uraJfJ" KM tmmifration I»M. attaint to <Am» thai trw «j*n n raturninf from a wnoorary >n>t abroad:
nor dull it M eannru«d to to tfts oac!uai«3 nwm of MtaOliittine ttial txa alien u to returning. Tha geuraiofl of tn urwxpircd reentry permit
r«l«trM WM sltsn to wflom n is isai»S >rom Irte nsessJitv o? tacunng 8 UIM from an Amwiean oomvl before returning to !hK country, n aeai
not. no«iMii«f . rattswa Siva p0>wn to mMNn the earoiit 13 iteued from meetirq ell otnar rMjwromenti of tne untntgiration )awn.P*r«ani wno riav« own
comieua of 01 stimti ne«m0 eommrnd aimat motiving moril lutpnutfa sithar bofora oa aStor efiutmg tlw United $t«e>. other cnmirul.. im-
moral, irusne. rntntgllv of cthyemllv (feteiiva giwra. mow BHInaca witit a oenfw out eon<a§«ou8 a«aas». end othen found to be inadmntible
under too Imnx^ietion and Waaicnelitv &sx MO suSsaEt to aECiuaion it stitmpting to rainier, nonsrittmanaing tnoy nuy be m pouanion of re-
entry Ofnos.
gFpeeY e? &astecg fK0M UMSTED STATES UPON iwTim&u£ATgrM euaiaiuTv
A reentry aernut dem not ralKPKJ Wis (ttxjtw to tarnom iwuad frem mwting tne reouirememi o* tne naturalization lawt. Notwiihnanding
In* potMtttatt e* a foamtv permit. MIKOTCJ from me Umtsi Stales bv sn aptMicgnt for nsturalizotien (or a continuous period of ) year or more
during the period for whten «ominueus nuOnnea in t«« United Statas n nsawred for adnritsanon to cuixnenip mil break tt>» eontmuity of wen
rM*de«GB, oucom wltare.prior thereto. <no Attornoy Oaner N hat eoorovstt an n&ranoi in tns emolovfiwnt ot. or unoer contract wttn. the United
Staiei Gownment or en Amwicon ingtitution Ot research refognittd is eudi by the Attortwy Sunerel. or in the emeloymoni of en American
firm or corporation engaged in whole or part in the develoomont of foreign trade and commerce of the United Sum or « tubudiwy tnweof .
more than SO percom ot whoae flock 11 owned Ov en Amertun firm or corporation, or in trw employment of a puMic international organisation
of which the United SIMM u a member by woatv or ttetute end bv "tucn the alien «m not emetoy«d until atiw (join* Imrfully Mrmmed tor
permwMAt reiKienei. In order to quality tor such sepoov* trw applicant mutt ham been pfcytietUy orfttam and rending m tne United State*.
after being lewlully admitted for permanent rotxtenm. tor an uninterrupted period ot ot lean one year. The granting ot tuen approval OOM not
exempt trw applicant from The reauiromont that he be pnysically oreiant in the United Stetei tor n MMI cfl»-hait o* the period of rewdenee
reouired for naiuraliution enepl in the CM» of thoM csreons who are *moiove<t by. or under cenrrect witn. the Government of the United
Sutet. thou pertora who are authonisd 10 perlorm tne mimitariai or printly function! ot a raligiouidenormnatiert having a bon* fid* orgeni-
ution within me United Stoifflt. end rhew panam <««o ere ene*9&d totely bv a reltgiou* eenormnation or oy »n interdenominational minion
organiutien having a bona tide or^nitation tmtnm the Unind Sutet e» o miuiongry. brotnar. nun. or unor. Such aeoroval mould ae applied
tor on Form N-47Q. "ApplicaiMMi a Pruiwva Revdanee for Wotureliisjion Purpogoe lundw Mctnn 316 Ibl or 117, immigretion and National-
ity Act!." MoilctaK at any office of ttte Immigration end Waiueoiijatioa Sarvtoa. AlMm who are adeem in connection with or for tne purpow ot
performing the rninutsrial ot ermstly functions of a reltfioua denofnimtion heving a bom fida organiution in the United States, or wno ere en-
gaged by auch a donanunatien or an mwosnemmationgl mifiMon CTgwiMjicn h««ring a ttana lid* orgsnintion within the United Statn.ata
rruutorujry. tonNtter. nun, or »ster are r*» alig^ia to nw&a such asjjJttjnica.
Sff EOT 0? CL&m TO KOtMESIOEOT ALIEN STATUS FOR
fiOMAl. INCOME TAK PUSP»OSSS
An «lim who nw setuslly eroJ*!i»;®iJ rawtenca in «M) Untied Siatss oflo having baan adminad M an immigrent or attar having adruflod
ttatui to that of an immigrant, and «rho » eBratOtring the filing ot a nonr«tidani alien tax return or the non-filing ot a tax return on the ground
mat he M a nanfcautsnt alien, snouki ceswata cesafully Ih® cemsiiuencss under tha Mnmijiraiion end ruturaliution Umrt if he Own to.
If an etisfi taket auen &«ien. h« msy !» rejsnsad as ruvmg abaodonad h.s rawdanee in tea United Sum «nd at having lost hit mwiigram
natia undar tha munigratian and nssnadiwtttm lean. A> a conwetuanca rw may tea inaligibta (or a vna or other documani tor which lawful per-
manent r*i»d«nt aliem an eliQibla; ha may M tit66fnig»bW to (Ha Umtea Siatet if he taetu eftowaxon as a ratunung ratidant; and ha may be-
come incugiitia tor naturalisation en the tjosa at his wifinsl enwv «M edmumnant
It you «nfn lawfuHy etfrnrrted to ttva Uwtsd Stetea M a trastv nwresum ounusnt to earnoii 3 (31 o< ttw Immigration Act a< 1024.
July 1, 1024 and July S. 1832, both datei inchnmt, and you mtond to dvpcirt temporBrily trom.trte United Sunn you thomd to mlorm DM
Immigraiien and Neturaliiatiofl Service atttea haoms H">KKtion onr your pUtea ot tmaanca. You snouk) then owgit the innructioni ot trtet
oflw* Mfora iubmitung Ua t
Severe portBitHri are provtdMi fty Uw tor (trawvingly and willlully talsityirm or concading a material tan or ining any falu document in the
tubmmion at Ww aoeucaixtn or for luwwioSV lorgir^. countarMnno. Mwrtng. or othsmmv mnututg |M> permit.
FORM NO.
1-131
size
8 X 10 1/2
use
REV.
APPLICATION FOR ISSUANCE OR EXTENSION OF PERMIT
TO REENTER THE UNITED STATES
& CFR 223.1. .2. 282.1, 299.1, .2; oi 223.1, 22^.8- AH
2301.07, 2384 Ex. 2, Pg. 2; II Hbk 8-2, -4. -4.1, -10
SUBMITTED TO THE SERVICE BY AN APPLICANT FOR ISSUANCE OR EXTENSION OF A PERMIT TO REENTER THE U.S.
PRIOR EDITIONS MAY NOT BE USED
SCRSOOLC B
1-131
Page 2
ADMINISTRATIVE MANUAL
Appendix 1
TM 766
- «>n,»e4TiQfs XM laauAmca OP aEiMTHV ggmmT
ucrai Mm -fouarm at euuuao HATWUUTV.* M * m> <
• t«UW. M 0 iMmr.
ran a • emu «M> M i« «• I «. ««• • JI*««B <9 • ouuilf MHOVHWI am> MOT «••• «• •*•« «• «•*•
, AM. •<,»»>*. "WIMCM !•«•» l.l»t. AIU. •• «*-IOJl II Ml art «^««M
» Mi «•> a« OK *•• i^ «•• SIIUM i«« •
UUIT M Q« T»M »«*(ll. KM a b«H «•>•
iml.iimn oo MOT MML CAW AixMttauCT
aau»«Tfil)lH~rMS(JU«TAMOUHT >«•••»• » ••» a •»•» «Mgr •»• p oa»« «. <
V «> C««WV *«» » MM>«I • U A *
ii am tnm i. n mnimfliltr tt
*_ a* u. ».•<»«»« a f i
- A«>tiCATio>» re* sxTsmxm OP Rg»trn»y itroiiT
«««ri»pi«ii. lt»a«
»Mr omttumawl ».«. •i»miiiiiiiii» nmxiii nmraa nil
10/1/80
TM 766
ADMINISTRATIVE MANUAL
Append 1.3C 1
1-131
U«TH> «AT» DEPaWMSNT Of JUSTICg
liwiijf«K(Mjn emd Naturalisation teraic®
APPLICATION FOR ISSUANCE OR EXTENSION
Of PERMIT TO REENTER THE UNITED STATES
as provided in section 223 of the
Immigration and Nationality Act
UM typawf IMT or prim in block latwrm with tell -point pan.
I h*raby apply for (ch«ck OM)
C*"~|
±T
|_J
of Puwmit to Reamer the United Statas
o&sm.v fej^ks (Cases* fe*<™WT>i w®§T ueffifx,
V YOU*) MAM
" IMPORTANT: You must HuWtut your Allan Registration niscatfH
Cflft3wr.hthia apphc«tion i< you ctoekad "laswiirce" saove.
<i*tt
kMCARS O?
If you eheckbd ' 'Extansion" you must submit Th« f®9f«rv (>ar-
~— — — (mu you wish Jo have antflncted.
MAILIMO •"••"• liass Baa
^^^Vv^'^^? ALIEN RSSISTUATIOM NVS^'lER
5J^y7 SBVl IKwM (S«TH
K *'
f IU IN ITS US 2 TMBOUOH 8 Q«H.V lt> &»>L(CATIOM IS PCM ISSUANCE 0* «SNTI»Y P£BM|T
2. DATE Of B»*TM/MJ»SWI. O«». vae/j COUNtWV Of BIRTN ™""v"~
:OU»IT»VOf CLAIMED NAtlONALITY I COLOffl Of IEV£S CO(.C« 0* HAI«
1
HilGWT FgtT INCHti VHMU »i*«KS; AW5 SCMI
J. 1 DOlO O DID WOT RSQtSTW FO» SILSCf IVg SSRVICS
1. Flu. IN THS ITSMg IN TMIt SLOCK AS TO /Irot ACSIVAI. IIM UMITQO ST&VJ.S
POO nicMAusNT KcsineMce o« AOJL.«TX«NT TO ra^uuvNiMT RESIDENT STATUS
MMIORAT(OM Office WHICH WHICH ADJUSTktSWT O? STATUS
Ga*Pft«0 ADJUSTMUNT WAtOAAMTHCI
| PILL IN REMAINING ITEMS IN THIS SLOCK ONL? \t YOU DID NOT ACOUIAE PERUANCNT HtSlOfwCE THROUGH ADJUSTMENT. |
UANHIH 0» FIRST ARfclVAI. IB) UMITiO STATS3 f OH PBmiAhfSwT RSSlOfNCE /A/ficu o/ Velltl. Airline, alt./
WOtHSWS MAIOEM MAME
4. f ILL IN THt ITEMS IN THIS SLOCK AS TO 'eir JtBKIV.tL JK U.!,. fC»cJo.-
..„ -».,„ .(.» ,„ »,.«. ., ,„„ ,AJM ... ,««„ ,. CfaMU „*,*,*,
NAMt UNOSH WHICH AOMITT8O
t-Qir- Gf AAHIVAL DATE Of ARfllVAl
NAUE OF VESSEL. AIRLINE 08 O'fHBH MANS OF CONVEYANCE:
6. »O)«T Of anwaiaif OtPARTU«E fKCM UWIYSD STATES DATE
Of ffeaotiH OCf ARTUHE LENGTH Of INTENDED A&3SKCZ. ASaoAO
NA«t Of TRANtPORTATtOM COM>AMV IF OE
PAflTUME $ TO B8 BV VESSEL. GIVE NAME Of VM£|.
FILL IN IT(U 7. ONLY If APH. ICATIOM IS PO« EXTENSION Of 8€EMTHY PERMIT
7. LI»I ill count'im uigitsd ftinse vmtf laui *eoj«nmei (rant toe umiiM $u
IM. in «i» orosr v.mteC OATI & POKt Of LAST CXfASTUOf K1CM OS.
S, fid IN ITHi a ONLY If YOU HAVS JPSBVIOUSLV Q8TAINEO A PERMIT TO WINTER
I$£UAMCC OATS Of LAlSi fSittsSlV LOCATION Of ItiMlttWATIOPS AND WATLWALUATlON O^flCf iSSu'j'SS C^Sf I^UlT L ' £? LA^f' WIGiV
/ C«y *«» SFB««/ T « /4T?iCM89
|f!""TW£ f-fMMir IS NOT Af fAfewidS. S7A7S e$ASOM:
W PimuHT l« AnACMlO. STATS i^MUTlOM DATS
ALL Aw^iCAsms UU«T PILL IN ITEMS 9 TMIOUQH 20. IWCLUSIVS
S. MtESENT OCCUPATIOW.
j*JMU£ end AODWSS 0> WL0vee
•.««~w»*4
1
1 . .
SOCIAL i£C UNITY ACCOUNT WUM«£«
iO. HMIUMd Affb'lKCS AJ9»OAO/**B«i»a' «•* &«»*« /e/'i./JVow/ iSrae/previHtA/Omtncu lCt>ieat>n
U.COUMTaiU TO HE ViEITgO rt.o« «o« cawiMrw
11 WASONS FOA COIMO AMO&O OR ISIEKING EKTSMION r»» co^;j.» «»
0 eamelattl:
««"••'»"*«*•"«»• OVES
ascicvsD i THAM3 1« njrci-THAMt.our coun.anQ
I ... .. ..
1-131 ADMINISTRATIVE MANUM, fl,
Page 4 Appendix 1
'* Lffe. «£r:.^. jaSn: rLT^rr^ ^siv: ssi^ «~ ' •— - s ""^ * •"• u~"" 8u"~ •* "•
!«. Sitoa i»o ii>»> i fexaeta a BWWWMKW rcm«.jsBK *» th» UMKMI States. 1 Ke»« 'iis« a lo^wai •«»
m tax ««turn M > owattiftaM. (j Yw Q] Ha. ill" i»«". »wt» IM
i. Sine* tfce (im l Mean* a BenmiuMii roaKani ot in« ooiioa SuJ««s. > nova (aiisd to lii« o fed
«__ D*.D ... ,^-.-«
-
14. 1 LJ oo Q «o rm mom «o ranun w inn urnled Sliroa *>wr rmr laaxccasm viail aft/aaa
17. l Q<M Qd««ai intaKt larataixmv MOIWI «« a iwui nanantM "M.«kw»t.
.,
Ig. CHUCK Q My Ailm> «ag>K«8<i«« OKOIM C<nO <a «nee(we\ Q i»o4<c«i«<i fata
r-M *a/ ts0ttiMC9 «4 Atl«A Jte9*a</«ff0<i Aoc«*0t C««tf IK dCt^cftiiitf.
10. Tlw r^exwt to ftaxxM*!. il iam»a « onia»awa. SKOT my Aim Cco^tranon oajMxoc Can) it l atdw
mte« w a«s*w« tar wet OMB. »MI<M M ianu>M>ti) <»
C O«w <S>a*itH ,.._._
JO. if omiteatui* <a 'er iaajtS/ISa.'rf * *w<ui '» Rmxws' waacw* aiasu A a> iraeo M aniv.
If (OMiaMlM 18 du SBJSUSOaa «* a ^W">< n Aetmoi eaoauM Slostl 8 «/ l(«m XI a»Kv>
SROCX A
»v mo an* met Bw ataaawom IK«B.W *ro ino «n8 csjvsol, B*
stoc&a
ivnlfw t(M« i know ma etwmrma *» Bus «WI.CMIO« *i«nj«
m« «M t^N ffte arftSwtsn&n AavAin «r<e t/u« a^l co»'»ci.
literature al nm^Ma
Mto , , „
"• ... ....... .,.„„„ ,,™,_,,.,».--&-a- I9,,,.m,.,— ,...,...™ "*»
Hswww I0a«1 iro*n
iD^MM^aNK. «»..««»« wm inn..
ju sioNATum w PsiaoN pfl^juutta FOHM: IF OTMCR THAM ;W.ICAWT
l to*t»ra t»m HIM aoaionM »«a ongaoroa frv «a « m* raauaat a» DM tantieaM and •• MMMO •« atl io<aniiaiMi> al wfuen i nawa a«w «no«r<a«>«a.
rS.fl<MM,,«il (M*n*»»t iDami
AIW.ICAM?-OO NOT WttTE KLO» THIS LINE
Aaiaa »>»> >«««nl «a All«a fiagiotrauefl IKiBCTEt Cwffl itctiaM <mi» nt^oM t« aaa*ic
Q i-iat cuGiiMwgi t* MMH raamud Q oewtao ca«w *»•«<* «
Q «»-IO9» A»-Ss<ie«««ttBd tw alie««fl«fn»l Q QR&MtlO FWOHI »al
Q «»»» MM Mcus* »« aawa •< i^e Q Knew «oa
Mien t«r la&uMta w ««wna«t«» of t>wn« u RMMW
•V Q Mul«l«M «an«k
KI IN <aMo«i«g cownriui ounood:
OATI oi«.»L HO. Of CWOMT isfiuno- 0«uv
<J# n
ACTION L- '
a
SH* 6* PtMMT iNtriALI O9> IMH-OTSt
IT MAD.
OffIC*
DAU
TM 766
ADMINISTRATIVE MANUAL
Appemdiz 1
1-131
Page 5
WanfiD STATES D^MTUSMT OF JUSTICE
CMS No 4MOO&2.
APPLICATION FOR ISSUANCE OR EXTENSION
Of PERMIT TO REENTER THE UNITED STATES
as provided in section 223 of tit®
Immigration ami Nationality A«
UM typawffitor or print in block tattwv with bs!l«po»m p«iv
\ hereby apply for (chock ono)
f~"r) i
C3 9Kta«»ion
of Permit to Rmmtar tti» United States
1. VOUMMAUC
IMPORTANT: You must submit your A/can H«giBtration noc«<pt
Cart with thia application if you chackad "latuanca" aboua.
If you chsckod ' 'Extension ' ' you must Sutonit th« rgwntry pe^
mit you wisn to have airlanded.
AUCH fSCUTKATIOM MUMtH
CIU. IN inuS 2 THROUGH 8 OM.Y 17 APPLICATION IS »OR ISSUANCE O* RSINTHv MRM
2. DAT! Of BI(tTH/Mo/iui. Oa».
COUNTRY Of HUTU COUMTavOVCUAIMCDMATIONAUTV COUQH Of iVIS CO LOW Of MAW
HJlOHT .
MfT
INCHI8 VISIBLE MARKS AMD SCAftS
>. i ypto D DID NOT «ioi8ti« "oa tiucrivt stavict
4. HU. IN TMS lTtU« IN TMI8 «I.OCK AS TO /<»( AMlVAl. IN UMITgO STATtS fOa MBMkNKNT CMWIMNCf 0* AOJUCTMMT TO PfMMIMNT MICIOINT STATUS
MAIM uMOM WHICH AOMirrao on ADJUSTED
AMIVAL oa LOCATION o? DATE o» AMIV At o« OATI AS o?
WHICH AOJUSTMSKT O* JTATUS
W AS G« ANTED
QRANTEO AOJUSTMSMT
nun IXTMISBI.OCK OMIV it YOU PIP NOT ACOU
H ADJUSTMENT.
MANNS) Of 'IRST ARRIVAL IN UM4TSO STATES HOM HAMANINT telOiixCS f W«WMI a/ VMM/. AMiae. me. I
»ATM»rf NAMf AT TIMf 0* VOUS AMAIVAL
MOTHfW'S MAIDS M NAkH
1. » ICt IN THS (TIMS IN THIS BLOCK AS TO '•«' ARRIVAL IN U.S. tl'tiuO* <*r '••*•*'» a/i«r » M
WHICH AOMITTU)
?o*r or ARRIVAL
OATI Of AMtrVAL
NAU( Of VfSSEL. AMLINI OR OTHSR MtANS Of CONVIVANCft:
«. K3XI Of tntoatM OfOARTuM FROM UNITtO STAHS
DATS Of PUNO*** Of CAATUflt UNOTH Of INTtNOf D AWSUCt AaMOAO
NAUf Of T«ANS*O«TATtON COMMPUY
If DIS'ABTLWZ It TO it 9V VBSSea.. CIVf MAUC Or
IN ITIM 7. ONLY i* A?«.ICATION n POR HruMSiOM or atswrm- r«RMi
1. Lwt all eawmtiM vi«i«a< ilooa vow l>»t Mo*nura trow nw
UIM. in KM onMv visitor
POUT O» LAST OWAtTUM WOK ILS.
«. riU IN ITIM • ONLY If YOU MAVE WtVIOLKLY OBTAINED A KAMlT TO MKNTM
T>« WttftlT it MOT ATTACHKfi. STAT
a ATTACHio. XATI tmtfuTiow OATI
ALL APPLICANTS MUtT riU, IN IT8MS « THHOUQH 20. IMCLUSIVt
9. MttSfNT OCCUPATION:
MCIALHCUMTY ACCOUNT NUMSlA
NAMK aol AOOWffi Or
10. MAILING ACOWU ABAOAD (Htm** etH ttf*aV
II.COUNTtUU TO ftl VISITEO lii»t e»CK tauMtvl
lAtONf ro« DOING AMOAD 0* SIEXINfi IJCTINSIOM /<» cofcut
•MB MSI MM. 4-v»IM
COPY
1-131
Page 6
ADMINISTRATIVE MANUAL
Appendix 1
TM 766
UNITED STATES DEPARTMENT Of JUSTtCI
legutGRanoN AND NATURALIZATION simica
A008i88 LABEL FOR PMMIT TO RIENTIR THE UNtTIO STAT8S
A permit to mentor th« United SIMM doe* not insure your resdrnisaton if. for any causa under lha general
immigration laws. you are not admissible into th« United States. You arc advised to read the information and inotruc-
tiara printed on ttM inside (rant cover tnd those beginning on page 1 5 of th« par mil.
Yow attention is »IM caned to Section 685 1 (dl of Titte 26. United Slate* Coda which read* as fellows: "No
alien shell depart from the UmtMl StotM un)M« h« Mm procure* from th» Sacrvuiy or hw d*logat« a canificata that
ha has complied with «H th* oWtgatiorw imooo«d upon him by the income tu lawc". it is luqgoated that you call at
or communicata with your local olftco of the Owthct Director of Internal Revenue. United Sutea Treacury Depart-
mem. for information concerning such a certificate. Tht» «houtd be done within 30 day* of the date of your pro-
poead departure from the United State*.
Requirement* 'or entry into and departuf e (ram countries on your itinerary should be a*ceneift«d from
•mrMMiea or consulate* of tho«e countries well in advance of your scheduled travel.
Your attention « also called to Section 266 of the Immigration and Nationality Act. This lew requires that
•very alien in the United States during January of each year shell notify the Attorney General, in writing, of hie cur-
rent address and furman such additional information as may by regulations be required. Ounng January of each year
appropriate forms are available from any United States post office or Immigration and Naturalization Service office.
Any a/Min temporarily absent from th* United States during Jenuery of any Y»»r shaH /u/m*A hit ctunnt atfoVess end
oitnrinformetion ft rfqutrad witfan ten f 101 deyattter ha return. Any alien temporarily absent from the United
Slates dunng January of any year, upon his return to the United Slates should call, in person, at the nearest Immi-
gration and Naturalitation Service office to secure and execute me required form. Failure to comply with this law
can result in Fine and imprisonment and may also result in deportation.
UNITED ftTATU OfPAMTMINT OP JUSTIC*
IMMIGRATION AND NATUMAUZATION StRVICS
fill in this address label only if you wish delivery of your permit to an address in the) United
States other then your address as shown in Block /1 .
Print your nam« and complete mailing address where the permit should be mailed in the
block below.
FORM 1-140
USED TO ACCORD AN ALIEN THIRD PREFERENCE OR SIXTH PREFERENCE
CLASSIFICATION FOR ISSUANCE OF AN IMMIGRANT VISA.
(NOTE: IF GRANTED, THE PETITION ONLY GRANTS THE ALIEN BENEFICIARY
A BASIS UPON WHICH TO APPLY FOR AN IMMIGRANT VISA. IT DOES NOT
GRANT THE ALIEN PERMISSION TO ENTER OR REMAIN IN THE UNITED STATES.)
II. ELIGIBILITY:
1. A PETITION TO ACCORD AN ALIEN A THIRD PREFERENCE CLASSIFICATION
FOR ISSUANCE OF AN IMMIGRANT VISA MAY BE FILED BY THE ALIEN
HIMSELF/HERSELF OR ANY PERSON ON HIS/HER BEHALF. THE ALIEN MUST
BE A MEMBER OF THE PROFESSIONS OR A PERSON WHO BECAUSE OF HIS/HER
EXCEPTIONAL ABILITY IN THE SCIENCES OR ARTS WILL SUBSTANTIALLY
BENEFIT PROSPECTIVELY THE NATIONAL ECONOMY, CULTURAL INTERESTS,
OR WELFARE OF THE U.S.
2. A PETITION TO ACCORD AN ALIEN A SIXTH PREFERENCE CLASSIFICATION FOR
ISSUANCE OF AN IMMIGRANT VISA MAY BE FILED BY ANY PERSON OR
ORGANIZATION DESIRING AND INTENDING TO EMPLOY WITHIN THE UNITED STATI
AN ALIEN WHO IS CAPABLE OF PERFORMING SPECIFIED SKILLED OR UNSKILLED
LABOR, NOT OF A TEMPORARY OR SEASONAL NATURE, FOR WHICH A SHORTAGE
OF EMPLOYABLE AND WILLING PERSONS EXISTS IN THE UNITED STATES.
III. REQUIREMENTS:
1. PROPER FEE.
2. THE POSITION MUST NOT BE OF A TEMPORARY OR SEASONAL NATURE.
3. THE APPLICATION FOR ALIEN EMPLOYEMEtfT CERTIFICATION FORM IN
DUPLICATE, MUST BE ATTACHED TO THE PETITION.
4. A VALID LABOR CERTIFICATION ISSUED BY THE DEPARTMENT OF LABOR,
STAMPED ON THE APPLICATION FOR ALIEN EMPLOYMENT CERTIFICATION FORM,
UNLESS THE BENEFICIARY IS ELIGIBLE FOR A SCHEDULE A LABOR
CERTIFICATION.
5. EVIDENCE THAT BENEFICIARY MEETS THE MINIMUM REQUIREMENTS OF THE
JOB OFFERED AS STIPULATED ON THE APPLICATION FOR ALIEN EMPLOYMENT
CERTIFICATION.
a. EVIDENCE SHOULD INCLUDE BUT IS NOT LIMITED TO:
(1) SCHOOL RECORDS INCLUDING DEGREES ATTAINED.
(2) EVIDENCE OF COMPLETION OF ANY SPECIALIZED SCHOOLS OR TRAININ
4/1/81
.ix nrnunvi i rvji\n ur nui_
POSITION HELD, PERIOD OF EMPLOYMENT, AND JOB DUTIES.
(4) ANY OTHER EVIDENCE DEEMED OF VALUE TO ESTABLISH BENEFICIARY'S
QUALIFICATIONS AS A PROFESSIONAL OR A PERSON OF EXCEPTIONAL
ABILITY IN THE ARTS OR SCIENCES OR REFLECTING ON HIS/HER
ABILITY TO PERFORM THE JOB OFFERED, FOR EXAMPLE, LICENSE
TO PRACTICE PROFESSION OR OCCUPATION.
IF AN ALIEN IS COMING TO PERFORM SERVICES AS A PHYSICIAN OR SURGEON,
THE FOLLOWING EVIDENCE MUST BE SUBMITTED:
a. GRADUATION FROM A MEDICAL SCHOOL;
b. SATISFACTORY COMPLETION OF PARTS I AND II OF THE NATIONAL
BOARD OF MEDICAL EXAMINERS EXAMINATION (OR AN EQUIVALENT
EXAMINATION AS DETERMINED BY THE SECRETARY OF THE DEPARTMENT
OF HEALTH AND HUMAN SERVICES). *
c. COMPETENCE IN ORAL AND WRITTEN ENGLISH.
(NOTE: 6b. AND c. ABOVE ARE NOT REQUIRED IF BENEFICIARY GRADUATED
FROM A UNITED STATES OR CANADIAN MEDICAL SCHOOL OR HAS NATIONAL OR
INTERNATIONAL RENOWN IN THE FIELD OF MEDICINE.)
ALL DOCUMENTS SUBMITTED MUST BE ORIGINALS OR CERTIFIED COPIES.
ANY FOREIGN LANGUAGE DOCUMENT MUST BE ACCOMPANIED BY A CERTIFIED
ENGLISH TRANSLATION.
PASSING THE VISA QUALIFYING EXAMINATION (VQE) OR MEETING ALL OF THE
FOLLOWING REQUIREMENTS:
HAVING A LICENSE IN A STATE AS OF 1/9/77;
PRACTICING MEDICINE IN A STATE AS OF 1/9/77; AND
HAVING A SPECIALTY CERTIFICATE ISSUED BY A CONSTITUENT
BOARD OF THE AMERICAN BOARD OF MEDICAL SPECIALTIES AS OF 1/9/77.
4/1/81
i.
PLEASE TEAR OFF HERE BEFORE SU3W.IT7ING PETITiOH
PETITION TO CL&8S8FY PREFERENCE STATUS OF ALIEN OH SASIS OF PROFESSION Oa OCCUPATION
INSTRUCTIONS
carefully — le* will not ttif telundait. Failure to tallow instruction may roqmrt feturn ol your palitiw. an& delay linal action.
t. HOW TO PREPARE PET8TlOf4.
a. Pnnl legibly in ink or use a typewriter
b. Submit onu copy only lo* ec-.ii awn &*«ifici«sry.
2. WHO MAY F8LE A PCTTOON.
a. TMrtf preference petition. A nswior. to moid an sKrai a Mnl p!otef ®rs:»
ctaeatBcotlon tor iaauanaa of an tenmfgreft! MM may bft Mas t<y f!w O'^i or any
portion on Ma/her behtfl. The ^Iten mugi to a member ol ura ^ctessteu or a
person who bocauaa ol axeep&onai aSiStv te tits &cit«-e3 cr o.u «»'! tjitet.'vXsay
b*rwtH proapecttvely fii® neibnal aocsnomy, euSurel i.-..'3-ioia, % c«!«sro o* ma
UnMadSlsMa.
b. S/xfA pntefimxt per/rwi 4 psfltlm (.1 E<:caij an alien a siath
prsferenca elatsillcallon lor issuam» o? en iminipiani visa may b« IHod by
any person or organuatlon (toisirmc snd int^ndii:^ to o.Ttoloy within tha
United States an alien *n.o is cavsWa t>l oo.tomunfl spscitisa lUillod or un-
skilled tabor, not ol a lampotarv or soasoiw.! natum. lor which & -.r\i-,il*jn ol
omployabla and willing pwiiana twists in tha aru of inlaid;!-! wriployn'.eiiv
X WHERE TO SIMM f TiiE PETSTIOK.
a. Outai(ta UniHm Sales A ..at son wecuting liso p«)il«si oulsids me
United Slates must take the completed petition to an immigration '-'"'t
Namralimion Service otliciir a* American Caniulu offerer. Tr.^t olficw wilt
administer tha oalh or animation and lurniih tf« &)Qm« a,' i':s ollict of
the Immigration and NaturolljuKton Service :.n th@ UniUid St^l^*j to vsticgh tha
petition should be «ent by tho petitic-^sr.
b. fn unrtflKf Sfar«3. A person s.'ocutm,} th@ aetttion m th® United
States must t&ttv or mail the complat@f1 petition tis th* nfficsr of the Im-
migration and Na!urali/.3!io,i Samcc iis»-:nij lunudiclton omr trtti intended
place ol employment.
4. SPOUSE OF BEKePSCIARY AKO
CH1LOHEM UNDER at YEARS OF A0£.
O. SUPPOK'fINQ OOCUMEOTS.
Ti.. I -,i:ov.ir.3 musl Cm> submitted with the petilion:
a '.jtita Diri^.'-wnl Forms rntitled Ifts) "Statement ol QualiHcalioAs ol
Alien" 2nii "Job O'ler lex »lia« Employment executed in accordanea
with the instructions lor complatldn at (hat lomv
£ tecu.T.anlJry evxldnce of m« btwieliclary's qualilicallons aa tallow*.
(1) Scnoo' flffco.^s — it alien's engiBility is basad in wnola or in
part on higher edujattun or attendance at a technical or vocational
3CKQ.7I. .Jiwc.'i cerlihed cony of Khoai record. The record mull alma
penoO ol iltcnilancs. malot field ol aludy, am) dtflresj or diplomas
2war08d.
(2) Ujsnae or O0xtr Of>fc:» ("s.i'.'itotf.-irt lo Pmcttc* a Probation. — •
sJJwi fe a rf^nftor rrf 8 omteiKMon. site* a copy ol KM Boons* w o«« official
pwnlMiom granM Mm/her b> practice »s Broiataton In Sis country «Har*
IWotie he.t to«n found edited to pracllo* that prof4«3ion. M a Icanaa or
O8M SiaraEasloo la r&ntl/ed In Uwt osunKy.
(3) Physicians or Satgtons. — II an all<3« Is coming lo perform
screicss as a maiviiwi of Che msdical profession the following eirlderm
must oa fluamitica.
(a) Criiduahon from a medical school.
(S) Satisfactory comptslion ol Parts I and II of the National Boatd
ol Medical Examiners Examination (or an equivalenl
essfflinaiion cs determined Dy tha Secretary ol the Depart-
ment of Haalin. Education, and Welfare).
(c) Competence in oral and wnlton Enghih.
(4) Kvktuoeo ol ExeffUfaaal M>Wy In On Sdonetf or OH Am. — 8
rfiw'aelHj-^ilylabaa^ujMrtiTO^ettonrioW^hiMietemwoorOtearts,
osxiianontaty eimienca sut^arting Ota claim ahouU be eubmttutf. Such «•!•
21 y«ani c( ago. Wha»i e ttod or tUain ^otmwcs (xsUSai la appfovefl, UM tw
iH/Marft ipoUM end unmarriad ciUiicii luider 21 ycara o? ma. tl accompanying
or toncvring to K*<. «"* KitodMiUsaav b* *»9*i«i tor tlw asms iwsfamnc® s!/«Ju«««
S. CERTIFICATION BY THE SECRCTARV OP LABOR.
A lr.W or ibrth pretmmoa eUnn may nol too ulmttM te (Ho UnMal SCOx)
untaffit tha SoenMwy ol labar hta> toata-1 a "Sehadui® K" or Indtvfciual Late'
CwtttteaUon eovwing ttw oowpaHan. Tlw DonectvMnt of Uitet puMsOea Ms
(SdwdulM) a occupallom In Pmt 853, Tilto 20, Coda ol Fadc,al Rj^juteSMVE.
blankM c«rWlcaUci tor ^uaWtel fwitsoro. H an KOtfUKaa. to n« Itslsd In
* appHciitlan for 8fts> CettMc&Uon muni bo mida <»«£% to tt-.-j 0«-
"Scheduta 8" la a list of occupanona lor which the Sacratary ol Lsiror
hoa found Mutt sufflciant wortwn are iwellsWo In the United Stales or lti«
admlaaion ol aliens lor emcxoymsnt In such occupations will eowwaoltf at
leel waoaa and working eaodUions ol «ocfe«n> In tlw UnilocS SIM«s oinHlaflv
rMmita«w>) imntf be mad* on LsSrar Qogtrtmmi ftmm waitott the "
QuaWtalBona o< AMen" and "Jsij OteJ tor Man Em^oy.'iM.-.'.,- In aocxwd-inco
»w DiattucHana Iw ttta oowij^ilten ol Mow terms. TtK» ta-.r
«M> Immlgrattart and Natunfemtaii Stevtsa, U.S. Owuuliv cftw Md si I
o«tos» o« W» StEts owpteynsMW sarctoa afmetae,
(o? ponaai or. Mafltar a«Jv^ eon ttfa a E»M jmsferanct patmon. An
Form t-UQ (Nov. &-20-SO) M
recognition etccordad Sh« aXen, show Blot ne/ahe IM» recohntd > nationally or
miomaitonoKy racogntz«d pilio or award or «on it naOoneHy or Mamallan-
ally re«ognaed cornrxMon lot axceJtenca tor 8 speerfc product or partenn-
ance « fcw ouotznding *ehi«»«miin(. ot KjaWy toattha attan is » mambtrlna
naltenii! <a Intanuttnul aaeoeteSon ol peraons w«leh malnWraatandaidaot
8 outssanding ncMmwmnt oa (ud««dbyrecoonlMdna-
! or ImnrrwHonal OTssrta In lh» epadBe dteeine or Cold o» andMwor.
IS) 4/f/oav;rj wry PuUtzhod Material — II alien's eligibility is basad
on to:rin,-ai training or spedaltaHS e>perl«nc«, documenlary avMenca
supporting tha claim should be submitted. Tha recommended lorms ol
evidence are allidavlts or published malanal
Ailuttvin. — Thase must be made Dy Independent sources, such aa
alien's former employers or recagni/ttd experts lamiliar with alien's
wofS. and iriuat:
(a) kb^thaaffli^«tawirq)ilMai<M^ In which hc^btes^
tng.
(hi Qfvo Uio atecs end 9i® datea during «Wdi alien gctrnd hMur
oapsrtetoo.
Ic) Dwettto ki <tat«l 8ie duKse pertormsd. tolg used. auponMon
uardMd owar tha aHon end easrctetK! by Mg «San. A mars oUca-
mant, tor eoumtsite, t!tM aw aSan was omployad aa • baker la not
(d)
PvtUisttea Mslerial.
(a) Copiaa o« matarOI pubMeKad by or about the alien may be
auamitted.
(bl The irutarlal must ba ktentilied aa lo data, placa and name o»
publication.
FORM NO.
1-140 & A
EDITION
REV. 6-20-80
TIT1X PETITIon TO CLASSIFY PREFERENCE STATUS OF ALIEN ON
BASIS OF PROFESSION OR OCCUPATION
ipsy
SIZE mSTRaCTIOMv3aJ5FE»JENCi:8 CFR Z04.1(c)(1), 282.1. 299.1, 299.3; 01 103.1(cKT), 204.4{c)
T4Tfl«J,Te},(h), 245. l(a), .2(b-l); AM 2301.07, 2482 Ex. 2, P.I, 2713.01, 2761 .01 ,.02.03, .04,
8 l .05, 2984 Ex. 2B Ex. 4. P. 2; II Hbk 1-2,3,24, 4-6, 5-8,8.1.14.1.15-19. 22. App 5-B; Inv Hbk
asl: ._ 21-18; GIB 7, 12, 15, 16, 19, App. -7, -31, -46
'• FILED TO ACCORD AN ALIEN THIRD PREFERENCE OR SIXTH PREFERENCE CLASSIFICATION FOR ISSUANCE OF
AN IMMIGRANT VISA
PRIOR EDITIONS MAV MOT BE USED
SCHKDOLX
4/1/81
E& FOR DOCUMENTS,
importing document*, must to sutomlttod In the original. No additional
required. However. H th» wtum of the dHglrtal to desired, and H a copy Is
nNtod to bo matte, a photostat or typewritten copy may be submitted.
coptea unaccompanied .by-tha ariginej may be accepted H the coptos
Mcafion by an invmiyatton or consular oSt&fThat lha ooptoa ware com-
iha original and found to b» Merrtieal. Any documents in a foreign ten-
rt bs accompanied by a summary translation In English. A summary
Is a. condensation or abstract of thfl document's laxt The translator must
h*/ah« is competent to tranatoia andihat ths translation b accurate. (Do
> copy of a certificate «f naturalization or citizenship.)
«5 DATE OF PETITION AND VISA ISSUANCE
ns is .governed by to chrohotogecal order in which such petitions were
d. Fsfciw to submit vrth tha petition the attachments required by paragraph
I prevent proper fling or the petition and result In Us return to 8»e petitioner. If
irg* number of aliens tor whom petitions were approved In a higher pf «t«f -
waiting period may be entailed before an immigrant visa can bo issued to
ten/ even if that petition b approved.
"H OR AFFIRMATION.
the United State* the oafli or afbmalion may be made before an immigration
loot IM) or a notary pubUe. The oath may also be made before an officer
to administer oaths for general purposes, in which case tfw official seal or
>( authority to administer oaths must be affixed.
jtsitte the United States, the oath or affirmation must be made before a
«* consular or immigration officer.
is person signing the petition may be 'required to appear before an officer of
atfcn and Naturalization Service to reaffirm or roswear to the allegations
n the petition and for other Inquiry which may be pertinent. However, when
isr Is an organization, that person may authorize another member of the
n to appear. In that event, a statement by the person who signed the petition
bmiaed to Ine effect lhat the nameo1 member of the organization, whose me
M indicated, has be«n authorized to appear before the Immigration and
ion Sen*"* In rwhiiM <rf «w ooWiarwr.
10. FEE.
A fee of twenty-five dollars ($25) musi be paid tor tiling this petition. It carmen
be refunded regardless of the action taken on the petition. DO NOT MAIL CASH.
ALL FEES MUST BE SUBMITTED IN THE EXACT AMOUNT. Payment by check
or money order must be drawn on a bank or other institution located in the United
States and be payable in United States currency. If petitioner resides in Guam,
check or money order must be payable to the "Treasurer, Guam." If petitioner
resides in the Virgin Islands, check or money order must be payable to the "Com-
missioner of Finance of the Virgin Islands." All other petitioners must make the
check or money order payable to the "Immigration and Naturalization Service."
When check is drawn on account of a person other than the petitioner, the name of
the petitioner must be entered on the face of the check. If petition is submitted
from outside the United States, remittance may be made by bank international
money order or foreign draft drawn on a financial institution in the United States
and payable to the Immigration and Naturalization Service in United States cur-
rency. Personal checks are accepted subject to coilectibility. An uncollectible
check will render the petition and any document issued pursuant thereto invalid. A
charge of $5.00 will be'imposed if a check in payment of a fee is not honored by the
bank on which it is drawn.
11. PENALTIES
Severe penalties are provided by law for knowingly and wtRtuHy falsifying or
concealing a material fact or using any false document in the submission of this petition.
12. AUTHORITY
The authority to prescribe this form is contained in 8 U.S.C. 1 154(8). Disclosure of
the Information is voluntary. The principal purpose for which the information is sol/cited is
for use by employees of the Immigration and Naturalization Service to determine
whether the aien in behalf of whom the petition is submitted is eligbte for classification
as a third or sixth preference immigrant as defined by section 203(a)(3) and (6) of the
Immigration and Nationality Act, 8 U.S.C. f 153<a)(3) and (6), respectively. The informa-
tion solkated may also, as a matter of routine use, be disclosed to other federal, state,
local and foreign law enforcement and regulatory agencies, the Department of Defense
including any component thereof (If the petitioner has served, or is serving in ihe Armed
Forces of the United States), the Department of State. Central Intelligence Agency.
Interpol, and Individuals and organizations, during the course of investigation to elicit
further information required by this Service to carry out its functions. Failure to provide
any or all of the solicited information may result in the denial of the petition.
4/1/81
Appendix 1
FORM M40
(Rev. 6-20*80) N
PETITION TO CLASSIFY
PREFERENCE STATUS OF
ALIEN ON BASIS OF
PROFESSION OR
OCCUPATION
UNITED STATES DEPARTMENT Of' JUSTICE
IWMIGIUTKX AND
CMS No. 43-DOtU
DATE RECEIVED
FEE STAMP
TO THE SECRETARY OF STATE
p«tritinn ixnc filiwj on
REMARKS
ft«n»firinry'l filo numl-nw; ^ , , , „
Petition is opprovad For status under section f~l 2i
O SBC. 2l2(oXl'4) certification attached.
O Blank*! Sec. 212(aXU) c«rtificalion issued.
>3(a)(3). D 203(aH6l
DATE
Of
ACTION
DO
DJSTWCT
PETITIONER IS NOT TO WRITE ABOVE THIS LINE
Read (his form and (he attached instructions carefully before filling in petition
Petition is hereby made to classify the status .of the alien beneficiary named herein for , issuance of an immigrant visa as ("X" one)
O A THIRD PREFERENCE IMMIGRANT - An alien who is a member of the professions, or who because of his exceptional ability in the scien-
ces or arts will substantially benefit prospectively the national economy, cultural interests or welfare of the United States, and whose services
are sought by an employer. (Sec. 203(aX3). Immigration and Nationality Act. as amended.)
O A SIXTH PREFERENCE IMMIGRANT — An alien who is capable of performing skilled or unskilled labor, not of a temporary or seasonal
nature, for which a shortage of employable and willing persons exists in the United States. (Sec. 203 (a) (6). Immigration and Nationality Act.
as amended.)
(If you need more iface to answer fully any questions on this form, use a separate sheet, identify each answer with the number of the tor-
responding question and sign and date each sheet.)
PACT 1- INFORMATION CONCERNING ALIEN 9EMEflClAaT
1. NAME (last, in CAPS) (first)
(Middl») 2. ALIEN REGISTRATION NO.
(If any)
3. PROFESSION OR OCCUPATION
4. OTHER NAMES USED (Married woman aive maiden norm) 5.DO NOT WRITE IN THIS SPACE
4. DOES BENEFICIARY INTEND TO El
PROFESSION OR OCCUPATION
STATES? D YES O NO. IF "NO
MCAGE IN HIS/HER
IN THE UNITED
.'EXPLAIN.
7. PLACE OF BIRTH (Country)
8. DATE OF BIRTH (Month, day, year)
9. NAME OF PETITIONER (Full name of organization; if potilionor is an individual giva full nonw with
ia«t in capital Utters)
10. NUMBER OF YEARS OF BENEFtCIARVS
EXPERIENCE (If nan* explain why.)
1 1 . OTY AND STATE IN THE UNITED STATES WHERE ADEN INTENDS TO RESIDE
(City)
(Slat.)
12. BENEFICIARY'S PRESENT ADDRESS (Number and *tr«et) (Glyortown) (Slat* or province) (Country) (ZIP Code, if in U.S.)
13. TO YOUR KNOWLEDGE, HAS A VISA PETITION EVER BEEN FILED BY OR ON BEHALF OF THIS BENEFICIARY BASED ON HIS/HER PROFESSION OR OCCUPA-
TION? Q YM D No. H "Y«s," giv» nams of «ach petitioner ami data and plaoa of filina.
14. IF BENEFICIARY IS NOW IN THE U.S. (a) HBSH
ASA
F 1 ACT AMfUFTt DM „ ,
(Month) (Day)
(h\ SHOWDAT1
E BENEFICIARY'S STAY EXPIRED OR WILL EXPIRE AS
, (Vnitor, stodant, oxchang* oiien, tmnporary worker, crewman, stowaway, «tc.)
SHOWN ON FORM 1-94 OR 1-93 (Show latest dat«)
15.
BENEHOAm
SPOUSE
NAME (Lasinanw)
(Rrstncnw) (Middle now*) (»»A». »<••.. »•
«,i.d.o-u.)
couniat OF MSTH
OATEOFtMRt fMESEMT AOOMU (H^ aid SlrM) (C^ a> MNM) (Slata «r rramwe) (Cawl^)
16.
•ErtEFtOAirS
CHMMEM
MAMt(Sko. M <K S lor •arrwd <x i»«U)
M^. aumoAiE covmnnr Of MHH AOCNHESS
MCEIVEO TIAHS.M *rrO-TIAN$.OUT
COMflfTiO
ruye *t
Appendix 1
1 7 "X" THE APPROPRIATE BOX BEL
O Alien mil apply lex * visa ab
D Alien is in the United SI]
Naturalization Service a<
tne Mien will apply lo> a VIM
OW AND FURNISH THE INFORMATION REQUIRED FOR THE BOX MARKED
iCity in foreign country) (Foreign country) .
tes ana »itl apply lor adiustment ol status lo tnai ot a lawful permanent resident in the office ol lh«. Immigration and
_ _. II the aoplicanon lor adiuslmenl ol status is denied
tCityi (Siaiel
lCit» in foreign couniryl (Foreign country)
PART 11-IMFORMATtON CONCERNING EMPLOYER AND POSITION
18 NAME OF PETITIONER (Full name o< orgaoijat'&n; if petitioner is an individual give lu'i n*me with last <n capital letters!
19 ADDRESS (Number and si'een down or ciiyi (Slate) (ZIP code)
20 PETITIONER IS (X one)
D US CITIZEN D PERMANENT RESIDENT ALIFN r A • NUMBER , 1 Q NONIMMIGRANT fj ORGANIZATION
71 NET ANNUAL INCOME
2? WILL BENEFICIARY BE EMPLOYED AT THE ABOVE ADDRESS? O YES O NO IF NO. GIVE ADDRESS'
WHBK THS ALIEN WILL WOMC.
23 DO tOU DESIRE AND INTEND TO EMPLOY TH£ BENEFICIARY D YES D NO
24 HAVE YOU EVER FILED A VISA PETITION FOR AN ALIEN BASED ON PROFESSION C= OCCUPATION? D YES D NO IF YES. HOW
MANY SUCH PETITIONS HAVE YOU FILED'
25 ARE SEPARATE PETITIONS BEING SUBMITTED AT THIS TIME FOR OTHER ALIENS' DrES D NO IF VES GIVE NAME OF EACH 'ALIEN.
26 THE FOLLOWING DOCUMENTS ARE SUBMITTED WITH THIS PETITION AND ARE MADE A PART THEREOF.
PART III— OATH OR AFFIRMATION OF PETITIONER OR AUTHORIZED REPRESENTATIVE
57 This petition was prepared by ("* ' one) -~ the petitioner 1? another otnan
« pennon was prepared By another person. Item 29 tx'o* musi also be completed
behj
II ol me alien bene'iciary. Hem 28 below mjsi be completed Dy thai person .
sent
^ y ry , Q g
documents are Hue ana co'iecl lo the t>
If pttttiantr it an organization,
nitd official who it tignim pi
Name and Title
esl ol my information and oeliel
print full name and till* of aulho-
lilinn in hrhalf af nrfartirnlinr, .^iRNATIIRF
(Petitioner s lull. true, and correct name)
SuCScnMri ana £unrn lo latliimpn, rwlnn m- ir,', oav nl 19
a'
[SEAL] MV cammiision *«p
i»i
(Signature of ollicer aommisienng oath) (Title)
28. DECLARATION OF PERSON FILING PETITION FOR THIRD PREFERENCE ON BEHALF OF ALIEN BENEFICIARY
auihor./ed 0, me an«r Denelc.ary to IHe tr. s pei.nt.- en Ms (hen benall
iSi<)naluie>
lAoflress-Numb-! Street C.iy Slate anc ZIP Codei (Date)
29.
SIGNATURE OF PERSON PREPARING FORM, IF OTHER THAN PETITIONER
,.. ., e .. . . recuest o. me penttone, anc 5 uase. ,n atl mtorrr.at.on o. which I have any knowledge
(Signal ure)
lAooress-Numor Street Guy Siale ana ZIP CoOei iDaiei
TO PETITIONER: DO NOT FILL IN THIS BLOCK - FOR USE OF IMMIGRATION OFFICER
a Corrections numnerea 1 ) to 1
were maae by me 01 at my *equesi
ibaiei (City)
(S gnatu-e o. pennon.
lOaie:
(Cilyl (Signature and Title)
4/1/81
TM 803
rT^lf^l1
ADMINISTRATIVE MANUAL
Appendix 1
I-
P<
Wwlll^^^1
NAME (Lo»l, in CAPS)
(First)
1 Middle)
OTHER NAMES USED (Married woman give maiden name)
ALIEN Kl
(If any)
SNDX CODE
DATE OF BIRTH (Month, day, year)
PETITIONER'S NAME
DATE AND ACTION ON VP
DATE
OF
ACTION
00
DISTINCT
0««p..,on P.M,on cm | SENT TO CONSUL AT:
Form H40A
(Rev. 6-20-80) H
SECTION
D 203(o) (3)
D 203 (a) (6)
DATE FILED
(Date)
DATE PETITION RECD
1
UNITED 1TATES Of FASTMCNT Of JU1"
ABANDONMENT BY ALIEN Of STATUS AS LAWFUL PERMANENT RESIDENT
,i,.i L.I.;:.J oinif MA*. -ipSit N.wt
c*i» i
lor OB»»BTU«« ' ' I U.A.
». »«U««Tlvt tCBVICI •«»»• MUMBCII AMO kOCATION fCllr. T««l -W iMMj
• D» APTUBC O» fftCtCHCV OUTtlOC TH> U*A. £j |4 ^J 19 MOT FO* TM* ^UW*O** OF AVOIOIM1 OK KVAOim
DOCUXINTI IWI>HKMO>lt«O. (Aff»Ht»)
»T« »!._»
con coveRMMEHT use ONLY
TLC DAT*
OAT«
FORM NO.
I-A07
COITION
RB7. 2-1-75
TITL£
AKAKDOMMEKT BT ALIBI OF STATUS AS
LAWFUL PEEMAWnnf SSStDEKT
S1Z£
8 X 10 1/2
INSTRUCTION REFERENCE
01 215. 1(«), .l(a)(2), 231.3; AM 2792.07; II Hbk 5-29. 8-14, App 5-1
US£
RJECORD OF AaAXDOKKEKT BT ALIZH OF STATUS AS PEKKAHKXX
HIP! EDITIORS MAT KQT BE PSED
SCKKDOUC
10/1
m
>
FORM 1-485 £
!
USE: 6
USED BY AN ALIEN TO APPLY FOR ADJUSTMENT OF STATUS TO THAT OF A M
PERMANENT RESIDENT.
ELIGIBILITY:
1. MUST BE ALIEN WHO WAS INSPECTED AND ADMITTED OR PAROLED INTO "^
THE UNITED STATES. ^
a. EXCEPTIONS - NOT ELIGIBLE C
s
(1) ALIEN CREWMEN j5
(2) TWOV (ALIEN IN TRANSIT WITHOUT VISA)
(3) ACCEPTED UNAUTHORIZED EMPLOYMENT OR CONTINUED THAT
EMPLOYMENT PRIOR TO FILING AND ON OR AFTER JANUARY 1, 1977,
(EXCEPT IMMEDIATE RELATIVES).
(4) J-l OR J-2 SUBJECT TO TWO-YEAR FOREIGN RESIDENCY REQUIREMENT
UNLESS THE ALIEN HAS RECEIVED A WAIVER OF THAT REQUIREMENT.
2. VISA NUMBER IN PREFERENCE CASES MUST BE IMMEDIATELY AVAILABLE.
3. ALIEN MUST BE ADMISSIBLE AS LAWFUL PERMANENT RESIDENT (NOT EXCLUDABLE).
REQUIREMENTS:
1. PROPER FEE.
2. PROPER PHOTOS AS DESCRIBED IN THE ADIT PHOTO SPECIFICATIONS. \
3. A SEPARATE FORM AND FEE FOR EACH APPLICANT REGARDLESS OF AGE. *
4. FORM G-325A. NOT REQUIRED IF UNDER 14 YEARS OLD.
5. FINGERPRINTS WHICH MUST BE TAKEN ON FORM FD-258, NOT REQUIRED
IF UNDER 14 YEARS OLD.
6. EVIDENCE THAT APPLICANT HAS SUFFICIENT MEANS OF SUPPORT SUCH AS:
a. FORM 1-134
b. LETTER OF EMPLOYMENT
c.' FINANCIAL STATEMENT
7. EVIDENCE OF BIRTH AND NATIONALITY
a. BIRTH CERTIFICATE
b. FAMILY REGISTER
c. BAPTISMAL CERTIFICATE
d. AFFIDAVITS
8. FORM G-138 FOR CHINESE APPLICANTS.
4/1/81
9. FORM 1-94, OR OTHER EVIDENCE TO ESTABLISH THAT ALIEN WAS
INSPECTED AND ADMITTED OR PAROLED.
10. PASSPORT (TO BE PRESENTED AT INTERVIEW).
11. EVIDENCE OF ANY NAME CHANGES
a. MARRIAGE CERTIFICATE
b. DIVORCE DECREE
c. ADOPTION DECREE
d. COURT ORDER
e. AFFIDAVITS
12. IF APPLICANT IS THE SPOUSE OR UNMARRIED MINOR CHILD OF A PERSON WHO
HAS BEEN GRANTED PREFERENCE CLASSIFICATION, AND HE/SHE IS CLAIMING
THE SAME PREFERENCE CLASSIFICATION, THE FOLLOWING SHOULD BE SUBMITTED:
a. FOR THE SPOUSE
(1) MARRIAGE CERTIFICATE AND PROOF OF TERMINATION OF ALL PRIOR
MARRIAGES OF EACH SPOUSE;
b. FOR THE CHILD
(1) MARRIAGE CERTIFICATE OF PARENTS, TOGETHER WITH PROOF OF
TERMINATION OF THEIR PRIOR MARRIAGES
(2) BIRTH CERTIFICATE SHOWING PARENTAGE
13. IF APPLYING UNDER SECTION 249, I & N ACT, AS A PERSON WHO HAS RESIDED
IN THE UNITED STATES CONTINUOUSLY SINCE PRIOR TO JULY 1, 1924, OR SINCE
PRIOR TO JUNE 30, 1948, DOCUMENTARY EVIDENCE MUST BE PRESENTED TO
ESTABLISH THAT CLAIM.
14. ORIGINAL DOCUMENTS ARE REQUIRED. COPIES SHOULD BE SUBMITTED IF
APPLICANT WISHES THE ORIGINALS RETURNED.
15. A FOREIGN DOCUMENT MUST BE ACCOMPANIED BY A TRANSLATION, CERTIFIED
BY THE TRANSLATOR AS TO THE ACCURACY OF THE TRANSLATION AND AS TO
HIS/HER COMPETENCY TO TRANSLATE.
(NOTE: APPLICANT SHOULD BE ADVISED NOT TO LEAVE THE UNITED STATES
WITHOUT INS PERMISSION AFTER FILING AND BEFORE A DECISION IS MADE ON
HIS/HER APPLICATION.)
16. MUST HAVE A MEDICAL EXAMINATION BY A PHYSICIAN APPROVED BY THE
IMMIGRATION & NATURALIZATION SERVICE AND MUST PRESENT FORM 1-486
SIGNED AND EXECUTED BY THAT PHYSICIAN AT THE TIME OF THE INTERVIEW.
A/I
APPLICATION FOR STATUS AS PERMANENT RESIDENT
INSTRUCTIONS
Read Instructions carefully. Fee will net be refunded.
1. AWUCAT10H.-A aaparata appMaUaa nuut bo meaned by
ooob aapUaaat. Am apaueatwi IB babaU of a ealM voder 14 roato
of aaa nbaU b> oaacuMd by UM psnat or luardua. Ate*, usual you
nlnantiml box "B- af black 1. you auut eaaiBtaw ned oubaatt tvtea
Ibat apaHcauaa a Fora CS— ft. AaPUeaUee loir ftonul SonuMy Nraa-
bar. noanllaai af your mo aad waMdlmiai el wbaUMr yeo abeady
BM a aoflnl aaeurlty aacouat Bumbar. 7 arm O— 82oA (BlaanabK
iBjorauuoa) nun ba ooaiplMad and automtttod ollfi oasb apptt-
eaUoa If UM apaUcaal U 14 yoara af BM or eMer. FaUuw to do eo
dalaya aattoa aad amy inmiH to prtuaa of UM apaaaattaa.
». FKC.— A BM of nwtry-frM daltan (BIS) auut ba n<M far fO-
to* tbto appteaoea. If yatar aapuaatue to nlocud oa UM gxoaad
tbat It to BM laaiiMarMl to ban bora anaofcr n>e bconsi o< tait-
tat to antiBili a wbar antiHoMioa If natdrad (BM lBOn»Uaa 10).
at boeaai» a vta> auaibor to not avatltbM. fat auy to nluBdad.
». UM f<« UHBO< bo nfoadod raaairdlMr a« UM attloa tati-
<lo»lt of Suspcrt) bora t mpoadbh iwuwott to lb> UnJtod *u>«. or
nublMi Uuu 7<w «n Dot Hfcolr » bMOao • »«b-
(S) If you an Oatfvua oruaaunwl mtaor ckIM af •
«r)w boa ban mnW4 pralemtet <r\*rmnrtllm by UM
. DO NOT MAIL CASH. ALL FUS MUST SE
sintftnrnto IN THE EXACT AMOUNT. rma«u by dm* «
•**« auBi ba dntra aa a b«ak o> Mkot lacUM
M lh« Unite* SU«M bad b« i»v>M* IB United SIMM nuraaoy. U
you mi«i to UM Viiato btoadi. gbadi ra aaaiy enbw not ba par-
•bu M IM "CaamiaiaaOT ol ?toWM» el Ib* Vbtfn li*in»nl« " II *<"•
t»MJ» la Ouam. cb»>k or noun- arter aiat ba Myabu <a UM
of rabaloa >ko baa baaa aeeardad
Ua: Far MM apottx: Manuca ontltKato aad proof of tamlaatlaa
of aD vitor nanlata* of aacb MKiliin. For lit* cMU: Mamaw c«ft»-
Beau of pmata. toootbar vttb proof af tarmUMttoa af UMIT prior
r»tiriiaa*T. U a««h daouBaata bow not boon. Mbariuod br a paraat.
(41 If you an a BoaimBiarut fom«n aovenuaaai official
or a EofOisa Bovorasnoat reanamtauv* to aa wtaraauoaal oraaaf
stuaa. a awntverof tb> faaUly or Mrmat af web panoa. or a tnoty
trador ar traoiy lawnos. tko apouao or ebtld of avftb panoa. yoo:
auot oubam Foraa I— MM vahm aU nafcu. pn.itonaa. I
tat joiBwaMMa vbWk vauld otbarviaa aactua to y<
. Ou
1 All I
•oaoy ardor aayobtt to <bo -taualffimttaa <aa NatanliluMMa ftcr-
•Ma." WboB cbvck to <rm oa aa aoeougtt of a pomoa eibat Uua
UM apalfaaat. UM aoaw of Uu apBBont must ba eataml ra Uw
too* of tba cback. If payBwm to aao* by tka tys« of tatanualaaol
<S> II y«t tbaatmit box "A" to black 1 of UM iynEnatlun,
ycu Biraffl. «saaato aa4 otteaa a MatM ooay af Foot I-6BO A.
c. n ran caooko* koa- "fl-ta klaofc I of na apUcatlo*. ukmtt
yeur nacrrtiav MrWkaM If yo« an «w o»»im; I/ you ai* UM *MW,
aiibiBlr W»«r b<rn oanMaott aa4 Uu womof* ttrUflmt tor yoar
r of UM atty to tM Ualtad States to vfet*B
tta aaalktMtaa gW b» BMiwd. aad Uutf «OT. tba <ae«ay •rAWBara-
bn. taa i»» aaw a>aot bo abowa ateaiiy oa tea ton autota af tax
btHay. Aa wBcoUoeUbM eboek will nad«r UM agoHfititeii aad aay
iHMiiaiiiiiu taawtf putmaoat tbnota timtu. A cbam of 8&.OO wUI
b« aaaoaaa U a cba*k IB BoyaMat of a In to act boattMd by tbo baak
aa wbteb U to arum.
1. rHOTOORAPHS.— «ttbaut too pbaloanvba of yowMtf takra
vMbia SO 4ayi of UM oat« of IBM aavUcauoo. Tbm> pbotaonwaa
•KM bt 1H by IM, UMBO> la «u. aa4 UM otataac* from U«« lop of
baad to paiat ol dun BBOOM b> apprailauioly IV to/sum. Tiny
•an aal b* poato4 oa earoi or noaatoo' lo any mr. aioot b< on
oua paoir. fca«* a b«bl bockiroaaa. aatf euaaty ahaw a froal vww
of TOUT lac* wUboat bat. Saapabau. (raup fu4H«art* portnuu or
unHlni ir-^'r- pbotoflropM Bill not ba ac«apt»n- Uaioa cnyoa
a. It you cAMaed oaz ~ff" M Mo*fc ' of ffca WUotloa. ma»ilf
dammmttry oKktmo to •>•»> yo« kow KMMod M fkr Uiaud
Stale* «M«MBtia«ia)y atoffii »rtor to ' Jury f. J*I4. /ryanKOMcaook'
a) bour ~7~. avkmit caatiatatngy ogiitoiMJ to aroaa you knot roaW*
od la Mba UlUJid ffiatai oMfbUMMUly aMor prior to .low JO. J»*».
<1) KaaaiakM of itoxiaMnui vntok auy W nilnunnd to
baalitlMka. toaiaa. aoada. Boaaoai. btftt r..o»4.
la of aWMmi bora te UM Hatted Slaw*, oaaow
Ntfau.
boaki at aay athot typa «« HMHBM; Mbool neoroa o* UM aabaafi
4. FINGERPRINT*.— A eontptowd Bamennt eaid (Fom Ft»-
IM) aixt b* oablBllMd ay ootb appbeaat »bo la 14 yaoat of ana or
oidar. Fiaai ntrtni earda «rttb uMtruetioafl for tbau* con&Mtwa at«
«"i»»tili at UM offMa of UM iBtaucraUoa aad NalunUiauoa Sentor
nit Hi you ialaait la Ol» yavr appltcatMa. You auy haw yoar na-
•wptiala roaoidod oa Foaai FO-1M at an ofOea of tbia Bmitoa o>
yau aaay pnlm to projanl Fom FO-lftl to a pout* Milan or
nboatn ofHoa aad raawMt as ofrim tban to racard TOW tumn-
pmu oa Uw aard. Tba card MUM b* laatuM by you la UM trummt
of tb« affltear takuMi your aaanpnata. wbo vsuet tb«o aon bia BOBM
aad (atar UM data «a UM agapM pxnWad. It U tmBoruat to fur-
aatb att Ibo nloamouaa cattad tar ea UM old.
S. DOC CM CUTS
m. Cotuml.—AII dooumoaia tutu bo mbmlliad la tk» ariataaL
If yaa daim to baw tbo araaaal of cat of UM otbar t
utraad. aad If coanaa an by la« ponanud to bz m
If yaoi
B>aa» ABB* oa MllnHjunil aaaor •luxulin «paHB« aaiaa of
bttateoBi ooalla** wttb you aad U»dto»nn« your ultraai duttw UM
ponod IB oawaxwa; tauon bom laadlorda bnllfaHin UM liuitlutd*!
a daaaaaf yaarw
<*&att aidy If you coaaaod ba>
NOTE: If aajanr aumMMil Piter laJary 1. 1M4. a noaid af I
fan. U yaa IUHO naWod rMnmainmty at UM Cattod tout* taaat i
daw pxtar «o 4uly 1. 1M4. a to wty Baponau to fimlik •rtdoaw
aouMUbwa UMt fan.
mtrna STATCS DCPAKTMENT OF tvsncx
Fao> WiM <»vn. 1-lO-n) M
Wanhtanao. D.C. MoM - FvMa «1 J* Far IPO am - »>aak
R€M. U-
H
FORM NO. EDITION
APPLICATION FOR STATUS AS
PERKANEOT RESTDEST
SIZE INSTRUCTION REHB
o ,. ,,u 1C3.Mc)(l), 105.10(b)
' "' i:x.2.Ps.3-4: II Hbk 1-
&XNCX S CFR 245. l(g), .2(*)(2)
, 245. l(a), .2(b)(l), ,2(e)(l),
18 i-24. 5-37. 6-24 ,8-4. 2, -14. 1,10-
, .2(d), .3, 249.2, 264.1(«), 299.1: 01
.2(d)(6). .3(b); AM 2301.07. 27S8.11, 2984
2.1, -5, -10. -22, -36, -38, App.5-F.l,.2
D**rT. v;c -"3-.; sEcric;: 245 oa 249 OR THE PROVISO TO SEC. 203 («){7) OF THE i&r; ACT OR SECTIOK 13 OF THE
.'-CT CT ''-I'.-S™
T-V. n>mo>:s :vci »:cn SE USED
| SODBDOIX B
1-435
P«E« 2
ALMIHTSTRATIVE MAOTAL
Appendix I
772
1. rMBUOIBIUrr.— You are ineUaiblt for mum a a jwromnont
imtdtat If you cna«fead bos "A" of "D" of block 1 and:
AppUcauoa for too <a«lflcauoii of ai» S«r«var» o ( Labor (or hit
deaonAtaxi rapnaantauvc) mutt ba mada on L«bor Daparunant
iiiiiiiiil or aircraft or wera de*Une>d to iota • vceaak or aircraft IA tha
(Jailed state* u • member of the cm when you Arrived la thlt
iwuiirr.
(b) You were not admlttad or paroled Into me Unite* SutM fol-
lovlM inipeouon by I United Stiwr unrnixrxuoa offtetr.
(«) You en or hav« been in etchanae alien, ni&ioct to. but haw*
MX eaea»leed with Wo (or*i«n reetdenc* requirement or wclioa
Mjob Off«r for Allan Cmplovmant". in «ceoraan«a with Ota inatruc-
uont (or lh< eomplouon of thoe. lormi. Th« forma. Lnnructwna.
and uaformalton eoncttnUnfl ib« >kS<b«duJrt" may bv obuuMd at
prlndpai offlcaa of tha tmmlintlon And SAtunotiAUoa Sarvlca.
U. 3. Conaular offlcx tnd al Joced offlcn of tba Stad arnplortnonl
»rvtc«.
If your oonipoUon la not lutod In "Vh«<luJ« A".ApoUc«uoo for
tnatdel > Mint of into requirement. (Tail bound ol inellalbulty
iMttn in pereaeu veka enacted box "A". "8". "C" or "D" at
•tank 1.)
tHrouan t>ia local afftca of th< SUu •mployrarnl Mrvtc*. Vh«n and
if a eaniaeauon K itauad to voui «mployar. it n\ould b« >ubmKL»d
with your apftlteauaa, toxaUtar witn tba "StaUmiint of QuAliIlCA-
copml Tniiitlnrmil enplctrxvont. unleat you An i*. immediate
retail** of * United Sun. citii«» AJ defined la union JOHb) of the
InuniajreUna end Nationality Act.
let Youeajimd the United SHIM u IB alien inuudt without vu*.
MOTt: If you an inelltibl* under MIT ol tat ton*oiiu but nava
renvdW la the United Sum contmuoutl" naee pnol to June Id.
lt-44. you mar ttiil Apply ot. Au form to have a record o( Uwful
eajaiartofi fof permanent reudonc* cMkUd uiul*r wcuoo 149. In*
OMnuaa <ad .<<«uaaiUti> ACL In meJi CMC ctwtK box "&" or"C"
o( bta«k 1.
I. 1MMBOIATX HILATlVt AND PRIFIRINCB AL!INS.-t(
ro« «n fl'^i^lrl tiJaibiUiir taroua* ralvuoiuriip to » L'uud Staus
citiua or v*nuamt r»d«nt illta, i vua p*nuoa mu« b* Mwl on
rottf tMiuJf for mmcoUau r<Wjiuv« or flx»c. iMOnd. fourtA, ar ttfth
TNtonac* cluBftaMlaa. If row «M elaimwl tUebUltr bavrt on row
>iol»»»oo or oceupiuo*. « third or «mu onlmne* vua gmtlaa
'•Schadul* A" you mutt tubait thr larau witb thU topllcauon
dlnctiv (o Uia Inmixraooa and XatumUitUoa Stmcm.
ba tubnutud with application for a labor cirtifUrauon-
A. lubor D«partm«nl Forma intltltd tha "Suummi of QuaJlhcio
Uont ot Allin" tad "Job O(far for Alien Employment" axacutad in
•ccordanca with Chi tnxrtKtJoM for eoraplaoon of tbat form,
b. Documentary *vtdanca of your quLUficAUona u foUova
(1) School Raconla— If your 'liability u buxi in vhola ,.T 10 :
Kttool. attach cwtiflnd copy ol Kliool record. Tha ncors mujt
Mow parted of .uia«danM. niaior field •)' ftudr. tnd d*f**n at
diploroaa awarded.
(2)Lican»»orOUl*r Oln«tal PerminMoa to ••mntc* • froftwon .-
or other official porminnoA arantad to you to practice the prof**-
(UtiM or foe Uu U»UUM< ol u ubaumat «i» und«t lay of UK
fnrodmm nlMaiflfttlitnff uiU«« rou u« tft« b«i«tt«i«rr of a vtiid uo*
•l*4r>d «U> pounoB appron^ oo youf 8«b«ll.
protoaaoii If A llcenae or olhar permtaaion u reoumKt in that
country.
(3) Evidence ol Exceptional Ability in the Scieneei or Ute Arta - '
•ppJleatlott. uutnjcuon 4 do«s Aot <srpjy to you.
If > VIM petition u nqumtf to oublutt >jnm*dliu rilauv< or pn-
ftnMMM tunu. il mmt ham tMA ap|>rov»d pnor la fUJofl tbM JPPO-
caMo*.
Lbo AJU. docuraentAry rvtdrnca rupporunf the clauti irtoiUd be tub-
mined. Such evidenco ntav tetufy. to th« uiuvenial acclaim tnd
ettoer nauonaJ or lacamationaJ recocflttlon aecorawo you: inaer thai
fonuuon H to >«M*diai« tnuiabiuty ol ut Immifnm vua mar b«
olHAUMd at UM tMatovt offica of thu 5«mc«.
i a. cxaTirtCATiON or THE Dtp A HTM INT or LABO».-
AJI aatiifloaUaw «>ul b« vaild al a* Umt of ippranl of UUi
wvMoauoa.
TIM foilo«iaa ianrucuon appU** to you oaiy If: you choakad
box "D" ol bl*«« t ol to* «ODU<:>tlon. tad you ara o«rtarmm» ot
MOM to perform iltjllad of ujukillad U*or. >ad you tra »«km« td-
ju*tai«nl A* a nonpr«f«r«nra a:j«n. You ar* coABHttrad to ba a pon-
arafvmnaa tlian If you aro not tbg banafleiary of a eumntlr valid
vtat »«IIUIB tpvrowd br tba (mmicraUoa ud Ntturtiluaoa *«r
-tc» u txord rou t »ral«TD« or lnmadlat> taUllvt clAMflcaUoo.
aitx you an not a m«mb«r of orta of uia cUawa of "ip«d«l taunt*
tn*M~ Unad In lacttoa lOKanil) of tl» Imaucnaon and Nation-
alitv Aat, u iatndtd. (Th« clAawa of '1v««lal Imintcranu" ineluda
ctruln fomar «tii»« or tha Uiut«d SUM<: cartaia mtnuun of
t»ll«loui dcooKLnAtiona. and <main .mploywt or booorulT t«-
mad (ortoar raployt** of th« I/iutad Sutaa Oov«mm«nl tbcoad.)
tf you an a nongiaUmua alian who baj «it««li«d box '*DM In
blavk 1 of Uua application, and you An tertoraUat at aaak. to D«r-
Imni ikilUd or uukilUd labor, rou an mblaot to u» raqulnmtat
>in«ni)a«< In Mtnon UJ(t)(V*l of ta> Imnuonuo* ana NtuooAl-
(rr Act. « AOKBdad. af obtuniu < wnUUttiao front t&a Sacn-
tu> of Lakot tnu lam* ira not mllUuol ootkan la th« Uolwd
SutM who u« ablo, vrUlina, «UAUOod, tad AvaiUbla to parforat
ntcb taskllad or unatailad labor, uul you> tranlo»ni«nt »1U no* ad-
vataair Utect Ula vrAaaa and worklAf condition! of worfcan in lb«
United Suua nasUadly taipJoyaa. Tb« Otpartjafaf of Labor pub-
Uaha* llau (3<h<dul»<l of oceupAtioiu la Fan «5«. Tltla 30. Coda
of radarat Kaiuiatianj. "SchMiua A" u > Utt of oecupauont fat
vouch Uu lacntary a( Labor bat uauod a ManJkat eantOcuion for
HUAlifUd pafaonx.
"S<h*dulo »~ li A Uat of oetuptuona (ot wnlch Uit Sacnury of
Lnbor bM found that lulflctral worliera an amiabta In tho Unltad
SUM* or ta« utaiiaalaa at tuaru rot «molavm»oi la tueb ocoupa-
tinna will advanalr >rnc> wt«at ud »orUa( coodlUoM of woi-
ko«a la tna UntlM Sou* ajnUady aaaployad.
WARNINQ. If you canumplau dtpartuu from Iht Uiuud Statal to aoy
UOA for excellence for • epeclfie product or performance or for out- !
Handing icnieveniant: or tmify that you *r» a m<mbrr i:. a aauon- {
A! or inteTRauooai a«oalacion of oertonj wluca tat'itjjuu icua-
dardJ of meioberahlv reo.uinn( outitandtng tcmevtfment AA lUdaetl 1
by reeofrured national or international vxperts m LA« n>eciftc ^Ue> i
ctpllne or field ol endeavor.
(4> PhvuciaM or Sur«eaeu.-(f you perform tervicei «e A member
uf the raedteal profeauon you mutt lufuntt rviden«e at crtduaUoa
from K medical KOool. uiuafaetory cotnpUuon of paxu 1 and tl of
the Mauona! Board of Medical CxamuMn CiAaunauon (or An e-
quivajenl axamtnatlqn aa datatmlned by the S««ntAnr ot the De-
partment of Health. EdiMation. And Welfare), eatf competence) in
oral and wntlen Enxlun.
country, mcludinc CiltAda or Meaico. before t deciaton a made on
Mtueuooa, laia aopuCAUon wtll b« nturaod lo you.
rtKALTtCS:
Savon MnalUn an provided by :•» for knowimJr And vulfully luatraa
mlaaion of thia u«u>uuoa.
or concetlUMI • material fact or uauil Any falea document in Uu MO-
10/1/80
TM 772
ADMINISTRATIVE MAHUA1
Appendix I
1-485
Pagi 3
APPLICATION FOR STATUS AS PERMANENT RESIDENT For»A,p«~4
O.M.B. No. 4*-B0400
FEE STAMP I
rUe No.
APPLICATION FOR THE BENEFITS OF SECTION:
DSoc. »0»aX7) and Sa*. 14k. r— 1
IAN Act LJ ***• **•• '*M ***
^] Sac. 214<d>. I1.N Act |~~] »ac. »4» I»N Act
^ Sec. 1 1. ACL ol I/I 1 IVI
(DO NOT WRITE ABOVE THIS LINE.) (SEE INSTRUCTIONS BEFORE FILLING IN APPLICATION. IF YOU NEED MORE SPACE TO
ANSWER FULLY ANY QUESTION ON THIS FORM, USE A SEPARATE SHEET AND IDENTIFY EACH ANSWER WITH THE NUMBER
OF THE CORRESPONDING QUESTION. FILL IN WITH TYPEWRITER OR PRINT IN BLOCK LETTERS IN INK.l
1. 1 hereby aptly lor the itaui> of a lawful permanent readout alien on the loUowmi baati: (Check boi A. B. C. D. E. or F)
A. rj At a refugee to whom an immigrant nee ii lm«Mdlal*ly available (Section JOS<aM7) and Section 146. UN Act).
B f~l At a aaraon who enlarad the UJ. with a ma uouod to me M the fiance* or fiano* ol a U.f. cUtten, whom 1 married within M dart
after aty enlo. or aa a ahtld ol MM* Ban*** or fiance (Sac. 214(d>. I* N AM).
C. [""I Aia former aovl -wont official. o>M>n>en>h*r of the immediate family ol Mch offlaUl 1 Section 13. Act ol September 11, 1917).
D. n A« a person l» whom an hanuaront vwa la Imaediatarr evnUahle. other than oaa liinirlbn above (Secuoo 246. I*>N Act).
E. Q A> a none* who haa rended In Ibe Unliod Slater conUnwoualy CUM* iHwr to July 1. 1M4 (Sec lion J4». i&N Act).
F. LJ Ai a paraon who haa reoided In the UmMd StMea oonturuauetr au>«* a date on or attar July 1. 1M4, hot Before June M. 1*4* (linllna
J4*. litN Act).
1. My name u ( Laal in captud letun) (Firm Name) (Middle Name
ISBHil'- S _ 1 ««-•— '
PiKifHni U "*>• D FMu>* !
ttawt » the U.S.? Qv*t QNO
4. My alien rawnrauan numoer 1. 1 am a Clluen al (Country) 1 1. Deu ol
U
a. Plaee of Birth ICrty or Town) (County. Provmoe. or Slat*) (Country)
1 laot arrived in tne United StatM at the pan al (City and Slate) an (Month
(Day) (Year), by (Name ol vernal or other meanaol travel)
at a (vuatar. atudenl. crewman, parolee. et«.) my — 94 pern-
It number i* __ —
I B
W 1 I Ljwat [_Jwa«n»l uupected.
\\ ur »___, ,».!«« number . wu imuad bT the on (Man
in) (DayXYearl 11. lam f~1 ameje 1 — Imarrled
PI divorced [~~] widowed
UnlMd Mam Cooout at (CltyXCountry)
aamed. ttf >ow enr now inoined flae the /aMowIn*:/
a. Number of lime* my huanand or wile haa been mamed b. Name
ol huahand or wile (Wife give maiden name)
c. Mr huahwnd or wit* ranVdea [__] with me Q apart from me at A«diw»
(Aw. No.MNa. «• SirwMXTotra or CUyxrmrtnoe or StajeHCooatry )
14. a. I h»i aona or dauahtom at loUowtt (Complete all ooluaana at ta *•
laot ooturnn: otaarwuw prve elty and Mate or country ol aan't or doughle
•a* aon or daudhtw. U Uvuu with you etau -wtlh mo" In
Name Se» 1 Place of Birth.
| Dale of Birth Mow Il«nd at
i
1
1
1
'
b. The following rnomben of my (amily are atoo apblymd lor permnnent ren
ident lUtut:
I &. I Utt below all oreanixauont. tocieue*. club*, and aetociaiioiu. paat or prew.
country, and the penodi and placet of tuch membenhtp. Itf you hane newe
nl. in which 1 Keve held mcmMnhip in thf United Sulft or t Ionian
l/HITECk SYATU OfcFAKTMKNT OF JU9TICK
RECEIVED TRANS. IN RET'^'T^ANS- COMPLETED
?orm l-4*k (R.OT. 1-1O-TT) N
1
(Pat. 1)
Page 4
Appeals I
t"** *"' bwa tn*M<> (or •
dltardar. iruo uddictton
aav« b»an. tapiain.)
17. 1 L_J
IB • ptuoa. (I( yo
fcM aal a*n iba anMAaian ofiaaido*. Muumr, rahaoUluuoa daara. otftat utt of cirauuy or nnuUnt uUoa. (Ifyouiuvi
•*««, «m»lata.)
I*. AWTt-ICAMT* fOB STATUS AS 'KRMANENT RESIDENTS MUST ESTABLISH THAT THEY ABE ADMISSIBLE TO THE UNITED
STATES. EXCETT A* OTHERWISE raOVIDED IY LAW. ALIENS WITHIN ANY Of THIS FOLLOWING CLASSES ARC NOT ADMIS-
SIBLE TO THE UNITED STATES AND A&E THEREfORE INELIGIBLE 'OB STATUS AS PERMANENT fCSSIDlNTS,
lllmn wae h»»a «o«BLlUad at w»a kJM bMa nmwud ol
wka too* b««t MMMd in »« wko bUMrf la IOUM ia ««x e
«( w iimuunl >iik «nr ComavnUt at oih»t
ir by IMV
aim* InroMlU monl tumllud* <do« l»t molu
taannulUMl muni xutnty. iJiMu vuo »™ or
ulituun putr. uicludinl uiy mMtvuioa at
o< wiy wntun gr ptut«<i maiur. or throutA
c*. (tii) Uja u
« mjiot tnvltle violicloiut; tli«ru
uiy iirno n««* o+*a. muttiuu.
iltlluu ti-..r»o(; ui«u who hrnv*
UXXKUKM. lu) UM o««fta»v a< jov»mm*ai by (ore* at no
l dunetn. (tv) U* uoltotul dMtnixuaa ol ppip«ny. (v) vkouw. at (n) th« doc
4tcUlonlup u> tk< Uncud Sum: iU«u »Bo Inwnd u> •n»u< in otciuaia*! «c
lucun: AUmu waa b«v« b<iB coovMUa o( tnokAUoa of «jiy lav or tvguiAUou nuuaa nt n**c<iue
ttMl la auvoue druu or manJIUAaa; ftJMiu wao luv« b««n ln«olv«d in Mautintf uir oib
3l*iM M ttt< trouad o( ill«m«i ud wao b*v< bun nllncd or dl»bU(Kl from Kick mount orotmu: mMieu
(or waaai RaUhv* p«uU«M «•«« bMa tporovwd) comuitf pnncipailr to p«t<orm Mrvte«* M m«raa*r* u( Ui« mt
aa*« paaoad Pwru 1 aaa (t o( (a« N*uaa*l Bowt ol M«dicai CcuauMt* £naaua«Uo« (or «A tquiviUvni 0E«mt
SMKIUT o( Hwllfc. IdiMWiaa. lad Wmun) ud »M an sotnixuni u> onj ud wniuo ln»il«B
wvi or {n«rihu«nA. or who
iliaaa to enut Ut« Umud
>du>i«i (otb«r Uun UIOM
ivply to y
No (
r u Vw.
J4. ICOMfLITt THIS tLOCIC ONLY tf YOU CHICKS & BOX "A", "g". "C". or "D" Or SLOCK II
ASfUCAMTS WHO CHXCEXO «OX "A" "9" "C" O« -D" Or StQCJC I (INCLVOrNO RerUOIKS) W ADDITION TO ESTABLISHiyO
THAT THEY AftB NOT MCMBEIU Or AMY Of THl IMAOMISSmLC CLAflSES OBSCRIBtD [N it. OCX. 10 A.BOVE MUST. EXCEPT
AS OTHEIWIJI fROVlDCD BY LAW. ALSO ESTABLISH THAT THEY AM NOT WITHIN ANY Of THK FOLLOWING INADMISSIBLE
CLASSES:
AU«u a-ko «r« mimHlly nunlad. lamx. or Uv» auTOtvd on* at nor* <tuck< at lA«a»ir: illDOi irttfaud with piyclloaathle (Wnanilily,
• xyal dmttUoa. BMUI dtlttt. uraatlc dnu KldUtUm. ehroau ikoboltan or uy diowroiu COEUUOUJI dii»M-. Ui«iu <otu> iuv< * ahyiual d«-
(•«, illauai m dlatatllly olfMUat UMU laUlty to «am * Uvtnu tii*«* who u* aagixn. ptctnuau Mann 01 v«4i»au. auniu who UK volv
umlaUot wivaMM polroaiy: >U«ai w»o inund to pnforn UuUed or luadtlUM Ubor u>d wbo h«v« cot Mna c,«ic;»l«a t>v tn* Sccntwr -t
Lata«r(M Uuawttaa 1O); >U*at Ululy la baeaiM > public cb«r»; >UMU »no h««. b«ra axeludKl fr:m -u. i;tuu- ,V_ui= -tibia th> put v«^t.
ar wao M ur UaM ka«« ban dcparKMl trom m« C/niud 3ut«. or wao u wy cunt h«"» b«a n.-_o.«d Crau u» fr.it... 3utjJ i> aonrnmrat
•K»«ttM! tUim waa haw* pra«u«d ar tiavv itUAPtad to pro«ur« a visa bv fraud or cntoraprvtvauuun, AUNOA w bo tu.«. awpoyimi from or rantain-
ad aulalda UM Uaitad 5l*U« lo avoid nditary tarvw* la ura« o( war or oaUoluJ am«n|aiMV; lUeiui wui; uu :'o-t»tfi ^«<-..VA£4« viatan wbo 4T*
lUblwrt la but am aat <o(apUad wlltt UM 'wo yaw lomaa nradaae* nra,iur«««ai.
D« my af la* (miaialau clainaia vrtti la yavt O YM O "* "'
. 1 [_] da Q da aat lauad la aMK uuatul <nplay*Mat la tha Uutwl SUWm. tf you tnuwl to >aak mr.ru! «mploym«nl la lh< Uulad Sutam.
Mala Ika oamaaUo* yaw Inuad ta ^lu^.
10/1/80
TM 772
ADMINISTRATIVE MANUAL
Appendix I
1-485
Page 5
11. (Camawtr >M> Mart only it yen c*«c*M oojt >t or D ol Mot* 1 1
r~l a. I na»» a pnanly on Uw conaular waiua*. kit al UM Aawncaii Caaaulau i
(Cur) <Dai»)
f"] b. A waa pallium aecaidMM ro« FH m>m«dial» i»UUvt Q] pnfomc* MUU wa> ipp»v*d by ih» diatnel
dliMtar >l - o« ^__—_—— -————_
(City and SUM) (Dau)
[ | e. A VIM p*uuon ba* nol tom approved » my b«kalf bMI 1 claim «btlbiUly t«r pi«l«rviM« Maun bvcauat [ | ny apouM
Qmv pwnt u Uw tenthriary of a via. MliUon apprawd by Ihf dtatncl difielor "
(Clly and suul
| [ 4. I am finmmi pf«l*i*ncv auitw aa a »lypf f ««4«T UK pcvvuo lo S*cuo« 301 (aMTk ol lh« Acl vho baa b««ii CMiliimamly pbyaicaUy
'~J pnoml in Uw Umud SUIM (or at IraM lh« paat t«o y*«n. Ill rmi dwck MM il«m. you KUMf txitulr and <IM<* a-«m f— 3po^ lo Ikb
Olb«T(£jM*iMI
U. IComrHU IHit »«M* ofi<* a yw c*»««l 3o« C
or for Woe* /I
A. I fun anr^d m Uw Ua»ud SUM* M <P*n)
by aM*na •< (Nam. al •
br «» u»nu»»-
and I «iaa *»•»»«• » (CUy and S«a<.)
C. Suwr my fint avuy 1 Q hanr Q ba<* aot
•MB abainl from Uw Uoiud SUUM. lit yaw
larttar I*, port. dM> and mavu or
14. Coaptoud F«n> G— 31SA Otoajrapbic lnlotaaaUM) I
| Campbrtad Form G— USA f Uaajaaawr latnnn I a aat
a imdtr 1 4 yaata af apjr.
I Dau at SMJUUM:
M. <S»a«»mr» ol pwiM ommraa term, if aHwr l»aa appbcaaj.) I drtlarr thai Addtaalat Plfion fliii|iiii»| tana. II aUwt Uwmppliinal
taw M aftwar or" Uw Jaaaawmoaa aid1
da »nrlaVMa>l UiM I fawnr Uw
»aa MSlwd by aw anUi my Iwll. inw ata
rfarntalnaMiuM aayidcc far
IMaaahk (Day) (Y.arl
t»tlr aC afhcwt >
Page 6
Appendix I
1. UyuaMlt (UalauounMunl <rtfM NUM> (MMdte N<UM) JNDXCODEI
4. I mu* IM i*« U*iu4 *uw« ti: («/o) (No. ud Sumt) (Apt. No.) (Cur) (1UM» <Ztr C<xt*l j
m «IOI*M | r. I at • ctwra o( <Couour) ;*. O««. o/ Btrti
». MM «< IMii (Clir OT Toon) ICouniy, rnMwa. of il««l (Coumrrl
ui UM Uwud luui 11 MM ran at (Clip <ad SUM) on (M»ol»> (O«r>
• I •
|x] »rrucxTtoH rot riRMANCNT IUIDINT riuto
r>« (-4MP <B«». 1-10-TTtN BIVOKT Or ACTION-H/1
10/1/80
4-51
FORM I-485A
I. USE:
USED BY A CUBAN REFUGEE TO APPLY FOR PERMANENT RESIDENCE.
II. ELIGIBILITY:
1. NATIVES OR CITIZENS OF CUBA WHO WERE INSPECTED AND ADMITTED OR
PAROLED INTO THE UNITED STATES SUBSEQUENT TO JANUARY 1, 1959, AND
WHO HAVE BEEN PHYSICALLY PRESENT IN THE UNITED STATES FOR AT LEAST
ONE YEAR OR;
2. SPOUSES AND MINOR UNMARRIED CHILDREN OF THE ABOVE WHO ARE NOT NATIVES
OR CITIZENS OF CUBA IS RESIDING WITH THE CUBAN SPOUSE OR PARENT AND
WHO WERE ADMITTED OR PAROLED INTO THE UNITED STATES SUBSEQUENT TO
JANUARY 1, 1959, AND HAVE BEEN PHYSICALLY PRESENT IN THE UNITED
STATES FOR AT LEAST ONE YEAR THEREAFTER.
III. REQUIREMENTS:
1. NO FEE.
2. PHOTOS AS DESCRIBED IN THE ADIT PHOTO SPECIFICATIONS.
3. FINGERPRINTS WHICH MUST BE TAKEN ON FORM FS-258. NOT REQUIRED
IF UNDER 14.
4. FORM G-325A.
5. EVIDENCE OF BIRTH AND NATIONALITY.
6. EVIDENCE OF ANY NAME CHANGE.
7. FORM 1-94, PAROLE DOCUMENT (A COPY OF FORM 1-94 IS ACCEPTABLE,
BUT ORIGINAL MUST BE SUBMITTED AT TIME OF INTERVIEW).
8. IF APPLICANT IS APPLYING UNDER II. 2., OF THE ABOVE:
a. AS THE SPOUSE
(1) MARRIAGE CERTIFICATE; AND
(2) EVIDENCE OF LEGAL TERMINATION OF ALL PRIOR MARRIAGES OF EACH
SPOUSE.
b. AS THE MINOR UNMARRIED CHILD
(1) MARRIAGE CERTIFICATE OF PARENTS
(2) PROOF OF TERMINATION OF THEIR PRIOR MARRIAGES
(3) BIRTH CERTIFICATE SHOWING PARENTAGE.
9. ALL DOCUMENTS MUST BE SUBMITTED IN THE ORIGINAL; COPIES SHOULD BE
SUBMITTED WITH CERTIFIED ENGLISH TRANSLATIONS.
(NOTE: APPLICANT SHOULD BE ADVISED NOT TO LEAVE THE UNITED STATES
WITHOUT INS PERMISSION AFTER FILING AND BEFORE A DECISION
IS MADE ON APPLICATION.)
10. MUST HAVE A MEDICAL EXAMINATION BY A PHYSICIAN APPROVED BY
THE IMMIGRATION AND NATURALIZATION SERVICE AND MUST PRESENT
FORM 1-486 SIGNED AND EXECUTED BY THAT PHYSICIAN AT THE TIME
OF THE INTERVIEW.
TM 803
ADMINISTRATIVE MANUAL
Appendix 1
I-485A
Page 1
tSirvase separar esla hoja antes de presentar la solicitudl
(Please (ear off this sheet before submitting application!
APPLICATION BY CUBAN REFUGEE FOR PERMANENT RESIDENCE
SOLICITUD PARA RESIDENCIA PERMANENTE DE REFUGIADO CUBANO
INSTRUCCIONES PARA LLENAR Y PRESENTAR UNA SOLICITUD
PARA LA RESIDENCIA PERMANENTE DE REFUGIADO CUBANO
1. SOLICITUD. Cada interesado debe someier una solicitud
par separado. Una solicited para un nirio o una niiia menor de
14 anos de edad debe ser preparada par uno de los padres o par el
tutor. El formulario Form G — 325A llnformacion Biograficai
debe compleiarse y someterse con cada solicitud en la que se haya
marcado la casilla de la Section I A si nl solieitante lenga 14 o mas
anas de edad. La falta de cumplimiento de to anterior ocasianara
demoras e incluso punde ocasionar la devolution de la solicitud.
Cada solicitud debe ser sometida a la oficina sucursat del Servicio
de Inmigracion que tiene jurisdiction sohre el lugar de residencia
del solieitante.
2. FOTOGRAFIAS. Se requierun dos fotografias en color
sobre fondo bianco: estas deben ser brillantes. sin retocar ni
montar. La imagen del rosiro debera ser de aproximadomente I
pulgada de la barbilla a la pane superior de la cabeza. La foto-
grafia debe mostrar al solicitanie de (rente, de modo que revele
3/4 del lado derecho de su rostra dejando al descubieno su oi'do
derecho. Con un topi; o una estilografica de punta de fieltro.
escriba su nombre en lelnts de molde sin hacer presion ly su
numero de regisiro de extranjero. en caso de lenerloi al dorso de
cada fotografia. Las fotografias deben tomarse no mas de 30 dias
antes de la fecha de la solicitud.
3. HUELLAS DIG/TALES. Todo solieitante de 14 o mas anos
de edad que haya marcado cualquiera de las casillas en el
CUADRO IA de su solicitud (Formulario FD — 2581 debera
someter una tarjeta con un juego complete de huellas digitales.
Las tarjetas de huellas digitales. junto con las instrucciones para
llenarlas. se pueden obtener en cualquier oficina del Servicio de
Inmigracion y Naturalization. Los solicitantes pueden hacerse
tomar las huellas digitales par empleados del Servicio de Inmi-
gracion y Naturalization, otros agentes de la policia. centros de
ayuda. organismos de caracter voluntario y benefico y por otros
organismos o personas respetables. Las tarjetas de huellas digi-
tales IFD — 2581 sobre las cuales se someten las mismas. la linta
que se utiliza. y la calidad y clasificabilidad de las huellas digi-
tales deben satisfacer las normas prescritas por la Oficina Fed-
eral de fnvestigaciones IFBI). Usted debe firmar la tarjeta en
prtsencia de la persona que le tome las huellas digitales. quien
debera entonces firmar su nombre y anotar la fecha en los espa-
cios correspondientes. Es importante que usted suministre toda
la information que se solicita en la tarjeta. Si usted marco una
casilla en el CUADRO IB. no necesitara someter una tarjeta de
huellas digitales con su solicitud.
4. DOCUMENTOS.
a. INSTRUCCIONES GENERALES. Todos los documents
que se envien deben ser los originates. Si desea que se le devuelvan
los originates de cualquiera de los documental, y si la ley permits
Hacer capias de los mismos. puede usted presentar capias
fotostaticas o Heches a mdquina. Si somete capias, los documentor
originates deben presentarse cuando usted vaya a examinarse.
Todos los documentos que no esten en ingles deben ir acorn-
panadas de una Induction resumida de los mismos al ingles. Una
induction resumida consiste en una sintesis o un extracto del
leito del documents. El traducior debt certificar que tiene la
capacidad para hacer traducciones y que la induction presentada
esfiel.
b. Someta los documentos siguienies unicamente si ha mar-
cado la casilla en la Section I A de la solititud:
III Partida de natimiento.
12) Cuando se le pida que se presente para hacerif una
entre-vista usted debera traer consigo su permiso provisional de
entrada iFormulario 1 — 94. REGISTRO DE ENTRADA-SA •
LIDAly su PASAPORTE.
131 Si usted ha marcado la Casilla 1A 12) de la solititud en su
condition de conyuge: certificado de matrtmonio y pruebas de la
termination legal de todos los matrimonies anteriores de cada
conyuge. Si usted ha marcado la Casilla 1A 12) en su condition de
hijo menor soltero: certificado de matrimonio de los padres, tanto
como pruebas de que todos los matrimonies anteriores de los
padres han terminado legalmente. a dichos documentos no han
sido presentados por uno de los padres.
14) Si usted es un funcionario no emigrante de un gobierno
extranjero. o sirvienle de tal persona, o un miembra del la familia
de tal funcionario o sirviente; o una persona cuyas actividades
estan autorizadas por un tralado. el conyuge o hijo de dicha
persona: o el representante de un gobierno extranjero ante una
organization international, o sirviente de tal persona, o un
miembro de la familia de tat representante o sirviente. usted tiene
que someier el formulario Form I — 508. renunciando a todos los
derechos. privilegios, exentiones e inmunidades que de otra
forma le serian concedidos en virtud de dicho status.
c. Si usted ha marcado la Casilla IB ft) o 121. someta su
Tarjeta de Recibo de Regisiro de Extranjero (Formulario
I— 151).
5. EXTRANJEROS QUE NO PL'EDEN SOL1CITAR UN
A JUSTE DE CONFORM1DAD CON LA LEY. No podra usted
ajustar su status conforms a la Ley si:
a. No llena usted los requisites que se indican en una de las
casillas de la Section IA o IB de esta solicitud.
b. Usted es o ha sido un visilante bajo el programs de inter-
cambio Icon 'visa J — lol — 2). sujeto al requisito de dos anos de
residencia en el extranjero. conformt a la section 212fe) de la Ley
de Inmigracion y Nationalization, a no ser que usted haya
cumplido con ese requisito de residencia en el exterior, o se le
haya concedido una exception al mismo.
ADVERTENCIA: Si tiene usted la intention de salir de los Estados Unidos a cualquier otro pats, incluso el Canada o Mexico, antes
de que se haya cursado su solicitud, consults con la oficina del Servicio dt Inmigracion y Naturalization que este tramitando su
caso antes de salir del pats.
La ley dispone penas serveras para todo aqu*l que. a sabiendas y con proposito dt tngano, falsifique o no revele un data pertinenle, o use
calquier documento falso al someier esta solicitud.
I -4MA(H«y. 11.J8.79lN
FORM NO.
I-485A
EDITION
REV. 11-26-79
TITLE
APPLICATION
3Y CUBAN REFUGEE
FOR PERMANENT RESIDENCE
SIZE
8 1/2 X 11
INSTRUCTION REFERENCE
8 CFR 103.7{b)(1), 245.2(a)(2),(c).
GIB App-47
264. l(a), 299.1;
A" 2301 .07, 2482 Ex.
2, P. 2, 2790.13;
USX
APPLICATION FOR ADJUSTMENT OF STATUS BY PERSON WHO BELIEVES HE MEETS THE ELIGIBILITY RFnUIRFMENTS
OF SECTION 1 OR 2 OF THE ACT OF 11/2/66
PRIOR EDITIONS MAY NOT BE USED
SCHEDULE
Page 2
Appendix I
INSTRUCTIONS FOR APPLICATION
UNDER THE ACT TO ADJUST STATUS OF CUBAN REFUGEES
1. APPLICATION. A separate application must be exe-
cuted by each applicant. An application in behalf of a child
under 14 years of age shall be executed by the parent or guard-
ian. Form G — 325A (Biographic Information) must be com-
pleted and submitted with each application in which a box in
Block 1A has been checked, If you are 14 years of age or older.
Failure to do so delays action and may result in return of the
application. The application should be submitted to the Immi-
gration and Naturalization Service office having jurisdiction
over your place of residence.
2. PHOTOGRAPHS. Two color photos with white back-
ground are required: photos must be glossy, un-retouched, and
not mounted: dimension of facial image should be about 1" from
chin to top of hair; subject should be shown in 3/* frontal view
showing right side of face with right ear visible; using pencil or
felt pen. lightly print name (and alien registration redeipt
number if known i on the back of each photograph. Photographs
must be taken within 30 days.
3. FINGERPRINTS. A completed fingerprint card (Form
FD — 258 1 must be submitted by each applicant, 14 years of age
or older, who checked any box in BLOCK 1A of the application.
Fingerprint cards with instructions for their completion are
available at any office of the Immigration and Naturalization
Service. Applicants may be fingerprinted by Service Employ-
ees, other law enforcement officers, outreach centers, chari-
table and voluntary' agencies, and other reputable persons or
organizations. The fingerprint cards (FD — 258) on which the
prints are submitted, the ink used, and the quality and classifi-
ability of the prints mus! meet standards prescribed by the
Federal Bureau of Investigation. The card must be signed by
you in the presence of the person taking your fingerprint, who
must then sign his name and enter the date in the spaces pro-
vided. It is important to furnish all the information called for on
the card. If you checked a box in BLOCK IB you should not
submit a fingerprint card with your application.
• 4. DOCUMENTS.
a. GENERAL. All documents must be submitted in the
original. If you desire to have the original of any of the
documents returned, and if copies are by law permitted to be
made, you may submit photographic or typewritten copies. If
you submit copies, the original documents must be presented at
the time of your examination. Each foreign document must be
accompanied by a summary translation in English. A summary
translation is a condensation or abstract of the document's text.
The translator must certify that he is competent to translate and
that the translation is accurate.
b. Submit the following documents only if you checked a box
in Block 1A of the application:
(1) Record of your birth.
(2) When you are requested to appear for interview you
will be required to bring with you your temporary entry permit
(Form 1 — 94, ARRIVAL-DEPARTURE RECORD) and your
PASSPORT.
(3) If you have checked Block 1 A (2) of the application as
a spouse: marriage certificate and proof of termination of all
prior marriages of each spouse. If you checked Block 1A <2) as
an unmarried minor child: marriage certificate of parents, to-
gether with proof of termination of their prior marriages if such
documents have not been submitted by a parent.
(4) If you are a nonimmigrant foreign government official,
or servant of such person, or a member of the family of such
official or servant; or a treaty trader, the spouse or child of such
a person; or a foreign government representative to an interna-
tional organization, or servant of such person or a member of the
family of such representative or servant, you must submit Form
1-508, waiving all rights, privileges, exemptions and immuni-
ties which would otherwise accrue to you by virtue of such
status.
c. If you checked Block IB (1) or (2), submit your Alien
Registration Receipt Card (Form I — 151).
5. ALIENS INELIGIBLE FOR ADJUSTMENT UNDER
THE ACT. You are ineligible for adjustment of status under
the Act, if:
a. You do not meet the description in one of the items of
Block 1A or Block IB of this application.
b. You are or have been an exchange visitor (visa symbol
J — 1 or J — 2) subject to the two-year foreign residence re-
quirement of section 212(e), Immigration and Nationality Act,
unless you have complied with that foreign residence require-
ment or have been- granted a waiver of it.
WARNING: If you contemplate departing from the United States to any country, including Canada or Mexico, before a decision is
made on your application, consult with the office of the Immigration and Naiurali/aiion Service processing your case before
departure.
Se\ere penalties are provided by law for knowlingly and willfully falsifying or concealing a material fact or using any false document in
the submission of this application.
4/1/81
TM 803
ADMINISTRATIVE MANUAL
Appendix 1
I-485A
Page 3
4-
UNITEO STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization S«rvice
APPLICATION BY CUBAN REFUGEE FOR PERMANENT RESIDENCE
SOL/C/TUD PARA RESIDENCIA PERMANENTE DE REFUGIADO CUBANO
DATE RECEIVED
FILE NO.
APPLICANT FOR BENEFITS OF
1 — 1 Section 1 of the Act of November 2. 1966.
LJ Section 2 of the Act of November 2. 1966.
.YO ESCHIBA MAS ARHIBA DE ESTA LINEA. VEA LAS MSTRUCCIONES AXTES D£ EJECUTAR LA PLANILLA DE SOLICtTUD. SI VECESITA MAS ESPACIO PARA
CONTESTAR POH COMPLETO ALGU.VA PREGUNTA. USE UP PLIECO SEPARADO E IDEMTIFIQUE CADA KESPUESTA CON EL NUMERO DE LA PREGVHTA
CORRESPOHDIENTE. ESCKIBA CON LETKA DE IMPRE.VTA.
DO NOT WRITE ABOVE THIS LINE. SEE INSTRUCTIONS BEFORE FILLING IN APPLICATION. IF YOU NEED MORE SPACE TO ANSWER FULLY ANY QUESTION ON THIS
FORM. USE A SEPARATE SHEET AND IDENTIFY EACH ANSWER WITH THE NUMBER OF THE CORRESPONDING QUESTION. PRINT IN BLOCK LETTERS.
1. A.
ILLENESE SOLAMENTE EL CUADKO IA O EL IBI (COMPLETE BLOCK 1 A OR IB ONLY)
Par la presente yo iolicito convertirme en residente permantnst extranjero sobre la siguiente base: (Marque solamenie (It o (2).)
I hereby apply to become > lawful permanent resident alien on the following basis: (Check (1) or (2) only.)
(1)1 — 1 Yosoy naHvo o ciudadano de Cuba. Fui inspeccionado par un funcionario del Servicio dt Inmigracion dt lot Estados Unidos da America y admiodo o permitido etarar bojo
palabra in lot Estados Unidos con poatriondad all da Enero 1959. y he eslado ftacamtnlt present* en liu fats, for lo mtnos dot mfiat despues dt tio. o
I am a native or citizen of Cuba. I was inspected by a U.S. immigration officer and admitted or paroled into the United Slam subsequent lo January 1. 1959. and have been
physically prcienl in the United Slain for at lean 2 yean thereafter, or
(2)1 — 1 Yo no soy nativo At ciudadano dt Cuba, sino soy — I — 1 laesposa \ — 1 elesposo.o 1 1 tahija \ 1 el hijo menor de edad yd* tsiada solttro. deun nativo ocitidadana
dt Cuba. Ml coma ha sido dficnlo anlenormerae tn "III", eon guien esloy residiendo. Yo fui inspeccionado par an funcionario del Serricio dt /n/mf ration dt lai Estados
Unidoi d* America y admitldo o pemilida tnlrar bajo palabra en las Eiiados Unidos. con paatrioridad all dt Entn 1959. v he eslado presente [iKcamtnlr tn tat paa
par lo mtnos dot anru dtsputs dt tso. ^^
I am not a native or citizen of Cuba but I am the tra husband KM wile, or ^ minor unmarried child of a native or citizen of Cuba described in "(1)" above with
whom I am residing. I was inspected by * U.S. immigration officer and admitted or paroled into the United Slates subsequent to January 1. 1959. and have been physically
present in the United States for at (east 2 years thereafter.
1. B
Pnf la petienle yo solicilo qtie mi permiso pan residencia ptrmante tenga conto fecHa
coma no tmifwanlt. o la del 3 dt Maya dt 1164. dt lai dot la gut tea posterior. IMart,
I hereby apply to have mv admission for permanent residence recorded as of the dale 1
whichever dale is later. (Cheek (1) or (2) only.)
( 1 1 I I Yo soy un nativo o cittJadano de Cuba, out fut ttgalmtnte admiudo en toj Ei
I am a native or citizen of Cuba woo was lawfully admitted into the United Si
(2) Li Yonotoy nauro ni ciudadano dt Cuba, jino joy LJ la esposa LJ tl espos,
la de mi' Utfada original a las Esudos Unidoi dt America euanda admilido bajo palabra o
ut solamenu (It 0 (It.)
originally arrived in the United Slates as a nonimmigrant or parolee, or as of May 2. 1964.
iados Unidos pan rtsidencta permantnie.
tes for permanent residence.
o.o 1 — 1 lahija 1 — 1 tl hi/a mtnor dt edad y de astado lalura. de un naan o ciudadano
adiendo. Fui odmitido tn las Estados t/nidos para residencia permanente.
w Ka minor unmarried child of a native or citizen of Cuba described in "(IT above wiih
Jence.
I am not a native or citizen of Cuba but 1 am the K£a husband KB wife,
whom I am residing. 1 was admitted into the United Slates for permanent resi
2. Minombnes lApeliidol INi
My name is (Last)
mbr* de pilal INombre intermedia!!! 1 SSSJSSSSSSSSS
(First) (Middle)
SEXO LJ Masculino CD Femenino
SEX iU Male [^ Female
3. Yo noo tn las Estado Unidos en: ICelltvNuml IHum. del Aplo.l iCiudadl lEslada) ICodifO postal • ZTPl
I reside in the United Stales at: I No. and Si reel) (Apt. No.) (Cifyl (Slate) (ZIP Code)
4. i H* •olicitaao Ud. alguna *ti residencia
permanu en las £E. UU. .' U Si D No
ISi la respuesta as "Si", indiaue fecha y
lugar at prestnucton y resolution definiura.l
Have you ever applied (or permanent residence
status in the United Stales? 83 Yts ESI No
(If "Yes', give date and place of filing and
final disposition.)
^ W< itL^^m Jf Rtumm Jr fgimtffntt ft 6. /
M> «U«« Kunmii,!. >w>l>n 11 |
am now a citizen of (Country) (>»'e ^ Binh iNuwllii idavt i>cari
8. Lugar dt nacimietuo f Pueblo o ciudadl fOepanamtnto o provincial tPaul
Place of Birth (CilyorTownl (County, Province, or Stale) (Country)
9. ttombre segun aparece se su documenso de entrada coma no
emifrante formulario 1-94. Name as appears on nonimmigrant
document Form 1-94.
10. Mi pnmen>Uetada a las Estados Unidos. dtsputs del 1 de enero de 1959. fut en: At putna o teroputrto de
My first arrivaj in the United States after January 1. 1959. occurred on At the Port of ICiry. Sate)
Fecka IMts. da y anal
Date (Month. Day. Year)
1 1 . Yo llegue par l\ombre del barco u am
I armed by INamt of vessel or other it
media de tnuupone) coma un tvjwanle. eaudiante. ciudadano dt lot F.K. VU. polkon. ui mi frame,
neans of travell tyo palabra. etc.)
as a / Visitor, student. U.S. citizen, nowaday, immigrant, parolee, etc.l
12.
t — 1 Pose 1 1 No past por la insptcci
I US was §i was not inspected
uu/ de las Estados Unidos en iCiudad. Paiil el iFecha: dia. met. anal
Consul at icily, state) on 1 month, day. year)
on.
Form I — 48SA (Rev. !1-26-79)N
TRANS. IN IRETD— TRANS. OUT! COMPLF.TED
(Page li
NOTE. Complete Blocks IJ through 19 only if you chccktd BLOCK IA.
1 A.
14. Yoio) LJ saltern <al D casada lal LJ diuomadolol LJ viudo lal
ahonl. I have been married twMw times, including my present mamage. if now married.
»!••>
le) c. /Vom6re* de mi marido (tsposa). (Same of hnabood (wUe),
IS/ ata casada anora de lot sifuieniei iotas:) llf you an now married, give the folio*
b. .Vfenrro d< tirra gut ml marido tapast) it Ha cosado. Nualxr ol flues ny Inubaad {«
hu b*» Mrrtad.
d. Mi marido <tspota) reside in I I fonimgo I — 1 sepandamtntt tn la dine
Ml Imhud l»tftl mU* liS with me ESS apart from me >i Address
non /Num. del apiol INum y callt) IPutblo o ciudadl tProvmcia o Esndo] IPaa)
Apt. No.) (Number and Street) (Town or City) (Province or State) (Country)
IS. i. Ttnto hijoi o hi/us: (lltnt tndas las cnlumnas correipondiinltsacada Mjo a hija: si riven con uiied indigue "conmlfo" tn la tiltlme columno; dt to contrarto. indiqut la
cludad. d tstado o pals dandt rtsidi coda Mjo o Mjal. 1 lu.« ESSJ MB or davgkicn a Follow: \coofkit all column u la each to* or daughter, ff Ihfag wtlb JOB
lute "»hh ««" hi Iml calmu; olktr-b. gKe clij utd itait ot eo«»rrj ol xm't w dataghtar'n raUcactl.
Wombrrl ISexol ILugar dt nacimii
Name Sci Place ol Birth
nloj (Ftcha de nacimtenlol (Ahora esta rtsiditnda en)
Due of Birth Now living at
r ptrmanenits: The (olio* ing members of my family are also applying for permanent resident status.
16. X romi/ruarlb'i nago bru /ma </f fcu/aj las orfaniiacioMt. socttdadtt, clubt y assaciaciones. pasadaj o preienles, de las qu* lie jida socio tn loj Estados Unidos o en atgun pais
utiramtro. y lot penadoi y lugam tn qut tn socio. ISI usitd nunca ta tldo toelo dt nlnt una orfanllocion. declare "Nlnguia. ") I list below all organizations, societies,
clubi. and auociiiioni. past or present, in which I have held membership in the United Slates or a foreign country, and the period: and places of such membership, fff you fail
nevtr bttn a mtmbtr of any organization. Jfdftf 'Won*. ">
17 1 I fit rwctbido 'I no he eteffiido tnlamiemo par nton dt un (rajromo mental, ttdtccion d drogas o afcohotisma. (Dt nabeHa rrriou/o. txptiquej
1^ h<ve ^ bate not been treated lor* menu) duorder. drug iddtciion or alcoholism. (If. you ha\e been, explain.)
18. 1 — 1 He ttdo \ — 1 no He ttdo orrtjiodo. /uzgodo culpable o enearctlado. fDt habtrio ado. expliqur 1
1 tSS have KS have not been arrested, convicted or contined in i prison. Ill you have been, oplain.)
19. 1 — 1 Hi recibido \ 1 no ne rteibido un perdon. unmijtia. dtcrtto dt nhabilitacion. u otro acto dt clemencia o accton similar. fDt hoberlo rtcibido. txpliqut.l
1 KJ have cSS have not been the beneficiary of i pardon, amnesty, rehabilitation decree, other act ol clemency or similar action. (If you have been, explain.)
20. TODA PERSONA QL'E SOLICITE EL ESTADO LEGAL DE RESIDENTS PERMAfENTt
SALVO DE OTRO MODO D1SPUESTO POR LEY. LOS EXTRANJEKOS COMPJtENDIDOS
DOS. Y POR LO TANTO. HO TENDKAN DEKECHO A SOUCITAR EL ESTADO LEGAL
Los txtntnftroi gut Man ruardadot mtnialts dtmtnits, o hoyan m frido uno o mas aiaques t
locun. loi txiranjeros qu* padtzcon dt personalidad piicopttlifa, desviacion stxual, defeelo me
ul. adtccton a drogas narcolicas. alfoholismo rroniro. o cualquier enfermtdad ptligrosa co
tagioto. lor txtranjtrcu qve Itngam un defeelo fislco. tn/ermtdad o incapacidad qtit aftcte
rtpaeidad de ganant la vtda' lot txmnjtrvf out seon mtndigos. pordiottroj o vogos dt proftsia
DEBERA PKOBAR QUE RE W£ LOS REQU1SITOS DE ADM1S1OH A LOS ESTADO UHIDOS
DENTRO DELAS S1GUIENTES CA TEGOR1AS HO SERAN A DM1TIDQS A LOS ESTADOS UHI-
DE RES1DENTE PERMAHENTE:
t division o filial dt los msmos; los txtranjtros qut hayan abogado o pro/esado. sta por mantft.- 'a-
T ciones ptrsonalti. tscritos o impretos. a mtdiantt afiliacion con un orgamsmo. Ill oposieion al
tv o tt asesinalo dt funcionarios gubemamtntales por razon de svr ptrsontnas oficiales, fivl la
n; destruction ilegol de pnptedod. tv) elsabolaje. Ivi) las dortrinas del comunismo iniemacionai, o el
fluido* de lot Eltadot Vntdojt dentro de lot ulltmoj doff mtsts. o que hayan tido tn euatquitr panicipar tn activi'dedes perjudieiales o ilrgales de faracter subversive; los ejciranfens que nayon
ocasion dtponados dt lot Estados Vmdos. o que en cualqvier ocasion hayansidoexpuisadosdelos sido hallados culpable* de violar cualquier ley o reglamtnlo rtlacionado con drogas narcottcaj o
Enadot L'nidos par euenta r fotto del Cobierno. los et(ran/eros qut noyau obltnid*. o inttntodo marikuana. a tju* haydn sido tnfic&ntes illcitas dt drogas narcolicas o marihuana: los txtranteras
obteneruna visa mediante fraudt ofahtdad: los txlranferos que hayansalido optrmanecidofittn out hayan tstado inmiscuidos en presiar oyuda a cunlquitr otro extranjero para entnr a los
los utranttm q*e kaymn tidu vutlanlesdt inlvrcambio y qut no nan eumptido el requisite dt dot de e/\lremamienlo o ttrvicio en Ims Futnas Armadas dt los Estados Unidos por raz&t dt ttructron-
rulpabltj de alfun delno que enrierre torptsa moral Ino se'iocluyen las infraccionts teves a las ' i — i i — i
de. o tfiluidos a cualquier partido communtsto u otro partido 'fotalitano. inctusivt cualquitr sub
APPLICANTS FOR STATUS AS PERMANENT RESIDENTS MUST ESTABLISH THAT THEY ARE ADMISSIBLE TO THE UNFTED STATES. EXCEPT AS OTHERWISE PROVIDED BY
LAW. ALIENS WITHIN ANY OF THE FOLLOWING CLASSES ARE NOT ADMISSIBLE TO THE UNITED STATES AND ARE THEREFORE INELIGIBLE FOR STATUS AS PERMANENT
RESIDENTS:
itticli ol tnsinity: aliens afflicted with psychopathic personality, se
x- ution; aliens who have deoarleo from or remained outside the United
delect, diseoe or disability allecting their ability 10 cirn a living, two year foreign residence requirement, aliens who hive comrnilied or
been deponed Iron the United States, or who at any lime have been r
e. who are or it any lime hive been anarchists, or members ol or alfilia-
lP«ir.7l
4/1/81
TM 803
ADMINISTRATIVE MANUAL
Appendix 1
I-485A
Page 5
4-?
[he assaulting or killing of government official! because of their offi- training or service in the Armed Forces of the United States un the
in prejudicial activities or unlawful ac(iviti« nt a subversive nature; Do any at the foregoing classes apply to you? B$3 Y«s SS! No (If answer it Yes, eiptainl
21 1 — 1 La la Un G ]25A dail 1 b ra/ 1 da n
dm esta nlicitud.
^jj Completed Form G — 325A (Biographic Information) is attached as part of this »p-
pUcattoo:
ESS Completed Form G— 325A (Biographic Information) u not attached as applicant is
under N years of age.
22. SI SU ALFABETO NATIVO NO ES DE LETRAS ROMANAS ESCRISA SU NOMBRE
EN SU ALFABETO NATIVO DEBAJO:
IF YOUR NATIVE ALPHABET IS IN OTHER THAN ROMAN LETTERS. WRITE YOUR
NAME IN YOUR NATIVE ALPHABET BELOW:
23. (Firma del solicttantel Signature of Applicant
tFecHa de la fimal Date of signature
tl'irma de la ptnono qu* ha pnrparado la planttta. n fuera otra qua el Jolidtante.t Yo decl
(Signature of person preparing form, if other than applicant.) I declare that this document
have any knowledge.
IFirmal
Signature
iro qua *stf documtnto ha sido pnpamdo par mi, a pcticion dtl solicilantt y qu* tsia basado
wu prepared by me at the request of the applicant and is based on all information of which I
(Dincciont
Address
IFecnal
Date
lOeupacioni
Occupation
(L* iolldtttd no debt ser flmada at pit, htuta qui rl soticllaMi apamca delante de un funcionario del Servlclo ide InmlgneUn y Naturalisation para ser ejamlrado.)
/Application not be agnfd below until applicant appears before an officer of the Immigration and Naturalization Service for examination. I
Yo juro tafirmoj que conoxco el contentdo da esta solicited, que el mismo es verdadero, segun mi mtf/'or conocimienlo. y que tat comedones numeradas f } a t 1 fueron heckas por mi
0 a peticion mia. y que esta jolicitud fue flrmada por mi con mi nombre complete y verdadero:
1 do swear (affirm) that I know the contents o/ this application subscribed by me including the attached documents, that the same are true to the best of my knowledge, and that correction
numbered ( ) to ( ) were made by me or at my request, and that this application was signed by me with my full, true name:
Subscribed and sworn to before me by the above-named applicant
(Day)
(Firma compttta y verdadera del solicitanttl
(Complete and true signature of applicant)
(Signature and title of officer)
(Page 3)
2. Mi nombre es lApellidol
My name is (Last)
/Nombre de pilal IfJombre intermediolsl /
(First) (Middle)
SNDX CODE
3. Yo vivo en los Estado Unidos en:
I reside in the United States at:
iCatle v iVum./ INum del Apia 1 iCiudadl
(No. and Street) (Apt. No.) (City)
lEstadol fCodigo postal • ZIPl
(Statel (ZIP Code)
- W, nimer,, .1,- Hfni.ln, J, i i|ruit(rr,,. ,-.
b. Ahora soy un ciudadano de IPaisI
I am now a citizen of 1 Country)
7
Dale .•! Binh mum
».. J.,,, >«„
8. Lugar de nacimiento 1 Pueblo o ciudadl iDepariamento o provincial
Place of.Birlh (City or Town) (County. Province, or State)
IPatsI
(Country)
emigranle formulario 1-94. Name as appears on nonimmigrant
document Form 1-94.
10. Mi pnmera lltgada a los Esiados Unidos. despues del 1 de enero de 1959. fue en:
My first arrival in the United Slates after January 1. 1959. occurred on
Fecha IMes. dia y anol
Date (Month. Day. Year)
Al fuerlo o aeropuerto de
At the Port of (City. State)
(X) APPLICATION FILED BY. CUBAN REFUGEE FOR PERMANENT RESIDENCE
Form I — 485B (Rev. ll-26-79)N REPORT OF ACTION-N/I
4/1/81
4-59
FORM I-485C
I. USE:
USED BY AN INDOCHINESE REFUGEE TO APPLY FOR CREATION OF RECORD OF
LAWFUL ADMISSION.
II. ELIGIBILITY:
1. NATIVE OR CITIZEN OF VIETNAM, LAOS, OR CAMBODIA WHO HAS BEEN
PHYSICALLY PRESENT IN THE UNITED STATES FOR AT LEAST ONE YEAR
AND:
a. WAS PAROLED INTO THE UNITED STATES AS A REFUGEE FROM THOSE
COUNTRIES SUBSEQUENT TO MARCH 31, 1975, BUT PRIOR TO
JANUARY 1, 1979; OR
b. WAS INSPECTED AND ADMITTED OR PAROLED INTO THE UNITED STATES ON
OR BEFORE MARCH 31, 1975, AND WAS PHYSICALLY PRESENT IN THE
UNITED STATES ON MARCH 31, 1975.
2. SPOUSE AND MINOR UNMARRIED CHILD(REN) OF THE ABOVE WHO ARE NOT
NATIVES OR CITIZENS OF INDOCHINA, BUT WHO WERE LAWFULLY ADMITTED
OR PAROLED INTO THE UNITED STATES.
III. REQUIREMENTS:
1. FORM 1-94, PAROLE ADMISSION DOCUMENT (COPY OF FORM 1-94 IS ACCEPTABLE,
BUT ORIGINAL MUST BE SUBMITTED AT TIME OF INTERVIEW).
2. PHOTOS AS DESCRIBED IN THE ADIT PHOTO SPECIFICATIONS.
3. G-325A. NOT REQUIRED IF UNDER 14.
4. FINGERPRINTS WHICH MUST BE TAKEN ON FORM FS-258, NOT REQUIRED IF
UNDER 14.
5. CLEARANCE FROM THE LOCAL POLICE STATION FOR EVERY AREA IN THE UNITED
STATES WHERE APPLICANT RESIDED FOR SIX MONTHS OR MORE. NOT REQUIRED
IF UNDER 14.
6. EVIDENCE OF APPLICANT'S BIRTH AND NATIONALITY, IF AVAILABLE.
7. EVIDENCE OF ANY NAME CHANGES OF APPLICANT, IF AVAILABLE.
8. IF APPLICANT IS APPLYING UNDER II. 2. ABOVE:
a. AS THE SPOUSE
(1) MUST SUBMIT MARRIAGE CERTIFICATE AND EVIDENCE OF LEGAL
TERMINATION OF ALL PRIOR MARRIAGES OF EACH SPOUSE.
b. AS THE MINOR UNMARRIED CHILD
(1) MUST SUBMIT MARRIAGE CERTIFICATE OF PARENTS, TOGETHER
WITH PROOF OF TERMINATION OF THEIR PRIOR MARRIAGES.
(2) BIRTH CERTIFICATE MUST SHOW PARENTAGE.
9. NO FEE REQUIRED.
10. IF APPLICANT WAS PRESENT IN THE UNITED STATES PRIOR TO MARCH 31,
1975, OR DID NOT PASS THROUGH A REFUGEE RELOCATION CAMP, MUST HAVE
A MEDICAL EXAMINATION BY A PHYSICIAN APPROVED BY THE IMMIGRATION
AND NATURALIZATION SERVICE AND MUST PRESENT FORM 1-486 SIGNED AND
EXECUTED BY THAT PHYSICIAN AT THE TIME OF THE INTERVIEW.
TM 793
ADMINISTRATIVE MANUAL
Appendix I
I-435C
Page 1
Form I
IR«v M
UNITED STATES DEPARTMENT OF JUSTICE
ImnufrsOcB tod Naturalization Service
APPLICATION FOR CREATION OF A RECORD OF LAWFUL ADMISSION FOR AN INDOCHINA REFUGEE
1 APPLICATION EACH AWUCA.NT MUST SUBMIT A SEPARATE FORM A PARENT 08 GUARDIAN MAY FILE AN
APPUCATION TOR A CHILD UNDER 14.
>. THE FOLLOWING ATTACHED FORMS MUST BE COMPLETED AND SUBMITTED WITH YOUR APPUCATION
in FINGERPRINT CARD (CORK FD-»I NOT REQUIRED V UNDER H
111 BIOGRAPHIC INFORMATION (FORM C-BMi NOT REQUIRED IT UNDER 14.
t> APPUCATION MUST ALSO INCLUDE
II. A CLEARANCE FROM THE LOCAL POUCE STATION FOR ANY AREA IN THE UNITED STATES WHERE YOU HAVE
UVED FOR SIX MONTHS OR MORE. NOT REWIRED If UNDER H.
Hi FORM i-**. PAROLE DOCUMENT WHICH WAS GIVEN TO YOU WHEN YOU ENTERED THE UNITED STATES
i A COPY or FORM \~* a ACCEPTABLE BUT ORIGINAL MUST at SUBMITTED AT TIME OF INTERVIEW)
i] i COLOR PHOTOGRAPHS COMPLYING WITH THESE SPECIFICATIONS.
PHOTOGRAPH INSTRUCTIONS - TWO COLOR PHOTOS WITH
S'STH
OUNI
WHITE BACKGROUND ARE REQUIRED. PHOTOS MUST BE GLOSSY.
UN-RETOUCHED. AMD NOT MOUNTED. DIMENSION OF FACIAL
IMAGE SHOULD BE ABOUT 1" FROM CHIN TO TOP OF HAIR.
SUBJECT SHOULD BE SHOWN IN 1* FRONTAL VIEW SHOWING
RIGHT SIDE OF FACE WITH RIGHT EAR VISIBLE. USING PENCIL
OR FELT PEN LIGHTLY PRINT NAME lAND ALIEN REGISTRATION
RECEIPT NUMBER IF KNOWN I ON THE BACK OF EACH PHOTO-
GRAPH PHOTOGRAPHS MUST BE TAKEN WITHIN X DAYS,
iUBMTT THE APPLlCynO.'Ji TAKE OR MAIL THE COMPLETED AWUCATION TO THE OFFICE OF INS
1SDICTIO.N OVER YOL'H PUCE OF RESIDENCE YOU WILL BE SCHEDULED FOR AN INTERVIEW
5 IMPORTANT. NOTE - FAILURE TO COMPLY WITH THE ABOVE INSTRUCTIONS WILL DELAY THE PROCESSING OF
\OUR APPUCATlbN
« PCHALTTB SEVERE PENALTIES ARE PROVIDED BY LA* FOR KNOWINGLY AND WILFULLY FALSIFYING OR
CONCEALING A MATERIAL FACT OR USING AN> FALSE DOCUMENT IN THE SUBMISSION OF THIS APPLICATION
1 AFTER YOU FTLE AND BEFORE A DECISION IS MADE ON THE APPUCATION DO NOT LEAVE THE UNITED STATES
WITHOUT GETTING PERMISSION FROM THE IMMIGRATION AND NATURALIZATION SERVICE
O U.I OCVOtM
FORM NO. EDITION /0-26-7.P
I-435C REV. 8-9-78 y
TITLX
APPLICATION FOR CREATION OF A RECORD OF LAUFUL ADMISSION
FOR AN INDOCHINA REFUGEE
SIZE INSTRUCTION REFERJCNCX
ax 10 1/2 8CFR245.2(a)(2), (e), 299.
1; AM 2482 Ex. 2
USX
FILED BY ANY ALIEN FOR
REFUGEE. FROM INDOCHINA
ADMISSION AS A PERMANENT RESIDENT WHO
WAS PAROLED INTO THE U.S. AS A
PRIOR EDITIONS MAY HOT BE USED
1 SCHEDULE 6
4-62
I-485C
Page 2
ADMINISTRATIVE MANUAL
Appendix I
TM 793
APPLICATION BY INDOCHINESE REFUGEE FOR PERMANENT RESIDENCE
Form Approved
OMB No. U-HOS9S
DATE RECEIVED
ni« Number
Applicant (or benattia of
Q Section lot of Uw Act of Octobtf 3. 1977
Q SacUaa in of tba Act of October 3. 1977
Q Settles 1M oj ta« Act of Octoeer a. 1977
DO NOT WRITE ABOVE THIS LINE. SEE INSTRUCTIONS BEFORE FILLING IN APPLICATION. IF YOU NEED MORE SPACE TO
ANSWER FULLY ANY QUESTION ON THIS FORM. USE A SEPARATE SHEET 'AND tDENtTFY EACH AWSWER WITH THE NUMBER
OF THE CORRESPONDING QUESTION. PRINT IN BLOCK LETTERS .
COMPUTE ONLY ONE OF THE FOLIO WING 1 1 A. 10. OR 1C I:
l.A. I hereby apply to become a lawful parmaasat nasuteai ate oa tbe following baaa:
I am i native or citusa of Vietnam. Uto& or Ounbotiu led hava been physically praaent In the United Slate* (or at lu*t two yean and:
ill fl «u paroled into too Unltsd Suta as a refujse frwn Utooa counlnes subaequent W March 11. UTS. but prior to January 1. 1971:
or
i2t O] «ae uapactsd and admitted or ptrolod Into tba United SUM on or before Marco 31. 1975. and waa phyxically promt in UM
Umwd Suua oa Marc4 a. 1873.
l.S. I tursby ipolr la turn my admiuton for parmsaant midearo recontsd ai o( Mucfc 11. 1JI3. or UM daw of mj amval in tb* United
Stain. wtodBRwr data ii later. I was law<uUy tdmtUsd lor permiatat midcac* prior to October 21, 1>77.
r~l I am a oattra or citiaa of Vietnam, Lao*, or Cambodia aad I jura oaen plrftieallr presort in Uw United Statos for at Idaii tw»
l.C. I heretay apply te boconia a latrful permaoefli reai4asK alien *a tba following bam:
I am not a native or attorn o( Vietnam. Laos, or rJrlh«ii« but I have been physically preteot la UK (Jailed SUtu for at least
two yon and I am tte f"! ifaae Q[] muar uumarriol caild o/ a native or cltlxea of Vietnam. Lao*, or Cambodii.
t My name u (ParaUy Nan») (Plnt/Glvea Mamat
IA. Name wtuch you were adnuued to Uie Uutcd SUlag (U dilfcrool Iron) above)
}. I mule u> the United Siata at: uVo. It Street) (Apt, No.) (Clry & Sutei- (Zip Code)
i. Alua rejittnuoa No. ) I. I am soar a cjttao at (Country) 1 7. Date of Birth
A-
S. Place of Birth (Oty or Town) (County, Pravlaca, or Slat*) (Cauniry)
}. Name a> appears on ooumnugrant documeat Perm
1-M
My 1-94 permit nvanber u:
10. My last arrival U the L'oitad Stala occurred oa:
DATE: (Moata. Day. Ytarl
m
At UM Port at iCity, Slate)
SEX CD Male d Female
4- Have you ever jppU«.' (or permanent re>
Idonra itanu m the Untied Stata?
Set f^] No (If "Yei". jive data and
of [Una; aad final dljpottuon.)
11. 1 amv*d by (Name of vessel or otoer cnaaaa of travel)
ai a (Vltitor, jtndeot, U.S. citizen, nowaway, unmitriot, parole*, etc)
li My ooeunnugraat visa, mgnoer.
on iMooca. Day, Year)
^ vat timed by the U.S. Comul
at (City, Country!
I have beta i
including my pr*MM irumaje, if now married. (It you are now married five the following)
A. Number of time* my huabaod or wife hat been tnametl.
B. Mam* of tnuband or wife (Wlfe'i maiden name)
C. My huaaand or wife midea Q *>Ui me Q apart from me at Addnaa (Apt .No.) (No. & Street) (Town or City) (Province or State) (Country)
IV 1 n luv« f 1 have not been abaenl from UM United Slate* during tan paat two yean.
FORM 1-WC
(Rev.
TM 793
ADMINISTRATIVE MANUAL
Appendix I
1-4
Pag
16 In the spaces below Us! all of vour entries into and departures from the Ununl Stales 'Show vour LAST rntrv FIRST'
Enirred ai iV
uujem parole* stuwiwa
Date of Departure
Port of Departure
daughter i residence '
Now living at
B The following members ol my Umuy are also appmng lor permanent raioent JUtus
18 1 lilt below all organizations societies, ciubs and associations. put or present in which 1 nave held memDersmp m the United Slates or i
foreign country aod Die periods and places ol such memoerstup ill you have never Dem a member of any organization slate "None
19 1 ii havr | i have not oeen treated lor a mental disorder drug addiction or alconoiism ill you have been, explain i
SO I [ I have I I have not been arrested convicted or confined in a prison i II you have been, explain >
21 I L I have !~~l have not tarn the beneficiary of a pardon, amnesty rehabilitation decree, other act of clemency »r similar action 'If vou
been explain •
22 I r~1 havr [~~1 have not ordered assisted, or otherwise participated m the persecution of any person because of race religion or political
opinion ill vou have, explain i
53 APPLICANTS FOR S7ATU? AS PERMANENT RESIDENTS MUST ESTABLISH THAT THEY ARE ADMISSIBLE TO THE UNITED STATES. EX-
CEPT AS OTHERWISE PROVIDED BY LAW ALIENS WITHIN ANY OF THE FOLLOWING CLASSES ARE NOT ADMISSIBLE TO THE UNITED
STATES AND ARE THEREFORE INELIGIBLE FOR STATUS AS PERMANENT RESIDENTS UNDER THE ACT OF OCTOBER 21. 1977
AJiere who have commuted or who have been convicted of i crime involving moral turpitude idoes not include minor traific violation! > aliens woo
have been engaged in or who intend to engage in anv commercialized sexual activity aliens who ire or at any time have b**n anarchists or members
of or affiliated wit!) any Communist or olfter totalitarian parry, including any subdivision or aifiliate thereof, aliens who have advocated or
taught. either by personal utterance or by meant of >ny written or printed matter, or through affiliation with an organization. in opposition to or-
ganized government IIP the overthrow of government by force or violence, inn the assaulting, or killing of government officials because of their
official character nv> the unlawful destruction of propem iv< sabotage or ivn the doctnnei of world communism, or toe establishment of i
totalitarian dictatorship in ihe United Slates, aliens who intend to engage in prejudicial activities or unlawful activities of a subversive nature.
aliens who have ben convicted of violation of any law or regulation relating to narcotic drugs or marihuana, or who have been illicit traffickers in
narcotic drug] or marihuana, aliens who have been involved in assisting any otbrr "alums in enter Uw United States in violation of law alien wno
have applied lor exemption or discharge from training or service in toe Armed Forces ol the Unitad Sum on the ground of alienage and who have
been relieved or discharged from such training or service aliem who ordered assisted or otherwise participated in ihe persecution *f any person
because of race, religion or political opinion
Do anv of the foregoing classes apply to you" l~~1 Yes f~lNo (U answer is Yes. explain'
34 LJ Completed Form C— J25A < Biographic Information i is attached as part of thu application
f~l Completed Form G-nSA i Biographic Information I is not attached as applicant is under U ytars of age
25 IF YOUR NATIVE ALPHABET IS IN OTHER THAN ROMAN LETTERS
WRITE YOUR NAME IN YOUR NATIVE ALPHABET BELOW
Signature of Applicant.
Date of Signature,
Aooress of person preparing form if outer than applicant
26 'Signature of person iirepanng form if otner than applicant i 1 declare that this
documem was prepared by me ai the request of the applicant and 15 based on all
information on which 1 have any knowledge
E2U.
Occupation
including the attached uocumenis. that the same are true
mad* By me or at my request, and that this application was signed b
., do swear i affirm i that I know Uw contents of this application subscribed by me
best of my knowledge and that corrections numbered ' i to i > wert
th my full, true name
iCoroplete and true signature of applicant!
Subscribed and sworn to before me bv the above-named apolicant at
iDayi
i Signature and title of officer •
P»g» 2'
10
Page 4
ADMINISTRATIVE MANUAL
Appendix I
TM 793
AUEN NUMBER
ADDRESS
LAST NAME
FIRST NAME
MIDDLE NA.VIE
EN CARE OF
NUMBER /STREET
CITY
L_J
STATE
ZIP CODE
MOTHER'S FIRST NAME
FATHER'S FIRST NAME
CITY / VILLAGE OF BIRTH
CTTY OF PRESENT RESIDENCE
CTTY OF FIRST U. S. RESIDENCE
INS ADJUSTING OFFICE
I I I I
I I
DATE OF BIRTH
POE CLASS ADJ. DATE
COB OFFICER'S DESIGNATOR
DO NOT FILL IN THIS PAGE. CONTINUE ON PAGE 9.
(P?|< 1)
10/1/80
4-65
TM 793
ADMINISTRATIVE MANUAL
Appendix I
I-485C
Page 5
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization Service
Form Approved
OMB No 4J-ROS9S
DEMOGRAPHIC DATA TO ACCOMPANY APPLICATION FOR CREATION OF A RECORD OF LAWFUL ADMISSION FOR AN iNDOCHLNA REFUGEE
'PLEASE TYPE OR PRINT'
1 (Family Name, in CAPS'
iFirsli (Middlei
2 Mien Registration Number
A-
la Name which you were aomitud to the United Suies n different from aoovei
Te ephone Number
3 Dale of Birm (Month) iDjyuYeari 4 Cm u
nd Country of Bint 4a Nationality b r~\ f^ait
CD Female
6 £3 Single fj Married
l~~l Divorced 1 1 Widowed
' Lai ill of your Dependents in the L-mied Sum:
Name and Relationship Sei
Place of Birth Dale of Birth Type of School /Grade Completed
a Family Name First Name
FATHER
MOTHER I Maiden name)
D*tt. City and Country of Birth (If unowni City and Country of Residence
4 Appbcant 5 resweBce last frve yean List present address dm. (EXCLUDE RELOCATION CAMPi From To
Street and Number
City Province or Stale Country Month Year Month Year
Presenl
10 1 am currently rending or
C Apanroent I I Mobile Home <~1 Condominium \~~\ House [~~! Other (Specify
11 Art you living rent free' FT] Yes [_"] No
i: Applicant 3 employment last three 111 yean
Usl present emoloymem first.
li Fluency in English
Full name and Address of Employer
Job Title W:ge / Hour
iChecu Poor Fair Good
Readme
Writing
Speaxing
14 Lut .iob title ABROAD
15 Name and Location of Schools Attended
Type of School From /To Highest Grade Completed Title of Degree
16 To be answered only by the head of household to the best 01 his/her ability
Have yon received any public / private auisunct
Public Assistance (Source i
Type From /To
Dollar Amount
Pmat* Assistance I Source i
(Page 5'
FORM I— MIC
(Rev t-»-7SiN
10/1/80
4-67
FORM 1-526
jP*
I. USE:
USED AS AN ADDENDUM TO FORM 1-485 BY APPLICANT FOR PERMANENT RESIDENT
STATUS TO ESTABLISH HIS/HER ELIGIBILITY FOR EXEMPTION FROM THE LABOR
CERTIFICATION REQUIREMENT OF SECTION 212(a)(14) OF THE IMMIGRATION
AND NATIONALITY ACT, BECAUSE HE/SHE IS AN "INVESTOR" IN THE UNITED STAT
II. ELIGIBILITY:
1. MUST BE ELIGIBLE TO APPLY FOR ADJUSTMENT OF STATUS ON FORM 1-485.
2. A NONPREFERENCE VISA NUMBER MUST BE AVAILABLE TO THE APPLICANT.
3. MUST HAVE INVESTED OR BE ACTIVELY IN THE PROCESS OF INVESTING AT
LEAST $40,000 IN CAPITAL IN AN ENTERPRISE IN THE UNITED STATES.
III. REQUIREMENTS:
1. ONLY THE FEE FOR FORM 1-485 IS REQUIRED. The 1-526 DOES NOT REQUIRE
AN ADDITIONAL FEE.
2. MUST SUBMIT EVIDENCE TO ESTABLISH THAT APPLICANT HAS INVESTED OR IS
ACTIVELY IN THE PROCESS OF INVESTING CAPITAL TOTALLING AT LEAST
$40,000 IN AN ENTERPRISE IN THE UNITED STATES.
a. EVIDENCE MAY INCLUDE BUT IS NOT LIMITED TO:
(1) CANCELLED CHECKS
(2) RECEIPTS
(3) BANK LETTERS
(4) BILL OF SALE
3. MUST SUBMIT EVIDENCE THAT APPLICANT HAS ESTABLISHED OR IS ACTIVELY
IN THE PROCESS OF ESTABLISHING AN ENTERPRISE IN THE UNITED STATES,
a. EVIDENCE MAY INCLUDE BUT IS NOT LIMITED TO:
(1) CORPORATE CHARTER
(2) PARTNERSHIP AGREEMENT
(3) LICENSE OR OTHER OFFICIAL AUTHORIZATION TO ENGAGE IN BUSINES
(4) BANK LETTERS
(5) FINANCIAL STATEMENT
(6) CONTRACTS
IN THE UNITED STATES AT WHICH TO OPERATE THE ENTERPRISE,
a. EVIDENCE MAY INCLUDE BUT IS NOT LIMITED TO:
(1) A DEED
(2) LEASE AGREEMENT
(3) OPTION TO PURCHASE OR RENT
MUST SUBMIT EVIDENCE TO ESTABLISH THAT THE APPLICANT IS QUALIFIED TO
ENGAGE IN THE ENTERPRISE.
MUST SUBMIT EVIDENCE THAT THE APPLICANT WILL BE THE PRINCIPAL
MANAGER OF THE ENTERPRISE.
MUST SUBMIT EVIDENCE THAT THE ENTERPRISE WILL EMPLOY A PERSON OR
PERSONS IN THE UNITED STATES WHO ARE UNITED STATES CITIZENS OR
ALIENS LAWFULLY ADMITTED FOR PERMANENT RESIDENCE, EXCLUSIVE OF
THE ALIEN, HIS/HER SPOUSE, OR CHILDREN.
ALL DOCUMENTATION SUBMITTED MUST BE IN THE ORIGINAL OR CERTIFIED COPIES
OF THE ORIGINALS.
ANY FOREIGN LANGUAGE DOCUMENT MUST BE ACCOMPANIED BY A CERTIFIED
ENGLISH TRANSLATION.
4/1/81
TO 771
ADMINISTRATIVE MANUAL
Appendix I
STATES DEPARTMENT Of JUSTICE
mfTttKw tut Nituriliutkm Swvlot
REQUEST FOR DETERMINATION THAT PROSPECTIVE IMMIGRANT IS AN INVESTOR
in order to b» relieved from labor certification requirement
of Section 212(a)(14) of the Immigration and Nationality Act
INSTRUCTIONS
READ INSTRUCTIONS CAREFULLY
1. CtKiral— An alien teeking to live in (he United Slain for die purpose of performing skilled or unskilled labor may become a
lawful permanent resident of the United Statti onlv if the Secretary of Labor haj iuued a certification in the alien'i behalf Such
certification mif be iuued onlv if the Secretary of Labor hai determined that (»l there an not sufficient worlien in the United States
who are able, willing and available for the contemplated work and (b) the employment of the alien wiU not advenely affect the wa|ei
and working conditioni of workers in the United State*.
Certain persons ruch M cloie relatives of U.S. citittni or at lawful permanent resident ilicni arc exempt from th« labor certification
requirement. Alio certain refugees are exempt from thil requirement.
In addition, the requirement for a certification bv the Secretary of Labor it not considered to be applicable to an alien who estab-
liihei that he hai mveited, or u actively in the proceti of investing, capital totaling at leui 140.000 in an enierprite in the United States
of which he will be a princ:p'l manscer and that the encerpnie will emplov a penon or penonf in the United Sutea who are United
Sutet citiiens 01 alieni lawluily admitted for permanent residence, exclusive of the alien, hit ipouM and children.
If you believe that vou qualify ai an investor within the preceding parairraph and yeni deiirc to request a determination to that
effect 10 that you will not be considered subject la the labor certification requirement, execute lad submit this form with the prescribed
supporting document*.
2. Wktrt If nhmit r««««l.— If vou are in the United Sutei vou may lubmil the rtquctt on thil form to an office of the Immigration and
Naturalization Service only if you are eligible to applv for adjustment of ttatui to that of a lawful permanent reiident on Form 1-4(5.
In IUCB cut thui forro muit be attached to Form 1-486 and mutt be tubmmed with it to the Service office having jurisdiction over your
place of residence. In all other caaet you may tubmit the requett to tne American Consulate or Embassy at which you intend to apply for
an immigrant vua.
3. Seppertt«i Dmtmttti.— Tie following lupponing document* aunt be tubaxitud with thil form:
a. Evidence that you have invetted or an actively in the proecM a! inverting capital totaling 140,000 in an enterprise located or to
be located in the United States. Such evidence may be in th« form of cancelled ch«du, receipts, bank letters, etc,
Ala
b. Evidence that vou have Mtabliihrd or are actively in the proem at establishing an enterprie in the United States, Sues
evidence ma\ comul of a corporate charter, partnership agnement, license or other official authoniation to engage in buuneu, bank
lettert. financial statement, contracu.
All*
c Evidence that vou have arranged for a place in the United States at which 10 operate the enterprise. SUCA evidence may enuiit
of a deed or leaae or opuon to purchase or rent
Att»
d. Evidence that vnu are qualified to engage in the enterprise. This evidence may contitt of letters from emploven or trainers by
whom vou were emploved or trained in jobs which qualify >ou to engage in ihe enterpriie. describing the title and duties of the job
including tooli and equipment used, the dale vou tuned and terminated such job. and the number of houn per week vou worked ; letters
from former business associates, contract!, invoices and other document! establishing that you have engaged in a similar enterprise., the
me and location of lucn rmerprne and the penod vou were so encaged; certificate*, decrees, professional or journeyman licenses or
other documents indicating you have been found qualified to engage in an occupation or business related to the cnterpriaa in which you
have invested or are acuvtly in the proceu of investing.
4. /tii/M for Dai<iminti.— All supporting documents must be submitted in the original. If you desire to have the original returned to
vou. and if copies are by law permitted to be nude, you mav submit phoiostatic or typewritten copies. PhotMtatic copies unaccompanied
bv the original mav be accepted if the copv bean a certification bv an immigration or consular officer that the copv wai coaparM with
Ihe on final and found to be identical. A foreign document must be accompanied by a translation, certified by the translator ai u the
accuracy of the iraiulaiioa and at to his competency to translate.
5. fKNALTlES.—- Severe penalties an provided by tew for knowingly and willfulrf falsifying or concealing a material fact or using any
false document in the tubrniuion of this fora. Also a lalse representation mav result in the denial of your application for status as a
permanent rendent or anv other application you may nuke for any benefit under I)M uamigrMMn laws of the United Sutea. Any state-
ment submitted with thil form ii considered pan of the form.
fen* k-OM (ftw. lo-7-7g)N
I-S26
Page 1
FORM NO.
1-526
EDITION
REV. 10-7-76
REQUEST FOR DETERMINATION THAT PROSPECTIVE
IMMIGRANT IS AN INVESTOR
8X10 1/2
DS£
REFERENCE
8 CFR 212. 8(b). 299.1; II Hbk 10-4.1, App. 10-E(d)
TO OBTAIN SPECIFIC DATA FROM ALIEN WHO CLAIMS EXEMPTION FROM LABOR CERTIFICATION REQUIREMENT
PRIOR EDITION MAY MOT BE USED
10
-326
age 2
ADMINISTRATIVE MANUAL
Appendix I
TM 771
.rirrtD STA«3 MMHTMtMT OF JU*TI« gjjy,
IfltniirotiM u%4 NituftJiuUofl Stnritt
*•»„
REQUEST FOR DETERMINATION THAT PROSPECTIVE IMMIGRANT IS AN INVESTOR
in order to to relieved from labor certification requirement
of Section 212fa)<14) of the Immigration and Nationality Act
flu. IN WITH TrPEWIITtK O« PRINT IK BLOCK UETTEIW WITH (MUJ'OINT PEN. OO NOT L£AVt AffY QUESTION UWANSWWeO. Wnari
apprapnate Imart "Nona" or "Not Applicable/'. If you na*d mot* <pae* to anjwer fully any quotion on Ui» (arm UK a ttotnu maet of paper
thil «a uxt idantify aacfi antow win tM number of th* oxroeondlng quneofl,
t nanrity doclar* that 1 am waking to becoma a lawful parmanwtt nmdant of th* Unitad Statn for tna purooM of t«|a(inf in an ant*nx>M.
and that 1 hm* inv**tx>. or am activaly in tnt pnxau al Lnvetunf, m men «nt«rwi« capital tatalinf at UMt HO.OOO. On tna Da«i of tuch
InwftAunt. 1 raqimt mat lha labor carnflcation r»<iuir«m«nt of S«ction 21Z(a)(14) of tna Immiiratlon and Nationality Act b« con«id«rad not
apthcaofci CO ma. 1 am submitting thlt rtquott al part of my application to bacoma a lawful p*rm*nant ntuoant of th* UnitM SUM*.
I. ApsiieaAr* Family (urn* (Capital Laflan) (First IUUTM) (Mlddl* ruHm> (M*ntwi ncnw. if mamori wom»n|
t. BMtMMM (Month, day, y**r) BLrOtalac* (City or town) (Country)
1
J. Praoant AddiM* (Numow ind craat) CCIty or towi| (Provmc* or StMa, ZIP Cod*) (Country)
4. Naitw «nd Loe*t«» al tnlarprtta
5. Namot and Imrmcration tutu* of partmri (if looMuoM)
«. Pwca«»»t» of portnannip or «toe« ownod By appik»nt
7. Natur* at antarpriu (Oaicnaa tMiafly; incliM* tolM numa*r of paraona amtlayod or to b* «noioy*d In th* antarpnm* awl ralatlon«Mp, if
any, to lha applicant. Giva nama. nom* aod'na. immitrauon Matua. <nd raianonihip of at lotat on* ampioyoo othar than your ipouio and
cniMran.)
». Chock on*; r] 1 h«v« maa* Uw invmtnwnt. Q ' "« *ottv*ly In th* praevoa of mitont tn* invaMmant.
>. Tho capital Invaumnt 1 mod* or am acuvaly in tA* praeMa of nwainf, camiaa of:
Otrw S Mncrltat
0««-jr S ,,„ toaocrlbak .. _. .
TOTAL S
19. Omcnb* brtafly now you mil *nf«f* in UM Miarpnw. indwdin« th* tiU* of «n» JOB you will fto»d Hi it and th* number of noun per «*•*. you
M* davou to the (ad.
turn l-*J« (**«. IO-7.7«H 4*W
10/1/80
TM 771
ADMINISTRATIVE MAMUAL
Appendix I
I -526
Page 3
i
I
11. EXPERIENCE— Cmploymant or training you heva had which qualify you to angaga in th« antarprisa:
Him* and ftddraat of empieysr or CTsuw
Dm started cw. toft
Kind of buslnM*
OMCrtba In tfotaU drtfaa you parformad. Including UM of tool*, machlrtas. or •quipmant. Ho. of houra par wo**.
Narto and (darns of amptayw or tnincr
NnMof tab
DMCTIIM M oauil dutM* you •arfomwd, todudln* ut* of took, moehina. or oquipmuic No. of hours por WM*.
12. Oaoertba any addrtional qualifications you poaaaas tor anfaging in tha am*rpnaa.
II. U*t licanaaa (prolaational. Joumayman, ate.) you hava ncawad.
14. I haw atuchad tha tollowinj doeunvnury awdanca (chack aach box appt«aW«).
Q Financial alMamants. such aa baianca snaat or profit and loss statamant.
Q Ucansa or othar official authoruaOon to anfafa In bualnasa In U.S.
G Corporata chartar or partnarship acaamant Q Uaaa or daad to prwrwaas. fj Canoallwi chaKta.
Q Bank staianMnt showing bank baianca. Q Businau contracts. Q Racolete.
Q Licansas racanwd outslda tha U.S. Q School racords. cartinCMas or diptomas. Q EfnptoymMrt Mtcri
Q Othar (daacrlba brlafiy).
19. If your natlva alphabat Is in othar than Roman Lattara. turrta your
narna In your natrva alphabet balow:
Si(natura of Applicant
it. (&(nalurt o< parson prapanng term, If otnar than applicant) I
oaciara that this documant was praparad by ma at tha raauast of
tha applicant and is baaad on all Information on which I nava any
knoviaeii.
Data of signature
Addrass et parson praoannj form, tt othar than applicant.
FORM 1-570
USE:
USED BY AN LAIEN GRANTED REFUGEE OR ASYLUM STATUS IN THE UNITED
STATES TO APPLY FOR THE ISSUANCE OF A REFUGEE TRAVEL DOCUMENT OR
AN EXTENSION OF A PREVIOUSLY ISSUED DOCUMENT.
(NOTE: THE REFUGEE TRAVEL DOCUMENT IS USED AS A TRAVEL DOCUMENT IN
LIEU OF A PASSPORT. IT IS ACCEPTED AS A VALID TRAVEL DOCUMENT BY
COUNTRIES SIGNATORY TO THE U.N. CHARTER ON THE STATUS OF REFUGEES.)
ELIGIBILITY:
MAY BE FILED BY AN ALIEN IN THE UNITED STATES WHO IS A REFUGEE.
(NOTE: ADJUDICATOR WILL DETERMINE IF APPLICANT QUALIFIES AS A REFUGEE.)
REQUIREMENTS:
1. APPLICANT MUST BE PHYSICALLY PRESENT IN THE UNITED STATES AT THE
TIME APPLICATION IS FILED.
2. PROPER FEE.
3. PHOTOGRAPHS PER INSTRUCTIONS ON APPLICATION IF APPLYING FOR ISSUANCE
OF A TRAVEL DOCUMENT.
4. ANY PREVIOUSLY ISSUED REFUGEE TRAVEL DOCUMENT OR REENTRY PERMIT STILL
IN THE POSSESSION OF THE APPLICANT.
5. ALIEN REGISTRATION CARD IF APPLICANT IS A PERMANENT RESIDENT.
(NOTE: APPLICATION SHOULD BE NOTED "FORM 1-151 OR 1-551 SEEN AND
RETURNED" AND THE CARD RETURNED TO THE APPLICANT.)
6. FORM 1-94 FOR ANY APPLICANT NOT A LAWFUL PERMANENT RESIDENT.
7. IF NOT PREVIOUSLY GRANTED REFUGEE STATUS, EVIDENCE THAT APPLICANT
QUALIFIES AS A REFUGEE. IN ADDITION, FORM 1-589, IF NOT PREVIOUSLY
SUBMITTED.
ADMINISTRATIVE MANUAL
Appendix 1
1-570
Page 1
(PleaM tear oil this shaet belou submitting application)
APPLICATION FOR ISSUANCE OR EXTENSION OF REFUGEE TRAVEL DOCUMENT
(Article 28, United Nations Convendon of July 28. 1951 and
Protocol of 1987 relating to Status of Refugees 8 CFR ??3 >|
INSTRUCTIONS
READ INSTRUCTIONS CAREFULLY. FEE WILL NOT BE REFUNDED.
IMPORTANT - Please read attached Instructions before Oiling out application. Use typewriter or print In block letters
with ball-point pen. Be sure this application and the attached address mailing label are legible. Do not leave any question
uuanswered unless the instruction on the form expressly states that under certain circumstances it need not be answered.
When appropriate Insert "none" or "not applicable". If you need more space to answer fully any question on this form
as* a separate sheet of paper this size, and identify each answer with the number of the corresponding question.
1. Eligibility. • An application lor a refugee travel document may be Iliad by any alien In the United Slate] who is a refugee as denned In paragraph 2.
A relugea travel document will not be Issued 10 an alien if:
a. It Is determined mat there are compelling reasons ol national secunty or public order for not Issuing the document, or
b. The alien Is in the United Sates unlawfully and it is determined in the exercise of discretion that the document should
c. The alien is a lawful permanent resident who is In possession ol a reentry permit previously issued unless such permit
aMllcatinfl
not be issued.
:h permit is surrendered with this
t. Definition of Refugee. • Refugee means an alien who has established that he/she, owing to i well-founded feai of being persecuted by reason of race, religion,
nationality, membership In a particular socnl group or political opinion, is outside me country of his/her nationality and is unaoie or. owing to such fear. Is unwilling to
tvall himself/herself of the protection of that country, or who, not Having a nationality and being outside the country of his/her former raatuai residence is unable or, ow-
ing to such fear. Is unwilling to return to II In the case of a person who has more Iran one nationality, the term "me country of his/hor nationality" shall mean eacn of the
countries of which he/she is a national, and a person stall not be deemed to be lacking tne protection of the countries of his/her nationality il, without any valid reason based
on well-founded tear, the alien has not availed himseil/herseif of the protection of one of me countries of which he/she is a national. The term refugee shall not apply to
any person who: (1) has voluntarily re-availed himself/herself of the protection of the country ol his/her nationality: or (2) having lost his/her nationality, has voluntarily
rucqulred It or (3) has acquired a new nationality, and enioys the protection of the country of his/nor new nationality, or (4) has voluntarily reestablished htmseil/henett
hi the country which he/she let or outside which he/she remained owing to fear of persecution: or (5) can no longer continue to refuse to avail himself/herself ol the oro-
(action ot the country of his/her nationality because the circumstances In connection with which he/she has been recogmied as a refugee have ceased to exist; or (6) be-
ing a person who has no nationality Is able to return to the country of his/her former habitual residence because the circumstances In connection with whicti he/she has
been recognized as a refugee has ceasad to exist.
The term refugee also applies to any person who hu been considered • refugee under the Arrangements of 1 2 Way 1 926 and 30 June 1 928 or under the Conven-
tions of 28 October 1933 and 10 February 1939, the Protocol ol 14 September 1939 or the Constitution of the international Relugee Organization. Persons who could
have been so considered include certain Russian, Armenian, Turkish and Assyrian refugees; certain refugees from Germanv and Austria: certain victims ol the nazl and
fascist regimes or ol regimes which took part on their side In tne Second World War, certain victims ol the Falangist regime in Spain and certain war orphans.
3. Definition ol Reluo.ee Travel Document. • The term "Relugee Travel Document" as used In this application means a document issued by the Immigration and
Naturalizabon Service on Form I 571 in imp'lemenutlon of Article 28 of the United Nations Convention of July 28, 1 95 1 1n accordance with the provisions ol Part 223a of
Tin* i of the Code of Federal Regulations.
4. Submission of Application lor Issuance of Relugee Travel Document. • Application lor Issuance of the document must be submitted while you are In the United
States and should be submittnd, at least 45 days Dolors the proposed date of your departure, to the Immigration and Naturalization Service olflce having jurisdiction over
your place ol residence.
A separate application must be executed by each applicant. A parent or guardian may file an application In behalf of a child who is under the age ol 14 years.
Form G-325A (Biographic Information) mst be completed and submitted witli each application if the applicant is 1 4 years ol age or older. Failure lodosodelays
action and may result m return of (he application. A Relugee Travel Document will cover only one applicant.
5. Documentary Evidence. • If you believe you are a refugee because you came to the United States under a U.S. refugee law or program or because you were granted
status or a benefit by the U.S. Immigration and Naturalization Service on the basis ol a claim to persecution, you need not submit with this application documentary
evidence to establish that you are a refugee. II it is determined alter review of your case that such evidence should be submitted, you will be so advised.
II you believe you are a refugee on grounds other than those descnbed in the preceding paragraph you should suomit the best evidence available to you to establish
that you are a refugee Such evidence may be in the form ol newspaper clippings or other published material, affidavits, tellers, etc. Copies ot newspaper clippings or
other published material must b» identiliixJ as to data, place and name ol publication. Affidavits must b« sworu to or afirmed by oersons having personal knowledge ol
the events or circumstances involved, and must set forth the loliowmg: Affiant's lull name, address, dale and place of birth, i.ilalionship to you, if any. lull Information
concerning the events or circumstances Involved, and complete details concerning how 'he affiant acquired knowledge ol the events or circumstances.
FORM NO.
1-570
EDITION
REV. IO.-I
TITLE
APPLICATION FOR ISSUANCE OR EXTENSION OF
REFUGEE TRAVEL DOCUMENT
size
8 X 10 1/2
INSTRUCTION RJCFESUCNCC
8 CFR 223*. 4. .7, 299.1; 01 22J...9; AM 2301.07. 2482 Ex. 2, P. 2. 29S4 Ex. 2, P. 2
OSJC
SUBMITTED BY A REFUGEE IN THE U.S. TO APPLY FOR EXTENSION OR ISSUANCE OF A REFUGEE TRAVEL DOCUMENT
PRIOR EDITIONS MAY NOT BE USED
SCHEDULE
J. Alien fteji.'lration Receipt Card You must attach lo tins applicjlion your Alien Registration Receipt Card (Form 1-1 51 , 1 551 . AR 3. AH- 103. Of I 94). II your form
194 IsitttcSd M you' passport, the iomi snouid M removed io» this purpose. DO NOT SEND IN YOUR PASSPORT I! you ve no; a lawlul aermanenl resident ct the United
States and do not .lava Form I 9J. apply ';' :hat lorn oy ewci-ling and CuWiitting an aapiication on Fo'm I 102 in accordance wi«i tne instructions on ttiat apoiica'jof II
you are a Uwiut permineni le-Xent <.' '.M 'jn.ted Slates and uc not have foim 1 1 SI or 1 i5'. . apply lor tha: lorn ay executing in jppiica!;OT on Form I 90 Your A^ier
Registration Receipt Card will M returned 10 yw.
t. Photographs • Ycvmusl sand with llus application two pnolojiaphs ol >oursell taken within 30 days ol the date ol mis application. These photographs must be
Identical. 2 byzinchos in si«. anc distinct 'torn top ol head lo pr*ni ol cnin should M appiemmateiy 1 "i inches Either black a«t while or color ptiolographs u» accep-
table. Photographs MIST BE OH THIN PAPER, have a Hgnt background, and clearly snow a Irom yiaw ol your tact wilhoul ha'.. Color photographs must M pnmed on a
paper base. Black and A-mte prints wt)ir-n rave seen colored, snapshots, gioup ppotoqiaphs. or machine made photographs will not Oe accepted. Using crayon or soli
pencil to avoid passion mutilation at the g.lotographs. write you alien registration number lightly on me reverse ol ine photographs.
I. Reentry Perm lls. • II you are a lawful permanent resident ol the United Stales you must submit witn this application any reentry permits previously issued to you.
I. Fee. • A lee ol live dollars (J5) must be paid for filing Ihis application it cannot be refunded regardless ol (he action taken on {he application 00 NOT MAIL CASH.
ALL FEE§ MUST BE SUBMITTED IH THE EXA.C1 AMOUNT. Payment by cneck or money otot' must be orawn on a bank or oirxt institution located in the Umtetf Salts
and be payable In Unl;«d States currency II applicant resides m Guam, check or money orcer must be Myaole to the "Treasurer, Guam." II applicant resides in the v.rj.n
Islands, check or money order must be payable 10 irte "Commissioner ol Finance ol me Virgin islands." All other applicants must make the crack or money order payable
to ttt "Immigration and Naturalisation Service " When check is drawn on account ol a person other than tn« applicant, the name ol tn* applicant must M entered on the
face of the check. II application is ^ubmirted Irom outside the United Sans, rerrirance may be mad* by Mr* international money order at foreign draft drawn on a finan-
cial institution in the United Stales are c-'vaM to tne ••Immigration and Naturalisation Service ' >n United Stales currency Personal enters are accepted suoiect to cciiec-
Utility. An uncollectlblg check will render ine application and any document issued pursuant thereto invalid. A charge ol J5.00 will Do imposed II a check in payment of a
tM It not honored try tn« bank on wived it is drawn.
10. Delivery el fleluoee Travel Document. • Wiwn a Refugee Travel Document Is Issued, it will be mailed lo the applicant at the Mdreu m me UftlMd States is shown
on the application lorm. un'ess :ne applicant reouesls trial it be manee to a rj'Mei;m address in the United Statss. II me aopi-cani ''ndc n absolutely necessary to depart
Irom me United States before securing ine OKumem. an immigration and Naturalisation Service officer snould be consulted before leaving the United States.
II. Extension. • A holder of an unexpired Refugee Travel Document wfcch has not been extended lor the maximum add.;.onai period of one year Irom ttw original e»
ptntloo date may apply tor an extension of the document The intension application should be submitted between 60 and 90 days prior lo the expiration ol the validity ol
the Relugee Travel Document. It may be suarnittu lo the Immigration office having lunsdict.w over the applicant's place ol residence in the united States or to the United
Stales Immigration officer stationed abroad having lunsdiction over the place where tne aponcant is temporarily soiourmng. It may also be submitted to certain American
consular offices Inquiry may be made it any immigration office tor the location ol United Slates immigration officers abroad and consular oltices authorised lo eitend
Refugee Travel Documents.
You mint attach Id this application your Relugee Travel Document so that appropriate endorsement ol tne extension, if granted, may be made therein.
II you are in the United States, the Refugee Travel Document will be returned to you by mail directed to your United Slates address. If you are abroad, it WIN be mail-
ed to Ine United Stales Immigration office aiiriud or the consular otiice nearest to yoj. and you will Be notified to appear at that office to accept delivery
The validity of a Refugee Travel Document may be extended for only one (1) additional year from the ongintl expiration date.
12. Foreign Visas The Refugee Travel Document contains pages on which consular officers ol foreign countries mjy arils visas lor entry into those countries. It is ad-
visable for you to check with the consular representatives of foreign countries which you intend to visit concerning ine) visa requirements (II any) of those countries,
before traveling to them.
13. Authority, • The autnortty lor collecting the Information requested on this form is contained In 8 U.S.C. 1 1 03 and Article 21 of the United Nations Convention of
July 2S. 1951 as modified by the Protocol Relating lo the Status ol Re'ugees of January 31 . 1 967, to which the United States is signatory. Submission ol tn* infornubon
solicited Is voluntary. The principal purpose lor which the information is solicited is lo determine the eligibility ol the applicant lor ttw benefits sought. Tn* mlormation
solicited may also, as a matter of routine a:, ee disclosed to other federal, slate, local, and foreign law enforcement and regulatory agencies, lie Department of Oelense
Including any component thereof (11 the Wicant has served, or is serving in the Armed Forces ol the United Sates), tne Department ol Sute, Central Intelligence
Agency. Interpol, and individuals and orgaart lions diinng the courst cf investigation to eta! further information required by Iht Service to carry out its function. Failure to
provide ttw solicited Information may result In tne denial of the application.
Fot«kbyU«Su(»nBW«)uil^Doauncnu. US GoMM Pnntw OTfiM
Wiiftinpina. DC XM(|] iPu 1001
S»iNu»boOJ7J02 00X114
4/1/81
(Please tear oft W» shMI Mtore submitting application)
4-75
LAWFUL PERMANENT RESIDENT ALIENS • DOCUMENTS FOB ENTRY INTO THE UNITED STATES
In feu al an Immigrant visa a lawful permanent resident alien upon reluming to the United Stalls may prawn! at time of application lor reentry an Allen Registration
teMfpt Card on farm 1-151 or I 551. a a Reentry Pemiil. or a Refugee Travel Document on Form 1-571.
An Atofl Registration Receipt Card Fomi 1-1 51 of 1-551 . may be presented Instead oi a Reentry Permit or a Refugee Travel Document on Form 1-571 after an absence of
not more than one year. The 1 -year time limitation is not applicable to the spouse or child ol a merouer ol the Armed Forces ol me United Sutes or of a civilian employee of
the United States Government stationed abroad pursuant to otlicul orders, il the spouse or child presrms Form 1-151 or I 551. did rot relinquish lawful permanent
residence, and Is preceding or accompanying the member or employee o' .s following to |om th« member or employee in the United States within 4 months of the return of
M member or employee.
If you prefer to travel with a Reentry Permit, you may submit an application lor such permit on Form M 31 . If you prefer to travel with a Refugee Travel Document, you
may Mbmit an application In that document on attached term 1 570.
LAWFUL PERMANENT RESIDENT ALIENS
EFFECT Of ABSENCE FROM UNITED STATES UPON NATURALIZATION ELIGIBILITY
A Refugee Travel Document Issued to a lawful permanent resident ol the United States dots not relieve tne person to whom issued Irom meeting the requirements ol
the naturalization laws. Absence Irom the United Sutes By.'" a&plir-n! lor naturalization for a continuous penod ol 1 year or more during the period for winch continuous
residence In the United Sutes is required lor admission to citizenship mil Break the continuity o! such residence, except where, prior thereto, the Attorney General has so
proved an absence (a) m the employment ol. or under contract »ith. tne United States Government * an American institution ol research recognized as such by the
Attorney General, or (b) in the employment ol an American firm or coiparaiion engaged in whole or pan in tne development ol foreign trade and commerce in tne United
States or a substdia^ tnereol. more than 50 percent ol whose SIOCK is owned by an American firm or corporation, or (c) in the employment ol a public international
organization of which the United Su'.es is a menser by treaty or staiule and by which the alien was not employed until alter being '.awfully admitted lor permanent
residence In order to quality lor such approval the applicani musl hive beta physically present ant! residing in the United States, alter oem; adm.tteo foi permanent
residence lor an uninterrupted period of at least one yna< Tho granting ol such approval does not exempt tne applicant Irom tne requirement that he/she be physically pre
tent in me United Stales lor al least one hall ol the period ol residence requimd lor naturalization except m the case ot those persons who (a) are employee Sy. o- under
contract with the Government ol the United Sutes. la) who are authored to pirtorn :he ministerial or priestly functions ol 4 religious denomination Having a buna dee
organization wilhm the United States, or (c) »no are engaged solely By a religious denomination or by an interdenominational mission organization having a bona tide
organization witlwi the United Stairs as a missionary. Prettier, nun. or sister Sucn apj'Oval shouio be appl'ed lor on Form N 470 "Application to Preserve Residence !o:
Naturalization Purposes (under section 316(b) or 31 7. Immigraiicn and Nationality Act)." available al any office of the Immigration and Naturalization Service Aliens wlu
are absent in connection with or lor the purpose ol performing the ministerial or pnestly lunctions ol a religious denomination having a bona Me organization in tne Umteo
Stales, or who are engaged by such a denomination or an interdenominational mission organization having a bona fide organization within tne United Stiles, as a mis
•ionary. brother, nun. or lister are also eligible to make Such application.
LAWFUL PERMANENT RESIDENT ALIENS
EFFECT OF CLAIM TO NONRESIDENT ALIEN STATUS FOR FEDERAL INCOME TAX PURPOSES
An alien who has actually established residence in the United Sutes alter having been admitted as an .mmigrant c* after having adjusted status to that of an immigrant.
and who Is considering the tiling of a non-resdent aimn lax return or the non-Minn, ot a tax return on the ground that he/she is a nonresident alien, should consider carefully
*• consequences under the immigration and raturakzanon laws if he/she does 50.
It in alien alus such action, he/she may be regarded as having abandoned his/her residence In the United States and as having lost his/her Immigrant status under the
Immigration and naturalization laws. As a consequence he/she may be ineligible let a visa or other document lor which lawful permanent residen' aliens are eligible: may be
Inadmissible IP the United Status il seeking admission as a returning resident; and may become ineligible lor naturalization on the basis ol his/her original entry and adjust
m*nt as an Immigrant.
H-/O
I-S70
Page
ADMINISTRATIVE MANUAL
Appendix 1
ALIENS WHO ARE NOT LAWFUL PERMANENT RESIDENTS
EFFECT OF ABSENCE FROM TH6 UNITED STATES UPON ELIGIBILITY FOR
STATUS AS PERMANENT RESIDENT ALIENS
K you were admitted to the United Stales is a conditional entrant and havs not yet been in the United States lor one y^ar, you will not be considered eligible to seek
status as a permanent resident under section 209(a) ol (ho lmmigratio.1 j>.rvj Nationality AcL as amended, until you nave return*} to trie Uo.ted SUIss and nave compltted
do balance of the required one yoar penod within the United Stales.
H you ire a refugee from Cuba who intends to apply lor status as a permanent resident under me Act of November 2. 1 966 and nave not yet been physically present in
he United States lor one year, you will nol be girdle lo apply lor that status until you have returned to the United States and have completed tne balance ol the required
one year period ol physical presence.
An alien who has been paroled or admitted to tne United Slates as a refugee, or who has been granted asylum In the United States, and who intends to apply lor perma-
nent residence under DM provisions ol SecUon 209 (a) or (b) ol Ira Immigration and Nationality Act. as amended, who departs the United Slates prior to completion ol one
year continuous physical presence will not be eligible to apply lor such status until that alien has returned to the United States and has completed me Balance of the re-
quired one year period of physical presence.
CAUTION: It Is the responsibility of each alien issued a Refugee Travel Document under the above conditions to establish trial He/she continues to be qualified a$ a
refuge* upon return to the United States. (See Instruction page t, paragraph 2. lor definition of refugee.)
PENALTIES
Seven penalties are provided by law lor knowingly and w.lllulry falsifying or concealing a material fact or using any lain document In the submission of Ws appUca-
Bon, v lor knowingly forging, counterfeiting, altering or otherwise misusing a Relugee Travel OccumenL
4/1/81
4-77
i
ADMINISTRATIVE MANUAL
Appendix 1
I -570
Page 5
Immigration and Naturalization Service
Form approved.
OMB No. 43 R 051 7
APPLICATION FOR
ISSUANCE OR EXTENSION OF
REFUGEE TRAVEL DOCUMENT
(Article 28, United Nations Convention of
Jury 28, 1951 and Protocol ol 1967
relating to Status ol Refugees. 8 Cffl 223a(
I hereby apply for (check one):
Issuance
D Extension of refugee travel document.
3. DATE OF BIRTH Month. Day. Yean
4. My present immigration status in the u.S is (Parolee, lawlul permanent resident, conditional entrant, visitor, etc.)
UJUUNC
WOttSS
KUS.
FAMILY NAM£ (Cmul Utlt
2. ALIEN REGISTRATION NUMBER
FEET INCHES
COUNTRY Of BIRTH
IMPORTANT: II you are an applicant tor Issuance ol a Refugee Travel
Document submit your Alien Registration Card and any reentry permits
previously Issued to you with tnis application
II you are an applicant tor ntutlm ol the document submit with this
application only thg document and complete blocks 1 . 2. 1 9, 20 and 21 ;
H you are a lawlul psrraanen! resident also complete Block 1 8.
COUNTRY OF NATIONALITY. IF ANY
VISIBLE MARKS AND SCARS
COLOR Of EYES COLOR OF HAIR
Country horn which I am a refugee
5. At (me ot my jasj arrival In me U S. I was accorded the immigration status ol
I last arrived In the U.S. at:
(city and Slate) (date)
I was last Issued a visa by a U.S. Consul m.
(city and country)
by: (name of vessel, alrhrw
or other means ot travel)
on: (dan)
Q wai
D was not
taptctod.
Type ol Visa
D l-belleve I am a refugee because I came to the U.S. under a U.S. refugee law or program, or because I was granted a status or benefit by
ttu U.S. Immigration and Naturalization Service on the basis ol a claim to persecution.
D I belltve I am a relugee lor the following reasons: (Furnish specific details and attach supporting evidence].
7. a. Since becoming a relugee:
I O rave O rave not voluntarily re-availed myself of the protection of tf« -ountry of my nationality.
O haw O have not voluntarily re-acquired the nationality which I lost.
O have CD have no; acquired a new nationality.
D have Q have not voluntarily re-established mysell in the country which I led, or outside which I remainad. owing to (ear ol persecution.
The clrcunutances In the country of my nationality (or country ol lormer habitual residence it stainless which resulted in my becoming a relug«i
D havi O have not ceased to exist.
b. I D am Q am not In possession ol a passport or similar document. II you have such document, give name ol country ol Issuance and date ot expiration.
1. 1 1st below all organizations, societies, clubs, and associations, past or present. In which I have held membership, and the penodi and places ol such membership.
(II you have never Men a member of any organization, state "none".)
1-570
Pag« 6
ADMINISTRATIVE MANUAL
Appendix 1
nature of each chargt jnf the <<rul reiulr.l
10. 1 d*1*** O "'"• B01 previously filed an application with the U.S. Government or any other government for a Refugee Tr
under the U. H. Convention of July 28, 1951 relating to the tutus of refugees. (II you have ever filed such application, give the place
ing and final disposition.)
avel Document
and date ol fil-
Q My Alien Registration Receipt Card it attached.
O Application Form 1-90 or 1-10? for issuance of Ali«i
Registration Receipt Card is attached.
12. FILL IN THIS BLOCK ONLY IF YOU HAVE PREVIOUS
Issuance date of last document Location of 1
LY OBTAINED A REFUGEE TRAVEL DOCUMENT FROM THE U. S. 1 A N SERVICE.
k N Service Office issuing last document (city and slate)
My last document Qu Q is not attached.
II document It not attached, state riaton.
13. 1 Qhive Q have not been under exclusion or deportation proceedings in the United Stales. If you have been under excli
don proceedings give date and plact proceedings were started.
sion or daporta-
14. The following members of my family are alto applying 'or a Refuge* Travel Document: (Give name and relationship.)
IS. Date of proposed departure from U. S.
Length of intended absence abroad
Mailing address abroad: (Number and street
(City/Town) (Sute/Provinca/OittricO
ICountry)
Countries to be visited ( List uch country)
Reasons for going abroad (Be concise and complete):
a
16. 1 Q did G did not reciter for Selective Servx
e.
17. Q Completed Farm G-32bA (Biographic Information) is attached Q Completed Form G 325A (Biographic Intermittent
at pert of this application. as applicant is under 14 years ol age.
t nut attached
4/1/81
ADMINISTRATIVE MANUAL
Appendix 1
I-S70
Pago 7
IS. COMPLETE THIS BLOCK ONLY IF YOU ARE A LAWFUL PERMANENT RESIDENT
have Q have not engaged in business or implovmcnl outside the United States since I became i permanent rendeni of the
iled Stale!. (I) you have engaged therein, briefly describe and show periods of such employment or business activity.)
United St.
b. Since the time I became a permanent resident of the United States. I have filed a federal income tax return as a nonresident.
Q Vet O NO. <>' "Yes", state (he yeais for which you filed tax return as * nonresident, your address shown in each such return, jn
the location (city and state) of the Internal Revenue Service office where filed.)
come I earned outside the U. S. because I regarded myself as a nonresident alien and therefore exempt from tax on such earning!
do not intend to return to the U. S. alter my temporary visit abroad. 'II not. explain:
«. I Q do Q do not intend to retain my status as a lawful permanent resident. If not, explain:
f. I Q Have QjHave not been issued a reentry permit. (Any reentry permit in your possession musi be attached to this application.)
19. COMPLETE THIS BLOCK ONLY IF YOU ARE AN APPLICANT FOR EXTENSION OF A REFUGEE TRAVEL DOCUMENT
Date and placr of issuance of attached Refugee Expiration dale of attached Date by which I intend to return
Travel Document document , to the United Slates
Lift of all countries visited since last departure fri
the U. S.. in the order visited
List of all countries I intend to
have Q have not established a lawful permanent residence in another country since the date of issuance of the at-
tached RalU9»e Travel Document.
20. The Refugee Travel Document, if issued or extended, should be forwarded to:
Q My address as shown in Block #1.
[""I U.S. Embassy or Consulate at:
U. S. Immigration and Naturalization Service Office at:
Other (Specify)
21. If your native alphabet is in other tha
in your native alphabet in this block.
thai this application was prepared by me at the request of the appli-
cant and it based on all information of which I have any knowledge.
Signature of Applicant'
Dm of Signature'
ng form, il other than applicant
Occupation:
APPLICANT-DO NOT WRITE BELOW THIS LINE
DATE
Oocunwnt Number. V«l.d To. ID.lt,
DEL
OF
D*
Status which may be accorded alien upon
1 1"
DO
return to U. S.
EMP
Restriction on travel in following countries waived
DELIVERY OF DOCUMENT BY.
D MAIL
Q PERSONAL DELIVERY
EMPLOYEE EFFECTING PERSONAL
A I
UNITtD STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
ADDRESS LABEL FOB REFUGEE TRAVEL DOCUMENT
(PLEASE INSURE THAT THIS ADDRESS LABEL IS LEGIBLE)
A Refugee Trtvet Document dots not Inure your readmtesion II, lor any causa under the general immigration laws, you in not admissible Wo the United
SUM*. You an advised to rud the Information and instructions printed in the Refugee Tnvel Document
Your attention is called lo Section 6851 (d) ol Title 28. Umtid Stales Code which reads as follows: "No alien shall depart from the United States unless
he/the fiat procures from thi Secretary or his/her delegate a certificate thai he/she has complied win all the obligations imposed upon rum/tar by the income
lax laws". It Is Suggested mat you call or communicate with your ixal office ol the District Director of Internal Revenue. United Slates Treasury Department, lor
MonMMn concerning such a certificate. This should be done within 30 days ol the date ol your proposed departure from ttte United States.
Requirements lor entry into and departure from countrief on your itinerary should be ascertained from embassies or consulates of those countries wall in
advance of your scheduled travel.
Your attention is also called to Secuon 265 ol the Immigration and Nationlity Act. This law requires that every alien in the United Stales during January o!
each year shall notify the Attorney General, in writing, of hisiher currant aoaress and turns!) such additional information as may by regulations be required. Dol-
ing January ol each year appropriate loans are available Ircm any United States post office. Anyalitn temporarily absent from tht United Stales during
January of any year shall furnuh his/her current address and other information as required within ten 1 101 day* after hither return Any alien
Mnpmrily absent from the Urvled Stales dunng January ol any year, upon nu/tei return to ing United Stales should call, m person, the nearest Immigration and
Natjraftaoon Service office tc securs and execute the required form or submit necessary mlumation regardinQ fts/her absence or change ol address, if any
Failure to comply with this law can result in line and imprisonment.
UNITED STATE* DEPARTMENT OF JUSTICE
HMMMRATION AND NATURALIZATION f CRVICC
TO In tM* a*lr*«a Ub«l ONLY H you with delivery ol your Refill** Trivol ttocumont to an
MUrtu In UM United SUtee othw than your xMraM thowit ki Block 1.
PrIM >car Mm* and complete malllnf ectdreet where the Retug** Tr»v«l Document ehoutd
b* molM In the Uock b*low. PLEASE INSURE THAT THIS ADDRESS LABEL IS LEOIBLE.
4/1/81
FORM 1-600
I- USE:
USED BY A UNITED STATES CITIZEN TO CLASSIFY AN ORPHAN AS AN IMMEDIATE
RELATIVE FOR THE PURPOSE OF ISSUANCE OF IMMIGRANT VISA.
II. ELIGIBILITY;
1. PETITIONER MUST BE UNITED STATES CITIZEN.
2. MAY BE MARRIED OR SINGLE.
3. IF MARRIED, SPOUSE NEED NOT BE CITIZEN OF THE UNITED STATES.
4. IF SINGLE, MUST BE OVER 25 YEARS OF AGE.
5. ORPHAN MUST BE UNDER THE AGE OF 14 WHEN PETITION IS FILED.
6. BENEFICIARY MUST BE AN ORPHAN BECAUSE:
a. BOTH PARENTS HAVE DIED OR DISAPPEARED OR;
b. BOTH PARENTS ABANDONED OR DESERTED THE BENEFICIARY, OR;
c. THE BENEFICIARY MUST HAVE BECOME LOST OR SEPARATED FROM BOTH PARENTS;
OR
d. IF BENEFICIARY HAS ONE-1ARENT, THAT PARENT MUST BE INCAPABLE OF
PROVIDING FOR BENEFICIARY'S CARE. .
III. REQUIREMENTS:
1. EACH BENEFICIARY (ORPHAN) MUST BE PETITIONED FOR ON A SEPARATE 1-600.
2. PROPER FILING FEE.
(NOTE: ONLY ONE FEE IS REQUIRED IF BENEFICIARIES OF MULTIPLE PETITIONS
ARE BROTHERS AND/OR SISTERS BEING PETITIONED FOR BY SAME PETITIONI
3. PETITION FILED AT IMMIGRATION OFFICE HAVING JURISDICTION OVER PETITIONER1!
PLACE OF RESIDENCE.
4. PETITION MUST BE SIGNED UNDER OATH BY PETITIONER AND NOTARIZED .
5. IF PETITIONER IS MARRIED, PETITIONER'S SPOUSE MUST ALSO SIGN PETITION
(HIS/HER SIGNATURE NEED NOT BE NOTARIZED.)
6. DOCUMENTS TO BE SUBMITTED:
a. EVIDENCE THAT PETITIONER IS UNITED STATES CITIZEN.
EVIDENCE OF PETITIONER'S AGE.
IF PETITIONER IS MARRIED, PROOF OF MARRIAGE AND EVIDENCE THAT
ALL PRIOR MARRIAGES OF PETITIONER AND SPOUSE HAVE BEEN TERMINATED.
IF PETITIONER IS SINGLE BUT HAS BEEN MARRIED, PROOF OF TERMINATION
OF PRIOR MARRIAGES.
PROOF OF BENEFICIARY'S AGE
(1) BIRTH CERTIFICATE
(2) IF BIRTH CERTIFICATE NOT AVAILABLE, OTHER EVIDENCE OF
BENEFICIARY'S BIRTH.
VALID HOME STUDY: A STATE AGENCY OR AGENCY AUTHORIZED OR LICENSED
BY A STATE TO CONDUCT HOME STUDIES MUST RECOMMEND ADOPTION.
FINGERPRINT CHART (FD-258). BOTH PETITIONER AND SPOUSE MUST
SUBMIT PRINTS.
IF BENEFICIARY HAS BEEN ADOPTED ABROAD, ADOPTION DECREE (ORIGINAL
OR CERTIFIED COPY) MUST BE SUBMITTED ALONG WITH CERTIFIED TRANSLATION.
(1) IF PETITIONER WAS SINGLE WHEN ADOPTION OCCURRED, PETITIONER
MUST HAVE BEEN AT LEAST 25 YEARS OF AGE AT THE TIME THE
BENEFICIARY WAS ADOPTED.
(2) IF PETITIONER WAS MARRIED WHEN ADOPTION OCCURRED, THE ADOPTION
DECREE MUST SHOW THAT THE ADOPTION WAS BY HUSBAND AND WIFE
JOINTLY.
IF BENEFICIARY IS IN AN ORPHANAGE, EVIDENCE THAT HE/SHE HAS BEEN
UNCONDITIONALLY ABANDONED TO ORPHANAGE.
IF STATE HAS PREADOPTION REQUIREMENTS, EVIDENCE THAT SUCH REQUIREMENTS
HAVE BEEN SATISFIED. THIS EVIDENCE IS NECESSARY ONLY WHEN THE
BENEFICIARY HAS NOT BEEN ADOPTED ABROAD AFTER HAVING BEEN PERSONNALY
SEEN AND OBSERVED BY PETITIONER AND SPOUSE, IF MARRIED.
IF BENEFICIARY HAS A PARENT:
(1) EVIDENCE THAT THE PARENT HAS, IN WRITING, IRREVOCABLY RELEASED
THE BENEFICIARY FOR EMIGRATION AND ADOPTION; AND,
(2) EVIDENCE THAT THE PARENT IS INCAPABLE OF PROVIDING FOR THE
BENEFICIARY'S CARE.
(NOTE: WHEN A CHILD WHO HAS A SOLE OR SURVIVING PARENT HAS BEEN
ADOPTED ABROAD, THE REQUIREMENT FOR AN IRREVOCABLE RELEASE IN
WRITING FOR THE CHILD'S EMIGRATION AND ADOPTION WILL BE CONSIDERED
TO HAVE BEEN MET IF THE ADOPTION DECREE CLEARLY SETS FORTH THAT THE
ADOPTIVE PETITIONER AND SPOUSE, IF MARRIED, RESIDE IN THE UNITED
4-83
AND THAT THE CHILD'S ONLY PARENT HAS AGREED TO RELEASE THE
CHILD FOR ADOPTION.)
(NOTE: AN ORPHAN WHOSE ADOPTION ABROAD IS DETERMINED BY
THE SERVICE TO BE INVALID FOR BENEFITS UNDER THE IMMIGRATION
AND NATIONALITY LAWS, OR WHO IS ADOPTED ABROAD WITHOUT
HAVING BEEN PERSONALLY SEEN AND OBSERVED BY THE PETITIONER
(AND BY THE SPOUSE, IF MARRIED) PRIOR TO OR DURING THE
ADOPTION PROCEEDINGS, SHALL BE PROCESSED AS A CHILD COMING
TO THE UNITED STATES FOR ADOPTION. BEFORE A PETITION IN
BEHALF OF SUCH A CHILD IS APPROVED, THE PETITIONER (AND SPOUSE,
IF MARRIED) MUST SUBMIT A STATEMENT INDICATING THE PETITIONER'S
AND, IF MARRIED, THE SPOUSE'S WILLINGNESS AND INTENT TO READOPT
THE CHILD IN THE UNITED STATES.)
TM 800
ADMINISTRATIVE MANUAL
Appendix 1
I -600
Page 1
4-85
PETITION TO
CLASSIFY ORPHAN
AS AN IMMEDIATE
RELATIVE
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization Sarvtca
(PUait liar off htn befort submitting pttition]
INSTRUCTIONS
Read instructions carefully— fee will not bt refunded
(Failure la follow instructions may rt quirt return of tht petition and delay final action.)
1. ELIGIBILITY. The term "orphan" under the immigration Uwi means an alien child who it under the age of 14 yean at the time the
visa petition in his behalf ii filed and who ii an orphan became both parent! have died or disappeared, or abandoned or deserted
the orphan, or the orphan has become separated or lost from both parents. If the orphan has only one parent, that parent mult be
incapable of providing for the orphan's care and must have in writing irrevocably released the orphan for emigration and adoption.
In addition the orphan either must have been adopted abroad or must be coming to the United States for adoption by * United States
citizen and spouse jointly, or by an unmarried United States citizen at least twenty-five years of age.
A petition to classify an alien as an orphan for issuance of a visa m.*/ be filed by a married or unmarried United States citizen (if
unmarried, the citizen must be at least twenty-five yean of age) . The spouse need not be a United States citizen. It must be established
that both the married petitioner and spouse, or the unmarried petitioner, wilt care for the orphan properly if the orphan is admitted
to the United Stales. If the orphan ...... ....
unmarried pe
1 Stales. If the orphan was adopted abroad it must be established that both the married petitioner and spouse, or the
:titioner, personally saw and observed the child prior to or during the adoption proceedings. If both the petitioner and
the petitioner and spouse, or the
petitioner and spouse jointly or by the i
proposed residence have been met.
Tied petitioner, must establish that the child will be adopted in the United State* by the
arried petitioner and that the preadoption requirements, if any, of the state of the orphan's
l{a). A prospective petitioner may request advance processing when the child has not been identified or where the prospective and/or
spouse is going abroad to locate or adopt a child. Such request shall be made to the District Director in writing and must be accom-
panied by Form 1-600 with Block Number 1 and the affidavit of the petitioner completed, the required fee and the fingerprints of
the petitioner and spouse, if married. Such a request will not be considered a properly filed petition until all required documentation
has been submitted, along with the information pertaining to the child required by Block 2 of Form 1-600. When the child has been
identified, a completed duplicate Form 1-600 shall be submitted to the District Director where the preprocessing request was made.
For those prospective adopting parents who are goinjr abroad to locate or adopt a child the duplicate 1-600 identifying the child
and the required documents should be submitted to the United States Consulate or the United States Immigration Service Office
abroad which has jurisdiction over the place of residence of the child.
NOTE: If any changes occur in the petitioner's marital status while the petition is pending, the District Director shall be notified
immediately.
2. SUPPORTING DOCUMENTS. The following must be submitted with petition:
a. Proof oj Uniltd States citizenship of tkt petitioner.
(1) If you are a citizen by reason of birth in the United States, submit (a) your birth certificate, or (b) if birth certificate is
unobtainable, a copy of your baptismal certificate under seal of the church, showing place of birth, (baptiim mtui ham
occurred within 2 monthi after birth), or (c) if birth or baptismal certificate cannot be obtained, affidavits of two
United States citizens who have personal knowledge of your birth in the United States.
(2) If you were born outside the United States and became a citizen through the naturalization or citizenship of a parent or
husband, atid have noc been issued a certificate of citizenship in your own name, submit evidence of the citizenship and
marriage of such parent or husband, as well as termination of any prior marriages. Also, if you claim citizenship through
a parent, submit your birth certificate and a separate statement showing the date, port, and means of all your arrivals
and departures into and out of the United States. (Do not makt or submit a photostat of a certificate of citiurahip. See
Instruction No. 3.)
(3) If your naturalization occurred within 90 days immediately preceding the riling of this petition, or if it occurred prior to
September 27, 1906, the naturalization certificate must accompany the petition. Do not make or submit a photostat of
such certificate (set Instruction No. 8).
b. Proof of marriate of petitioner and tpouse.
The married petitioner should submit a certificate of the marriage and proof of termination of all prior marriages of himself/
herself and spouse. IN' THE CASE OF AN UNMARRIED PETITIONER, WHO WAS PREVIOUSLY MARRIED, SUB-
MIT PROOF OF TERMINATION OF ALL PRIOR MARRIAGES.
c. Proof o\ eti oj orphan.
Petitioner should submit certificate of orphan's birth if obtainable; if not obtainable submit an explanation together with best
available evidence of birth.
d. A home study favorably recommending the adoption by M agency of the Stall of tht thild's proposed residence, or by an
agency authorized by that State to conduct such a study, or, in the case of a child adopted abroad, by an appropriate public
or private adoption agency which is licensed in the United Slates. The home study must contain but is not limited to the
following elements: the financial ability of the prospective parent or parents to rear and educate the child; a detailed description
of the environmental conditions of the living accommodations where the child will reside; a factual evaluation of the physical,
mental, and moral capabilities of the prospective parent or parents in relation lo rearing and educating tho child.
«. A eertifid cop) of adaption deem together with certified translation, if the orphan hat been lawfully adopted abroad.
f. Evidence that the sole or surviving parent is incapable of prodding for tht orphan's cart and hat in writing irrevocably
released ike orphan for emigration and adoption, if tht orphan Hat only ont parent.
g. Evidence that the orphan has btn unconditionally abandontd to an orphanage, if tht orphan hat been placid in an trphanfgt
by Au parent or parents.
•
EDITION
Rev. 11-20-79
TITLE
PETITION TO CLASSIFY ORPHAN AS AN rMMFfHATF RFLATTVF
INSTRUCTION REFERENCE
AH 2301.07, 2414 Ex.1, 2761
GIB P. 12, App.-8, -31
8 CFR 204. l(b), 299.1; 01 204. 3(a), (b), (c), (f), (g);
06 2984 Ex. 2, Ex. 4; II Hbk 1-29, 5-51, -52, -53, App. 5-B;
FILED BY PROSPECTIVE ADOPTIVE PARENTS OF CHILD
PRIOR EDITIONS MAY NOT BE USED
ISCHEDUU
A/1 /«!
4-86
1-600
Page 2
ADMINISTRATIVE MANUAL
Appendix 1
^^•^•i
h. Evidence that the preadopiion requirements, if any, of the State of the orphan's proposed residence haoe been met, if the child
is to be adopted in the United States.
i. Fingerprints.
Completed fingerprint cards (Form FD-258) must be submitted by both the married petitioner and spouse or by the unmarried
petitioner. Fingerprint cards with instructions for their completion are available at any office of the Immigration and
Naturalization Service. The fingerprints may be recorded on Forms FD-258 at any office of this Service or the Forms FD-258
may be presented to a police station or sheriffs office with a request that an officer there record the fingerprints on the cards.
The cards must be signed by the person being fingerprinted in the presence of the officer taking the fingerprints, who must then
sign his name and enter the date in the space provided. It is important to furnish all the information called for on Form FD-258.
3. DOCUMENTS IN GENERAL. All supporting documents must be submitted in the original. An official copy of the original record
issued by and bearing the ser.l of the official custodian of such record may be submitted as the original. If you desire to have the
original returned to you, and if copies are by law permitted to be made, you may submit photostatic or typewritten copies. Photostatic
copies unaccompanied by the original may be accepted if the copy bears a certification by an immigration or consular officer that the
copy was compared with the original and found to be identical. Any document in a foreign language must be accompanied by a
summary translation in English. A summary translation is a condensation or abstract of the document's text. •The translator must
certify that he is competent to translate and that the translation is accurate. (Do not make a photostat of a certificate of naturalization
or citizenship.)
4. PREPARATION OF PETITION. A separate petition for each beneficiary must be typewritten or printed legibly with pen and ink
(one copy only). The petitioner must be a United States citizen and execute the petition under oath. The certification (not under
oath) on the petition must be made by the married petitioner's spouse.
a. In the United Stales the petition may be sworn to or affirmed before an immigration officer without die payment of fee, or
before a notary public or other officer authorized to administer oaths for general purposes, in which case the official seal or
certificate of authority to administer oaths must be affixed.
b. Outside the United States the petition must be sworn to or affirmed before a United States immigration or consular officer.
c. A member of the Armed Forces of the United States, cither in the United States or abroad, may swear to or affirm the petition
before an officer of the Armed Forces authorized to perform notarial acts under Article 136. Uniform Code of Military Justice.
5. SUBMISSION OF PETITION. A petitioner residing in the United States should send the completed petition to the office of the
Immigration and Naturalization Service having jurisdiction over his place of residence. A petitioner residing outside the United States
should consult the nearest American consulate as to the foreign office of this Service designated to act on the petition. The petition
must be submitted before the child becomes 14 years of age.
6. FEE. Read instructions carefully. A fee of thirty-five dollars ($35 ) must be paid for filing this petition. It cannot be refunded regardless
of the action taken on the petition. DO NOT MAIL CASH. ALL FEES MUST BE SUBMITTED IN THE EXACT AMOUNT.
Payment by check or money order must be drawn on a bank or other institution located in the United States and be payable in
'United States currency. If petitioner resides in Guam, check or money order must be payable to the "Treasurer, Guam." If petitioner
resides in the Virgin Islands, check cr money order must be payable to the "Commissioner of Finance of the Virgin Islands." All
other petitioners must make the check or money order payable to the "Immigration and Naturalization Service." When check ii
drawn on account of a person other than the petitioner, the name of the petitioner must be entered on the face of the check. If
petition is submitted from outside the United States, remittance may be made by bank international money order or foreign draft
drawn on a financial institution in the United States and payable to the Immigration and Naturalization Service in United States
currency. Personal checks are accepted subject to collectibility. An uncollectible check will render the petition and any document
issued pursuant thereto invalid. A charge of $5.00 wLH be imposed if a check in payment of a fee is not honored by the bank on
which it is drawn.
7. ASSISTANCE. In connection with the adoption of an orphan it is suggested that assistance be obtained from a recognized social
agency or from any public or private agency recognized by the appropriate authority of the State. The following recognized social
agencies, which have offices in many of the principal cities of the United States, have agreed to furnish assistance.
American Bunch of International Social Setvlcu, Inc.
345 Eait 46th Str«t
New York, N«w York 10017
Greek ArchdlocaM of North and South Arnold
10 E»t 79th Street
Now York. New York 10021
United HIAS S*fvlc*, Int. ' •
200 Park Avenue South
New York, N«w York 10003
Catholic CommittM for Refugee*
Unltad State* Catholic Conferanc*
201 Park Avwiue South
New York. New York 10003
Chuck World Service, IRC.
475 Rivtnld* Drlw
Nev York, New York 10027
8. PENALTIES. Willfully false statements on this form or supporting documents can be punished by fine or imprisonment. U.S. Code,
Title 18, Sec. 1001 (Formerly Sec. 80). Title 18, U.S. Code, Section 1426(h) provides: "Whoever, without lawful authority, prints,
photographs, makes, or executes any print or impression in the likeness of a * * * certificate of naturalization or citizenship, or any
pan thereof, shall be fined not more than $5,000 or imprisoned not more than 5 yean or both."
9. AUTHORITY. The authority to prescribe this form is contained in 8 U.S.G. 11 54 (a). Submission of the information is voluntary.
The
Ser
(1)(F), and classifiable as an immediate relative as specified in section 201 (b) of the Act, 8 U.S.C. 1151(b). The information
solicited may also* as a matter of routine use, be disclosed to other federal, state, local, and foreign law enforcement and regulatory
agencies, the Department of Defense including any component thereof (if the petitioner has served, or is serving- in the Armed Forces
of the -United States), the Department of State, Central Intelligence Agency, InUrpol, and individuals and organizations during the
course of investigation to elicit further information required by this Service to carry out its functions. Failure to provide any or all
of the solicited information may result in the denial of the petition.
For sale by the Superintendent of Document!, TJ.8. Government Printing Offleo
Washington, D.C. 20402 • Prlc* per 100
Stock Mo. 027-002-00202-4
MwZT^^^
UNITED STATES DEPARTMENT OP JUSTICE
Porn approved
OMBN..4J-ROSW
PETITION TO
CLASSIFY ORPHAN
AS AN IMMEDIATE
RELATIVE
(Section 101(b)(l)(F) of
the Immigration and
Nationality Act. as
amended.)
Date Filed
Fes Sump
FOoNo.
TO THE SECRETARY OF STATE:
The petition was filed by:
LJ Married Petitioner LJ unmarried Petitioner
The petition is approved for orphan:
PI adopted abroad LJ coming to U.S. for adoption.
Preadoption requirements have been met
Remarks:
DATE
or
ACTION
DD.
DISTRICT
(PETITIONER IS NOT TO WRITE ABOVE THIS LINE)
Petition it hereby made to clasiify the orphan named herein a* an immediate relative.
BLOCK L-INFORMA TION ABO UT PETITIONER
UM)r MOW U (Lull
(Middle)
1. I reeide U tin United SUIM at (C/0, It appropriate)
(Number .nditTMt)
(TowBordty)
(flute)
4. Addne* abroad U( any)
(Number and atr*«t)
(Towaordty)
(Cooatrj)
5. I waa born: (Month) (Day) (Year) lu
(Town or city)
(Sut* or Province)
(Country)
4. My phona amber b
lanacltUenottheUnitedStatM LJ through birtk In the U.S. LJ through pareaU LJ through natanlbattaa
(1) If acquired through aaturalUaUoa. give name under which naturalized, Dumber of naturalization certificate, and date and place of aa tor
L_lthra«
|1imiiTb««
IX) U acquired through parentage or marriage, have you obtained a certificate ot citiienahip In your own name baaed on nek acqgtaiUtwT.
la) Ifao,gfvenumberofcertincaUanddaleandplaceo(uuuanee!
Ik) If not. submit evidence of eltlxenahlp la accordance with Instruction 2-1.12).
Have you arany person through whom you claim dtbanihlp ever lott United Statei citixenahlp? .
U ao, attack detailed explanation on tepante iheeU
la. My marital (tabula D Married Q Widowed D Divorced Q Single
b, I LjHive LJ Have not been previously married.
«. If you have been prevlouily married, itate number of Umea .-
9. If you are BOW married, give the following Information
a. Deteaad place of preHntmamate
h. N«nw of prewnlipouM (include nuMea naroeotwif*)
e. DaUo(Mrtko<ipaaee(H(Mtii) (Dey) (Year)
<L PUoofbirlhatipouMlCllyl
(Country)
e. Number o( prior marrUfes of «OOUM.
L My IBOUM reaidee [J with roe Q Apart from meet addreaa (Apt. No.) (No. and ilreet) (City) (State) (Country)
FORM l-«00
(Rev. 1 1-20-79) N
Received
Trana.In
Ret'd-Trana. Out
Completed
4/1/81
4-88
1-600 ADM I
Page 4
NISJRATIVE MANUAL TM 800
Appendix 1
Block II.- Information pertaining to orphan beneficiary
10. Name tt birth (First)
(Middle) (Laat)
11. Nanualprceenl IFlnl) (Middle)
(Lull 12. Sex
13. Any other name* by which orphan U or wukaewB
U. Date- of birth (City) (Stale or Province) (Country)
1J. The oeoefWUry to an eligible orphan o«eau»e: (Check one) [_j He hi* no parenu PI He hu only oat parent who U the tol» or *urriving parent
1*. U the orpl^Ko only eiie parent, aiuwer the fcDowlnj:
Out* wbtt hu bt*mt «f «th«r jnrr*'
U the renaamlng parent capable of providing tor the orphan'aaupport? O Yea Q No __ ._
H»»th«r«m»Ulnjp»rMU 1« writing, far* vocabUr»to»»^lh«orph»n for MnlgriiUoiinKltdoptloDT LJ Y« LJ No
IT. Theorpban CD hu Q hunrt boon lawfully adopted ahrou! by Q petitioner and apou** jointly Q ^married petitioner. It »dople<i abroad, did Q peti-
tioner and ipora d unmarried petitioner personally nee and observe the orphan prior to or during, the adoption proceeding? [JY** Q No
DaU tad ploen of adoption:
IS. If Uw orphan hu not b*n lawfully adopted abroad by the petitioner mod ipouM Jointly or by the unmarried petitioner, or U adopted abroad, the orphu hu BO* beei peon and
•btarred penonaDy by the petitioner and apouM or by th« umarriod petitioner nrior to or during tketdoptlon proceodinp, five the foUowlnfr Do p«titiooor««d«po»««jotally or
doea the wuoanrM petitiooer iatond to adopt tbe onhaa in the Vnlud StaUiT (_] Y« MNo. Ham the praadoptkn roqulremuta, if any. of th* orphu'j pro-
po*odiUUoIr«l<leaee been met? Q Ye. Q No.
U. To poUUoowrVi knowledge, dot* the orphu hav« any phyaieal or mental affliction? QVei C] No. UM>, unto Un affliction;
Mi Hu petltloow or inouM or unmarried petitioner ever petitioned for the adoption of any ether chUdT Q Yea Q No. If to, (1** the sane of each child at birth and
la petitioner or epoute or (nmarrfed petitioner, in the proceat of petitioning tor the adoption of any other ehfld? O Ye* Q No. If eo. five the name of each child at
birth awl the dat* and place of birth:
21. la the orphan the ward of a foreign country or a political auhdlvuikw then!?
Q Yea Q No
ZS. Name of child welfare agency. If any. auiiting In Ihtaeaao:
J3. Name aneTaddKaa of attorney abroad. If any, repmenting petitioner in thli cue:
U. Addreub the United Suu* (Number) (Street)
where orphan will wide
(City) (Stale) (Zip Code)
IS. PmentuUreee 4 Apartment) (Number) (Street)
ef orphan
(City) (SUU or Province) (Country)
U orphaa hi reeidlng In an Imtltution. give full name of lutltution-
It orphan t§ not reeling In an iutltutlon, give lull name of penon with whom orphan in redding
Give any additional information neeeeaary U locate orphan eueh U Bame o( dialricU aeetlon, aone or locality In which orphan mldu
tt. Ixcatlon of American CoaaulaU
where application for naa will
be made
(City In Foreign Country) (Foreign Country I
AJTIDA VTT OF PBTTnONEB
CERTIFICATION OF MARRIED PETTnONElfS 8POU8K
I .wear (affirm) that all the •tatementa I have made in this • I certify that my spouse and I will care, for the
petition are true and correct to the best of my knowledge and that I beneficiary of this petition properly if the beneficiary is ad-
will care for the beneficiary of this petition properly if the mitted to the United States,
beneficiary U admitted to the United States.
Dated at
(Signature of Petitioner)
" This davof 19
>• . ... . T *»
d*7 (Signature of PoUtloner'i apouae)
Signature of Person Preparing Form, if Other than Peti-
'. IE
tioner.
EALI I declare that this document was prepared by me at the
request of the Petitioner and is based on all information of
which I have any knowledge.
My enmmlaatoB eipiree _____________________________
Signature!
(Signature of Officer admlniatering oath)
Addneet Detei
(Title)
.
B.I. eoruuuun nunriw errict eTO— J»- SSlMp-l
CTION 212(a)(H) OF THE IMMIGRATION AND NATIONALITY ACT PROVIDES THAT AN
IEN SEEKING TO ENTER THE UNITED STATES FOR THE PURPOSE OF ENGAGING IN
ILLED OR UNSKILLED LABOR MUST FIRST OBTAIN A CERTIFICATION FROM THE
PLOYMENT AND TRAINING ADMINISTRATOR OF THE DEPARTMENT OF LABOR THAT
ERE ARE NOT SUFFICIENT AMERICAN CITIZENS OR PERMANENT RESIDENT ALIENS
ARABLE WHO ARE ABLE, WILLING, AND QUALIFIED TO DO THE WORK THE ALIEN
TENDS TO DO, AND THAT THE CONDITIONS OF THE ALIEN'S EMPLOYMENT WILL NOT
VERSELY AFFECT THE WORKING CONDITIONS OF PERSONS SIMILARLY EMPLOYED IN
E UNITED STATES.
CEPTIONS TO THE LABOR CERTIFICATION REQUIREMENT:
FIRST, SECOND, FOURTH AND FIFTH PREFERENCE CATEGORIES;
IMMEDIATE RELATIVES;
PERSONS COMING TO MARRY UNITED STATES CITIZENS OR LAWFUL PERMANENT
RESIDENTS WHO HAVE GUARANTEED THEIR SUPPORT;
SPECIAL IMMIGRANTS;
ACCOMPANYING FAMILY DEPENDENTS;
PERSONS NOT ENTERING THE LABOR MARKET;
INVESTORS;
MEMBERS OF THE UNITED STATES ARMED FORCES.
E APPLICATION FOR ALIEN LABOR CERTIFICATION IS MADE TO THE UNITED STATES
PARTMENT OF LABOR THROUGH THE LOCAL OFFICE OF THE STATE EMPLOYMENT SERVICE
VING JURISDICTION OVER THE ALIEN'S PLACE OF INTENDED EMPLOYMENT. APPLICA-
ON IS MADE ON DEPARTMENT OF LABOR FORMS, "APPLICATION FOR ALIEN EMPLOYMENT
RTIFI CATION", "STATEMENT OF QUALIFICATIONS OF ALIEN", (ETA 750B) AND
FFER OF EMPLOYMENT" (ETA 750A) SUBMITTED IN DUPLICATE. QUESTIONS
NCERNING ALIEN CERTIFICATION SHOULD BE DIRECTED TO THE LOCAL STATE
PLOYMENT SERVICE. FORMS MAY BE OBTAINED FROM UNITED STATES CONSULAR
FICES ABROAD, AT LARGER OFFICES OF THE IMMIGRATION AND NATURALIZATION
RVICE, AND AT LOCAL OFFICES OF THE STATE EMPLOYMENT SERVICE AGENCIES.
ANY PERSON WISHES TO APPLY FOR A SCHEDULE "A" BLANKET LABOR CERTIFICATION,
/SHE SHOULD BE TOLD TO SUBMIT THE APPLICATION FOR ALIEN EMPLOYMENT
RTIFI CATION FORM IN DUPLICATE WITH THE SUPPORTING DOCUMENTS (AS
SCRIBED ON THE FORMS) TO THE IMMIGRATION AND NATURALIZATION SERVICE
TH THE APPROPRIATE APPLICATION.
4/1/81
2.
G.
7.
r
U.S. DEPARTMENT OF LABOR
Employment and Training Administration
APPLICATION
FOR
ALIEN EMPLOYMENT CERTIFICATION
IMPORTANT: READ CAREFULLY BEFORE COMPLETING THIS FOR
I'HIN'i legibly in ink or use a typewriter. If you need more space to
answer tiucstions on this form, use a separate sheet. Identify each answer
with the number of the corresponding Question. SJGN AND DATE each
sheet I'M original signature.
To knowingly furnish any false information in the preparation of this forn
and tin'j supplement thereto or to aid, abet, or counsel another to do no i
a 1'e.luny punishable by $10,000 fine or 5 years in the penitentiary, or bol
(L9 U.N.C. 1001).
PART A. OFFER OF EMPLOYMENT
Name of Alien (Family name in capital letter, First, Middle, Maiden)
Present Address of Alien (Number. Street, City and Town. State 7.1V Code or i'ronince. Country)
The following information is submitted as evidence of an offer of employment.
Name of Emplover (Full name of organization)
3. Type of Visa (If in
U.S.)
5. Telephone (Area Code
and Number)
Address (Number, Street. City or Town, Country, State, '/.U' Code)
Address Where Alien Will Work (if different from item 6)
. Nature of Lmployer's Business
Activity
9. Name of Job Title
10. Total Hours Per Week
11. Work
Schedule
(Hourly)
12. Rate of Pay
a. Basic
b. Overtime
a. Basic
b. Overtime
a.m.
$
$
p.m.
per
per hour
3. Describe Fully the Job to be Performed (Duties)
A. State in detail the MINIMUM education, training, and experience for a
worker to perform satisfactorily the job duties described in Item 13
above.
15. Other Special Requirements
EDU-
CATION
IK nt>-r
lumber of
yi'tirm
Grade
School
Hiq*)
School
College
College Degree Required (specify)
Major Field of Study
TRAIN-
ING
No. Yrs.
No. Mot.
Type of Training
£XPERI-'
ENCtl
Job Offered
Related
Occupation
Related Occupation (specify)
Yrs.
Nurr
Mos.
iber
Yrs. Mos.
1C. Occupat
Person
Alien's
onal Title of 17. Number of
Who Will Be »"• *•"• • Employees ^
mmediate Supervisor Alien will Supervise
-*•[ ENDORSEMENTS (Make no entry in
section • for government use only)
Date Forms Received
L.O.
S.O.
R.O.
N.O.
Ind. Code
Occ. Code
Occ. Title
)NLY IF JOB IS TEMPORARY
19. IF JOB IS UNIONIZED (Complete)
. Exact Dates You Expect
To Employ Alien
From
a. Number
of
Local
To
b.. Name of Local
c. City and State
IVE-AT-WORK JOB OFFERS (Complete for Private Household Job ONLY)
mber of
looms
b. No. Persons Residing at Place of Employment
Adults
BOYS
GIRLS
Children
Ages
c. Will free board and private
room not shared with any-
one be provided?
("X" one)
CD YES CD NO
S TO RECRUIT U.S. WORKERS AND THE RESULTS. .(Specify Sources of Recruitment by Name)
juire various types of documentation. Please read PART It of the instructions to assure that appropriate
jmentation is included with your application.
23. EMPLOYER CERTIFICATIONS
irtue of my signature below, I HEREBY CERTIFY the following conditions of employment.
igh funds available to pay the wage
ered the alien.
offered equals or exceeds the pre-
and I guarantee that, if a labor certi-
ranted, the wage paid to the alien when
jins work will equal or exceed the pre-
1 which is applicable at the time the
work.
ffered is not based on commissions,
other incentives, unless I guarantee
I on a weekly, bi-weekly or monthly
lie to place the alien on the payroll
re the date of the alien's proposed
o the United States.
e. The job opportunity does not involve unlawful discri-
mination by race, creed, 'color, national origin, age,
sex, religion, handicap, or citizenship.
f. The job opportunity is not:
(1) Vacant because the former occupant is on
strike or is being locked out in the course of
a labor -dispute involving a work stoppage.
(2) At issue in a labor dispute involving a work
stoppage.
g. The job opportunity's terms, conditions and occupa-
tional environment are not contrary to Federal,
State or local law.
h. The job opportunity has been and is clearly open to
any qualified U.S. worker.
24. DECLARATIONS
Pursuant to 28 U.S.C. 1746. I declare under penalty of perjury the foregoing it true and correct.
DATE
TITLE
F
ER
1 HEREBY DESIGNATE the agent below to represent me for the purposes of labor certification and 1 TAKE FULL
RESPONSIBILITY for accuracy of any representations made by my agent.
OYER
DATE
15. WORK EXPERIENCE. List all jobs held during past three (3) years. Also, list any oilier jobs related to the occupation for which the a
seeking certification as indicated in item f).
a. NAME AND ADDRESS OF EMPLOYER
NAME OF JOB
DATE STARTED
Month
Year
DATE LEFT
Month
Year
KIND OF BUSINESS
DESCRIBE IN DETAILS THE DUTIES PERFORMED, INCLUDING THE USE OF TOOLS, MACHINES, OR EQUIPMENT
NO. OF HOURS PER WE
t>. NAME AND ADDRESS OF EMPLOYER
NAME OF JOB ' DATE STARTED DATE LEFT KIND OF BUSINESS
Month Year Month Year
DESCRIBE IN DETAIL THE DUTIES .PERFORMED, INCLUDING THE USE OF TOOLS, MACHINES, OR EQUIPMENT NO. OF HOURS PER WE
c. NAME AND ADDRESS OF EMPLOYER
NAME OF JOB DATE STARTED DATE LEFT KIND OF BUSINESS
Month Year Month Year
DESCRIBE IN DETAIL THE DUTIES PER FORM ED ."INCLUDING THE USE OF TOOLS, MACHINES. OR EQUIPMENT NO. O~F~~HOURS PER WE
16. DECLARATIONS
DECLARATION
OF ^
ALIEN
Pursuant to 28 L'.S.C. 1746, I declare under penalty of perjury the foregoing is true and correct.
SIGNATURE OF ALIEN
DATE
AUTHORIZATION
OF I*- »
AGENT OF ALIEN
/ hereby designate the agent below to represent me for trie purposes of labor certification and I take full
responsibility for accuracy of any representations made by my agent.
SIGNATURE OF ALIEN
ft
DATE
NAME OF AGENT (Type or print)
ADDRESS OF AGENT (No.. Street. City, State, ZIP Code)
PART B. STATEMENT OF QUALIFICATIONS OF ALIEN
VICE CONCERNING REQUIREMENTS FOR ALIEN EMPLOYMENT CERTIFICATION: If alien is in the U.S., contact nearest office of
ion and Naturalization Service. If alien is outside U.S., contact nearest U.S. Consulate.
IMPORTANT: READ ATTACHED INSTRUCTIONS BEFORE COMPLETING THIS FORM.
legibly in ink or use a typewriter. If you need more space to fully answer any questions on this form, use a separate sheet. Identify
answer with the number of the corresponding question. Sign and date each sheet.
e of Alien (Family
name in capital letters)
First name
Middle name Maiden name
int Address (No., Street, City or Town, State or Province
and ZIP Code
Country
3. Type of Visa (If in U.S.)
Vs Birthdate
ith. Day, Year)
5. Birthplace (City or Town, State or Province)
Country
6. Present Nationality or
Citizenship (Country)
ress in United States
Where Alien Will Reside
e and Address of Prospective Employer If Alien has Job offer In U.S.
9. Occupation in which
Alien Is Seeking Work
the appropriate box
below and furnish the information required for the box marked
Allen will apply for a visa abroad at the American
City in Foreign Country
Foreign Country
n
Alien Is in the United States and will apply for adjust-
ment of status to that of a lawful permanent resident
In the office of the Immigration and Naturalization
City
State
*s and Addresses of Schools, Col- Field of
and Universities Attended (Include ct,,Hv/
» or vocational training facilities) siuoy
FROM
Month Year
TO
Month Ye< r
Degrees or Certificates
Received
,
-
SPECIAL QUALIFICATIONS AND SKILLS
itional Qualifications and Skills Alien Possesses and Proficiency In the use of Tools, Machines or Equipment Which Would Help Establish if
n Meets Requirements for Occupation In Item 9.
Licenses (Profettional, journeyman, etc.)
Documents Attached Which are Submitted as Evidence that Allen Possesses the Education, Training, Experience, and
Abilities Represented
nents
DATE REC. DOU
O.T. & C.
' no entry in
ection — FOR
nment Agency
ONLY)
(Item* continued on next page)
4/1/81
ITEMIZED INSTRUCTIONS FOR COMPLETING FORM ETA 750
PART A. OFFER OF EMPLOYMENT (To be completed by Employer).
4-95
Item 1. Name of Alien. Enter full name exactly as it
appears on Part B, "Statement of Qualifications of Alien. "
Item 2. Present Address of Alien.
United States or abroad.
Enter whether in the
Item 3. Type of Visa. If the alien is in the United
States, enter the type of visa held, i.e., B-2 (visitor), F-1
(student), or current status as shown on INS Form I-94.
Item 4. Name of Employer. Enter full name of busi-
ness, firm, or organization, or if an individual, enter
name used for legal purposes on documents.
Item 5. Telephone Number. In job offers for private
households, enter a business and home telephone number
when all adults are employed.
Item 6.
Address of Employer. Self explanatory.
Item 7. Address Where Alien Will Work. Enter the
full address of site or location where the work will actual-
ly be performed, if different from the address in Item 6.
Item 8. Nature of Employer's Business. Enter a brief,
non-technical description, i.e., retail store, household,
university, financial institution.
Item 9. Name of Job Title. Enter the common name
or payroll title of the job being offered.
Item 10. Total Hours Per Week. Enter the basic hours
of work required per week and overtime hours per week
in accordance with State or Federal law for the work
and locality.
Item 11. Work Schedule. Show the daily work schedule
for the job, i.e., 9 a.m. to 5 p.m., 7 a.m. to 1 1 a.m. and
4 p.m. to 8 p.m.
Item 12. Rate of Pay. Enter a guaranteed wage and the
unit of pay, such as $5.00 per hour, $850 per month, or
$12,500 per year. Wage offered cannot be based on com-
mission, bonuses, or other incentives, unless the employer
guarantees a wage paid on a weekly, bi-weekly, or month-
ly basis.
Item 13. Job Duties. Describe the job duties, in detail
what would be performed by any worker filling the job.
Specify equipment used and pertinent working con-
ditions.
Item 14. Minimum Education, Training, and Experience
Required to Perform the Job Duties. Do not duplicate
the time requirements. For example, time required in
training should not also be listed in education or experi-
ence. Indicate whether months or years are required. Do
not include restrictive requirements which are not actual
business necessities for performance of the job and which
would limit consideration of otherwise qualified U.S.
workers.
Item 15. Other Special Requirements. Enter the job-
related requirements. Examples are shorthand and typing
speeds, specific foreign language proficiency, test results.
Document business necessity for a foreign language re-
quirement.
Item 16. Occupational Title of Person Who Will Super-
vise Alien. Self explanatory.
Item 17. Number of Employees Alien Will Supervise.
Self explanatory.
Item 18. Complete Only if Job is Temporary. Does not
apply for offers of permanent employment.
Item 19. If the Job is Unionized. Enter the number of
the local, the name of the union, and the City and State
in which the local has its main office.
Item 20. Statement of Live-At-Work Job Offers in Pri-
vate Households. (Do not complete for other job offers).
20(a). Description of Residence. Self explanatory.
20(b). Number of Persons Residing at Place of Employ-
ment. Enter the number of adults, children under 18
years old, their sex and specific ages of children.
20(c). Room and Board. Self explanatory.
Item 21. Recruitment Efforts. Describe in detail ef-
forts to recruit U.S. workers for the job opportunity and
the results. List sources of recruitment by name, i.e..
Lane Technical School, the Daily Tribune Newspaper,
Scientific Journal of America. Specify the number of
applicants interviewed from each source and the lawful
job-related reasons why they were not hired.
Item 22. Read the GENERAL INSTRUCTIONS for ad-
ditional supporting documentation which must be sub-
mitted, in separate attachments, along with this appli-
cation. General Instructions will provide information
that may be required. Documentation for Schedule A
may be found in Part II. Department of Labor regulat-
ions require that an employer submit documentation to
clearly 'show that the job offer and the recruitment of
U.S. workers are in compliance with regulations. In ad-
dition, special documentation is required for certain
occupational groups.
Item 23. Employer Certifications. Read carefully. Th,e
employer certifies to these eight (8) conditions of employ-
ment by signing the form.
Item 24. Employer Declaration. All copies of this form
must bear the original signature of the employer or the
employer's duly authorized representative with hiring
authority. False statements are subject to Federal pre-
jury and fraud penalties. The authorization of agent is
completed only when the employer designates an agent
to represent the employer in applying for labor certifi-
cation. It is recommended that the employer not sign a
blank form, since the employer takes full responsibility
for any representations of its agent.
PART B. STATEMENT OF QUALIFICATIONS OF ALIEN (To be completed by the Alien)
Name of Alien. Self explanatory.
Present Address. Enter the address where the
jntly resides, whether in the United States
Type of Visa. If alien is in the United States,
e type of visa now held, i.e., B-2 (visitor),
nt), etc., or the alien's current status as shown
rm 1-94.
Alien's Birthdate. Do not use number for the
/rite out, e.g., March 21, 1942.
Birthplace. Seif explanatory.
Present Nationality or Citizenship of Alien.
country of which alien is currently a national
Address in U.S. Where Alien Will Reside.
latory.
Name and Address of Prospective Employer.
Business name and address.
Occupation in Which Alien is Seeking Work.
: entries are physicist, bricklayer, registered
tries such as "construction work" or "scienti-
i" are not acceptable.
Self explanatory.
Education Training. Identify all educational
icluding trade or vocational schools, attended
which give evidence of the alien's education
ig related to the occupation listed in Item 9.
Item 12. Additional Qualifications and Skills. Entries
should relate to the occupation listed in Item 9 and
should help establish the alien's qualifications for work-
ing in that occupation. Appropriate entries include any
unusual occupational knowledge or abilities such as the
ability to speak, read, and write languages other than the
language of the alien's native country.
Item 13. Licenses. List licenses held by the alien which
give evidence of proficiency in a profession, trade, or
occupation.
Item 14. Documentation. List any documents submit-
ted with this form as evidence of the alien's qualifi-
cations. These may include statements from past em-
ployers, diplomas, and educational or training certifi-
cates.
Item 15. Work Experience. Job descriptions should in-
clude specific details of the work performed, with em-
phasis on skills and knowledge required, services rend-
ered, managerial or supervisory functions performed,
materials or products handled, and machines, tools, and
equipment used or operated.
Item 16. Declarations. All copies of this form must
bear the alien's original signature. If an agent is involved,
the alien must complete the authorization of agent and
take full responsibility for any representations the agent
makes on behalf of the alien. It is recommended that
the alien not sign a blank form.
US. GOVERNMENT PRINTING OFFICE : 1380 O— 329-045
For sale liy the Siipprinti'iKlrnt of llorumeut*. I'.K. Govi'rnmi'iir I'rlntiiiR Office
WiisliiiiKiiui. n.c. 2(Mo:> ipor 100)
4/1/81
5-1
CHAPTER 5
5. APPEALS, MOTIONS AND CERTIFICATIONS
Moti ons to Reopen and Reconsi der 5-1
Form I-290A - Notice of Appeal to the Board of
Immigration Appeals 5-3
Form I-290B - Notice of Appeal to Regional Commissioner 5-5
Form I-290C - Notice of Certification 5-12
5-1
MOTIONS TO REOPEN OR RECONSIDER
I. USE:
TO REQUEST A DECISION RENDERED ON AN APPLICATION OR PETITION BE REVIEWED.
II- ELIGIBILITY:
1. FOR REVIEW OF A DECISION ON A PETITION:
(a) THE PETITIONER MAY FILE THE MOTION
(b) AN ATTORNEY OR REPRESENTATIVE REPRESENTING THE PETITIONER
MAY FILE THE MOTION.
(NOTE: THE BENEFICIARY OR AN ATTORNEY OR REPRESENTATIVE
REPRESENTING ONLY THE BENEFICIARY CANNOT FILE A MOTION
CONCERNING A PETITION.)
2. FOR REVIEW OF A DECISION ON AN APPLICATION:
(a) THE APPLICANT MAY FILE THE MOTION
(b) AN ATTORNEY OR REPRESENTATIVE REPRESENTING THE APPLICANT
MAY FILE THE MOTION.
HI- REQUIREMENTS:
1. MUST BE IN WRITING; A LETTER WILL SUFFICE;
2. MUST BE FILED IN DUPLICATE;
3. MUST BE FILED IN THE OFFICE WHERE THE ORIGINAL DECISION
WAS RENDERED;
4. MUST BE ACCOMPANIED BY THE APPROPRIATE FEE UNLESS ORIGINAL (8CFR 103.7(b)(l)
APPLICATION IS EXEMPT FEE, THEN NO FEE IS REQUIRED; OR IF
ACTION ON APPLICATION OR PETITION WAS AUTOMATICALLY TER-
MINATED PURSUANT TO 01 103. 2(o) OR 01 245. 2(b) NO FEE IS
REQUIRED.
FORM I-290A
USE:
USED TO APPEAL CERTAIN ADVERSE DECISIONSTO THE BOARD OF IMMIGRATION
APPEALS.
REQUIREMENTS TO FILE:
1. BOARD OF IMMIGRATION APPEALS MUST HAVE APPELLATE JURISDICTION:
a. APPEALS SHALL LIE TO THE BOARD OF. IMMIGRATION APPEALS FROM (8 CFR 3.1(b))
THE FOLLOWING:
(1) DECISIONS OF SPECIAL INQUIRY OFFICERS IN EXCLUSION CASES,
(2) DECISIONS OF SPECIAL INQUIRY OFFICERS IN DEPORATATION CASES
EXCEPT THAT NO APPEAL SHALL LIE FROM AN ORDER OF A SPECIAL
INQUIRY OFFICER GRANTING VOLUNTARY DEPARTURE WITHIN A
PERIOD OF AT LEAST 30 DAYS, IF THE SOLE GROUND OF APPEAL
IS THAT A GREATER PERIOD OF DEPARTURE TIME SHOULD HAVE
BEEN FIXED,
(3) DECISIONS ON APPLICATIONS FOR THE EXERCISE OF THE DISCRE-
TIONARY AUTHORITY CONTAINED IN SECTION 212(c) OF THE ACT
(APPLICATION - FORM 1-191.)
(4) DECISIONS INVOLVING ADMINISTRATIVE FINES AND PENALTIES,
INCLUDING MITIGATION THEREOF.
(5) DECISIONS ON APPLICATIONS FOR THE EXERCISE OF THE DISCRETIONARY
AUTHORITY CONTAINED IN SECTION 212(d)(3) OF THE ACT
(APPLICATION - FORM 1-192)
(6) DETERMINATIONS RELATING TO BOND, PAROLE, OR DETENTION OF AN
ALIEN AS PROVIDED IN PART 242 OF THIS CHAPTER.
(7) DECISIONS OF SPECIAL INQUIRY OFFICERS IN RESCISSION OF ADJUSTMENT
OF STATUS CASES, AS PROVIDED IN PART 246 OF THIS CHAPTER.
(8) DECISIONS ON 1-130 RELATIVE VISA PETITIONS, INCLUDING REVALUATION
AND REVOCATION THEREOF.
2. MUST BE FILED IN THE IMMIGRATION OFFICE THAT RENDERED THE ADVERSE DECISION
BEING APPEALED,
(NOTE: THOUGH APPELLANTS ARE LIMITED ON THE AMOUNT OF TIME THEY HAVE
TO FILE THEIR APPEAL, ALL APPEALS UNDER THE JURISDICTION OF THE BOARD
OF IMMIGRATION APPEALS WILL BE ACCEPTED AND FORWARDED TO THE BOARD REGARDLESS
OF TARDINESS.)
10/1/80
5-3
3. MUST BE SUBMITTED IN TRIPLICATE.
4. MUST BE ACCOMPANIED BY PROPER FEE.
5. MUST BE SIGNED BY PETITIONER, APPLICANT, OR ATTORNEY OR
REPRESENTATIVE FOR THE PETITIONER OR APPLICANT.
(NOTE: THE BENEFICIARY OF A PETITION MAY NOT APPEAL THE DECISION.
THE PETITIONER MUST MAKE THE APPEAL.)
5-3
TM
ADMINISTRATIVE MANUAL
Appendix I
1-250*
P«g« I
NOTICE OF APPEAL TO TOE BOARD OF IMMCIUTION APPEALS
SUBMIT IN TRIPLICATE TO:
IMMIGRATION AND NATURALIZATION SBHVICC
la th* Mcttot of:
FU«H«.
1. 1 barafcy •ppeaJ to Uw BMM! at laausretioti Appaola (*M tb« teteiaa.
i« Ib* abowt veUUad COM.
2. Briefly. MM*
OL C
4. I
i ftinatmi, JIMW. C«*. JMM. I* CaM
MPOirrANTi SEE WSTWUCnONSOW REVERB SOS. OF TBS MOmCE
FORM NO. ' eOSTJON
1 *240A &£l^iMlkMltftJtfe
NOTICE OF APPEAL TO BOARD OF IMMIGRATION APPEALS
ilXC INSTRUCTION udrXUEHaB 8 CFR 3.Kd)(l-«), J.:
8 x ,0 ,/2 242.21, 2*6-7, 299-1; 01 3.K«)i AM 29M Ex. 1; II Hbk
)(•). 136. 5 (b), 2«2.19(b), M.
1-1S.I, 12-10, 12-13. App. 5-H
DM
FILED WITH DISTRICT DIRECTOR Oft OFFICER IN CHARGE 9Y THE ALIEN OR
AFFECTED IV A SERVICE DECISION
OTHER PARn ADVERSELY
PRIOR EDITIONS KAY NOT K USED
I •amauc A
I-29QA
Page 2
TW 763
J. F»
e®. A fee r
S*i® Ja tbe Vtn,"*! seL. „
ia lolacd "La
AJi •* -&. "•
BOBB ei tta tin „ i
pet <
maM
basic <sa w&ich r it, C'T_
c t. a._^ b^ djafjQ oa a baafe es
o w _ v."-y K app^lki*"
en fc ^. _ j-jacO-'C'* r* Ftaaet*
. Q 61 aa
f r „ -L o a u
a ^o sj
« •5"€La
a j5a sfa efci. ejpsei will
of afcio a^paci fa. -j, i
en c 7 u,
3. Eciefa. A b? P " w,,^ c.
havng aglnspB^f!^ i ?j ;
otha? additionr<« ^J^K t- i^.
the tecisioa. Steii of >-
reply brieL 1 fee PC iitu in «,-»
©v«at
i «L,J vpiosantatives.
„ » i ©asd.
,„ cii, > if a brief is fil«i it
c c < ^s^"alisotio» Sefvisa
~ t t 3 ™ap«si o-J wathia aisy
< S ^>" v tvie® officer wto mad®
* „ t i few !iiiug a brief or
aJh it, so which
I. 3 II-
4. Ow8 argaaeae. Oral rj&E^cri °( '* tie t t tn <-
sffissf Jeaysrg c '.j'sfit OK. t< >, u>i -cJ { vi"t a
6y <&« fioorsti Oral jsg'3u,c»i<. tsc ijJ, j t _ u. ti >_ k <_i. t
wf|Misad. Tto BeaeJ will ^,u 3- i^ t, i. < - ~s 6 r^c«,a(J
smtatioos aw ffiad®. <Ht,5 j gHr it. i i . ->t , a r i » -> Jd
»o»ns.. «*i k~b ^'Ji6« s ._ ta c -an i_' Jttii tb-js Lc^cd "3
e-det of c special tn^ii irjr
(IS) miss»
will ssoi «X) to' j^rj 'i »( f m - p^. _isica to c ti~ tho Uiuted Stataa to pn*«nt
iJ r <_ tici^, i „' E i J j JIL. »»i.t ^ „ i^j jeeaSt bin b«fo»» the
TT. i^c 10 ^ <- ' » Vi Ao -i r Jai s token. th« Bsarf will not
the easo to Qir^two 8.
S. No apip«BL TAere ia no efpeusi from ea ordw ef a asccte? 8sgc58sy officer granting wlswswy rfe-
paftaft within Q pswsod e/ e« Jc«i3* ;ki(Cy &v/.? sf ffic selc gtssmd of epperf w llw^ <a g»-«a««P
peried of dgpennfa lime skestlel lusv® bsaa [ised.
& S«waary dseaisaaS of a^cala. 'i'ke Bssc.jJ lijuy dcsy oiei argitzcst aad Qtsatnarily dismiss say ap-
in aay depoBtatica procewdifjg ia w&iefa (i) tha pasty easi*»ra«d faate eo s^eify 4ba r®«soa lof
oa the reverse sid«:; of ihirj ?e::at (is) the oaly reasca cpestfied by Sha party cooe«a®«l
foe hi« Appeal involves R ^jcdiRg •;;" £r.r£ 03 eaueiissiea o£ laiv which was conseded by him at tfe®
towing, (sis) the appeal is fccsi ass osdae ifasi girasiU; £&Q pafty coasssasd the raise! whiefe to
i, of (iv) if lie Bo&fd is satisfied, J'.O.T: s ravia& of ska eeeofd, tkot ike appeal is ftioo*
fa
?. FIUNC OF NOTICE 0F APPEAL. THE riG'Il'CE OF APPEAL, IK TRIPLICATE, WITH THE
HEQU1RED FEE, JII/SF BS SUBMITTED TO THE JKMKSRATION AND NATURALIZATION
SERVICE OFFICE THE CASE •£ .^L'KDiKC-. TKE NOTICE OF APPEAL IS NOT TO BE
FORWARDED DIRECTLY TO THE OF I6SMIGRATIOM APPEALS.
in/i
I. USE;
USED TO APPEAL CERTAIN ADVERSE DECISIONS TO THE REGIONAL COMMISSIONER.
II. REQUIREMENTS TO FILE;
1. THE REGIONAL COMMISSIONER MUST HAVE APPELLATE JURISDICTION.
a. APPEALS SHALL LIE TO THE REGIONAL COMMISSIONER FROM THE FOLLOWING:
1. DECISIONS ON BREACHING OF BONDS AS PROVIDED IN 103. 6(e).
2. DECISIONS ON THIRD-AND SIXTH-PREFERENCE PETITIONS, AS
PROVIDED IN 204. He), EXCEPT WHEN THE DENIAL OF THE
PETITION IS BASED UPON THE LACK OF A CERTIFICATION BY
THE SECRETARY OF LABOR PURSUANT TO SECTION 212(a)(14)
OF THE ACT; (FORMS 1-140),
3. DECISIONS ON INDOCHINESE REFUGEE APPLICATIONS FOR ADJUSTMENT
OF STATUS, AS PROVIDED IN 245.2(a)(4) AND 245. 2(e); (FORM I-485c).
4. DECISIONS ON ORPHAN PETITIONS, AS PROVIDED IN 204. l(b); (FORMS 1-6
5. DECISIONS REVOKING APPROVAL OF CERTAIN PETITIONS, AS PROVIDED
8 CFR 103. l(m) IN 205>3 .-j^s AND i
6. DECISIONS ON APPLICATIONS FOR PERMISSION TO REAPPLY FOR ADMISSION
TO THE UNITED STATES AFTER DEPORTATION OR REMOVAL, AS PROVIDED
IN 212. 2i (FORMS 1-212).
7. DECISIONS ON APPLICATIONS FOR WAIVER OF CERTAIN GROUNDS OF
EXCLUDABILITY, AS PROVIDED IN 212, 7(a); (FORMS 1-601)
8. DECISIONS ON APPLICATIONS FOR WAIVER OF THE TWO-YEAR FOREIGN
RESIDENCE REQUIREMENT, AS PROVIDED IN 212. 7(c); (FORMS 1-612)
9. DECISIONS ON PETITIONS FOR APPROVAL OF SCHOOLS, AS PROVIDED IN
214.3; (FORMS 1-17)
10. DECISIONS BY SPECIAL INQUIRY OFFICERS IN PROCEEDINGS TO WITH-
DRAW THE APPROVAL OF PETITIONS BY SCHOOLS, AS PROVIDED IN 214.4(J)
11. DECISIONS ON PETITIONS FOR TEMPORARY WORKERS OR TRAINEES AND
FIANCEES AND FIANCES OF CITIZENS OF THE UNITED STATES, AS PROVIDEC
IN 214.2; (FORMS 1-1298 and I-129F)
-1-
I£. UtLlMUNS UN AKKLiUU 1UNS PUK iSSUMNUt Ur KttNl KT
PROVIDED IN 223.1; (FORMS 1-131)
13. DECISIONS ON APPLICATIONS FOR REFUGEE TRAVEL DOCUMENTS, AS
PROVIDED IN 223a.4; (FORMS 1-570)
14. DECISIONS ON APPLICATIONS FOR BENEFITS OF SECTION 13 OF THE
ACT OF SEPTEMBER 11, 1957, AS PROVIDED IN 245.3;
15. DECISIONS ON ADJUSTMENT OF STATUS OF CERTAIN RESIDENT ALIENS
TO NONIMMIGRANTS, AS PROVIDED IN 247.12(b);
16. DECISIONS ON APPLICATIONS FOR CHANGE OF NONIMMIGRANT STATUS, AS
PROVIDED IN 248. 3(d) (FORMS 1-506)
17. DECISIONS ON APPLICATIONS TO PRESERVE RESIDENCE FOR NATURALIZATION
PURPOSES, AS PROVIDED IN 316a.21(c);
18. DECISIONS ON APPLICATIONS FOR CERTIFICATES OF CITIZENSHIP, AS
PROVIDED IN 341.6;
19. DECISIONS ON ADMINISTRATIVE CANCELLATION OF CERTIFICATES,
DOCUMENTS, OR RECORDS, AS PROVIDED IN 342.8;
20. DECISIONS ON APPLICATIONS FOR CERTIFICATES OF NATURALIZATION
OR REPATRIATION, AS PROVIDED IN 343.1;
21. DECISIONS ON APPLICATIONS FOR NEW NATURALIZATION OR CITIZENSHIP
PAPERS, AS PROVIDED IN 343. l(c); AND
22. DECISIONS ON APPLICATIONS FOR SPECIAL CERTIFICATES OF
NATURALIZATION, AS PROVIDED IN 343b.ll(b).
23. DECISIONS ON APPLICATIONS BY ORGANIZATIONS TO BE LISTED ON THE
SERVICE LISTING OF FREE LEGAL SERVICES PROGRAMS AND DECISIONS
TO REMOVE ORGANIZATIONS FROM SUCH LISTS SEE PART 292a OF THIS
CHAPTER.
2. MUST BE FILED IN THE IMMIGRATION OFFICE THAT RENDERED THE ADVERSE
DECISION BEING APPEALED.
3. ONLY A SINGLE COPY NEED BE SUBMITTED.
4. MUST BE ACCOMPANIED BY PROPER FEE.
5. MUST BE SIGNED BY PETITIONER APPLICANT, OR ATTORNEY OR REPRESENTATIVE
FOR THE PETITIONER OR APPLICANT.
(NOTE: THE BENEFICIARY OF A PETITION MAY NOT APPEAL THE DECISION.
THE PETITIONER MUST MAKE THE APPEAL.)
, 10/1/80
5-7
6. THE APPEAL MUST BE FILED WITHIN 15 DAYS OF THE DATE OF THE
DECISION IF THE DECISION WAS DELIVERED BY HAND. IF THE
DECISION WAS DELIVERED BY MAIL, THE APPEAL MUST BE MADE
WITHIN 18 DAYS OF THE DATE OF THE DECISION.
(NOTE: AN APPEAL WHICH IS BEING PRESENTED LATE SHOULD NOT BE
ACCEPTED. THE APPELLANT SHOULD BE INFORMED THAT THERE IS NO
PROVISION ALLOWING THE ACCEPTANCE OF AN UNTIMELY APPEAL. THE
APPELLANT SHOULD BE INFORMED THAT HE CAN HAVE THE CASE REVIEWED
IF HE WANTS TO FILE A MOTION TO REOPEN OR RECONSIDER.
IF THERE IS CONFUSION WHETHER THE APPEAL IS BEING FILED TIMELY,
OR IF THE APPELLANT INSISTS ON FILING AN UNTIMELY APPEAL, REFER
TO AN OFFICER.)
t
~T*^^7
TM 800 ADMINISTRATIVE MANUAL I-290B
Appendix 1 Page 1
NOTICE OF APPEAL TO REGIONAL COMMISSIONER
IMMIGRATION AND NATURALIZATION SERVICE
In the Matter of: File N°'
1. I hereby appeal to the Reaional Commissioner from the decision, dated
, in the above entitled case.
2. „ . filinq o written brief or a written statpmenl wnh the above Service
office within the time allowed for such filing.
3. Briefly, state reasons for this appeal.
APPELLANT (OR ATTORNEY OR REPRESENTATIVE)
Name:
IT-rpe or Prinll
Address:
IHambtrl (Strectl
IDattl (Cilll rSlatel (Zip Code!
IMPORTANT: SEE INSTRUCTIONS ON REVERSE SIDE OF THIS NOTICE
(Rev. 6-20-80) N
FORM NO. EDITION TIT LE
!"290B Rev- 6-20-80 NOTICE OF APPEAL TO REGIONAL COMMISSIONER
SIZE INSTRUCTION REFERENCE 8 CFR 103.3(a), 214.4(h)(2) , (j) , 299 1- AM 2482 Ex 1
^ * n 2984 Ex. 2, Ex.4; II Hbk 1-18.1, -19, 6-6. -9. -22! 10-50, A^.B-H; GIB A-7
USE
RvElE«^rLE^Bn^HE REGULATIONS T0 APP«L TO THE REGIONAL COMMISSIONER THIS NOTICE IS FILED
Hi AN ALlhN UK OTHER PARTY
PRIOR EDITIONS MAY NOT BE USED SCHEDULE A
ADMINISTRATIVE MANUAL
Appendix 1
TM 800
INSTRUCTIONS
1 Fees A fee of fifty dollars ($50) must be paid for filing this appeal. It cannot be refunded regardless
of the action taken on the appeal. DO NOT MAIL CASH. ALL FEES MUST BE SUBMITTED IN THE
EXACT AMOUNT. Payment by check or money order must be drawn on a bank or other institution
located in the United States and be payable in United States currency. If appellant resides in Guam,
check or money order must b« payable to the "Treasurer, Guam." If appellant resides in the Virgin
Islands, check or money order must be payable to the "Commissioner of Finance of the Virgin Islands."
All other appellant must make the check or money order payable to the "Immigration and Naturalization
Service." When check is drawn on account of a person other than the appellant, the name of the
appellant must be entered on the face of the check. If appeal is submitted from outside the United
States, remittance may be made by bank international money order or foreign draft drawn on a financial
institution in the United States and payable to the Immigration and Naturalization Service in United
States currency. Personal checks are accepted subject to collectibility. An uncollectible check will
render the appeal and any document issued pursuant thereto invalid. A charge of $5.00 will be imposed
if a check in payment of a fee is not honored by the bank on which it is drawn.
2. Counsel. In presenting and prosecuting this appeal the appellant may, if he desires, be represented
at no expanse to the Government by counsel or other duly authorized representatives.
3. Briefs. A brief in support of or in opposition to an appeal is not required, but if o brief is filed, it-
shall be submitted to the offices of the Immigration and Naturalization Service having administrative
jurisdiction over th.j case within the time fixed for the appeal or within any other additional period
designated by the Service officer who made the decision. Such officer, for good cause, may extend
the time for filing a brief or reply brief.
4. Ora! argument. Oral argument before a Regional Commissioner or officer designated by him may be
requested by letter attached to this notice. The letter should set forth the reason oral argument is
desired in support of or in lieu of a brief. If oral argument is granted, the officer to vvliom the appeal
is taken will designate in writing the time, date, and place the oral argument may be heard. Oral
argument in any one case should not extend beyond fifteen (15) minutes, unless arrangements for
additional time are made with the Regional Commissioner in advance.
5. Dismissal of appeals. The Regional Commissioner may deny oral argument and dismiss any appeal in
which (i) the party concerned fails to specify the reasons for his appeal on the reverse side of this
form, or (ii) the appeal is patently frivolous.
6. Filing of Notice of Appeal. The Notice of Appeal, with the required fee, must be submitted to the
Immigration and Naturalization Service where the case is pending.
GPO 871 344
4/1/81
5-12
FORM I-290C
I. USE:
NOTIFICATION OF THE APPLICANT OR PETITIONER THAT BECAUSE OF UNUSUALLY
COMPLEX OR NOVEL QUESTION OF LAW OR FACT, THE CASE IS BEING CERTIFIED
TO THE APPELLATE AUTHORITY FOR A DETERMINATION ON THE PROPRIETY OF THE
DISTRICT DIRECTOR'S DECISION.
II. REQUIREMENTS:
1. NO FEE.
2. APPLICANT OR PETITIONER HAS TEN DAYS AFTER RECEIPT OF THE NOTICE TO
FILE A BRIEF OR OTHER WRITTEN STATEMENT FOR CONSIDERATION BY THE
REVIEWING AUTHORITY.
3. IF APPLICANT OR PETITIONER DESIRES ORAL ARGUMENT BEFORE APPELLATE
AUTHORITY, THE REQUEST MUST BE MADE IN WRITING WITHIN THE 10 DAYS,
TO THE BOARD OF IMMIGRATION APPEALS, 2 SKYLINE PLACE, 5203 LEESBURG
PIKE, FALLS CHURCH, VA 22041.
5-13
ADMINISTRATIVE MANUAL
Appendix I
I-£90C
TO
IN THE MATTER
OF
LIMITED STATES DEPARTMENT Of JUST1CI
IMMIGRATION AND MATU8ALIZATIOM SERVICE
Data
NOTICE OF CEBTIFICAT1ON
File No.
Pleaae take notioa that ti»« following Action ho* been taken in the above entitled
matter:
The caae hu been certified for review to .
You may nbmit to tkU office within Urn d«.ys aftwr r»c«iptof this notice a brief or
other written statement for consideration by the reviewing authority.
(TiO.)
(Office)
(FOLLOWING PARAGRAPH APPLICABLE ONLY WHEN A CASE HAS BEEN CERT1-
FIED TO THE BOARD OF IMMIGRATION APPEALS -
If you desire to preaeat oral argument before the Board at its offlee, Washington,
D.C., 20530, your request for such argument rouBt be made promptly by letter addraaaed
to the Board of Immigration Appeal a.)
Fora I-2»0 C
(Rev. «-8ft-6«) «M> tit.tti
>.
90C
EDITION TITLE
REV. 9-30-66
NOTICE OF CERTIFICATION
10 1/2
INSTRUCTION REFERENCE
8 CFR 3.7 and OI 103.4
NOTICE TO ALIEN THAT CASE HAS BEEN CERTIFIED TO BLA/REGIONAJL COMMISSIONER
6-1
CHAPTER 6
6. WAIVERS
Form 1-191 - Application for Advance Permission to Return
to Unrelinquished Domicile 6-1
Form 1-192 - Application for Advance Permission to Enter
as Nonimmigrant 6-5
Form 1-212 - Application for Permission to Reapply for
Admission into the United States after Deportation 6-9
Form 1-601 - Application for Waiver of Grounds of Excludability. 6-13
Form 1-612 - Application for Waiver of Foreign Residence
Requi rement 6-21
4/1/81
FORM 1-191
I. USE:
USED BY A LAWFUL PERMANENT RESIDENT ALIEN TO REQUEST ADVANCE
PERMISSION TO RETURN TO THE UNITED STATES AND RESUME HIS/HER
UNRELINQUISHED DOMICILE WHEN THE ALIEN WOULD BE EXCLUDABLE IF
APPLYING FOR ADMISSION INTO THE UNITED STATES.
(NOTE: DOES NOT APPLY TO EXCLUDABILITY UNDER 212(a)(26), (27),
(28), (29), and (33).)
II. ELIGIBILITY:
1. MUST BE LAWFUL PERMANENT RESIDENT.
2. MUST HAVE BEEN LAWFULLY DOMICILED IN THE UNITED STATES FOR
SEVEN (7) CONSECUTIVE YEARS.
3. IF THE ALIEN IS PROCEEDIN ABROAD OR HAS PROCEEDED ABROAD, IT
MUST BE OR HAVE BEEN VOLUNTARILY AND NOT UNDER AN ORDER OF
DEPORTATION.
4. THE ALIEN'S TRIP ABROAD MUST BE OR HAVE BEEN TEMPORARY.
5. THE ALIEN NEED NOT DEPART THE UNITED STATES TO BE ELIGIBLE FOR
THIS WAIVER.
6. MUST NOT BE EXCLUDABLE UNDER SECTION 212(a)(27), (28), (29), OR
(33) OF THE IMMIGRATION AND NATIONALITY ACT.
III. REQUIREMENTS:
1. PROPER FEE.
2. MUST BE SUBMITTED TO THE DISTRICT DIRECTOR IN CHARGE OF THE AREA
IN WHICH THE APPLICANT'S INTENDED OR ACTUAL PLACE OF RESIDENCE
IS LOCATED PRIOR TO, AT THE TIME OF, OR AT ANY TIME SUBSEQUENT
TO APPLICANT'S ARRIVAL IN THE UNITED STATES.
3. FORM G-325A MUST BE COMPLETED AND MUST ACCOMPANY THE APPLICATION.
4. EACH QUESTION ON THE APPLICATION MUST BE ANSWERED COMPLETELY. IF
THERE IS NOT SUFFICIENT SPACE ON THE FORM, AN ATTACHMENT SHOULD BE
SUBMITTED.
5. IF AN ATTACHED IS NECESSARY, THE ANSWERS ON THE ATTACHMENT SHOULD
BE NUMBERED TO CORRESPOND WITH THE QUESTIONS ON THE APPLICATION.
TM 805
ADMINISTRATIVE MANUAL 1-191
Appendix 1 Page 1
u
(
Form Approved
OMB No. 4J.ROJJ9
Immigration and Naturalization Service
APPLICATION FOR ADVANCE PERN
TO RETLRN TO t.NRELINQliSHED D(
(Pursuant to Section 212(c) of the
Immigration and Nationality Act)
FEE STAMP
ISSION
)MIC!LE
Utien Roclatratlon No.
on reverse. Pleas.
Nationality Act
WY NAME IS:
ffirarj
(MldHlf) fLaai;
DATE OF BIRTH: (Month, a»y. yearj
PLACE OF BIRTH: fClly. province, country) I AM A CITIZEN OF: ICountryJ
(2) I was lawfully
admitted to the Un
ited States for per
man
:nt residence at:
PORT.
5ATE: (Month, dty. yt*i) NAME OF VESSEL OR OTHER MEANS OF CONVEYANCE:
DEPARTED FROM THE UNITED STATES
RETURNED TO THE UNITED STATES PURPOSE OF TRIP
For,
^d'aVar/'
Data Veaial or Other Mean"
P°" (Month, day. y««r> of Conveyance
•
PUc..,fL,.,p,...n, .-*".,.»«
— (C°S'!" M.A<
.)
19 Prc««nc tim«
19 19
19 19
19 19
19 19
(5) During the pas
t 7 years I have been employed as follows: (Lin pre*enr employment lint)
From-
To -
Employ"'!
Nan
*—» 0ccr8g°.nin.r.Ji">'
19
Prei.nt
19
19
19
19
19
19
(6) My immediate
family consists of the following persons:
Name
Relation
Dat« and Country o( Birth Citizen o( Pre»«nt Addre««
in I
d) temporarily fro
ffnlend to o
r have.)
(•Dale)
jpproximatelv . for the Duroose of
(Country)
and
(Lfngt* ol Tim*)
Form 1-191 (Rev. 6-20-SQ) N
(Port)
FORM NO.
1-191
EDITION
REV. 6-20-80
TITLE
APPLICATION
TO UNREL
FOR ADVANCE PERMISSION TO RETURN
INQUISHED DOMICILE
SIZE
8 X 10 1/2
INSTRUCTION REFERENCE
8 CFR 212.3, 299.1; AM 2301.07, 2482 Ex. 1
R-10.4: R1R A-7
, P. 6, 2984 Ex. 2, Ex. 4, P. 3; II Hbk 6-22.1, -24,
use
FIELD BY AN ALIEN WHO BELIEVES HE QUALIFIES TO RETURN TO THE U.S. AND RESUME
UNRELINQUISHED DOMICILE AS PROVIDED BY SECTION 212(c) OF THE I&N ACT.
PRIOR EDITION MAY NOT BE USED
SCHEDULJC A
/fil
(8) 1 believe I ITS;, be inadmissible to the Uniied States for the following reasons
I understand :ha'. :r.e information herein contained may be used in any criminal or civil proceedings, including deportation at
exclusion, herear.er instituted against me.
I certify that the statements above are true and correct to the best of my knowledge and belief.
f Signature of Appltcantj
SIGNATURE OF PERSON PREPARING FORM. IF OTHER THAN APPLICANT
I declare that t-.is cr.-ument was prepared by me at the request of the applicant and is based on all information of which 1 have any
knowledge.
•Signature) (AddrelE) (Date!
Decision:
[^] Application grar.-.ed upon the following terms and conditions:
DATE
OF
ACTION
OD
DISTRICT
INSTRUCTIONS TO THE APPLICANT
READ INSTRUCTIONS CAREFULLY - FEE WILL NOT BE REFUNDED
(A) This form »!-.en c:npletely executed, should be submitted to the District Director of the Immigration office having jurisdiction
over your place if permanent residence.
(B) A fee of thirty. five dollars ($35) mult be paid for filing this application. It cannot ba refunded regardless of the action taken
on the oppl.catic-. DO NOT MAIL CASH. ALL FEES MUST BE SUBMITTED IN THE EXACT AMOUNT. Payment by check
or money orcer r-.st be drawn on a bank or other institution located in the United States and be payable in United States
currency. If opp can* resides in Guam, check or money order must be payable to the "Treasurer, Guam." If Applicant resides
in the Virgir Islc-ds, check or money order mutt be payable to the "Commissioner of Finance of the Virgin Islands." All
other appliceits -ust moke the check or money order payable to the "Immigration and Naturalization Service." Vihen check is
drawn on acccurv of a person other than the applicant, the name of the applicant must be entered on the face of the check. If
application is su:mitted from outside the United States, remittance may be made by bank international money order or foreign
draft drown ci o -'inonciol institution in the United States and payable to the Immigration and Naturalization Service in United
States currency. 9ersonal checks are accepted subject to collectibility. An uncollectible check will render the application and
any documert tu.ed pursuant thereto invalid. A charge of $5.00 will be imposed if a check in payment of a fee is not honored
by the bonk en w-ich it is drown.
dcr 14 years of age, the application shall be executed by his parent or guardian.
(F) If applicant ;s rr.sr.tally incompetent or is un
The authority for collection of the information requested on this form is contained in 8 U. S. C. 1103(a). Submission of the infor.
mation is voluntary. The principal purpose for which the information is solicited is for use by a District Director 'of the Immi-
gration and Natural izi:ion Service to determine whether the applicant is eligible for advance permission to return to an un-
relinquished domicile pursuant to the provisions of section 212(c) of the Immigration and Nationality Act, 8 U. S. C. 1182(c). The
information solicited =ay also, as a matter of routine use, be disclosed to other federal, state, local, and foreign law enforcement
and regulatory agencies, the Department of Defense including any component thereof (if the applicant has served, or is serving in
the Armed Forces of the United States), the Department of State, Central Intelligence Agency, Interpol, *»d individuals and
organizations, during the course of investigation to elicit further information required by the Service to carry out its functions.
Failure to provide an) or all of the solicited information may result in the denial of the application- ,-p.,
4/1/81
6-5
FORM 1-192
I. USE:
USED BY ALIEN SEEKING TO ENTER THE UNITED STATES TEMPORARILY TO
REQUEST ADVANCE PERMISSION TO ENTER AS A NONIMMIGRANT IF THAT
ALIEN IS EXCLUDABLE UNDER 212(a) OF THE IMMIGRATION AND NATIONALITY ACT.
(NOTE: AN ALIEN WHO IS APPLYING FOR A NONIMMIGRANT VISA AT AN
AMERICAN CONSULATE ABROAD DOES NOT FILE A FORM 1-192 WITH THE
SERVICE. IN THOSE CASES THE CONSULAR OFFICER RECOMMENDS THAT
THE APPROPRIATE SERVICE CONCUR IN GRANTING A WAIVER. THE FOLLOWING
PROCEDURE APPLIES ONLY TO ALIENS WHO DO NOT REQUIRE VISAS, OR WHO
HAVE BEEN ISSUED VISAS AND ARE APPLYING FOR ADMISSION.)
(NOTE: DOES NOT WAIVER EXCLUDABILITY UNDER 212(a) (27) (29) or (33).)
II. ELIGIBILITY:
1. MUST BE SEEKING TO ENTER THE UNITED STATES TEMPORARILY.
2. MUST NOT BE EXCLUDABLE UNDER SECTION 212(a) (27)(29) OR (33) OF
THE IMMIGRATION AND NATIONALITY ACT.
III. REQUIREMENTS:
1. PROPER FEE.
2. MUST BE SUBMITTED IN DUPLICATE.
3. MUST BE SUBMITTED TO THE DISTRICT DIRECTOR IN CHARGE OF THE PORT
OF ENTRY THROUGH WHICH THE APPLICANT INTENDS TO ENTER THE UNITED STATES
4. IF APPLICATION IS MADE BECAUSE APPLICANT MAY BE INADMISSIBLE DUE TO
PRESENT OR PAST MEMBERSHIP IN OR AFFILIATION WITH ANY COMMUNIST
OR OTHER TOTALITARIAN PARTY OR ORGANIZATION, THERE MUST BE ATTACHED
TO THE APPLICATION A WRITTEN STATEMENT OF THE HISTORY OF APPLICANT'S
MEMBERSHIP OR AFFILIATION INCLUDING THE PERIOD OF THAT MEMBERSHIP
OR AFFILIATION, WHETHER APPLICANT HELD ANY OFFICE IN THE ORGANIZATION
AND WHETHER MEMBERSHIP OR AFFILIATION WAS VOLUNTARY OR INVOLUNTARY.
IF VOLUNTARY MEMBERSHIP OR AFFILIATION IS ALLEGED, THERE MUST ALSO
BE ATTACHED TO THE APPLICATION A WRITTEN STATEMENT TO SUPPORT THE
ALLEGATION.
5. IF APPLICATION IS MADE BECAUSE APPLICANT MAY BE INADMISSIBLE DUE TO
DISEASE, MENTAL OR PHYSICAL DEFECT OR DISABILITY OF ANY KIND, THE
APPLICATION MUST DESCRIBE THE DISEASE, DEFECT OR DISABILITY. IF THE
PURPOSE OF SEEKING ADMISSION TO THE UNITED STATES IF FOR TREATMENT,
a. THAT SATISFACTORY TREATMENT CANNOT BE OBTAINED OUTSIDE THE
UNITED STATES;
b. THAT ARRANGEMENTS HAVE BEEN MADE FOR TREATMENT, INCLUDING WHERE
AND FROM WHOM TREATMENT WILL BE RECEIVED;
c. WHAT FINANCIAL ARRANGEMENTS FOR PAYMENT OF EXPENSES INCURRED IN
CONNECTION WITH THE TREATMENT HAVE BEEN MADE; AND
d. THAT A BOND WILL BE POSTED IF REQUIRED BY THE ATTORNEY GENERAL.
6. IF APPLICATION IS MADE BECAUSE APPLICANT MAY BE INADMISSIBLE DUE TO
CONVICTION OF CRIME, THE DESIGNATION OF THE CRIME, THE DATE AND
PLACE OF ITS COMMISSION AND OF THE CONVICTION, AND THE SENTENCE OR
OTHER JUDGMENT OF THE COURT MUST BE STATED IN THE APPLICATION. IN
SUCH A CASE, THE APPLICATION SHOULD BE SUPPLEMENTED BY OFFICIAL RECORD
OF CONVICTION, AND ANY OTHER DOCUMENTS RELATING TO COMMUTATION OF
SENTENCE, PAROLE, PROBATION, OR PARDON.
7. FORM G-325A MUST BE SUBMITTED WITH THE APPLICATION.
8. ALL FOREIGN LANGUAGE DOCUMENTS MUST BE ACCOMPANIED BY A CERTIFIED
ENGLISH TRANSLATION.
4/1/81
IM 800
ADMINISTRATIVE MANUAL
Appendix 1
1-192
Page 1
UNITED STATES DEPARTMENT OF JUSTICE
F.. Stan?
OMB No. 43~RO]3I
(Please read instructions on reverse)
APPLICATION
FOR ADVANCE PERMISSION
TO ENTER AS NONIMMIGRANT
(Pursuant to Section 212 (d) (3) of the
Immigration and Nationality Act)
File No.
I hereby apply to the Attorney General for permission to enter the United States temporarily under the
provisions of section 212 (d) (3) of the Immigration and Nationality Act.
1. FULL NAME (Print!
S. DATE OF BIRTH
PLACE OF BIRTH (Clty-Toum, Stato/Proviiut. Countrfl
4. PRESENT CITIZENSHIP
8. MEANS OF TRAh
It. MY PURPOSE FOR ENTERING THE UNITED STATES IS: CE«j>(«ui fully/
13. I | 1 have | | have not heretofore filed an applicot on (or adv
nonimmigrant, nn , 19 , at ,
ance permission to enter as a
14. 1 understand that the information herein contained may be used in any proceedings (including civil or criminal
judicial proceedings, or deportation or exclusion proceedings) hereafter instituted against me.
1 certify that the statements above and all attachments hereto are true and correct to the best of my knowledge and
belief.
(Signature or Appllc
«i)
(D.le)
IS. SIGNATURE OF PERSON PREPARING FORM IF OTHER THAN APPLICANT
1 daclarn that thi* docum«nt wo* propar«d by mo at tha raqua*t of tha applica
ony lcnowl«J9«.
it and i> bated on all information of which 1 h«v«
(Slgnotur.)
(Add.o.o
(Dot.)
Form 1-192 (Rev. 6-20-80) N
_L^'_r__| ft .T"""- 1 "— ET"
FORM NO. EDITION
1-192 t Rev. 6-20-80
TITLE
APPLICATION FOR
ADVANCE PERMISSION TO ENTER AS NONIMMIGRANT
SIZE INSTRUCTION REFERENCE
84 x 11 8 CFR 212. 4(b), 299.1; 01 214. 2(b), 235. 4(b); AH
2984 Ex.2; II Hbk 6-15, -38
USE
FILED BY ALIEN
TO APPLICATION
FOR PERMISSION TO ENTER U.S. TEMPORARILY, PRIOR
FOR ADMISSION AT PORT OF ENTRY
PRIOR EDITIONS MAY NOT BE USED
| SCHEDULE A
Page 2
Appendix 1
ACTION BY IMMIGRATION AND NATURALIZATION SERVICE
Q Granted, subject to revocation at any time, upon the following
terms and conditions:
DATE OF ACTION
DO OR O1C
OFFICE
INSTRUCTIONS
1. This application must be executed in duplicate and filed with the district director having jurisdiction
over the port of entry.
2. A fee of fifteen dollars ($15) must be paid for filing this application. It cannot be refunded regrardless
of the action taken on the application. DO NOT MAIL CASH. ALL FEES MUST BE SUBMITTED IN THE
EXACT AMOUNT. Payment by check or money order must be drawn on a bank or other institution located in
the United States and be payable in United States currency. If applicant resides in Guam, check or money
order must be payable to the "Treasurer, Guam." If applicant resides in the Virgin Islands, check or money
order must be payable to the "Commissioner of Finance of the Virgin Islands." All other applicants must
make the check or money order payable to the "Immigration and Naturalization Service." When check is
drawn, on account of a person other than the applicant, the name of the applicant must be entered on the
face of the check. If application is submitted from outside the United States, remittance may be made by
bank international money order or foreign draft drawn on a financial institution in the United States and
payable to the Immigration and Naturalization Service in United States currency. Personal checks are
accepted subject to collectibility. An uncollectible check will render the application and any document
issued pursuant thereto invalid. A charge of $5.00 will be imposed if a check in payment of a fee is not
honored by the bank on which it is drawn.
3. If application is made because applicant may be inadmissible due to present or past membership in
or affiliation with any Communist or other totalitarian party or organization, there shall be attached to the
application a written statement of the history of applicant's membership or affiliation including the period of
such membership or affiliation, whether applicant held any office in the organization, and whether membership
or affiliation was voluntary or involuntary. If involuntary membership or affiliation is alleged, there shall also
be attached to the application a written statement to support said allegation.
4. If application is made because applicant may be inadmissible due to disease, mental or ptiysical
defect or disability of any kind, the application shall describe the disease, defect or disability. If the pur-
pose of seeking admission to the United States is for treatment, there shall be attached to the application
statements in writing to establish -
(a) that satisfactory treatment cannot be obtained outside the United States,
(b) that arrangements have been completed for treatment, and where and from whom treatment will be
received,
( c) what financial arrangements for payment of expenses incurred in connection with the treatment have
been made, and
(d) that a bond will be available if required by the Attorney General.
5. If application is made because applicant may be inadmissible due to conviction of crime, the designa-
tion of the crime, the date and place of its commission and of the conviction thereof, and the sentence or
other judgment of the court shall be stated in the application. In such case the application should be supple-
mented by official record of conviction, and any other documents relating to commutation of sentence, parole,
probation, or pardon.
4/1/81
6-9
FORM 1-212
I. USE:
USED BY AN ALIEN TO APPLY FOR ADMISSION INTO THE UNITED STATES AFTER
DEPORTATION OR REMOVAL.
II. ELIGIBILITY:
1. PERSONS WHO WERE EXCLUDED FROM ADMISSION AND DEPORTED WITHIN
ONE YEAR OF FILING.
2. PERSONS WHO WERE DEPORTED OR REMOVED AT GOVERNMENT EXPENSE.
III. REQUIREMENTS:
1. MUST BE FILED IN DUPLICATE.
2. PROPER FILING FEE.
3. PROPER FILING PLACE.
a. APPLICANT FOR AN IMMIGRANT VISA AT AN AMERICAN CONSULATE:
(1) I.N.S. OFFICE IN WHICH LAST DEPORTATION PROCEEDINGS WERE
HELD, UNLESS CONCURRENTLY APPLYING FOR A WAIVER OF GROUNDS
OF EXCLUDABILITY UNDER SECTION 212(h) OR (1), I & N ACT
(FORM 1-601).
(2) AT THE AMERICAN CONSULATE SIMULTANEOUSLY WITH APPLICATION
FOR WAIVER UNDER SECTION 212(g), (h) OR (i), I & N ACT
(FORM 1-601) IF APPLICANT NEEDS SUCH A WAIVER.
b. APPLICANT FOR ADJUSTMENT OF STATUS UNDER SECTION 245.
(1) I.N.S. OFFICE HAVING JURISDICTION OVER APPLICANT'S PLACE OF
RESIDENCE.
c. APPLICANT SEEKING ADVANCE PERMISSION TO REAPPLY PRIOR TO HIS DEPARTURE
FROM UNITED STATES.
(1) I.N.S. OFFICE HAVING JURISDICTION OVER APPLICANT'S PLACE OF
RESIDENCE.
d. APPLICANT FOR A NONIMMIGRANT VISA (NIV) OR BORDER CROSSING CARD (1-186)
(1) AMERICAN CONSULATE WHERE SUBJECT IS APPLYING FOR NIV OR 1-186,
IF REQUESTED TO DO SO BY THE CONSUL.
e. ALIEN AT A PORT OF ENTRY APPLYING FOR ADMISSION INTO THE
UNITED STATES.
(1) I.N.S. OFFICE HAVING JURISDICTION OVER THAT PORT.
4. SERVICE CORRESPONDENCE RELATING TO THE APPLICANT'S DEPORTATION THAT
HE HAS IN HIS POSSESSION.
5. APPLICANT SHOULD ATTACH A STATEMENT GIVING THE FACTS HE BELIEVES
THE SERVICE SHOULD CONSIDER IN MAKING A DECISION ON HIS APPLICATION
AND MAY INCLUDE ANY EVIDENCE IN SUPPORT OF HIS STATEMENT.
EVIDENCE:
1. IF THE APPLICANT HAS LISTED ANY RELATIVE UNDER ITEM 18 ON FORM 1-212,
HE MUST SUBMIT DOCUMENTARY EVIDENCE OF HIS RELATIONSHIP TO THAT PERSON,
SUCH AS HIS MARRIAGE CERTIFICATE AND EVIDENCE OF LEGAL TERMINATION OF
ANY PRIOR MARRIAGE IN THE -CASE OF A CLAIMED MARITAL RELATIONSHIP.
2. IF A FORM 1-130 HAS BEEN FILED IN BEHALF OF THE APPLICANT, HE SHOULD
PROVIDE THE DATE, PLACE AND RESULT OF THE FILING.
3. PROOF OF U.S. CITIZENSHIP OF RELATIVE NAME IF APPLICABLE. IF NOT
A U.S. CITIZEN, THE PERSON'S FULL NAME, DATE, PLACE, AND MANNER
OF ADMISSION TO THE UNITED STATES, AND HIS/HER ALIEN REGISTRATION
NUMBER IF
"X
10/1/80
TM 761
ADMINISTRATIVE MANUAL
Appendix )
1-212
Pag* 1
APPLICATION
FOR PERMISSION TO REAPPLY FOR
ADMISSION INTO THE UNITED STATES
AFTER DEPORTATION OR REMOVAL
(To be filed in duplicate)
Read Inettructiima en Rover Bo
OMB No. «J-B053.!
n...
I hereby request permieaion to re apply for admission into tne United States.
HI knawn)
i. NauM taaaa Wat*. mat ooponoa f rweonroa' fraai U» U.S.
,».... —a,
MO «ar» a> wan. <ia» arnmtiao. an aowinr
liaioo (ot.ee* ta»litfttl» aiaeAaJ
UJ»J «f W»4»M1 W <tu UlUUJ . tV«J.J
; I Excluded, ood oepcvttfrd /f0«a then one yaor &$o)
. AfT9Bt@4 e&d dapttn^d
' Ranuevod otter hdvuis lalJett wto diocrass
?=
. Ronovad as alien eoofn?
~ Romowd at U. S. Cowmnoat enpsiaa Ml tin of
<iaportatio«
10 place Ooaanoian H»aria« Ho 14 or
application for raaavol nado retrf)
Miaaaa. mtut "Naoo-M
1
wexd futr ana4 OUH*; n» not
1) Don ol Canon X. no » nwnaj <ra» United Slauci
14 Pan ol OoaaMun ln» Uiumd ei*toe
f~~ Parnaiwni Raoideot | Viaitw ^J Student
" i:L"'",'1'«,T."»Tn.5:"""°" •*"" <wu~""b
U. Kesxi aaitf ralattaainip of Uiutod Itotoi cittxii a leoful raouMii
atiaa enawoo . parvm or >Kila>oa, If any
tOTMtuM o Apr* leant
30 fttrvot and auaiboi. ally ar IOIMI; •
910 ar aroftincv end country of
SIGNATURE Qf PERSON PREPARING FORM; f OTHCR THAN APPLICANT
IS.»«a.u.a) (Adaral.) lOaW.
THIS SPACE FOR USE Of IMMIGRATION O'flCE*
riu A—
Dai. of
Acitan
DD
OIC
Konn 1-212 UNITED STATES oePARTMewT of JU'.TICI
(ftav. 2-24-76)N '«•>»*•«« »<i Noh.roii»»o« S....CT
aiecivie TK*Ni. IN
""t'tol7r"AH*-j ««•-"•«»«
!
FORM NO. EDITION
APPLICATION FOR PERMISSION TO
THE U.S. AFTER DEPORTATION OR
REAPPLY FOR ADMISSION INTO
REMOVAL
SIZC INSTRUCTION JtXrSRJENCJB 8 CFR 212.2, 239.1 ; 01 212.2
8 X 10 1/2 298A> £x' 2: " Hkb 6'12' "13« "1J*« ''Si -2'. -22*
2!A.2(k)(M; AM 2301.07, 2301.10,
USE
FILED BY AN ALIEN WHO IS EXCLUDABLE UNDER PARAGRAPH (16) OR <17) OF SECTION
2)2a OF THE I*N ACT
PRIOR EDITIONS HAY NOT BE USED
SCHEDULE A
10/1/80
ADMINISTRATIVE MANUAL
Append ix I
TM 761
INSTRUCTIONS
Submit application in duplicate.
WHERE TO SUBMIT APPLICATION
1. If you are abroad and intend to apply for an immigrant visa, submit the application to the District Director of
the Immigration and Naturalization Service of the district in which your deportation proceedings were held,
unless yo« are concurrently applying for a waiver of grounds of excludability under Section 212(h) or (t) of the
Immigration and Nationality Act, as amended. In the latter event, this application should be filed with the
American Consul with whom you are also filing your application for a waiver of the grounds of excludability.
If you are abroad and intend to apply to an American Consul for a nonimmigrant visa or a border crossing card,
this application should be filed with the American Consul with whom you at® also filing your application for
nonimmigrant visa or border crossing card, if requested to do so by the Consul.
2. If you are at a port of entry into the United States, applying for admission into the United States, submit the
application to the District Director of the Immigration and Naturalization Service having jurisdiction over that
port:
3. If you ar* in the United States and will file an application for waiver under Section 212fg). (h), or (i> of the
Immigration and Nationality Act with an American consul you should file this application and the applica-
tion for the waiver simultaneously with the American consul. If you are in the United States and are apply-
ing for adjustment of your status under Section 245 of the Act, or are seeking to be granted advance per*
mission to reapply prior to your departure from the United States, submit the application to the District
Director of the Immigration and Naturalization Service having jurisdiction over the place where you are
residing.
WHAT MUST ACCOMPANY YOUR APPLICATION
1. CORRESPONDENCE that you have in your possession relating to your deportation.
2. If you have listed any relative under Item 18 on the face hereof, you must submit documentary evidence of your
relationship to such person. In addition, if such person is a U.S. citizen you must submit proof thereof and if
he is not a U.S. citizen you must furnish such person's full name, date and place of birth and date and place of
admission to the United States, and his Alien Registration number, if known.
3. If you wish, you may attach a statement giving the facts you believe the Immigration and Naturalization Service
should consider in making a decision on your application, and you may attach any evidence in support of your
statement.
4. Fee.
A fee of twenty dollars ($20) must be paid tor filing this application. It cannot be refunded regardless
of the action taken on the application. DO NOT MAIL CASH. Payment by check oif money order must be
drawn on a bank or other institution located in the United States, and be payable in United States, currency.
If applicant resides in the Virgin Islands, check or money order must be payable to the '.'Commissioner
of Finance of the Virgin Islands." If applicant resides in Guam, check or money order must be pay.ible to
the 'Treasurer, Guam." All other applicants must make the check or money order payable to the "Immi-
gration and Naturalization Service." When check is drawn on an account of a person other than the appli-
cant the name of the applicant must be entered on the face of the check. Personal checks are accepted
subject to collectibility. An uncollectible check will render the application and any documents issued
pursuant thereto invalid. A charge of S5.00 will be imposed if a check in payment of a tee is not honor«_a
by the bank on which it is drawn. If payment is made by the type of international trcvtei order that cannot
be mailed, the money order must be drawn on the postmaster of the city in the United State's to whi- h the
application will b« mailed, and that city, the money order number, and the date must be shown elf -ly on
the top margin of the application form.
PERSONS WHO ARE PERMITTED TO REAPPLY FOR ADMISSION WITHOUT FILING THIS APPLICATION
1. Persons who were excluaed from admission and deported mom than one year airo.
2. Persons who voluntarily departed from the United ^tates without expense to the United Sthtes Government and
without an otder of deportation having b^en entered.
NOTE: Attach all correspondence in vour possession retatinis sf*° ""••"•
(o \our deportation
WRO 10/1/80
I. USE:
USED 8Y ALIEN APPLYING FOR PERMANENT RESIDENT STATUS WHO IS EXCLUDABLE
UNDER ONE OR MORE OF THE FOLLOWING SECTIONS OF THE IMMIGRATION AMD
NATIONALITY ACT:
212(a)(l): MENTALLY RETARDED ALIEN
212(a)(3); ALIEN WITH HISTORY OF MENTAL ILLNESS
212{a){6): ALIEN WITH TUBERCULOSIS
212(a){9): ALIEN CONVICTED OF OR ADMITTING A CRIME INVOLVING .
MORAL TURPITURE
212(a)(10): ALIENS CONVICTED OF 2 OR MORE SUCH OFFENSES
21 2 (a) (12): PROSTITUTES , PROCURERS
212(a)(19): ALIEN WHO OBTAINED A VISA BY FRAUD OR BY MISINTERPRE- SECTK
TATION OF A MATERIAL FACT. 212("°1
APPLIE
II. ELIGIBILITY*
1. 212(g) WAIVER:
a. APPLICANT MUST BE THE SPOUSE, UNMARRIED SON OR DAUGHTER* OR
MINOR UNMARRIED ADOPTED CHILD OF:
(1) A UNITED STATES CITIZEN OR;
(2) A LAWFULLY ADMITTED PERMANENT RESIDENT ALIEN OR;
(3) AN ALIEN WHO HAS BEEN ISSUED AN IMMIGRANT VISA OR;
b. THE APPLICANT MUST HAVE A SON OR DAUGHTER WHO IS:
(1) A UNITED STATES CITIZEN OR;
(2) A LAWFUL PERMANENT RESIDENT ALIEN OR;
(3) AN ALIEN WHO HAS BEEN ISSUED AN IMMIGRANT VISA
c. APPLICANT MUST BE OTHERWISE ADMISSIBLE TO THE UNITED STATES.
2. 212{h) WAIVER:
a. APPLICANT MUST BE THE SPOUSE, CHILD OR MINOR UNMARRIED ADOPTED
CHILD OF A UNITED STATES CITIZEN OR PERMANENT RESIDENT ALIEN OR;
b. APPLICANT MUST HAVE A SON OR DAUGHTER WHO IS A UNITED STATES
CITIZEN OR PERMANENT RESIDENT ALIEN.
c. APPLICANT'S EXCLUSION WOULD RESULT IN EXTREME HARDSHIP
TC THE APPLICANT'S UNITED STATES CITIZEN OR LAWFUL PERMANENT
RESIDENT SPOUSE, PARENT OR SON OR DAUGHTER.
d. APPLICANT'S ADMISSION INTO THE UNITED STATES WOULD NOT BE CONTRARY
TO THE NATIONAL WELFARE, SAFETY, OR SECURITY OF THE UNITED STATES,
e. APPLICANT MUST BE OTHERWISE ADMISSIBLE TO THE UNITED STATES.
212(1} WAIVER:
a, APPLICANT MUST BE THE SPOUSE, PARENT OR CHILD OF A UNITED STATES
CITIZEN OR LAWFUL PERMANENT RESIDENT ALIEN .
b. APPLICANT MUST BE OTHERWISE ADMISSIBLE TO THE UNITED STATES.
UJROCNTS:
APPLICATION MUST BE FILED AT THE PROPER OFFICE
a. FOR 212(h) OR (1) WAIVER.
(1) IF APPLYING ABROAD AT THE CONSULAR OFFICE HAVING THE APPLICANT'S
VISA APPLICATION.
(2) IF APPLYING IN THE UNITED STATES AT THE IMMIGRATION OFFICE
CONSIDERING APPLICANT'S APPLICATION FOR PERMANENT RESIDENT
STATUS,
b. FOR 21 2 (g) WAIVER
. {1} IF APPLYING ABROAD AT THE CONSULAR OFFICE WHERE THE APPLICANT'S
VISA APPLICATION IS PENDING.
(2) IF APPLYING IN THE UNITED STATES AT THE IMMIGRATION OFFICE
CONSIDERING APPLICANT'S APPLICATION FOR PERMANENT RESIDENT STATUS.
(3) AT THE DISTRICT OFFICE HAVING JURISDICTION OVER THE PORT OF
ENTRY WHICH DETERMINED THE APPLICANT IS INELIGIBLE TO ENTER
WITHOUT SUCH A WAIVER, IF APPLICABLE.
PROPER FEE FOR 212(h) OR (i) WAIVER.
MO FEE FOR 212(g) WAIVER
EVIDENCE THAT PROPER FAMILY RELATIONSHIP EXISTS TO QUALIFY APPLICANT
FOR WAIVER. '
EVIDENCE THAT APPLICANT'S QUALIFYING RELATIVE IS A UNITED STATES CITIZEN
OR LAWFUL PERMANENT RESIDENT.
10/1/80
6-15
6. APPLICATION MUST BE PROPERLY EXECUTED AND SIGNED.
a. IF THE APPLICANT HAS TUBERCULOSIS OR IS SUSPECTED OF HAVING IT.
(1) STATEMENT "A" MUST BE FILLED OUT.
(2) STATEMENT "B" MUST BE FILLED OUT BY PHYSICIAN OR MEDICAL
FACILITY THAT WILL ADMINISTER TREATMENT.
(3) STATEMENT "C" IS COMPLETED BY LOCAL OR STATE HEALTH OFFICE.
b. FOR ALIENS WITH HISTORY OF MENTAL ILLNESS: MUST FURNISH STATEMENT
THAT ARRANGEMENTS FOR MEDICAL REPORT HAVE BEEN MADE. THE MEDICAL
REPORT DESCRIBED IN SECTION IV OF THE 1-601 APPLICATION IS SENT
TO THE UNITED STATES PUBLIC HEALTH SERVICE.
7. FOR*212(h) WAIVER, MUST SUBMIT EVIDENCE TO ESTABLISH THAT APPLICANT'S
EXCLUSION WOULD CAUSE EXTREME HARDSHIP TO APPLICANT'S UNITED STATES
CITIZEN OR LAWFUL PERMANENT RESIDENT RELATIVE.
TM 803
ADMINISTRATIVE '•'AMUAL
Appendix 1
1-601
Page 1
6-17
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization S*rvte<»
APPLICATION OF WAIVER OF GROUNDS OF EXCLUDABILITY
INSTRUCTIONS
READ INSTRUCTIONS CAREFULLY FEE WILL NOT BE REFUNDED.
Plaaae Typewrit* or Print Plainly With A Ball Point Pen.
I. FILING THE APPLICATION: This application a-.d supporting documents should be filed at the American Con-
sulate at which you are applying for a visa. If ycj are in the United States and applying for status as a permanent
resident, you should die the application and docjmeits with the office of the Immigration and Naturalization Ser-
vice having jurisdiction over your place of residence.
II. FEE: A fee of thirty-five dollars (S3S) must be paid for tiling this application if it is filed pursuant to Section
212 (h) or (i) of the Immigration and Nationality Act. as amended (relating to aliens who are Inadmissible under
Section 21 2 (a) (9). 212 (a) (10). 212 (a) (12).0'<M2 'a) (19). It cannot be refunded regardless of the action taken
on the application. 00 NOT MAIL CASH ALL =EES MUST BE SUBMITTED IN THE EXACT AMOUNT. Payment
by check or money order must be drawn on a ba-.k or other institution located in the United States and be
payable in United States currency. If apphcar: resides in the Virgin Islands, check or money order must be
payable to the "Commissioner of Finance of the Virgin Islands." If applicant resides in Guam, check or
money order must be payable to the '"Treasure* Guam". All other applicants must make the check or money or-
der payable to the "Immigration and Naturalization Service." When check is drawn on an account of a person
other than the applicant, the name of the appNcant must be entered on the face of the check. Personal checks
are accepted subject to collectibility. An uncoilectiDle check will render the application and any documents
issued pursuant thereto invalid. A charge of S5 00 will be imposed if a check in payment of a fee is not honored
by the bank on which it is drawn. If application is submitted from outside the United States, remittance may be
made by bank international money order or fo-eign draft drawn on a financial institution in the United States and
payable to the "Immigration and Naturalization Service" in United States currency. If this application is filed pur-
suant to Section 212 (g) of the Immigration and Nationality Act (relating to aliens afflicted with tuberculosis,
mentally retarded aliens, or aliens who have a history of mental illness) no fee is required.
HI. APPLICANTS WITH TUBERCULOSIS: An applicant with active tuberculosis or suspected tuberculosis is re-
quired to execute statement A on the reverse side of page one of this form. In addition, such applicant or his/her
sponsor is responsible for having statement 3 executed by the physician or health facility which has agreed to
supply treatment or observation, and statement C. if required, executed by the appropriate local or state health
Officer. This form should then be returned to the applicant for presentation to the consular office if he/she is
allying for a visa, or to the appropriate office of the Immigration and Naturalization Service if applying for
status as a permanent resident. Submission of the application without the required statements being fully
executed will result in its being returned to the applicant without further action.
IV. MEMTAL CONDITIONS: AN ALIEN WHO IS MENTALLY RETARDED OR WHO HAS A HISTORY OF MENTAL
ILLNESS SHALL ATTACH TO THE APPLICATION A STATEMENT THAT HE/SHE HAS ARRANGED FOR SU8-
MISSION OF A MEDICAL REPORT. AS FOLLOWS. TO THE OFFICE WHERE THIS FORM IS FILED:
Thti medical report shall contain a complete medical history of the alien, including details of any
hospitalization or Institutional care or treatment for any physical or mental condition; findings as to the
curront physical condition of the alien, r.cludmg reports of chest X-ray examination and of sarologic
test for syphilis if the alien is 15 years of age or older, and other pertinent diagnostic tests; and findings
as to (he current mental condition of the alien, with information as to prognosis and life expectancy and
with a report of a psychiatric examination conducted by a psychiatrist who shall, in case of mental retar-
datron. also provide an evaluation of the intelligence. For an alien with a past history of mental illness,
the medical report shall also contain available information on which the United States Public Health
Service can base a finding as to whether the alien has been free of such mental illness for a period of
time sufficient in the light of such history to demonstrate recovery.
The medical report will be referred to the United Slates Public Health Service for review and, i! found acceptable, the
alien will be required to submit such additional assurances as the United -States Public Health Service may deem
necessary in his/her particular case.
FORM NO.
1-601
EDITION
REV. 6-20-80
TITUS:
APPLICATION FOR WAIVER OF GROUNDS OF EXCLUDABILITY
SIZE
8 1/2 X 11
INSTRUCTION REFEJLENCE 8 CFR 21 2.7(a ), (b), (b)(l},(2), 234.2(c)(l), 299.1; 01 212.7(a)(l)
(i), (ii),(iii), (b)(f), 214.2(k)(3), 235.12(a); AM 2301.07, 2482 Ex. 2, P. 2, 2712.01, .02, 2984 Ex
2, Ex. 4, P. 3; II Hbk 6-2,3,4,7,10,11,14, 10-30, App. 6-A; GIB App. A-54; DO Hbk25-3 App. IV-36 thru 99
use
USED BY CERTAIN EXCLUDABLE ALIENS FOR WAIVER
WITH APPLICATION
Carbon-Interleaved (Original and 1 copy)
OF EXCLUDABILITY AND TO REQUEST INVESTIGATION IN CONNECTION
PRIOR EDITIONS MAY NOT BE USED
| SCHEDULE B
ADMINISTRATIVE MANUAL
Appendix 1
TM 803
llNITFn ^TATF^ DFPARTMFMT flF IIKTIfF ,
Form Approved
OMB No. 43-RO391
Immigration and Naturalization Service
APPLICATION FOR WAIVER
OF GROUNDS OF EXCLUDABILITY
(Pursuant to Section 212 (g). (h). or (i)
FEE STAMP
01 the immigration and Nationality Act)
NAME (Family Name in Capital Letters) (First Name)
(•Middle Name)
FILE NUMBER
PRESENT ADDRESS (Number and Street) (City at Town)
(Country)
(Zip Code. If In U.S.)
DATE OF BIRTH BIRTHPLACE (City
or Town) (Country)
\ APPLIED FOR A VISA AT THE AMERICAN CONSULATE AT DATE
OF VISA APPLICATION
1 WAS DECLARED INADMISSIBLE UNDER SECTIONIS) (PLACE AN "X" IN THE APPROPRIATE BLOCK(SI)
~2Ula)(l) F]ZI2ta)l3> £3212(8)16) Q212lal(9) Q2I2UI110) Qzi2la)(12) Qzi2(a)O9)
FOR THE FOLLOWING REASONS (Lilt acts, conviction* or phyilcal or mental condition*) (If alien ha* active or auapected tuberculoal*. the
revcrae at thi* page mutt be fully completed.)
PRINCIPAL RELATIVE IN THE UNITED STATES THROUGH WHOM I CLAIM ELIGIBILITY FOR WAIVER
NAME ADDRESS
RELATIONSHIP
IMMIGRATION STATUS
ALSOHAVETHE FOLLOWING RELATIVES WHO ARE CITIZENS OR LAW
FUL PERMANENT RESIDENT.
5 OF THE UN IT ED STATES:
NAME ADDRESS
RELATIONSHIP
IMMIGRATION STATUS
*
1 WAS PREVIOUSLY IN THE UNITED STATES AT:
STREET ADDRESS CITY AND STATE
FROM (DATE) 1 TO (DATE)
IMMIGRATION STATUS
SIGNATURE OF APPLICANT OR OF PERSON SUBMITTING APPLICATION IN BEHALF OF APPLICANT
SIGNATURE RELATIONSH p. IF ANY TO APPLICANT
1
DATE
SIGNATURE OF PERSON PREPARING FORM IF OTHER THAN APPLICANT
r and it burned on all inforr
nation of which I have any knowledge.
SiOSA7u«E [ADDRESS
i
DATE
Fortr. 1-t.Ol
|
|
4/1/81
TM 803
ADMINISTRATIVE MANUAL
Appendix 1
1-601
Page 3
6-19
TO BE COMPLETED FOR APPLICANTS WITH ACTIVE
TUBERCULOSIS OR SUSPECTED TUBERCULOSIS
A. STATEMENT BY APPLICANT:
Upon admission to the United States I will go directly to the physician or health facility named in Section B;
will present all X-rays used in the visa medical examination to substantiate diagnosis; will submit to such
examinations, treatment, isolation, and medical regimen as may be required; and will remoin under the pre-
scribed treatment or observation, whether on inpatient or outpatient basis, until discharged.
Date
Signature of Applicant
APPLICANT'S SPONSOR IN U.S.: Arrange for medical care of the applicant and have the physician complete'
Section B. '
B. STATEMENT BY PHYSICIAN OR HEALTH FACILITY (May be executed by a private physician, health
department, other oublic or private health facility, or military hospital. NOTE: Upon arrival of the aljen in
the U.S., -Form CDC 4.451 — " Report on Alien with Tuberculosis Waiver"-will be sent to the address given
below.)
I agree to supply any treatment or observation necessary for the proper management of the alien's tubercu-
lous condition.
I agree to submit Form CDC 4.451 to the health officer* named below either (a) within 30 days of the
alien's reporting for. care, indicating presumptive diagnosis, test results, and plans for future care of the
alien; or (b) 30 days after receiving -Form CDC 4.451 -if the alien has not reported.
Satisfactory financial arrangements have been made. (NOTE: This statement does not relieve alien of sub-
mitting such evidence as consul may require to establish that alien is not likely to become a public charge.)
represent ( enter X in the appropriate box and give complete name and address of facility) :
1 Q Local Health Department Outpatient Clinic 3 n Other Public or Private Health Facility
2 [J
Military Hospital
Private Practice
Address (If military, enter name and address of receiving hospital)
* Military submits direct to
Center for Disease Control. Atlanta, Ga. 30333
Date
Signature of Physician
APPLICANT'S SPONSOR IN U.S.: If medical care will be provided by a physician who checked box 3 or 4
in Section B, have Section C completed by the Local or State Health Officer who has jurisdiction in the
area where the applicant plans to reside in the U.S. Provide the Health Officer with the address at which the
applicant plans to reside in the U.S.
C. ENDORSEMENT BY LOCAL OR STATE HEALTH OFFICER
Date
Endorsed by: Signature of Health Officer
Health Officer:
. Endorsement signifies recognition of the physician or facility for the purpose of providing care for tubercu-
losis. If the facility or physician who signed in Section B is not in your health jurisdiction and is not famil-
iar to you, you may wish to contact the health officer responsible for the jurisdiction of the facility or
physician prior to endorsing.
Enter name and address of the Local Health Department to which the "Notice of Arrival of Alien with
Tuberculosis Waiver" should be sent when the alien arrives in the United States.
Local Health Department Address
6-21
FORM 1-612
I. USE;
CERTAIN EXCHANGE VISITOR (J-l AND J-2) ALIENS ARE SUBJECT TO A TWO-YEAR
FOREIGN RESIDENCY REQUIREMENT BEFORE THEY MAY BECOME PERMANENT RESIDENT
ALIENS IN THE UNITED STATES.
II. ELIGIBILITY FOR 1-612 APPLICATION;
1. AN ALIEN WITH A UNITED STATES CITIZEN OR PERMANENT RESIDENT ALIEN
SPOUSE OR UNMARRIED CHILD WHO CAN ESTABLISH THAT THE TWO-YEAR FOREIGN
RESIDENCY REQUIREMENT WILL IMPOSE EXCEPTIONAL HARDSHIP ON THAT SPOUSE
OR CHILD.
2. AN ALIEN WHO ESTABLISHES HE/SHE CANNOT RETURN TO THE COUNTRY OF
HIS/HER NATIONALITY OR LAST FOREIGN RESIDENCE BECAUSE HE/SHE WOULD
BE SUBJECT TO PERSECUTION BECAUSE OF RACE, RELIGION OR POLITICAL OPINION,
III. REQUIREMENTS;
1. APPLICATION IS FILED AT THE IMMIGRATION OFFICE HAVING JURISDICTION OVER
APPLICANT'S PLACE OF RESIDENCE.
2. IF APPLICANT IS PRESENTLY ABROAD, HE/SHE FILES AT THE IMMIGRATION OFFICE
HAVING JURISDICTION OVER HIS/HER LAST UNITED STATES RESIDENCE.
3. PROPER FEE.
4. THE J-2 SPOUSE OR CHILD OF A J-l PRINCIPAL MAY BE INCLUDED ON THE
APPLICATION OF THE PRINCIPAL. ALL PRINCIPAL J-l NONIMMIGRANTS MUST
SUBMIT A SEPARATE APPLICATION.
5. HARDSHIP CASE:
a. APPLICANT MUST SUBMIT EVIDENCE THAT SPOUSE OR CHILD IS UNITED
STATES CITIZEN OR PERMANENT RESIDENT ALIEN.
b. APPLICANT MUST SUBMIT EVIDENCE OF MARRIAGE AND PROOF OF TERMINATION
OF ALL PRIOR MARRIAGES OF SELF AND SPOUSE.
c. APPLICANT MUST SUBMIT BIRTH CERTIFICATE OF CHILD IF APPLICATION IS
BASED ON HARDSHIP TO CHILD.
d. APPLICANT MUST SUBMIT A STATEMENT REGARDING THE NATURE OF THE
EXCEPTIONAL HARDSHIP TO SPOUSE OR CHILD AND DOCUMENTARY EVIDENCE .
SUPPORTING THE CLAIM.
6. IN PERSECUTION CASES, APPLICANT MUST SUBMIT A STATEMENT AND SUPPORTING
DOCUMENTS TO ESTABLISH THAT HE/SHE WOULD BE SUBJECT TO PERSECUTION.
7. APPLICANT MUST SUBMIT HIS/HER 1-94 (AND I-94'S OF MEMBERS OF
HIS/HER FAMILY WHO ARE ALSO INCLUDED IN THE APPLICATION).
IV. ELIGIBILITY FOR WAIVER WITHOUT FORM 1-612
1 . A UNITED STATES GOVERNMENT AGENCY WISHES TO REQUEST THE SECRETARY OF
OF STATE TO RECOMMEND A WAIVER IN THE ALIEN'S BEHALF. THAT AGENCY
SHOULD COMMUNICATE DIRECTLY WITH THE EXCHANGE VISITOR WAIVER REVIEW
BOARD, DEPARTMENT OF HEALTH AND HUMAN SERVICES, WASHINGTON, DC.
2. THE FOREIGN COUNTRY OF THE ALIEN'S NATIONALITY OR LAST FOREIGN
RESIDENCE FURNISHES A STATEMENT IN WRITING TO THE SECRETARY OF STATE
THAT IT HAS NO OBJECTION TO A WAIVER IN THE ALIEN'S CASE. THE FOREIGN
COUNTRY'S EMBASSY OR FOREIGN MINISTRY MUST FURNISH THIS STATEMENT
DIRECTLY TO THE SECRETARY OF STATE.
4/1/81
TM 803
ADMINISTRATIVE MANUAL
Appendix 1
1-612
Paqe 1
6-23
APPLICATION FOR WAIVER OF THE (Please tear off this sheet before
FOREIGN RESIDENCE REQUIREMENT submitting application)
of Section 212(e) of the Immigration and Nationality Act. as amended
INSTRUCTIONS: (READ CAREFULLY— FEE WILL NOT BE REFUNDED)
Application on (nil I arm may be tuamitttd on/y by an alien wno bi'ieyei Iliai compliant* wi
Section 212ft) a/ tne Immigration onrf Nationality Act. at amcnaW. would impon eicepfii
eounfry erf nii/*er nerfiono/i/y or /art reiirfenee would sub/ecf Aim/ner 'o periecu*ic
Me foreign rctia'ence requ/rcmcn/ of
al noro/fnip upon nii/ner fpouic or cni/a*
ount of race, religion, or political opinion.
1. FOREIGN RESIDENCE REQUIREMENT. In order to be eligible to apply for an immigrant visa or for permanent residence in the
United States, or for a nonimmigrant visa as a temporary worker, certain exchange visitor! (visa symbols J-l and J-2) must reside
and be physically present in the country of their nationality or last foreign residence for an aggregate of at least two yean following
departure from the United States.
An exchange visitor a subject to the two year foreign residence requirements only if:
a. His/her participation in the exchange program was financed at any time in whole or in part, directly or indirectly, by an agcncv of
the United States Government or by the government of his/her country of nationality. or last foreign residence; or
b. prior to issuance of art exchange visitor visa, or admission as an exchange visitor without visa, or acquisition of status
as an exchange visitor, to participate in an exchange program, his/her country of nationality or last foreign residence was designated
by the Secretary of State as clearly requiring the alien's specialized knowledge or skill ;
c. he/she entered the United States as, or changed status to that of an exchange visitor on or after January 10, 1977, to
participate in graduate medical education or training.
If a participant in an exchange program is subject to the two year foreign residence requirement, his/her spouse and unmarried minor
children who were admitted as exchange visitors or acquired such status after admission are also subject to this requirement.
If you have any question as to whether you are subject to the two year foreign residence requirement, the nearest Immigration and
Naturalization Service office or American Consulate will be glad to advise you.
2. ELIGIBILITY FOR WAIVER OF THE T\VO YEAR FOREIGN RESIDENCE REQUIREMENT. Waiver of the two year foreign
residence requirement may be authorized only if:
a. The alien has a United States citizen or lawful resident alien spouse or unmarried minor child and establishes in an application
to the Immigration and Naturalization Service that compliance with the two year foreign residence requirement would impose
exceptional hardship upon such spouse or child; or
b. the alien established in an application to the Immigration and .Naturalization Service that returning to his/her country of
nationality or last foreign residence would subject him/her to persecution on account of race, religion or political opinion ; or
c. a United States Government agency request! the Secretary of State to recommends waiver in the alien's behalf for the reason
that compliance with the two year foreign residence requirement would be detrimental to a program or activity of official interest
to the agency; or
d. the country of the alien's nationality or last foreign residence furnishes the Secretary of State a written statement that it has
no objection to the waiver. This ground, however, is not available to the alien who came to the United States on or after January 10,
1977 as an exchange visitor, or who acquired such status on or after that date, in order to receive graduate medical education or
training.
In no case may the two year foreign residence requirement be waived unless a favorable recommendation is made by the Secretary
of State to the Attorney General
3. SUBMISSION OF APPLICATION. Application on this form may be submitted only by an alien who believes that compliance with
the two year foreign residence requirement would impose exceptional hardship upon his/her spouse or unmarried minor child who is a
citizen of the United States or a lawful permanent resident thereof, or by an alien who believes that returning to the country
of his/her nationality or last foreign residence would subject him/her 10 persecution on account of race, religion or political opinion.
If you are in the United States, submit the application to the office of the Immigration and Naturalization Service having jurisdiction
over your place of residence. If you are abroad, submit the application to the office of the Immigration and Naturalization Service
having jurisdiction over the place of your last residence in the United States.
An alien who believes that a United States Government agency may be officially interested in his/her case and may wish to request a
waiver in his/her behalf should inquire directly of that agency whether it would make such request.
An alien who seeks a waiver of the foreign residence requirement on the basis that the foreign country of his/her nationality or last
foreign residence has no objection to the waiver should, if in the United States, apply directly to the Embassy of the country
concerned; if abroad, should inquire of hit/her foreign ministry.
4. SPOUSE OF APPLICANT. If your spouse is or was an exchange alien who is subject.to the foreign residence requirement solely
because of relationship to you, he or she may be included in this application by checking Box A in Block 6 of the application. If
your spouse is subject to the foreign residence requirement because of participation in an exchange program, your spouse may
apply for a waiver of the foreign residence requirement by submitting a separate application on Form 1-6 1 2 ; in such case Box B of
Block 6 should be checked on each application.
5. PREPARATION OF APPLICATION. The application must be typewritten or printed legibly in ink with block letters.
Form 1-612 (Rev. 6-20-80 )N
Page 1
FORM NO. •
•1-612
EDITION
REV. 6-20-80
TITLE
APPLICATION FOR WAIVER OF THE FOREIGN RESIDENCE REQUIREMENT
SIZE
8X10 1/2
INSTRUCTION REFERENCE 8 CFR 212. 7(c), 299.1; 01 212. 8(e) (2), 214.2(j)(4); AM 2301 07,
2482 Ex. 1, P. 7, 2984 Ex. 4, P. 3; II Hbk 1-25, 31, 6-53, 54, 56, 59; Gil A-8
USE
USED BY AN ALIEN WHO RELIEVES COMPLIANCE WITH FOREIGN RESIDENCE REnillRF.MENT OF SECTION 212(e) WOULD
IMPOSE EXCEPTIONAL HARDSHIP ON A SPOUSE OR CHILD WHO IS A CITIZEN OF THE UNITED STATES OR A LAWFUL
PERMANENT RESIDENT OF THE UNITED STATES
PRIOR EDITIONS MAY NOT BE USED
SCHSDITJLJC R
nppeiicux i
6. SUPPORTING DOCUMENTS. The following documents must be submitted with this application.
a. To prove United States citizenship of spouse or child, if you checked Box "A" in Block 5. ,
( 1 ) If your spouse or child is a citizen by reason of birth in the United States, submit (a) birth certificate of spouse or child;
or (b) if birth certificate is unobtainable, a copy of the baptismal certificate under seal of the church, showing place of
birth (baptism must have occurred within 2 months after birth) ; or (c) if birth or baptismal certificate cannot be obtained,
affidavits of two United States citizens who have personal knowledge of the birth of your spouse or child in the United
States.
certificate of citizenship. See instruction No. 8.)
(3) If naturalization of spouse or child occurred within 90 days immediately preceding the filing of this application, the naturalization
certificate must accompany the application. (Do not make a photostat of such certificate. See instruction No. 8.)
b. To prove relationship between applicant and spouse or child, if you checked Box "A" in Block 5.
( 1 ) Every application must be accompanied by a certificate of marriage to the spouse and proof of legal termination of all previous
marriages of applicant and spouse. If application is based on hardship to a child, also submit the birth certificate of the child.
c. To support your application for waiver.
You may, in addition to your own required statement, submit any documentary evidence available to you which you believe
bears on the matters of exceptional hardship or persecution.
d. If you are in the United States, you must submit y ••- temporary entry permit (Form 1-94, Arrival-Departure Record) and the
entry permit of your spouse if the latter is in this t .try and is not a U.S. citizen or lawful permanent resid:nt. If the entry
permit is attached to the passport, remove it for this purpose. DO NOT SEND IN THE PASSPORT.
7. DOCUMENTS IN GENERAL. All supporting documents must be submitted in the original. If you desire to have the original of
any of the documents returned, and if copies are by law permitted to be made, you may submit photographic or typewritten copies,
with the originals, and the originals will be returned to you. However, a photographic or other machine-made copy unaccompanied
by the original document may be accepted if the copy bears a certification by an Immigration or Consular officer that the copy
was compared with the original and found to be identical. Any document in a foreign language must be accompanied by a summary
translation in English. A summary translation is a condensation or abstract of the document's text. The translator must certify
that he is competent to translate and that the translation is accurate. (Do not make a copy of a certificate of naturalization or
citizenship. To do so is prohibited by law ^
8. PENALTIES. Title 1 8, United States Code, Section 1001 provides: "Whoever, in any matter within the jurisdiction of any department
or agency of the United States knowingly and willfully falsifies, conceals or covers up by any trick, scheme, or device a
material fact, or makes any false, fictitious or fraudulent statements or representations, or makes or uses any false writing or document
knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or
imprisoned not more than five years, or both."
Title 18, United States Code, section 1426(h) provides: "Whoever, without lawful authority, prints, photographs, makes or executes
any print or impression in the likeness of a * * * certificate of naturalization or citizenship, or any part thereof, shall be
fined not more than $5,000 or imprisoned not more than five years, or both."
9. A fee of thirty-five dollars ($35) must be paid for filing this application. It cannot be refunded regardless of the action taken on the
application. DO NOT MAIL CASH. ALL FEES MUST BE SUBMITTED IN THE EXACT AMOUNT. Payment by check or
money order must be drawn on a bank or other institution located in the United States and be payable in United States currency.
If applicant resides in Guam, check or money order must be payable to the "Treasurer, Guam." If applicant resides in the Virgin
Islands, check or money order must be payable to the "Commissioner of Finance of the Virgin Islands." All other applicants must make
the check or money order, payable to the "Immigration and Naturalization Service." When check is drawn on account of a person
other than the applicant, the name of the applicant must be entered on the face of the check. If application is submitted from
outside the United States, remittance may be made by bank international money order or foreign draft drawn on a financial
institution in the United States and payable to the "Immigration and Naturalization Service" in United States currency. Personal
checks are accepted subject to collectibility. An uncollectible check will render the application and any document issued pursuant
thereto invalid. A charge of $5.00 will be imposed if a check in payment of a fee is not honored by the bank on which it is drawn.
Page 2
4/1/81
TM 803
ADMINISTRATIVE MANUAL
Appendix "1
1-612 6
Page 3
UNITED STATES DEPARTM
Immigration and Naturalization Service
ENT OF JUSTICE
Form approved
OMB No. 43-R0416
Fea Stamp
APPLICATION FOR WAIVER OF THE FOREIGN
RESIDENCE REQUIREMENT
of Section 212(e) of the Immigration and
Nationality Act, as amended
1. Name (Last in CAPS)
First Middle
If a married woman, give maiden name
2. Mailing Address (Apt. .Vo.)
(Number and Street) (Toum or City)
(State or Province) (Com
itrv) (ZIP Code, if m U.S.)
Present or last U.S. Residence
(Number and Street) (City) (State)
(ZIP Code)
3. Date of Birth
Country of Birth Coun
ry of Nationality Country of Last Foreign Residence
Alien Registration Number, If Known
4. I believe I am subject to the foreign residence requirements because: (Check appropriate box (es) )
A. Q I participated in an exchange program which was financed by an agency of the U.S. Government or the government of the country of my
nationality or last foreign residence for the purpose of promoting international educational and cultural exchange.
B. £j An agency of the Government of the U.S., or the government of the country of my1 nationality or last foreign residence gave me a grant
(such as a Fulbright grant), stipend or allowance for the purpose of participation in an exchange program. Name of U.S. Government
C. £] I became an exchange visitor after the Secretary of State designated the country of my nationality or last foreign residence as clearly
requiring the services of persons with my specialized knowledge or skill.
D. Q I entered the United States as, or my status was changed to that of an exchange visitor on or after January 10, 1977, to Participate in graduate
medical education or training.
5. I am applying for waiver of the foreign residence requirement on the ground that: (Check appropriate box(es) )
A. Q My departure from the United States would Impose exceptional hardship upon my United States citizen or lawful permanent resident
spouse or child.
B. Q I cannot return to the country of my nationality or last foreign residence because I would be subject to persecution on account of race, religion,
or political opinion.
6. If married, check appropriate box(es) : (Sta Instruction No. 4)
A. Q My spouse is Included in this application. B. Q
My spouse is filing a separate application for waiver.
7. List all program numbers and names of all program sponsors.
8. Major field of activity (Check one)
Q (1) Agriculture
Q (2) Business Administration
£] (3) Education
Q (4) Engineering Q
n (5) Humanities Q
Q (6) Medicine Q
(7) Natural and Physical Sciences
(8) Social Sciences
(9) Other
9. Occupation
10. Date and port of last arrival In the United States u participant in a designated exchange program.
11. If you are now abroad, give date of departure from U.S. 12. Number of i
If married,
number of prior marriages of appl!
13. Name of spouse
Date and Country of birth National
ty Country of last foreign residence
14. Names of children
Date and Country of birth National
Uy Country of last foreign r
evidence
6-25
Form 1-612 (Rev. 6-20-80)N
OVER
Page 3
15. If you checked Box "A" in block 5 above, furnish the following information concerning your spouse or one of your children who is a citizen
of the United States and who you believe would suffer exceptional hardship if you resided outside the United States for two yean following your
departure from this country.
Name of United States citizen spouse or child:
United States citizenship of spouse or child was acquired through (check one)
p Birth in the United States Q Naturalization Q Parent (s)
If United States citizenship of spouse or child was acquired through naturalization, give the following:
Number of naturalization certificate Date of naturalization Place of naturalization
If United States citizenship of spouse or child was acquired through parent (s), has spouse or child obtained a certificate of citizenship?
If so, give number of certificate If not, submit evidence in accordance with instruction 6 («) (2) .
16. If you checked Box "A" in block 5 above and you do not have a spouse or child who is a citizen of the United States, furnish the following
information concerning your spouse or one of your children who is a lawful permanent resident of the United States and who you believe
would suffer exceptional hardship if you resided outside the United States for two years following your departure from this country.
Name of lawful resident alien spouse or child:
Alien Registration Number
Date, place, and means of admission for lawful permanent residence:
I certify that the information furnished above and in the attachment (s) hereto is true and correct.
(Date) (Place)
(Signature of applicant)
Signature of person preparing form, if other than applicant: I declare that this document
based on all information of which I have any knowledge:
was prepared by me at the request of the applicant and is
(Signature)
(Address of person preparinp form, if other than applicant)
(Date) (Occupation)
IMPORTANT: If you have checked Box "A" in block 6 above there must be attached to this application a statement dated and signed by you giving
a detailed explanation at the basis for your belief that compliance by you with the two-year foreign residence requirement of Section 212 (e) of the
Immigration and Nationality Act, as amended, would impose exceptional hardship upon your spouse or child who is a citizen of the United States or
a lawful permanent resident thereof. Without such statement your application is incomplete. You must include in the statement all pertinent Information
concerning the income and savings of yourself and your spouse. There should also be attached such documentary evidence as may be available to support
the allegations of hardship.
If you have checked Box "B" in block 5 above there must be attached a statement dated and signed by you setting forth in detail the reason (s) you believe
that you cannot return to the country of your nationality or last foreign residence because you would be subject to persecution on account of race, religion,
or political opinion. There should also be attached such documentary evidence as may be available to support the allegations of persecution.
US. GOVERNMENT PRINTING OFFICE : 1MCH-O-324-175
Page 4
fc.
4/1/f
7-i
CHAPTER 7
7. FREEDOM OF INFORMATION AND PRIVACY ACT
Form G-14 - Unidentifiable Communication Follow-up 7-1
Form G-23.26A - Statistics - Freedom of Information
Act 7-6
Form G-23.26B - Privacy Act Workload Record 7-10
Form G-28 - Notice of Entry of Appearance as Attorney
or Representative 7-13
Form G-342 - Transmittal Letter for Information
from Servi ce Fi 1 es 7-18
Form G-343 - Reply to Request for Information
from Servi ce Fi 1 es 7-20
Form G-347 - Request for Information from
Natural i zati on Fi 1 e 7-22
Form G-350 - Certification of Birth Data 7-24
Form G-351 - Request for Copies of Documents 7-26
Form G-396 - Request for Review of Classification 7-28
Form G-617 - Correspondence Control Card 7-30
Form G-639 & A - Application for a Search of the Records
of the Immigration and Naturalization Service under the
Freedom of Information Act 7-32
Form G-640 - Worksheet for Freedom of Information
Act Requests 7-36
Form G-641 - Application for Verification of Information
From the Records of the Immigration and Naturalization
Service 7-38
Form G-652 - Affidavit of Identity 7-42
Form G-657 - Privacy Act Information Request 7-44
Form G-658 - Record of Information Disclosure 7-48
Form G-715 - Acknowledgment and Status of Applications. 7-52
Form G-734 - Third Agency Referral Memorandum 7-54
Form G-747 - FOI/PA Response 7-56
7-1
FORM G-14
I. USE:
USED TO OBTAIN ADDITIONAL INFORMATION NEEDED TO LOCATE RELATED RECORDS
OR RELEVANT INFORMATION.
II. ELIGIBILITY:
ANY PERSON WHOSE INITIAL INQUIRY HAS NOT PROVIDED SUFFICIENT INFORMATION
TO CONDUCT A SEARCH FOR THE REQUESTED RECORDS.
III. REQUIREMENTS:
A SEPARATE FORM MUST BE COMPLETED FOR EACH PERSON WHOSE RECORDS ARE
SOUGHT.
TM694
G-14
Appaadix 1
UNITED STATES DEPARTMENT OF JUSTICE
InmigfBtiott and Natwalisation Service
Yow aoaiatanca in formatting additional identifying information ia roo^ttotod so UMI wa BMy act npoa or
reply to your communication. Pl«»ea fill is th« sac«aa»ry information and return ibia lettw and any
attachvd matarial to thio of flea.
Your "A-" (Alien R«giMntion) No. .
Your Full Name
Any Other File
No., if Known .
Complete Present Addrvaa .
ia L'.S. >t Tim* of EJitry.
Birthdate
Bifthplace
Date of Entry .
Place of Ruin-.
Airiiae aad Flight Number or V««a«l of Arrival
Typ« of Entry /Temporary Vititor, Student, Psrmansiu
Rttidtn.ee Vita, Retntiy Permit, tie. > _
Deaxiaatioa in U.S. aa Shown on Entry Document .
Name U«xi at Ti»» of Arrival
Othw Names Used at Any TIBM
Pleaae fill ia the following if un application or previoua correapondaace eoBCernmjt tkia matter wae
furwarr*«d to thi* Service:
Type of Application:
Date of Application or Correspondence:
Your addmaa ae ahowa on application or cotreapondence:
Addreaa of Service office where appticatioa or correapondence waa forwarded:
ttnt 0-1 «
row MO.
6-14
DXTTOet TXTU
Kaw. 4-7-72 OnUMTirXABU COMMOnCATIOll 70UXW « UF
812!
8 X VHt
AM 2743.03, 2793.09
rjsi
one TO UTOB
JMCOP IB TO
COMMDMXCAXZOH WOT UQUUIT F<* ADDITIONAL DQTOIMAI10M TO ASSIST U IOBMTIFTXM6
I CASI
Ap?«adis 1
DEPAHTAMENTO DE JUSTICIA DE LOS ESTADOS UNIDOS
Servicio d* laeugnciJa y Naturalization
Expedient* Num.:
F«cha:
Teaga la bonded de proporeioaar iafoimacioa adictonai de identificacion con el fin de que po ja.:-.o» dar
cttrao o raopooder a M corauaicacio'a. SirvOM lleaar loa eap acioa indicados y envi<sr eata forma junto
eoa caalqaier otro mat«fiai a «sus ofieiau.
& niin«R> "A" (Ragiatro d« Cxtraajares) _„_
Cualquiar otro ntfmero da ragiatro, d« aalMrio
S« aonbre corapleto _ ._. _ -
SM direcci6a actual complata ________,_>___„___._____
So direccifa m lo* Catadoa Unidoa m el momcato de »u
Pacha d« aacimiaato .
F«eha d« eatrada
, LuflV da nacimiento .
Lugar 4« eatMid*
Luta air*a y awnato d* vualo o buqna aa q«« lla§<{ .
Ttpo de Mtrada (Viaitaata Temporal, fotadiiutte, Viaa de Reaidrncta Permanaate,
Pemiao da Rcinareao, e«c.) __
Oe*tiaacioa en loa Fstadoa Unidoa •egoa aparece en el documento de
eatrada
Nombra <pi« ««4 ea el monentn d» M lleawia
Otfoa aombrea quc hay* uaado ea cualquier mom en to
Sirvoae llenar loa •iguiantea eapacioa ai aa ha enviado ana solicitud a este Servicio, o si ha habido
alguna cotreapoadencia en torno a aata aauato:
Tipo de aolicitud:
Fecktf da la aolicitud o corresponded cia:
SM diraccio'a Mgua apareea ea la aolicitud o corresponded cia:
Direccina de la oficiaa d*l Servicio a la eual ae envid la solicitud o correspondencia:
000 *1«>M)7
10/1/80
I. USE:
USED BY REGIONAL, DISTRICT AND OTHER FILES CONTROL OFFICES TO REPORT THE
STATISTICAL DATA ON FREEDOM OF INFORMATION REQUESTS REQUIRED FOR INPUT
INTO THE CONSOLIDATED INS ANNUAL REPORTS.
II. ELIGIBILITY:
ALL REGIONAL OFFICES, FILES CONTROL OFFICES, AND OTHER OFFICES WHICH PROCESS
ACTIONS UNDER THE FREEDOM OF INFORMATION ACT.
III. REQUIREMENTS:
1. ALL FILES CONTROL OFFICES PREPARE THE REPORT IN ACCORDANCE WITH
INSTRUCTIONS PRINTED ON THE REVERSE SIDE OF THE FORM.
2. EACH DISTRICT, SUBOFFICE, AND BORDER PATROL SECTOR MUST SUBMIT THE
REPORT TO THEIR REGIONAL OFFICE AND CENTRAL OFFICE STATISTICS BRANCH
WITHIN TEN WORKDAYS AFTER THE END OF EACH MONTH.
4/1/81
7-7
TM 760
AWIBISTRATIVg MAflUAL
6-23.2S Supp. A
tamo STATES omiimm or JUSTICE
Immigration and naturalisation S«rviea
c&m • 3
WCJOtmOSi ACT
I. Boa;iM«t8 for tnforaselao (in paroea, by lacto*.
by font S-«M. ate.)
A* ffttttrflfi^ fe®@168&iRg 02 fBQVlMt
S. Oacaivod
C. Ttaasforvea1 ta
D. CooplBtad
la. Granted
b. Oaaiad la part (aaaBpctetts tfl-7. 332<b» .
c. Denied IB entirety " « " " "
4. Hat eeaellad vtth (enter authority)
2o. te«
b. ffao MMOBC
T. feadlag aad «f pariod
II. Aaaunta •< f<Ma akavgad/mllactca
A. total fa«a sfeairgsd Ll_
2. Faea dMrgad for dupltoatloa
B. Total faoa eollectad Li-
ill. Total ptootactlva
1. Officer
2. Suparvlaory
3. Clerical
D. Cuatodlaneblp of Public leading MMM
IV. Authority relied upoa for each deMal, partial
denial, or nanceapllanee 4«taraln>tlo«— taeber
of tlaaa Imokad
A. tMBptloea in JM(b): ( uuli urn J)
1. tae^tloa #1 '....
2. boBptlon n
1. beaatlaa #3 * (eit« atatutaa OB page 2)
t. bunptlon **
). iBoaptloB #J
6. btmotion #4
7. lf»rm>tlon Fl (tilai • thra «)
a. baaBtlon »7(A) .", .
b. I»a«|»tlO« #7(B>
e. laNMotion *7(C)
d. bMoetlon #7(D)
a. beaiptlon *7(I)
f. Ea«B9tien »7tr>
». Other authority (apoclfy If not Hated)
1. Moap«aaaa<lon of raeorda
2. Failure to adequately identify rocorda ..
Ton C-2J.26 Supplaawnt A (oaf* 1) ( >*«. 2*
6-IJ.2* Sun*. A
*«V. 2-15-7*
OF IMFOMMTIOH ACT
•IS*
I X 10 l/t
AN 2301. 01-. M. 01, .5*. 01 -.56- 02, .54. OS. 2780.09
SIMMITTU NONTHIV TO KtPMT STATISTICS CO* 6-63 J AW. I CAT I QMS
?HIOft UITIOMS HAt HOT 1C UttD
acmssous A
rmoo* of IWOMUTION ACT
irotna ft-JJ.J* Suffplw
a.gatbar data MMUBCV e» «ca»ly wltb W7& Fteoitta of I««ora*tlo« *ct teaaOa
»bl«a raajiim aa awwal rapart to bo guteictari u cba gpaatar of tba ItauM o< tspraaane
(J U.*.C. '531(4)). AUw, « auaztarly cvaarx u r»a.ulr«u by th* 0«(«iey Attonuj C..H.M I.
.L. 43.1O2. «nacc*d Havonfrtr 21. It 74,
an* tba Pn«ldanc a( ClM S«lt*ca
MT». Ueb ealuaa sttl roilosc a aaosa cou&anclng J««»ry for tha first J aanthn. A»rtl for tba nost 1 soMba. ac«. Tba
(era coon a J.«wtb jsortod. Tha 1*4 1 coluaa Hill IM tho cotal far eta 3-«wiib period.
Una t. latmma Jar. Inlnrmetaa Ha giafitti & I EM"- & Z2SS C'*M • aisi.- '
A. famaiM »a«maing at xrlod. Sn««r eaa ma*or of nwoaica otde fur ItUomaclon chat la pirating at cba bagtn*la( o*
tba reporting *erlae. (flgura la fro* Urn l.r far prior »ario4. >
i. jacalM*. littor eb* luobar of «a» raquaata received. Iaqua<ti, .aa* bo oada In panon. By a*U. try UM of C-»M. ate.
C. Traaaftrrat ^j.. tatar cba mater at ra<n»aaea eoiiMfarraa' IB Itoa otbor aCfleea.
0. OKMlUCBd. Ttw ra^uaac ihall ba ccafilacad vbta Cba Iniervwtlon ha a toon (urntslMMi. funrtotioa in pare wttfc clw
raaalMar aonled, or oanlad In <mtraey or haa ~« IMOR ce=spU«<l vith. (rtgura la cho total of llnaa I.O.I* thru o;
It tfl alta cha total o( tlnaa l.O.Za and b. )
U. CrgBtX. All Infonmtloa la CM rasuaac 1> furtrtahoa.
Ib. 0»nt<rt ijj t/Ui-
t»» ataa oea cit
'H l» »«rt «ttli tba ranua«. »«.»oit for uanylng balanca o{
gaall ba ll«taa
U. b. or c abooa. ( Ma*taaoaaal«a of racavri.
ta part VI.
U. »at cmal.it* aiill <<*lat <m)iorttt). net «eaowica4 f« la
ramtaacar fatlad ca a4aa,uacaly IdaactCy rxora. etc.)
U. its., tatn cba nuaatr of cooBlataa raquaaca far wklck n («« MS mtulratt. ragardlaea of ubacbar or we aald.
n. Ifta «agf»M- tatar cba auiMr of ceafilacad raowxca for vatcb Cba faa <a» oatvad or not rvqklrad.
«. JptiafunrM out, fetor cba auBbar of nquaaca craaafamd ca ucKa- afflcaa.
f . rairitM ajjd. ji i^rltd. bear ruobar o< nmii«it« joafllnj nc tk« aim af th« cowrciag partvd.
II. Mnuaca ji jm tbarjad/ccllactaa {or. «jJHB« mccrda avnlUbU.
*. Tocit ixii cbaraad. tncor tha caul aanmnc o( «»it«y n»an«l *n Unaa tl.A.l aM 1. OU»CJU> u tba uaunt of aaaay
raawatad far furmottlng cba lotatoactaa. U <M>aa nvc naeuMMrtly mua tUac cba faa uaa »Macc»4 fraa ar oa botaaU
»( cba ayallcaat.
I. t<nt char«ad igi ««arcb. tatar cbac porelan at tba f*a <dlcb vao ckargv^ Jor caarc* at tb« raaord.
1. fa«i cbatmrt (Of aualtcaelaa. tatar that portion a( tba faa wfelcb «aa coargad for outilicacing aacartal.
a. Total ftff eollaetad. bear cba «lu»l aaauac of aaaay aetl<Nca4.
In- Tot<t< »r»<iuttlv« Noun, (near cha total nuattar of Mura raaartaa oa Unaa tit. A «nd a.
»• >t«»i»«n« r»«iu««t«
tho total «ua*ar of Soura raaarta
:iI.A. 1. t. and } Includaa all ctaa da«ata<
p^ -.'«r Ion ftnd forv«rdlr:g of ralaCad conraaoofidatK«. «cc.
ularlcat. Shew Na«r« «a»araealy aa inalcacad. Sui»r»1«iry So«r»
». CuacadlaMhla jjf, fubllc «««dln» looa. bt«r total nusbar of hours laaac an dueiaa ralatod co cba f«
•uta aa tllla*;. laarcnlag far aacorial, ouplleatlng. att.
IV. Aucharttt mlitd uatn for ««ch cnnlal. ixrrul diml« I . or. noncoajUancra d«c«n«ln«tlofi--n>ji»b«r o£ ct»af (nvolml. Kara
chaa aaa of tba .aaaaclana aay ba rallad upan iiban danytng t nqviax. THarcfora. cbo total OB Una W.A ihaald ba oqual
Co of iraatar cbiin cha coCAl af llnaa 1.0. l.b ana c (daalad In oart and •nclraty). TV* cotal oa Una LV.8 ralacaa ca
Una 1. 0.1. a (not tao#ltod ottb).
A. lM«allo~» in !»(!>). tncar eha tot. I of Unaa W.A.I tbru 7.
1. thru 71. t»aaaclyn tl_ enni tmapimn »7(r). tafar Co cha rmdam ot Inforaacioo Ace (} a.S.C. J5I) for
oa((aitlona of cha aiaapcloao and «near cba nuaaar of cliua <ncb of cba nanwtlonl vaa Intokad vbaa daayiBg
ar partially danylng nquaaca. le la naeaaaary Co elca cho oeaeucaa litookad pursuant eo teaaaetoa >} and
Ua anabar of Claaa aaeb of cba (caeutaa vat lavoaod. Soar* la providod on imga 3 of cba fora. Una 1V.A.7
lo tba toeal of Uaaa IV. A. 7. a tbru f. Ltoaa 7. a tbru f *ra a furthar braabilatM o( Iiaa«claa fl by typo o«
da<iaod la cba Me.
••
' «"Cbai^ty (laaclff ]i 3U. UUSi'- '•r raauaaca chat camwa ba raoallad -let (ochar tba ft doMalo). ••aelfy
a« It MC UiCM and aacar «uater al cloaa aa«b a< cba raaaana t« '
. for
vitbta 10 unr>la« day* af car ra<atpc.
:a eltac oro 101
1ft »«lct< li Sit »«ca«»4r» la jjj^ m attanaloi 2i UM aro'nn djja by cba cbr<M cy*aa «< "uauaual
clr<ua<ica«c<xi". flit» t« t count of f«M»-jt» for >*leb IB lalilal dacarulnuclon coaU nac ia tiada vtebla 10 «>rkla)
day* a<ca« racalot am «taaaio«a of tlaa not co «and 10 —rutnj davt in «^raimci "»ro invoaad. Thl« tr «Bt <
cetuK af tba avatar of utooaloM aauakc. le U • covac af ck* lalclol rranneota ctec mm e«BBla«*d <urla( cba
Ift-aay •aeamiia* ^MI«IO<J. le could bo po*4.*%la CAMC «A »^C4nal«rH <^t*4 r-d-i.vc.i.tv, T t *.wiru >li«ih <"*> :«4»4il. In tHilch
oaaa, a taa>aat w>uld L« cavxad unca f«r aa<b raaaiM.
total nuaaar jj.
«mur»<i ii
rnni««c«t »a« [ntontoH oi shj Saryjca.'t jnabjAUt m Mac tin Bra««rl»«d
a rMtatt ( »»«<; t f T r»a«a« (or l«c« n«ttr«tr^ct<>n). Tat« la «
J j£ UMI rMvutt ( »»•<; i (y r»a«o« (yr l«c«
eauac of raquaic* far •oich «a Initial dataralnaeia* eaula not ba aad* during cba 20-day partod In V.A okovo
Tkay ibauld nac M countad In V.A.
cUl«t oj ,«h Mr .OB wjjj, ^
Jjr. tha ln
cho cotal af Ita
»<H)Tt"« *X9 PUt PATH. Tha data ib<~« o* C->1.2i Supalaaaat A U Includad la Cba 0-23.34 cavort vhero «»»ro»rl«ta. OlltrKC
offlcaa and iubo<21ea> raqulrad ca cubaic a Fora C-23.26 «ra raautrad alaa ca tubalc cba Su»plaw»nt A. tn^^uqln|i na«a C I va
riancii. Ib. Supalaaant A i> ca ba >ccacb«4 c« cba e-U.ja. lardar ratrol S«ceara ara alao rasulrad co lubatc Fora C-2}.2a
iuMilaaaac A ava* tbxi^b cbay ara not raa.iurad to lubut tba C-21.26 ntoort. (aoarta ara dua la tba SCatlatiaa Srancb. Contra 1
Mflca. aad raflaaal ofeieaa ulcbla J vMrbUya «ft.t cba claaa af cba aantb. national afflcaa <ball tutalc batb a oMaalldatMl
rational C-J3.H Supalaaaat A racort l^ a C-n.J* Sua^laaaa* A raaarc «owrlr.4 acclvtcy taking >Uea Mlaly lo cba caglonal
offloa ca raacb cba Cancral Ottlca. Atcanciaa: S£«el«clci tranta. ultbln 10 urckdaya ifcar cba cloa* o( cba aaacb.
TH 760
ADMINISTRATIVE MANUAL
Appendix 1
G-23.26 Supp. A
Page 3
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization Service
FREEDOM OF INFORMATION ACT
(caatlauatUn pae«) Soportlo.
Porlod e
RCS: CADM - 3
9 OtfiM , ,
ivarod
Total for
quarter
IV. Continued
* A. 3. Cite statute(s) invoked pursuant to
Exemption 3 and nuaber of tines invoked
(iMWt nuater <r«a HM UJ.J, me* (}
«. Section 264, I and N Act
b.
c.
d.
a.
V. Compliance with tine limitations for initial
determinations
A. Instances in which it was necessary to seek an
extension of tiae broken down as follow*:
1. The need to search for and collect the
requested records from field facilities or
other establishments that are separate
froa the office processing the request ....
2. The need to search for, collect, and
appropriately examine a voluainous amount
of separate and distinct records
3. The need for consultation with another
agency or with another component of the
Department of Justice having a substantial
interest in the determination of the
B. Total numbers of instances in which the
requester was Informed of the Service's
inability to meat the prescribed deadline
and assured of continued processing of the
request (specify reason for late determination)
1.
2.
3.
4.
3.
VI. List names and titles of each person who is
responsible for the initial denial of record's
requested and the number of Instances of
participation of each
Ju* JlUi
Form £-23.26 Supplement A (page 2) ( Hev. 2-1,5-76 ) wo»o»-«n
I. USE:
USED BY REGIONAL, DISTRICT AND OTHER FILES CONTROL OFFICES TO REPORT THE
STATISTICAL DATA ON FREEDOM OF INFORMATION REQUESTS REQUIRED FOR INPUT
INTO THE CONSOLIDATED INS ANNUAL REPORTS.
II. ELIGIBILITY:
ALL REGIONAL OFFICES, FILES CONTROL OFFICES, AND OTHER OFFICES WHICH PROCESS
ACTIONS UNDER THE FREEDOM OF INFORMATION ACT.
III. REQUIREMENTS:
1. ALL FILES CONTROL OFFICES PREPARE THE REPORT IN ACCORDANCE WITH
INSTRUCTIONS PRINTED ON THE REVERSE SIDE OF THE FORM.
2. EACH DISTRICT, SUBOFFICE, AND BORDER PATROL SECTOR MUST SUBMIT THE
REPORT TO THEIR REGIONAL OFFICE AND CENTRAL OFFICE STATISTICS BRANCH
WITHIN TEN WORKDAYS AFTER THE END OF EACH MONTH.
4/1/81
TM 784
mwm,
G-M.26, Suppl.
Page 1
United itatoa Dapartaent of Jus lies Saporting
lanlgratloa and Iteturallsatlon Carvleo Sarlod 2*
mVACY ACT
Offlea
erod ,., „
* ATTACS TO ?(SUJ C-23.36
Total for
^^ajtijr ,,,_.„„
*• Raquaota by individuals for disclosure of records
relating to tbsasaalvaa
1. Individual
2. Oth«r portiaa with eonaoat .,
6. S«quast8 for aaendasnt or cArreccloB
C. Aaquaata transferred in
1. Granted
3. Qanlad in part
11. Wacloeura* to third pattlaa (Tocal A + 9 •*• C)
A. BAutlna usa (3 UK 532a(b)(3)) (total 1 thru 3) ..
B. Uw anforcaunt dlselosurn* undar 3DSC5S2a(b>(7) .
v. r»M
VI. bc^tloiw rallad upoa for d«nlal or partial d«nl«l
daeanlMCiom ouster at tlMi lim>k*d (A * 8> ....
A. Privacy Act (5 USC 332a): (total 1 thru 7)
1. btmptioit (j)(2)
2. bMoptlan (k)(2)
3. bnapclon (k)(3)
3. Eiaop ion (k)(3)
6. Ssaop ion (i)(«)
7. buop loo (k)(7)
B. F.O.I. Ac (3 OK 332): (total 1 thru 7)
1. Zaana ion (b)(l)
2. Imp ion (b)(2)
3. CuMBtlon (b>(3) *
4. E««opWon (b)(A)
3. baavtlon (b)(3)
t. Cawatlon (b)<6>
7. Ixaaftioa (b>(7) (total a thru f)
a. bastion <b)(7)(A)
b. bcBBtloa (b)(7)(B)
1
d. Exnatloa (b)(7XD)
-=d
f, Kxamptlan (b)(7)(r)
* C. Cit* (tatuta* Invokad purauAot to A.4. »lua
8.3, (abovo *> - nwbar of tln< Invokad
2.
3.
Win «UajJ|. fao.iM^H B ,»„. ,_,.„, „
NO.
G-2J.20, Suppl. I
urc
• 1/2 X 14
COITION
MV. 1-1-7*
TITLE
PRIVACY ACT KMJCLQAD keCORD
lucrxaucNcc
AM 2301. 56. OS. .54.09, .56.11. 2775.02
WMSHECT FOR PRIVACY ACT RHWRTINC
PRIOR EDITIONS MAY NOT BE USED
10/1/80
nlVACY ACT
(Fore G-23.lt>. S^lmm 8)
1. rt)«f«f. T« |«eiMr data naaaaaairy ts caaBly vltb tM L474 Privacy &tc. P. 1. 41-7*. «McB nqulraa an annual capon Co ha lubatttaa
to cba Otftc* o< Nannataox ••* tudaac.
1. HKwqtHC BA.TA. ta*b calvaa vtll nflttt * raocb coaoantln* January (or eha flrac cbiraa wneha. Aarll (or tlM naac chraa aoncha.
tor tha l-csetb part oil.
UM t. lawwaca b; Individual* (or dlMloaur* ot racaraa raUclf* co ehaaa«l«aa.
A. *>«.»««« nannlmi bail ant «• af. Mrlod. Cncar tha nunhar at raa.ua.eta (or Iflfaraaclaa chat la pandln« at cha baa,laata«
of Mcb npnrtlaa parlod. (Tlaure auac agrM vita that reported on Urn l.t. for ebe prtor anneh.)
IT** - Tatal,. later tha nuabar of na» raa.ua»e ra*alv»d aach axith. Ue,uait» aay In BUM la parton.
b; Mil. by uaa of fora 0-437. ate. iffjura U cha total af llnaa S.t. 2. 3. <•. and 3. )
l- Individual* Ia4uaata by Individuals for accost Co or Infenaaeian frea tbalr own racorda. (Include all Individual
rotuaeta Tor aaaaae ar ceptaa.)
I. Otb«r aarttaa wit If eanjain. laa^iaita by othar aartlaa (or infaraatloa (roai aa Individuals raeowl aaov «lth cha
3. CaaajraailoigA. iwtiaaeg nda by Haaaara af Con«raaa aa. bahaK af a conacituane ts «haa cha record partalna.
*. taajtaata for aajaaaaam or Cornel Ion, laouaatt (or taaMBanc at eorracttan af racarda. !»i»t i* raqvwata (raa
cba Individual co ubaa cba raconj partalna.
3. Qtjltfr raauaaca r^aalvao:* bear cha nuadJar of raauaac* racaivad uaiich ara not covarad abova und«r 5.1. 2. 3. ar t.
C. bauaata cnoifarrad IB- btar cba nuaoar of raa,uaeca cranafarrad In freoi othar off Icaa.
• lacad • Total, bear
•nd I.)
1. Cqptbd'. All InConaatloc in cka rvquaac lua baan (urnlihad.
J. Oxrtad lci-8KClrat|. Ma corcloa of cha raquaacad tnforaaclan 1« tumlahaa.
1. Dantoa In aart. Coa»UaA la aart mcb cha raquaic: l.i.. part of tho ta«uaatao li.faraatton la tuvpllaa. ><rt la
daata«.
4- H» ranting roMM. Tba Ufamcloa raquaataa <oulo me ba {urnlabad bacauaa no raUclnc racord oaa found.
1. 9tb|y canalatlaM. bear cba aunbar of raa.uaiea coaalaead (ar raaaona other Chan cl|o*« cavar«a >bava uMar
O.I. 1. 3. or 4.
t. tafu^aan tranatitraa jjif., letar eb* -mTir of raquaaca tvanafarrad ouc ca otbar adteaa.
f. taamaci aandtM and of gactod. tataf tba nmibnr of rrloacy Act rawaaaca »aMlna. ac tba and of aach ravorttnt rarlad.
tt. JHialamraa la cMfa atttlal. bear Iba e»ttl
Infonacto* f mm an indtvtduaU raearaa. (fit
il of Una* II. A. I.
A. teutlaa ya| H IMf iiia^ibXil. Maclaturaa aada to ocbar Faaaral CavamMU afaitctaa. Itata. local, ar auniciMl
fovarflajaat i^anciaa. fnral$n to««riManta. ace., froa raaorda aartainlng co Indlvlduala for roucliw uaaa aa <aaclflad
la (M "flotua of SvataM of Utardi." (Flgura 1> cha caul of llnaa A.I. 2. an* ). I
1. U«r anforcaaani icclvltln. Mac
1. 1« H*««H.«*HV« «ettvtfl. Ol»c
fro. athar touraaa lor IncU.lo.
). Orhar rautina uif dtlcloai^rtf . Houttaa uaa ulaeloauraa MK covaratf abooa ond«r A.I ar 2.
a. J^a aafercMMft dl«el<nur«« unoir i U»C 152^1 bH7l. ftttcloauraa aada In raapanaa Co <paci(lc urlita* r««u«oc« aada
(ar l*a anfarcaaMroc purpoaaa ay lav «ni'orCKa»nt Jtanciee or organifarinna.
C. Debar third aerrv. dtaclaauraa. (near cha nuabar of dlaclaauraa co third parciaa not co»ar*d abova unaar (t.A ar 1.
ill- »aa.uaati net, aetad uaao vUhlr) ]£ nava. btar tha nuabar af Privacy Act roquaata net acted upon »nhtn 30 WOT » 1m
aaye afear racaipc.
TOM I. taiar tba total maabar of noun raportad on llnaa IV. A and t.
tmtmtan <ag Clarlcal. lavorc clav taparacaly aa ladlcatad.
IV. traduttlvj
* *°* •• Q
V. faaa
A. faaa charaa^. bear cba aavuac of aaaay CHMBIO for duplication of rxordi.
I. tUt. calla^etd. btar tea aawm of coaay COLUCTtD (or du»Uc«Hoe of ra««rda.
VI. Uanactona raltad uaoa (of danlal oj[ eartlal danfa| Hatamlimlaiia • nuabar o^ cl«a« inveliafl. Hen Chan ana of tK.
•«aa*cl«aa aay »a callad u»a« ubaa, d.ai>ytA| a nquaat. TSata<ora. tha caul of llnaa VI. A ana t will &a advial to or
fnatar thaa cha IUB of Uaaa t. a. 2 and ) (daniad In antlraty and daaiad In pare).
4- triply JjjC. (i MC Mla>. (mar tba total at llnaa A.I thru 7.
i- tklH 1- "«<•' ca cba IrloMT MI (t UIC JSJa) (or daftMtMM «J tba naiiiiiDllliiian (Mar tba nuattar of claaa
aa«a laaayrtea via Imokad. <*aa aaitylnf or partially danylni raa.uaata. tt U nacaaaarv t« «<t» cb« acMutaa
lirmbaa purauaa« ta Ijmaptloa «• and tba nuowr at claaa aacb acatuea Ma tnvokaa. S»aca (or tha citatlana haa
baaa an»td«d ac tba bottoai «( tba <oi» (vt.c.l thru J).
I. f.a,I. to, <» UtC ffl>. bear tba cowl at Uaaa 1.1 thru 7.
V. tbjQt 7.. tofar ta tba FraadM o( toforaatlon Act (J USC 55 J) for daflntttona of tha aimaa^iona. tnc.r cha moWwr
of Claaa aaab asaavcloa, uaa lawkad <<ba« danytna. or partially danylng raa^taaca. *>ta chae baaption '7 ;« th> total
o( Una* 1.7. a thru (. It li nacaaaary to ctca cha (ucuCaa litoahad purauanc Co Exaction «3 and cha nuabar of tlaaa
aacb itaruct uaa lexkad. Iptca (or chaia ctcaclona haa b*«n pravldad at cha boeeoa of cha (ana. I VI. C.I thru 1).
^m
3. «0ynn<| £QI Oy| 0«Tn. Tka oaea tlKwa oa C-13.lt. Suaplaaant ». it Includad la tha e-».2a rapore whara •paroprtata. IH'trtcc
offlcaa and aubofflea* raa.uirad ta tubatt a fora C-I3.)a ara raa,ulraal to alaa aubaiit tha Svpalaaant t. t m lu? t na naa.atl»a raaortt
TtM •Wlaaaac a ia to ba l tea chad ca cba G-23.J* raport. fcrdar raerol Saccon ara alaa raqulrad ca luMU ror«~C-2).2h.
luaplaaane I, alcbaufb ebay ara not rvaulrad eo luftalc cba C-33.21 raport. laaorti ara aua la cha fcadacKa Iranch. Caneral
Off |ca. ana ra|kanal off Uaa utcala J xoradaya attar cba claaa af aacb aontb. ta«taiMl.aff Icaa tbalt lubajlt bach a coaaolleacad
raftanal S.JJ.2*. «u*pla«ae I, rapare im 4 C-J3.J*. Supplawnc a, rapact ca»arln( activity taktn« placa talaly In tba U(len«l
Offlca to raach cba Caacral OffUa. Attantioa: lutlaelca Iranch. uttbta 10 uarkdaya aftar eba claaa af aacb Mitcb.
(•••. UI-711
/?=
10/1/80
FORM G-28
USED BY AN ELIGIBLE PERSON TO NOTIFY THE SERVICE OF HIS APPEARANCE
AS THE ATTORNEY OR REPRESENTATIVE OF A PERSON ENTITLED TO REPRESEN-
TATION.
II. ELIGIBILITY:
1. ATTORNEYS IN THE UNITED STATES WHO ARE IN GOOD STANDING OF THE
BAR OF THE SUPREME COURT OF THE UNITED STATES, OR OF THE HIGHEST
COURTS OF ANY OF THE FIFTY STATES, TERRITORY, INSULAR POSSESSION,,
OR DISTRICT OF COLUMBIA.
2. LAW STUDENTS ENROLLED IN THE FINAL YEAR OF AK ACCREDITED LAW
SCHOOL OR LAW GRADUATES NOT YET ADMITTED TO THE BAR, PROVIDED
THAT:
a. APPEARANCE IS ON AN INDIVIDUAL CASE BASIS AND AT THE REQUEST
OF THE PERSON ENTITLED TO REPRESENTATION.
b. THE LAW STUDENT HAS FILED A STATEMENT THAT:
(1) HE IS PARTICIPATING IN A LEGAL AID PROGRAM OR
CLINIC CONDUCTED BY THE LAW SCHOOL.
(2) SUCH PARTICIPATION IS UNDER THE DIRECT SUPERVISION
OF A FACULTY MEMBER OR AN ATTORNEY.
(3) APPEARANCE IS WITHOUT DIRECT OR INDIRECT REMUNERATION.
c. /PPEARANCE IS PERMITTED BY THE OFFICIAL BEFORE WHOM HE
WISHES TO APPEAR.
3. REPUTABLE INDIVIDUALS OF GOOD MORAL CHARACTER, PROVIDED THAT:
a. APPEARANCE IS ON AN INDIVIDUAL BASIS AND AT THE REQUEST OF THE
PERSON ENTITLED TO REPRESENTATION.
b. HE FILES A DECLARATION TO THE EFFECT THAT APPEARANCE IS WITHOUT
DIRECT OR INDIRECT REMUNERATION.
c. HE HAS A PREEXISTING RELATIONSHIP OR CONNECTION WITH PERSON
REPRESENTED.
d. APPEARANCE IS PERMITTED BY THE OFFICIAL BEFORE WHOM HE WISHES
TO APPEAR.
4/1/81
4. REPRESENTATIVES OF ORGANIZATIONS LISTED IN "ROSTER OF ORGANIZATIONS
CURRENTLY QUALIFIED FOR RECOGNITION BY THE BOARD OF IMMIGRATION APPEALS,"
MEMORANDUM CO 292-P DATED JULY 14, 1977, AND CURRENT REVISIONS.
5. ACCREDITED OFFICIALS, IN THE UNITED STATES, OF THE GOVERNMENT
TO WHICH AN ALIEN OWES ALLEGIANCE, IF THE OFFICIAL APPEARS
SOLELY IN HIS OFFICIAL CAPACITY AND WITH THE ALIEN'S CONSENT.
6. ATTORNEYS OUTSIDE THE UNITED STATES, PROVIDED THAT THEY:
a. DO NOT MAINTAIN AN OFFICE IN THE UNITED STATES.
b. RESIDE OUTSIDE THE UNITED STATES.
c. ARE LICENSED TO PRACTICE LAW AND ARE IN GOOD STANDING IN A
COURT OF GENERAL JURISDICTION OF THE COUNTRY OF THEIR RESIDENCE.
d. ARE ENGAGED IN THE PRACTICE OF LAW IN THE COUNTRY OF THEIR
RESIDENCE.
REQUIREMENTS:
1. EXECUTION OF CONSENT BOX REQUIRED UNDER THE PRIVACY ACT OF 1974
WHEN A PERSON REPRESENTED IS A UNITED STATES CITIZEN OR A LAWFUL
PERMANENT RESIDENT ALIEN.
2. EXECUTION OF CONSENT BOX REQUIRED BY II. 2. A AND 3. A AND 5., ABOVE.
3. NO FEE FOR FILING - STANDARD FEES ARE CHARGED FOR COPIES, SEARCH,
AND CERTIFICATION.
4. ALLOWS ACCESS "ONLY" TO THE RECORD OF PROCEEDING CURRENTLY BEFORE
THE SERVICE.
5. FOIA OR PA REQUEST MUST ALSO BE SUBMITTED FOR REVIEW OR COPIES OF THE
COMPLETE FILE, BUT FURTHER CONSENT IS NOT REQUIRED IF 6-28 IS PROPERLY
COMPLETED.
6. G-28 IS VALID UNTIL IT IS WITHDRAWN.
TO 751
ADMINISTRATIVE MANUAL
I
C-28
NOTICE OF ENTRY OF APPEARANCE AS ATTORNEY OR REPRESENTATIVE
to re:
DATE
FILE H«.
1 hereby enter ray appoerenco as attorney for (or ropra&entotivs of), and et the rankest ef, tho
named peroon(8):
MAUB
grr:, g^"0*4
ASDBKOt (*»u M».) (MtBtoer fc temi) (Clqr) (State) (1? Coda)
MAMB
g^n, g^toi"
AMBUS (Mb *••) . (!' ill in * Baroiil) (Cllr> (Stag) (SB» CUtdo)
CA«ct AfflicoU* ltaa(a) btlaa:
L_J «• I en on «tftem«y onj a ««mker jn food standing of th« ba ef the Svpraae Ceort _ol <ha United &etea or of lh«
the following S»»», tomt«ry, iiiMitcv po«M«sion, er District o
(Mtam »t Co*!}
court or adAinUtrOive agency order wiapoiding, onjoining, rattreiniag, Ssborring, er»tiranBiaa
restricting BW in practicing law.
.end an nut under a
l""l 2. I an «n occreditad raoroMnlotiv* of tho follawinf nanad religious, cWitabJe, doeioj sorviea, or siwller
orponiaotion Mt«Mi»Kad in rt»« Unltod StOos end wltidi is so recognized by tho Board:
Dl I M ossecitfad with
tho ottOfnay of record who proviovsly filed a notice of ODpoaranca in this case and my oppoerenco i< of His
roajost. f// yew check Ms itttn, •alao cheek item J or * tcAicAsoer it aytrovriote.) •
Others (E«»lain Mly.)
SIGNATURE
COMPUETE ADDRESS
TELEPHONE NU0E8
t HUVACT ACT op j»r< j N«w0r COMMENT TO TUS DttcLotuxa TO TUB POUOBWO BASSO ^nonmr a«
JWKBI UTT4TIKI OP AWT MtCOM J»BXrAMDN» TO «C MUCH AffEAlU IN AWT WWOIM1KW <UVO NATTaiAUJMlMW 4HIMC*
nrSTBM OF JUCOMOI' ______
nw AROVB cotnsnr TO oitctolt it IN connfcnott mm rut POIXOHNO t
PBMKMT OONCBWTINO
(NOTE: EneuUm tf Ail »M u r«ywu«a' under tAe Privacy Act of 197+ wtore U*.?«rao»
u a eitwn o/ <*« t/»u<«<< StM*t or an oit«» JatrfWiy edaitttd for ftrmtmeni ntidtnot.)
»oo.n o>u
V4
FORM NO.
6-28
EDITION TITLE
KJEV.«» !»•»" 80TICZ OF ENTRY OF APPEARANCE AS ATTOKMET OK KEPUESENTATIVE
size
8 Z 10%
8 CTK 282.1, 292.4(«), 299.1, .2; 01 103.1(c)(l) j AM 2798.121; II Hbk 1-fi, -9, -10, 4*2.
-3. -7: Inv Hbk 7-21
CHUB
USED n ATTOINETS AND UPUSKNTATIVE5 AFTEAKIMC IN CASES
mom EDITIONS MAT HOT IE USED J SCHEDULE A
10/1/81
.Ar;A«w.ta.a ««• AB appearance soau am iu®u on rora u— ia 37 tss auoraey or
representative appearing la eaeh case. Thereafter, substituting zaay be permitted
apen the writttn withdrawal of the attorney or representative of record of upon
notification ol the sew attorney or representative. When an appearance is stde by
a person acting ia a eepieseatative espmeifcy, his persoeal app@t£ance of signature
shall constitute a ;ept@seatatisa that uadtf th® pfovisioss of this ehsptsf h® is
aathoriztd aad quaii£i©4 to mprassat, Fosthsf p?ool of authonty £e act ia a
»«atativ@ capacity a&y b®
AVAILASILrTY OF RECORDS <*> Duziaf th® time a cass is p©admf, sad exctpt
as otherwise provided ia 8 CFH 103,2(b), a pasty to a pfeetediai or his attorney
or representative shall be peoiitted to examin® the recofd of pm€©@diag ia a
Service office. He may, ia eoafosmity with 8 CFH 103.10, obtain copies of Service
records or information therefzoa and copies of documents or transehpts af evidence
furnished by aim* Upon mquest, he 0ay» in addition* be loaned a copy of the test-
imony aad exhibits contained ia the record of proceeding upon giving his receipt
for such copies and pledging that it will be suznmdered upon final disposition of
the case or upon detaand. If extra copies of exhibits do aat exist, they shaH aot
be furnished tree on loan; however, they shall be made available for copying or
purchase of copies as provided ia 8 CFH 103.10.
"THIS FORM MAY NOT BE USED TO REQUEST RECORDS UNDER THE FREEDOM
OF INFORMATION ACT OR THE PRIVACY ACT. THE MANNER OF REQUESTING
SUCH RECORDS IS CONTAINED IN 8 CFH 103.10 AND 103.20 ST. SEQ,"
re?mA* b? tta tapaftaurtnttf OaaaBaatt. U.S. GtovwHMat Mattel OSw. WaaJslspm, D.C. 90MK
10/1/80
FORM G-342
I. USE:
USED TO PROVIDE INFORMATION FROM INS RECORDS TO A PERSON REQUESTING
THE INFORMATION.
:i. ELIGIBILITY:
USED BY INS PERSONNEL TO RESPOND TO REQUESTS FOR INFORMATION (OTHER THAN
FREEDOM OF INFORMATION AND PRIVACY ACT REQUESTS) WHEN THE INFORMATION IS
OBTAINED FROM A PERSONAL FILE.
:i. REQUIREMENTS:
1. THE INDIVIDUAL REQUESTING THE INFORMATION MUST BE ENTITLED TO RECEIVE
THE INFORMATION BY MEETING ONE OF THE FOLLOWING CONDITIONS:
a. THE INFORMATION PERTAINS ONLY TO THE PERSON REQUESTING IT, OR THAT
PERSON HAS GIVEN CONSENT.
b. THE PERSON REQUESTING THE INFORMATION IS AUTHORIZED TO REPRESENT
THE PERSON TO WHOM THE INFORMATION PERTAINS.
c. THE INFORMATION IS PUBLIC RECORD INFORMATION WHICH MAY BE
FURNISHED TO ANY PERSON.
2. THE REQUEST FOR THE INFORMATION HAS NOT BEEN MADE UNDER THE PRIVACY
OR FREEDOM OF INFORMATION ACTS (THOSE REQUESTS MUST BE ANSWERED IN
THE FORMATS PRESCRIBED).
d/l
TM 784
ADMINISTRATIVE MANUAL
Appendix I
UNITED STATES DEPARTMENT OF JUSTICE
IttMIBRATlOM AMD NA.TURM.IIATIOM SERVICE
In reply co yoiu recent request, d>e following information is furnished from ttae records of
thi< S*r*ice:
Name of Subject:
Age or Date and Place of Birth:
Other (indicate)
Remarks:
The above information «aa taken (tow the document indicated below which <
recorded on
(Uil.l
Check one:
~ Birth Certificate
'. , Petition foe Naturalisation
'ID Other __n__..Kr___
Sincerely yours,
(Hi.. 10-M-771N
IX)RM NO.
G-342
COITION
R£V. 10-15-77
TRANSMITTAL LETTER FOR INFORMATION FROM SERVICE FILES
SIZK
8 X 10 1/2
INSTRUCTION Jl£F£HJ34C£
AM 2482 Ex. 1; GIB A-6
USE
TRANSMITS INFORMATION FROM SERVICE RECORDS TO PARTY REQUESTING THE DATA
PRIOR EDITIONS MAY NOT BE USED
SCHEDULE A
FORM G-343
I. USE:
TO PROCESS AND REPLY TO REQUESTS FOR INFORMATION FROM, OR
AMENDMENT TO, SERVICE RECORDS.
II. ELIGIBILITY;
SERVICE EMPLOYEE RESPONDING TO PRIVACY ACT OR VERIFICATION
OF INFORMATION REQUESTS. -(G-639A USED FOR FOIA REQUESTS)
III. REQUIREMENTS:
1. TIMELY REPLY AS REQUIRED BY DOJ REGULATIONS. THIRTY (30)
WORKING DAYS FOR G-641 VERIFICATION AND TWENTY (20)
WORKING DAYS FOR G-657 PRIVACY ACT REQUESTS.
2. TO MAKE INTERIM REPLY, ACKNOWLEDGMENT, NO RECORD REPLY,
AND EXTENDED TIME OR DELAYED RESPONSE.
3. COPY OF "NO RECORD" REPLY MUST BE SENT TO COREC - ATTN;
PA/FOIA.
4/1/81
TM 783
ADMINISTRATIVE MANUAL
Appendix I
G-.V:"
UNITED STATES DEPARTMENT OF JUSTICE
Ifaraigrotiofl end Naturalisation Service
FWwene® is tRocJo w> your stesnt lows?, explication, or request. In this connection, please rood and comply
with the inrtnsetiofta checked Wow:
Ths infefwetien soe.yuswd has b**n sent te:
Your r»quast should bo directed to:
r~l This will ock«owl®df« raceipJ of yew request Tor amendment of record under the Privacy Act. You may exp«et
e decision within __________ d®ya.
["""1 Your request same® within th© (urindiction of the office shonm baloto. It has been reWrad to that office for
jjriate ettuntien end all fui-ttsexr eEsnra&iranoWico with rhta regard should ba sent directly to:
Qj Your rcxniost hen bem (faferras ta ?heo office for procosaing. Any csHnmunicationa cencaming this mortar
should ba wb»im>d to A® ofco^a «ltin>as.
I 1 On tlw Iracis ef tho infomettef) furaisked, this Sorvieo is unabU to identify a record relating to th« subject
of ywr insfuiry. This Service therefore, eon b* of no aeeisrenea to you in this Ktottsr.
1^2 THs iniomorion you sfe re^ijoassre;) is not evoilobU fr«ra the records of lEwigraticn end Noturolixotion Service.
C A fe» is reqainiid in the em«ajf« of S . Money order or cheek should bo mod* payable to lh« "Imtsi-
ewrtien raid Nurture! i set ion Servic®, Deportment ef JuBtico". THE ATTACHED COPY OF THIS LETTER
SHOULD BE RETURNED WITH YOUR REMITTANCE.
I 1 Fm» returned in ife* «s»unt oi $ i .
> ti»ia.
:t fo» W«B Bubsiitt®d. Foa for t!>:s service it S
[31 E*r rosuknissiefl with «h» isnetesasS e^aileetien.
RiDSpsnso to your «qweo« has U«( doloyad. We as^act a detenninotion to U wodo by.
We soak your pa»isrw:s aid understandii^ &snmg Aa aBtwisioo of tint® or daloy which is due to:
Sincerely ymttris,
C-J43
[Re*. 7-1 1-77 )N
FORM NO.
G-543
EDITION
REV. 7-11-77
TITUE
REPLY TO REQUEST FOR INFORMATION FROM SERVICE RECORDS
SIZZ
8 X 10 1/2
use
XMiTKUCTlOM
AM 2482 Ex. 1. 2780.11. 2782.10.02, .12, 2984.12; CM 101-9
USED TO PROCESS REQUESTS FOR INFORMATION FROM SERVICE RECORDS
SCHEDULE A
hORM G-
I . USE :
USED TO OBTAIN INFORMATION FROM MICROFILMED NATURALIZATION CERTIFICATE FILES
NUMBERED FROM 1 TO 6,500,000. (NATURALIZATION BEFORE 1951).
ELIGIBILITY:
USED ONLY BY INS PERSONNEL TO REQUEST VERIFICATION OR COPIES OF
INFORMATION FROM A NATURALIZATION FILE.
REQUIREMENTS:
1. A FORM G-641 APPLICATION MAY BE ATTACHED TO THE G-347, IN WHICH CASE
THE G-347 WILL SERVE AS THE CONTROLLING DOCUMENT AND ONLY ITEMS 2S 33
AND 6 WILL BE COMPLETED.
2. FORM G-347 IS USED ONLY TO REQUEST THOSE NATURALIZATION CERTIFICATE
FILES NUMBERED 6,500,000 OR BELOW. IF THE CERTIFICATE IS NUMBERED
ABOVE 6,500,000, USE FORM G-100. (WHEN THE CERTIFICATE NUMBER IS
NOT KNOWN, PRESUME IT IS BELOW 6,500,000 IF THE NATURALIZATION OCCURRED
BEFORE 1951.)
3. SEND TO CENTRAL OFFICE. ANY FILES RETURNED WITH THE FORM WILL BE
SENT ON LOAN ONLY, AND MUST BE RETURNED TO CENTRAL OFFICE.
4/1/81
7-23
TW 775
ADMINISTRATIVE MANUAL
Appendix 1
G-347
RjBW
UNITED STATES DEPARTMENT OF JUSTICE
llfitfORATKSN AND MATURALIZATtON SERVICE
REQUEST PO8 INFORMATION PROM NATURALIZATION PIL!
Of C-64J Is eMeefawl, illl ta «»OM 2, 3 end 4 e»M
1 CERTIFICATE NO :
2. REQUESTING Of PICE
g. NAME OP APPLICANT
& REASON P08 REQUEST
CD e.Dari»ettw>
CD b. Le«» Popvt
CD «• J*<xld CeriMteoa
CD ^ New Norn CortJlfcwsSo
OM Cartlftcc»» Btibamed
CD o- >4»w Neoe Cwtrftcata
CS«! C««l<te«« l«ai w owlllfli^
7. NAME OP NATURALIZED PERSON
AT TIME OP NATURALIZATION
CD i- Ajvllctftea t* CatMtato. W-S89
CD ^.aw«% EM»
CD i> M*nM»h« fraa Racarrf - feamiok copy eJ Pvtttla
?. COURT (TITLE wJ LOCATION)
1L CD NO EVIDENCE OP LOSS OP dTIZEMSMP APPEARS M PR.K
11 CD COMPLETE PILE PORVARDtO
11 a PWTOCRAPM OP CCTTIPICATB ATTAOMB)
M. CD PHOTOCAAPH OP PETITION ATTACHED
W. CD PfTITWN PILED OM . SHOW* DATi OP WRTH TO If
SMMATURE OP TRANSCRIBER
DATE TRANSCRIBED ...._.. —.,-.—
f»*v.9-22-75)N
>ra ••..on
FORM NO.
5-3*7
EDITION T1TLJC
REV. 9-22-76
REQUEST FOR INFORMATION FROM NATORALIZATION FILE
size
a x 10%
mmujcnos* BjemuDtcx
2772.01, 2799. 03. .11; II Kbk
01 204. 2(c), 343.2, •.5(e); AH 2713.10, .11, .12, 2771.02,
5-26, App.S-M; GH A-<
osc
USED TO OBTAIN nffOBMACXON FROM HATOULUATIOM FILE
PRIOR BDSZOH MAY NOT BE USD
SCHKDOUS A
FORM G-350
I. USE:
USED TO ISSUE CERTIFICATE OF FACTS OF BIRTH FROM SERVICE
RECORDS TO A CHILD UNDER 21 YEARS OF AGE.
II. ELIGIBILITY:
1. CHILD MUST BE UNDER 21 YEARS OF AGE.
2. PARENT, GUARDIAN OR OTHER ADULT HAVING LEGITIMATE INTER-
EST MAY FILE FOR CHILD UNDER 14 YEARS OF AGE.
3. PERSONS BETWEEN 14 AND 21 YEARS OF AGE MAY FILE IN THEIR
OWN BEHALF.
III. REQUIREMENTS:
1. FORM G-641 IS USED TO REQUEST THIS CERTIFICATION.
2. PROPER FILING FEE IS CHARGED.
3. IF EVIDENCE IS PRESENTED TO SHOW LEGAL NAME CHANGE,
CERTIFICATE MAY BE ISSUED IN NEW NAME.
4. DO NOT IMPRESS SERVICE SEAL ON THESE CERTIFICATES.
10/1/80
TM 791
I
G-350
CiRTSFSCATSON OF BIRTH DATA
FROM IMMIGRATION AND NATURALIZATION RECORDS
THIS 18 TO CERTIFY THAT THE RECORDS OF THE UNITED STATES
IMMIGRATION AND NATURALIZATION SERVICE INDICATE THAT:
Was bara en
Hamas
File Nu«b«r:
of
TltloCaf Issstuiind Otlicer
THIS IS NOT PROOF OF UNITED STATES CITIZENSHIP
U*$. D»pas»t$nont &l Jwattco *> Immigration and Naturalization Sorties
m> G-350 (Rev. !2«l»?@) N 6f>o sa 9-817
F01M 10.
G»350
ESITIOSi TXTLB
CERTIFICATION OF BIRTH DATA
S1£E
21/2X3 3/4
DiimUCTlOi
AM 2482 Ex. 1, 2780.15
USE
USED TO ISSUE A CERTIFICATE OF FACTS OF BIRTH FROM SERVICE RECORDS TO A
CHILD UNDER 21 YEARS OF AGE
PRIOR EDITIONS HAY HOT BE USED SCHEDULE A
10/1/80
FORM G-351
I. USE:
USED TO REQUEST COPIES OF INS DOCUMENTS IN PUBLIC READING ROOMS.
II. ELIGIBILITY:
ANY PERSON REQUESTING COPIES OF DOCUMENTS FROM INS PUBLIC READING ROOMS
III. REQUIREMENTS:
DUPLICATION FEES, ACCORDING TO SCHEDULE ON FORM.
4/1/81
TM 786
ADMINISTRATIVE MANUAL
Appendix I
l-il
G-351
REQUEST FOR COPIES OF DOCUMENTS
TO: UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
FEE STAMP
I, the undersigned, hereby request the Immigration and Na
uralization Service to furnish me with
below:
fiVum&.i-J
SIGNATURE DATE
ADDRESS
FEE SCHEDULE: A fee of 10 cents per page shall be paid for copies of Service records. No fee shall be
collected when the aggregate charge is less than S3.00. A charge of S5.00 will be imposed if a check in pay-
ment of a fee is not honored by the bank on which it is drawn.
FOR USE BY IMMIGRATION AND NATURALIZATION SERVICE
DISPOSITION:
1 I Copies furnished as requested.
! I Other disposition made r««pi»*n)
SIGNATURE
TITLE
Form G-3S1 UNITED STATES DEPARTMENT OF JUSTICE • Immlgrotlan and Naniral!iotl«n S.rvid
(Rev. 9-3Q-78)N
FORM NO.
G-351
EDITION T1TUE
REV. 9-30-78 REQUEST FOR COPIES OF DOCUMENTS
SIZE
8 X 10 1/2
INSTRUCTION REFEJLENCE
AM 2482 Ex. 1, 2780.01; GIB A-6
use
USED BY READING ROOMS THROUGHOUT THE SERVICE
PRIOR EDITIONS MAY NOT BE USED SCHEDULE /
4/1/8
I. USE:
USED TO HAVE DOCUMENTS THAT ARE CLASSIFIED REVIEWED TO DETERMINE WHETHER
CONTINUED CLASSIFICATION IS STILL APPROPRIATE.
II. ELIGIBILITY:
INS PERSONNEL WORKING WITH CLASSIFIED DOCUMENTS OR ACTING ON REQUESTS FOR
CLASSIFIED DOCUMENTS WHICH MAY BE WITHHELD UNDER THE FOIA OR PA WHEN
CLASSIFICATION OF THE DOCUMENT IS STILL VALID.
III. REQUIREMENTS:
1. DOCUMENTS MUST BE REVIEWED BY APPROPRIATE CLASSIFICATION AUTHORITY.
NON-INS 'CLASSIFIED DOCUMENTS MUST BE REFERRED TO THE APPROPRIATE
AGENCY COMPONENT FOR ACTION (SEE FORM G-734).
2. MAY BE USED TO INSURE THAT INFORMATION THAT APPEARS TO WARRANT
CLASSIFICATION IS PROPERLY UNCLASSIFIED.
4/1/81
TH 710
MANUAL
7-29
G 3*6
RECIES7 FOB REVIEW OF CLASSIFICATION
DATE:
TO
FROM
., CltMifyinji Authority
. , Reviewing Authority
Fil. No.
Subject
*A doeiUMat eoauiaiaf ia/oraatioB ;l*j>i5*d by you M tb* d«U indicated above ia coaUiii«d in this
fill. It IB nqu««Ud Chit Lb* C\M»I ricatioo b« r«vt«*«d »t this tiro* for th» pufpo«« ol declassifying,
if utioml ixority conaidermtioo* perroil.
DATE
may be> Downgraded tn
""} li/orm»Uo« should be Upgraded to
~1 Treteat cl»«aificaUoa mu«l be retained
FORM NO.
C-396
COITION
M». 5-1-7J
TITLE
UQUBST FOE RIVIIV 07 CLASSITICATION
size
8 X 10 1/2
D4STKOCTION JtXJTXXNCX
AH 2103.01
use
USED THBOUCHOUT TEX SOLVICZ TO UEXZST UVIIU OF AN ASSIGNED CLASSIFICATION
rtlOK EDTTIOHS HAT MOT BE USD
SCHXDULX A
I. USE:
USED TO CONTROL PROCESSING ACTION ON CORRESPONDENCE RECEIVED.
II. ELIGIBILITY:
USED BY INS PERSONNEL FOR INTERNAL DOCUMENTATION AND CONTROL OF CORRESPONDENCE
RECEIVED WHICH MUST BE ACTED UPON BY A PARTICULAR TIME.
III. REQUIREMENTS:
1. MAY BE USED TO CONTROL THE PROCESSING ACTION ON ANY CORRESPONDENCE
WITH AN INTERNALLY OR EXTERNALLY IMPOSED DUE DATE.
2. THE ORIGINAL COPY MUST REMAIN WITH THE ORIGINAL CORRESPONDENCE UNTIL
THE ACTION IS COMPLETED. OTHER COPIES MAY BE USED FOR ALPHABETICAL,
CHRONOLOGICAL, OR DUE-DATE FILES, AS SUITABLE, TO PROVIDE EFFECTIVE
CONTROL OF THE ACTION TO ITS COMPLETION.
3. CONTROL RECORDS OF FOIA/PA REQUESTS MUST BE RETAINED FOR FIVE YEARS.
4/1/81
TM 775
ADMINISTRATIVE MANUAL
Appendix 1
DAT* OP MVLT t IUI
cotrraouno. or nee
DOft BATS rOB
M »ATtt) CTO)
TAAWBrkBBUI <BATt> (TO)
BAnam*K» AATCI rr«i
TK Btroar mitt
CMRKSPON&eMCf OOMTML CAW
3X5
»-12-76
COWIESPONDENCE CONTROL CARD
INSTRUCTION &Bf13LD4CK
27S0.08. .10. 2782 Ex. 8 Pg. «, 10, 14, 2795.12.01
TO CONTROL THE PROCESSING OF COORESPONDENCE
(Carbon interleaved, original and 4 copies)
PRIOR EDITIONS MAY NOT BE USED
n /i /on
FORM G-639
I. USE:
USED TO REQUEST INFORMATION UNDER THE FREEDOM OF INFORMATION ACT.
II. ELIGIBILITY:
CANNOT BE USED BY ONE GOVERNMENT AGENCY TO OBTAIN INFORMATION FROM
ANOTHER GOVERNMENT AGENCY.
III. REQUIREMENTS:
1. INFORMATION ABOUT INS AND ITS MISSION OR FUNCTIONS.
2. INFORMATION ABOUT NONIMMIGRANT PERSONS.
3. INFORMATION ABOUT LPR'S OR USC'S WITHOUT THEIR WRITTEN
CONSENT.
4. NO FEE FOR FILING - STANDARD FEES CHARGED FOR COPIES,
SEARCH AND CERTIFICATION.
5. TEN (10) WORKING DAY RESPONSE TIME BY LAW.
4/1/81
TM 803
ADMINISTRATIVE MANUAL
Appendix 1
6-639 & A
Page 1
APPLICATION FOR A SEARCH OF THE RECORDS OF THE
IMMIGRATION AND NATURALIZATION SERVICE
UNDER THE FREEDOM OF INFORMATION ACT (5 USC 562J
INFORMATION AND INSTRUCTIONS
1 . APPLICATION • Form G-639. Persons desiring a search of the records of this Service under the Freedom of
Information Act may submit trvs completed application to the Immigration and Naturalization Service office having
jurisdiction over the applicant's place of residence.
NOTE: When an applicant requests information concerning himself which would appear in a record relating to another
individual, then items 3 thru 1 7 should be completed in the name of that individual.
2. IDENTIFICATION OF THE RECORD. The personal data requested in Items 3 thru 1 7 should relate to the in-
dividual from whose record the information is sought. It should be complete and as accurate as possible.
3 . CONSENT. The subject of a Service record may consent in writing to another person's obtaining information
to which the subject would be entitled. A block is provided in the application form where such consent is shown.
4. FEES. (a) No fee will be submitted with the application. However when the cost of services rendered total
$3.00 or more, you will be billed for the amount due in accordance with 8 CFR 103.7.
(b) CORES AND CERTIFICATIONS. A fee of 1 0 cents per page sh*ll be paid for copies of Service
records. A fee of $2.00 is required for each certification of a record whether it is under seal or not under seal.
(c) MANNER OF SUBMISSION OF FEES WHEN REQUIRED. DO NOT SEND CASH. Fees must be
submitted in the exact amount. When requested to do so. submit a check or a United States Postal money order (or. if
application is submitted from outside the United States, remittance may be made by bank international money order or
foreign draft drawn on a financial institution in the United States) made payable to the "Immigration and Naturalization
Service", in United States currency. An applicant residing in the U.S. Virgin Islands shall make his remittance payable
to "Commissioner of Finance of the Virgin Islands," and. if residing in Guam, to "Treasurer, Guam." A charge of
$ S.OO will be imposed if a check in payment of a fee is not honored by the bank on which it is drawn. Every remittance
will be accepted subject to collection. •
5. REQUESTS WHICH ARE GENERALLY NOT APPROVED. Any information which would be a clearly unwar-
ranted invasion of personal privacy, such as address and place of employment.
6. If this application is mailed, the envelope containing the application should be clearly marked: "FREEDOM OF IN-
FORMATION REQUEST" or "INFORMATION REQUEST"
UNITED STATES DEPARTMENT Or J'jSTICt - tmmigritan tnd NttiMliution S«vic*
"FORM NO. EDITION
G-639 4 A REV. 6-20-80
TITLE
APPLICATION FOR A SEARCH OF THE RECORDS OF THE IMMIGRATION AND
NATURALIZATION SERVICE UNDER THE FREEDOM OF INFORMATION ACT (5 USC 552)
SIZE INSTRUCTION RETERENCE
B * in I/? 8 CFR 103.10(a) (2); AM 2301.56.06, 2482 Ex. 2, P. 1, 2771.01, 2780.01.05, .09
, Ex. 2, P. 1,
use
USED TO PROCESS FREEDOM OF INFORMATION ACT REQUESTS
PRIOR EDITIONS MAY NOT BE USED
SCHZDUIJC e
» '.:
4/1/81
Form toptovta
OMB No 43 RO589
APPLICATION FOR A SEARCH OF THE RECORDS OF THE
IMMIGRATION AND NATURALIZATION SERVICE
UNDER THE FREEDOM OF INFORMATION ACT (5 USC 552)
Type or prim the name, address and phone number of the person to
whom the information should be returned in the box below.
NAME
VEILING
ADORESS
CITY STATE
ZIP cooe
P-.OS.E
NUMBER
PLEASE READ ALL INSTRUCTIONS CAREFULLY BEFORE COMPLETING THISKJRM
(SEE INSTRUCTION 3.)
PERSON CONSENTING
SIGNATURE OF PERSON CONSENTING
1 SPECIFIC INFORMATION' DESIRED
;2 STATE PURPOSE FOR WHICH DESIRED
DATA FOR IDENTIFICATION OF THE RECORD TO BE SEARCHED'
•NOTE LACK OF SUFFICIENT INFORMATION MAY RESULT IN OUR INABILITY TO LOCATE THE INFORMATION REQUESTED
•3 FAMH.Y NAVE
GIVEN NAME
MIOOU NAME
4 ALIEN REGISTRATION NUMBER
15 OT«tRNAV£SuSED IF ANY
6 NAME USED AT TIME OF ENTRY INTO UNITED STATES
~Ta DATE OF BIRTH
.7 P.ACE OF 3IRTH
9 PORT ABROAD FROM WHICH LEFT FOR UNITED STATES
|1C PORT OF Ef.TflY INTO UVTEO STATES
rl 1 DATE OF ENTRY
1 2 NAME OF VESSEL OR OTHER MEANS OF ENTRY
GIVE THE FOLLOWING INFORMATION IF THE PERSON WAS NATURALIZED
(13 NiVlf OS '.A TuRALlZATiQN CERTIFICATE
14 CERTIFICATE NUMBER
IS NATURALIZATION DATE
10 A^DPfSS AT TIME O* NATURALIZATION
1 7 NAME AND LOCATiO'tGF NATURALIZATION COURT
1 agree to pay all cost* incurred for search and duplication of materials amounting to $3.00 or more. Additionally, where
thf anticipatfd fe* churui-able exceeds $25 00. I agree to pay an advance depoiil of 25r; of the anticipated fee or S2.1.00,
whichever n ^fater
c tj» »«. e JO no N
SIGNATURE OF APPLICANT
UNITED STATES DEPARTMENT OF JUSTICE - lmm,g,ai,on and N«iur«laai<on Se'vic*
RECORD COPY
4/1/81
TH 803
ADMINISTRATIVE MANUAL
Appendix 1
G-639 & A
Page 3
7-,
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
DATE:
FILENO.
Your request for a search of the Immigration and Naturalization Service records under the Freedom of Information Act
(5 DSC 552) has been received. Please note the paragraph checked below.
I ] Time limit for response to your request has been extended to
1 Response to your request has been delayed . We expect a determination to be made by .
..We
seek your patience and understanding during the extension of time or delay which is due to:
You may elect to treat this interim response as a denial of your request and file an appeal in writing to the Associate Attorney
General (Attention: Office of Privacy and Information Appeals) Department of Justice. Washington, D.C. 20530
I ] Your request was forwarded to this office, since.we have,na)urisdiction in the matter. Date received
I ] On the basis of the information furnished, we are unable to identify any relating record.
I I The following available information is furnished. No other information relating to your request is contained In
available records.
I 1 A fee of .
. is charged for services rendered. Please submit this amount immediately in the form of
a check or money order made payable'to the "Immigration and Naturalization Service." Be sure to
return your remittance with the attached copy of this letter.
I ] This is confirmation of conversation on .
. concerning the delay in responding to your request.
Sincerely,
F<ymO-639AlREv 6- 20 801 N
RESPONSE COPY
Ve
Fcxm G-B39A I HIV 6 20-601 N
REPORT COPY (FOIA)
FORM G-640
I.
USE:
PREPARED AND ATTACHED TO ALL FOIA REQUESTS TO DOCUMENT
STEPS TAKEN TO LOCATE RECORD AND TIME SPENT ON SEARCH.
II.- ELIGIBILITY:
PREPARED BY SERVICE EMPLOYEES ASSIGNED TO PA/FOIA DUTIES.
III. REQUIREMENTS;
1. ATTACHED TO EVERY FOIA REQUEST (G-639 OR LETTER).
2. RETAINED IN FILE WITH ORIGINAL REQUEST.
3. EMPLOYEE MUST DATE AND INITIAL EACH ACTION TAKEN'LINE.
4. CAN ALSO BE USED ON G-657 AND G-641 TO DOCUMENT STEPS
TAKEN TO LOCATE RECORD.
10/1/80
7-
TM 731
ADMINISTRATIVE MANUAL
Appendix I
G-6AO
Pl^
WORKSHEET FOR FREEDOM OF INFORMATION ACT REQUESTS
Date Applicant Advised re
Extension on G-633A:
Date:
File Ho.
Requester:
Subject of Record:
ACTIONS [ DATES | INITIALS
Freedom of Information Act Request Race ived— — — — -—
Local Search Completed—- — — — — — — —
Index — — — — — --- - —
Fl U Shelf—
Feder»l Record Center Docket — —
Requested from Federal Record Center-—- —
Received from Federal Record Center . _.
Special Search Starced— — ... —
Special Search Complettd— - — — —
Telephone to C.O. for Index Search--—— ~
Response from C.O. Index Search— — •• — •—•—-—--- — —
Record located at: (Location )
Telephonies I ly requested *"*"""" — — — -—
Information Obtained — — — — —
file Received———"- --——>-——..— —
Final Response Hade————— — — —
Forwarded to P.P. for decision, when applicable — -—
Placed on wire circular, if necessa-y—
Response on circular
FOIA request transferred to office having jurisdiction,
when applicable """ .——..—. ..-.-.—.
Received by Office having Jurisdiction—————
COMMENTS :
I ALL WKHtMXTIOM KMTBKCD ON TNI! POKM AS TO THC DATS Of ACTION 7VKKJV WILL ttt INITIALED BV THE
INDIVIDUAL TAKING SUCH ACTION!
Form G-640 (3-1-75) "MIT*.. «TATI..»I»*FAHT».NT ,.» M.>TI. v ,-....-»- ~. N«..U.-I« »-«,
FORM NO.
G-640
COITION
3-1-75
TITLX
WORKSHEET FOR FREEDOM OF INFORMATION ACT REQUESTS
SITE
8 X 10 1/2
INSTRUCTION RJCFOLBNOC
AM 2780.08
USX
TO BE PREPARED FOR ALL REQUESTS UNDER THE FREEDOM OF INFORMATIOM ACT
SCHEDOLJC A
I uivn vj— \j~r i
I. USE:
USED TO PROCESS APPLICATIONS FOR VERIFICATION OF INFORMATION
FROM SERVICE RECORDS.
II. ELIGIBILITY:
ANY PERSON, COMPANY, ORGANIZATION, OR GOVERNMENT AGENCY SEEKING
VERIFICATION OF INFORMATION FROM INS RECORDS.
III. REQUIREMENTS:
1. PROPER FEE - UNLESS WAIVED FOR CONVENIENCE OF GOVERNMENT
OR OTHER REASON.
2. VERIFY IDENTITY OF REQUESTER (IF APPLICABLE).
3. CONSENT BLOCK SIGNED (IF APPLICABLE).
4. PURPOSE OF VERIFICATION AND INFORMATION TO BE VERIFIED
MUST BE REASONABLY DESCRIBED.
5. MUST PROVIDE SUFFICIENT INFORMATION TO LOCATE RECORD.
6. THIRTY (30) WORKING DAY RESPONSE TIME.
4/1/81
TM 803
ADMINISTRATIVE MANUAL
Appendix '1
G-641
Page 1
7-39
(ase lear oil this si
submitting ap[)li<
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
APPLICATION FOR VERIFICATION OF INFORMATION FROM
IMMIGRATION AND NATURALIZATION SERVICE RECORDS
INSTRUCTIONS
Failure to comply with instructions may make it necessary to reject your application.
1. APPLICATION. Form G-641 shall be used where it is requested that verification of age or date of birth, naturali-
zation ot citizenship and genealogical information be provided to a person or organization. The form shall also be used
for any other requests where the information is to be furnished directly to another Government agency or Court.
2. IDENTIFICATION OF THE RECORD. The personal data requested in items 5 thru 19 should relate to the
individual from whose record the information is sought. It should be complete and as accurate as possible.
3. CONSENT REQUIRED. The subject of an INS record 'may consent in writing to another person's obtaining in-
formation to which the subject would be entitled. A block is provided in the application form where such consent is
shown. If the record subject is deceased, a death certificate and/or statement of the requester's right of access to the
records may be required.
4. IDENTIFICATION OF REQUESTER. INS regulations implementing the Privacy Act of 1974, P.L. 93-579,
require that a United States citizen or an alien lawfully admitted for permanent residence who is seeking access to records
about himself or herself, or consenting to disclosure from records about himself or herself, shall establish their identity
before access of disclosure may bs granted. Such an individual appearing in person may identify himself or herself by
showing a document bearing a photograph (such as an Alien Registration Card, Form 1-151 or 1-551, Citizen Identifica-
tion Card Form 1-197. Naturalization Certificate, or passport); or two items which bear his or her name and address (such
as driver's license or credit card). By mail, such an individual shall identify himself or herself by signature, address, date
and place of birth, alien or employee identification number (if any), and one other identifier such as a photocopy of a
document bearing name, address, and signature. If the aoove mentioned identification is not available, Form G-652,
Privacy Act Affidavit of Identity, or similar Department of Justice form may be used. Identification is not required if
the information requested is contained in a public record such as a naturalization proceeding.
5. FEES, (a) Basic Charges. A fee of S5.00 shall be charged for the filing of each application. The fee is not return-
able. When the information requested relates to two or more persons a separate form shall be filed on each individual
with accompanying fee.
(b) Certifications. In addition to the basic fee of S5.00, a fee of $2.00 is required for each certification of a
record, (see instruction No. 8), whether it is to be under seal or not under seal.
(c) Manner of submission. If this application is mailed. DO NOT SEND CASH, ALL FEES MUST 3E S'JB-
MITTED IN THE EXACT AMOUNT. Attach a check or a United States postal money order (or, if application is sub-
mitted from outside the United States, remittance may be made by bank international money order or foreign draft drawn
on a financial institution in the United States), made payable to the "Immigration and Naturalization Service" in
United States currency. An applicant residing in the U.S. Virgin Islands shall make his remittance payable to "Commis-
sioner of Finance of the Virgin Islands," and if residing in Guam, to "Treasurer, Guam." Personal checks are accepted
subject to collectibility. An uncollectible check will render the application and any documents issued pursuant thereto
invalid. A charge of S5.00 will be imposed if a check in payment of a fee is not honored by the bank on which it is drawn.
6. NATURALIZATION RECORDS. Records of naturalization may be obtained directly from the clerk of the court
in which the person was naturalized. INS also maintains records of naturalization created on and after September 27, 1906.
7. ARRIVAL RECORDS. Records of arrival prior to 1891 are not available from INS. Some passenger lists of the
Bureau of Customs dating from 1820 are maintained by the Central Reference Section, the National Archives, Washington,
D.C. 20408. Inquiries concerning these records should not be made on this form but should be forwarded directly to the
National Archives with sufficient information for an adequate search, i.e., approximate dates of travel, name under which
the person arrived, name of vessel, and port of entry and embarkation.
INS has records of arrivals at the port of New York since June 16, 1897, and at certain other ports since 1891.
Our records of arrival prior to July 1 , 1924, do not contain birthdates but merely show age at time of entry.
(OVER)
FORM G-641 (REV. 6-20-801N
FORM
NO.
G-641
EDITION
REV. 6-20-80
TITLE
APPLICATION
IMMIGRATION
FOR
AND
VERIFICATION OF INFORMATION FROM
NATURALIZATION SERVICE RECORDS
SIZE
8 1/2 X 11
INSTRUCTION REFERENCE 8
P. 1, 2713.10, 2771 .01, 2780.04,
GIB P. 11, App. A-6, -30, -33
CFR 103.10 (f),
.10-. 11, .13, .
299.1, 343c.l, 499.1; AM 2301.56.01, 2482 Ex. 2,
15, 2782.08.04, 2984.12, Ex. 2, 4, P. 1, 6; Hbk
use
TO BE USED TO PROCESS APPLICATIONS
Carbon-interleaved (Original and
FOR VERTIFI CATION OF
2 copies)
INFORMATION FROM SERVICE RECORDS
PRIOR EDITIONS MAY MOT BE USED
SCHEDULE B
4/1 /,
G-641
Page 2
ADMINISTRATIVE MANUAL
Appendix 1
TH 803
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization Service
Form approved
OMB No. 043-R0570
APPLICATION FOR
VERIFICATION OF INFORMATION FROM
IMMIGRATION AND NATURALIZATION SERVICE
RECORDS
TYPE OR PRINT THE NAME AND MAILING ADDRESS OF THE PERSONS TO WHOM IN-
FORMATION OR COPIES OF RECORD SHOULD BE RETURNED IN THE BOX BELOW:
Fee Stamp
PERSON CONSENTING
NAME
STREET
ADDRESS
CITY. STATE
ZIP CODE
NAME AND ADDRESS
SIGNATURE OF PERSON CONSENTING
CHE
c
c
CK TYPE OF VERIFICATION REQUESTED :
AGE OR DATE OF BIRTH
NATURALIZATION OR CITIZENSHIP
GENEALOGICAL INFORMATION
OTHER (CERTIFICATE OF BIRTH DATA. ETC.)
2. STATE PURPOSE FOR WHICH DESIRED
3. NUMBER OF COPIES
DESIRED. IF ANY:
2A. NAMES OF BENEFICIARIES
4. IF INFORMATION IS FOR
SOCIAL SECURITY
BENEFITS, SHOW SOCIAL
SECURITY NUMBER:
ATA FOR IDENTIFICATION OF THE RECORD TO BE VERIFIED
FAMILY NAME
GIVEN NAME
MIDDLE NAME
6. ALIEN REGISTRATION NUMBER
OTHER NAMES USED, IF ANY
8. NAME USED AT TIME OF ENTRY INTO UNITED STATES
PLACE OF BIRTH
10. DATE OF BIRTH
11. PORT ABROAD FROM WHICH LEFT FOR UNITED STATES
i. PORT OF ENTRY INTO UNITED STATES
13. DATE OF ENTRY
4. NAME OF VESSEL OR OTHER MEANS OF ENTRY
IVE THE FOLLOWING INFORMATION FOR VERIFICATION OF NATURALIZATION OR CERTIFICATE OF CITIZENSHIP
.NAME ON CERTIFICATE
16. CERTIFICATE NUMBER 17. DATE ISSUED
.ADDRESS WHEN CERTIFICATE WAS ISSUED
19. NAME AND LOCATION OF NATURALIZATION COURT OR IMMI-
ORATION OFFICE ISSUING CERTIFICATE OF CITIZENSHIP
20. SIGNATURE OF APPLICANT
DO NOT COMPLETE THIS BLOCK -
RESERVED FOR GOVERNMENT USE ONLY
LAWFUL ADMISSION FOR PERMANENT RESIDENCE ON .
NATURALIZATION INFORMATION AS SHOWN ABOVE IS CORRECT.
NATURALIZATION IN (COURTI _ ,
AT (LOCATION)
II DATE OF BIRTH
ARRIVAL RECORD DATED
UNABLE TO IDENTIFY ANY RECORD
COPIES ATT ACHED AS REQUESTED
SHOWED SUBJECT'S AGE AT TIME TO BE .
PRIVACY ACT
IDENTIFICATION
(WHEN REQUIRED)
Approved By:
Q IDENTITY ESTABLISHED IN PERSON
DATE
DAT^ACEHEDS — G"652 AMldav" ' — ' OTHER (Liit)
ORM G-641 (REV. 6-20-80JN
TM 803
ADMINISTRATIVE MANUAL
Appendix 1
Page 3
8. CERTIFICATES OF NATURALIZATION RECORDS. Section 343(e> of tr.e immigration and Nationality Act
authorizes the Attorney Gsneral to make and issue certifications cf any part of the :Jturjii::3£icn records, cf any court,
or of any certificate of naturalization cr citizenship, for use in complying with any status, state or feelers!, or J.-i any
judiciai procseding. '.$ such ct-rdfication is required, block No. i should contain a listing of i.^s specvfic information
desired followed by the phrase: "n certification, form" or the phrass: "in csrtificition form under 522!." if v.ie za'-.cs
provided is insufficient, attscn an sdditional si-jeet of paper. If the certification is reouiVed for use in complying wiiri a
statute, the relevant statute should he cited or described cleany in block No. 2. If j ~:i{ific.jti3n io required for use in a
judicial proceeding, ^ttacn a separate sheet of paper, listing the title and cnaracter of thj proceedings, ihu court in which
it is pending and ths specific use to which tho wrtif ication will be put.
9. •Ci-HTiFiCATICW OF 3iKTH DATA FROM IMMIGRATION AMD MATiJRALiZATION RECORDS. A Certifi-
c«te cf Birth Data may be issued for the basic fee of £5.00 to forei'jn-bcrn cnildran undar twenty-ona years of age who:
i'c) !-isve been ad'niitea to ths '.Jiited States for permanent J4ic-<nce. whether or not thsy have since beccrsis
naturalized, or
(b) Are citlzer-i of ths United ftatss «.nd have b«en iiauec a Certificate of Citizenship by iNS. The parent,
guardian, or other adult hjving a legitimate interest in a person wr.o i; ut--jer vourtsen years of age may t'i'e an applicaoon
on -i-jch person's behaif. A parkin bePwetn tha ages of 14 2nd 21 msy apply for :uch a certification on his own behalf.
Where documentary evidence is presented to show the child's nama nas been iwaily changed, the certification may be
issued in the child's new name.
10. PRIVACY ACT !W FORMATION. The authority for collecting the infor.T,2tion requested on this form is con-
tained in 8 U.3.C. 1*02(3). Submission of tha information solicited, including the social security number, is voluntary.
The purpose for which ths information is solicited is to identify '.he records or information which is to be verified accord-
ing to applicant's request. Fiiiure xa provide osiy or all of the solicited information moy ""jsult in delay or iiiabiiity *o make
the requested verif tcation.
FORM G-652
I. USE:
USED TO ESTABLISH IDENTITY UNDER THE PRIVACY ACT.
II. ELIGIBILITY:
INDIVIDUAL (LPR OR USC) SEEKING RECORDS ABOUT HIMSELF, BY
MAIL OR IN PERSON, WHO CANNOT PROVIDE NECESSARY DOCUMENTATION
OF IDENTITY.
III. REQUIREMENTS;
1. MUST BE SWORN TO OR AFFIRMED. BEFORE A NOTARY PUBLIC OR A
SERVICE EMPLOYEE AUTHORIZED TO ADMINISTER OATHS.
2. ATTACH TO FORM G-657.
3. NOT REQUIRED FOR ACCESS TO RECORDS AVAILABLE UNDER THE
FREEDOM OF INFORMATION ACT.
10/1/80
M)MIN1STRATIV1: MANUAL
Appendix 1
United SidCss Department of Justice
Ifluaigration and Naturalization Service
Affidavit of Identity
I { ] Swear [ j Affirm that 1 aa
residing *t
street
anJ that I <*«** born in
State
-ip Cooe
Country of ~kj.rtn Date of Birth
1 understand mllfuilv f*ii< st»te*«ni;s on this for« can b<
punished b/ f^n* cr iapi-i2onae.-ni. (U.S. Code, Title 18, Sec. 1001.
(Signature]
in and for t..
that
aforesaid, do hereby certify
' personally ap-
peared before me ard then and there executed the above Affidavit
of Identity and acknowledged it to be _______ lawful act and deed.
GIVEN under siv hand and official seal, this
dav of
fVVW* NO.
EMTION
REV. 2-1-78
AFFIDAVIT OF IDENTITY
6 i 10 1/2
INSTRUCTION WCFJCWCNCJC
8 CFR I05.21(b)(2); AM 2482 Ex. 1, 2782.11
031*.
L.
USED TO ESTABLISH IDENTITY UlNDER THE PRIVACt ACT-
EDITION KAY »E USES
SCKKD
FORM G-657
USE:
USED TO REQUEST INFORMATION UNDER THE PRIVACY ACT.
ELIGIBILITY:
1. INDIVIDUAL WHO IS A LPR OR USC.
2. THIRD PERSON WITH CONSENT OF INDIVIDUAL WHO IS LPR OR USC
REQUIREMENTS:
1. NO FEE FOR FILING - STANDARD FEES CHARGED FOR COPIES OR
CERTIFICATION. (SEARCH FEES NOT CHARGED UNDER PA).
VERIFY IDENTITY OF REQUESTER.
INFORMATION DESIRED MUST BE REASONABLY DESCRIBED.
SUFFICIENT INFORMATION MUST BE PROVIDED TO LOCATE RECORD.
CONSENT BLOCK SIGNED (IF APPLICABLE).
6. TWENTY (20) WORKING DAY RESPONSE TIME, BY DOJ REGULATIONS
4/1/81
rn 303
ACMINI?Tr.ATIVE MANUAL
,"poend1x 1
•aamoowfflOi
J>j
PRIVACY ACT INFORMATION REQUEST
(fCH INS INTERNAL Ua-'l SEc INSTRUCTIONS ON HEVSP.3C
OFFICE SYMBOL
rn/.«' finltTH-nii -.nhjri-1 i<> criminal penalties. s-(1(. />./.. •')•"">.;* «m<. /«d f i f -.''.
)> SECTION 1 — REQUESTER AND R5COPT IDENTIFICATION 4
*
A COMPl£T5 n AH*. OF INDIVICl^L 'O WliC
'.1 HSLOr3 Fi=aTAINS
8 ACO-;SJ ,,i.,*-i f!(oc«rt»l
i
i
1
*
1
;
i
C. TELE. SO
larta cotiu*
0 ALIASES
E. 3ATE AND PL\C£ OF 3IRTH
^ A" «W -•« OrMEfl F'LE NO
0 ACTION REQUESTED [
' 1 OTHER (S0*ctly)
13 PERSONAL ACCESS C? AMENDMENT CDC-'^V
H LOCATION t,* RECORD (0«IC8. CItY. Ofgiflll
ai.onl
1 CESCTHTION OF RECORD (HIM. tntiwn no.
Q onten IS*«:IFV%
e.c.l , ! NA'jflALiiAriON
a =...««-.' a"—™H
0*tE t PLAO: Of SNTP* INTO U 3
1
DATli«eW.«irar.«TOU.
NAU* LS«D CM HATUHAUZAria* OB CITIZENSHIP CFV IFICA76
CEnT'FiCArt .NC OAP- 'Ssueo
UXATIQH CF COIWT O« IMflCflATION OFflCf :SS
IIINC CSOTIFICATE
J. -IAW6 (ULSI) (1,131)
imioaiei
LTAL'tOVvnOM REC7RO "SWTAiNS
, f»:a»ec'1«>
M AUTVORIZATION lAMcn •ulrxxuniion MIMT .'crn G • it DOwvol illc'r.«y
ei/xa tMlowl [— ; AUTH uerrEH CD G - JB Q p ' A f~) OTH
cR AUT OOCL!Wi>.T
1 1 AUTHORIZE tUirrmi TOSSi'.lY HECOPO
' gnaiuff i
N SIGNATURE Or R6CUESTEB
DATE
O SlCNATuflE OF ACCOMPANYINO PERSON
SECTION 2 - AGENCY RESPONSE
ITEMS MARKED "X ' AP=LY TO i-OUR RzOUEST) 4
1 1 NO FEE O SUBMIT S
O 3 WE HAVc THE flECOflQ FOP Pgf»",
ESS PLEASE CALL <;^ WRITE T
WHOSE NAME APPEAr.S 8E-OW F
PLEASE SUBMIT 5
FEE IN
ONAL ACC-
16 PERSON . — .
C3R A CC=V L_! ° 'v
._ .. FEE d S Tt-
IN
CE
-OPMADCN !5w °«<n3f»s baio«l
i
E Bifcono von HEQUFSTED is EXEMPT F=ICW CISCLOSURS
*0=R THE LAW iSi'it flcm»fH o«o» Or )0»cuic eitmodonl 0'ILV
NIAL OF ACCESS iS« li" fjelions on Rn«r*»l.
F REMARKS
C SIGNATURE of OFFICIAL
, H TITLE OF OFFICIAL
1 ADDRESS OF OFFICIAL
J DATE
!
SECTION 3 — POR AGENCY USE ONLY ^
. DATE
8. IDENTITY ESTABLISHED IN PERSON APPROVED BY
OATE
1
C ACTION j"iSIGNf.C TO
1 DATE i
1
0 HS^ONSE DUE DATE
E. TEEUAfA-
AUO\W<TDUEJ r
,OATE
|
FOflMO-447 •*.*, S-I5-SOIY
RECORD COPY (INS USE ONLY)
RESPONSE COPY (FOR REQUESTING INDIVIDUAL) '
L
v ,, , .-
x ° '/-
?.? \TJOK
. 5-15-80
PRIVACY ACT INFORMATION REQUEST
3TRUCHON RyJJ 8 CFP m3.21fa). - 3C(aV, AM 2301.56.09, 2482 Ex. 2, P.I,
2705 :5, 2771.01, 273?. 08. 03, .08. u4, .09. 2792.12, .15-. 16, Ex. 2, P.1, 2, 2793.09, 29S* Ex. 2'.
USED TO PROCESS ^fQOESrs UNDER THE ^IVYCY A;.T
PRIOR tOITIOHS MAY BS USED
SCHSDUJJC
PRIVACY ACT INFORMATION REQUEST (iNS Form G-657)
Instructions
The Privacy Act of 1974. with certain exceptions, permits an individual (United States citizen or permanent
resident alien) to gain aocesc to information pertaining to nim in federal agency records, to have a copy
made of all or any p£rt thereof, and to correct or amena such records4 cc permit an individual to prevent
records pertaining lo him from being used or made available to another person without his consent; and to
permit an individual to detarmine what records pertaining to him are collected, maintained, used or disseminated.
Requests may be submitted in person or in writing, if an application is mailed, the envelope should be clearly
marked "Privacy Act Information Request".
1. Description of Request. The information in Section 1 of Form G-657 is needed to identify the requester,
the records desired, and the individual to whom the record pertains. In order to identify the records
desired, the request should include, name used at time of entry into U.S.; date and place of entry into U.S.
and if record is of naturalization or citizenship, name used on naturalization or citizenship certificate;
certificate number, date naturalized or date citizenship cerificate issued; name and location of naturaliza-
tion court or location of immigration office is'suing certificate of citizenship. Failure to provide complete
information may result in a delay in processing.
2. Identification of Requester.
A. Individual. An individual appearing in person may identify himself by showing a document bearing a
photograph (such as an Alien Registration Card, "orm 1-151, Citizen Identification Card, Form 1-197,
Naturalization Certificate, or oassocrt); or two items which bear his name and address (such as driver's
license or credit card). By mail, an individual shall identify himself by signature, address, date and place
of birth, alien or employee identitication number (if any), and one other Identifier such as a photocopy of a
document bearing name, address, and signature. '* the above-mentioned identification is not available,
Form G-652, Privacy Act Affidavit of Identity, or similar Department of Justice form may be used.
S- Guardians. Parents or legal guardians must establish iheir own identity as parents or legal guardians
and the identity of the child or other person being represented.
C. Accompanying Persons. An individual seeking to review records about himself may be accompanied
by another individual of "His own choosing. Both the 'ndividual seeking access and the individual
accompanying him shall be required to sign the required authorization on Form G-657.
3. Authorization or Consent. Other parties requesting information about an individual usually must have the
• consent of that individual. Consent may be given by signature of the individual- on Form G-657, or by
authorization letter, together with appropriate identification.
4. Fees. For copies of documents, SO 10 per page may be charged, provided that the totai amount is S3. 00 or
more. A maximum of 10 copies of each document will be supplied. If the total fees amount to more than
$25.00, an advance authorization will be requested and an advance deposit of part or all of the fee may be
required.
5. Appeals fror-* Denial of Access cr Refusal to Amend. Except for certain records which are not subject to
amendment or correction by individuals, an individual whose request for access to the records concerning
himself or request for amendment or correction of information pertaining to himself in records maintained
by the Immigration and Naturalization Service pas been denied, may appeal such refusal to the Associate
Attorney General within 30 days after receipt of notif.calion of f.he refusal, to the following address: Office of
the Associate Attorney General. U.S. Depart merit of Justice, Washington, D.C. 20530. Appeals from denial
of access should be markea "Privacy Appea'— Denial of Access" on {.he 'ace of the document and on the
envelope. Appeals from refusal to amend or correct should be similarly marked "Privacy Correction
Appeal."
4/1/81
FORM G-658
I. USE:
USED TO RECORD ROUTINE USE DISCLOSURES OF INFORMATION
UNDER THE PRIVACY ACT, TO AGENCIES, ORGANIZATIONS OR PERSONS
OUTSIDE THE DEPARTMENT OF JUSTICE.
II. ELIGIBILITY:
1. REPRESENTATIVE OF ANOTHER AGENCY.
2. INS INVESTIGATOR.
3. OTHER INS EMPLOYEE.
HI. REQUIREMENTS:
1. SIGNED BY AUTHORIZED REPRESENTATIVE.
2. RETAIN IN FILE TO ACCOUNT FOR DISCLOSURE UNLESS EXEMPT.
3. RECORD COPIES MAINTAINED FOR FIVE YEARS OR LIFE OF FILE.
4. REPORTED ON THE G-23.26, SUPPLEMENT B.
5. ROUTINE USES DISCLOSURES FOR INS RECORDS (LISTED IN PRIVACY ACT
SYSTEM NOTICES IN AM 2782, EXHIBITS 8, 9, AND 10) ARE GENERALLY
AS FOLLOWS:
a. TO OTHER FEDERAL, STATE, LOCAL, OR FOREIGN GOVERNMENTAL AGENCIES
TO CARRY OUT THEIR LEGAL FUNCTIONS WHICH RELATE DIRECTLY TO INS
FUNCTIONS.
b. TO OTHER GOVERNMENTAL (FOREIGN AND DOMESTIC) AGENCIES FOR LAW
ENFORCEMENT PRUPOSES.
c. TO COURTS AND AGENCIES OF THE COURTS HAVING JURISDICTION OVER
IMMIGRATION AND NATURALIZATION MATTERS.
d. TO OTHER FEDERAL AGENCIES IN CONNECTION WITH THE CONDUCT OF
SUITABILITY AND SECURITY INVESTIGATIONS.
e. TO THE SUBJECT OF THE RECORD OR HIS/HER DESIGNATED REPRESENTATIVE
(NOTE: REFER TO REFERENCES FOR COMPLETE SPECIFICATION OF ROUTINE
USES AS PUBLISHED IN THE FEDERAL REGISTER.)
4/1/81
7-'
TM 760
ADMINISTRATIVE MANUAL
Appendix 1
G-658
Page 1
UMITEO STATES DEPARTMENT OF JUSTICE
L
aaasae
RECORD OF INFORMATION P8SCLOSlJRjJ[PmVAC^^^
Pll« UiotUa (FCO)
Mom
FlUNmbw
"•—»»•*
""*"*"*
Dow •* Maoioawm
S, A»» BoioeMd
Paapna •( DSoaJewsw;
muua
Miptftoitid ftl Dlaatoawo C™!?®*® Kta«
Q Bw»l«w. Q Co^f f~| tt«4»ftm [^
)O*M
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Fan •! OtMtoMM (^ t» Q IB ml «nft
ea««M« to iBdi-ottW. HMOWII
F«asC-SM (11-1.73)
RECORD COPY (MS USE ONLY)
^| Fwn&AM (11-1-7?)
REPORT COPY (Fo
* Privacy An lUrponia^ OO!Y)
FORM NO.
G-658
EDITION TITJJE
u,},7e RECORD OF INFORMATION DISCLOSURE
SIZE
8 X 5
INSTRUCTION BJEFEJtENCE
AM 2782
USE
USED TO RECORD ROUTINE USE DISCLOSURE OF INFORMATION UNDER THE PRIVACY ACT
(Carbon- interleaved - Orig. & 1 copy)
| SCHEDULE 8
INSTRUCTIONS
This tern m«y be a sad to record disclosures of iafofetaliea for which aa accounting
aay be required aader the provisions of the Privacy Act of 1974. Such disclosures
iaduib nMtiae BMW of iufanaaUoa fn« INS systems «f records (repeats by other
gavenmeet sgeaeiea; iav^tigatioas by INS officers; otc.) or other requests for which
Fora G-657. Privacy Act laforaiaUoa R«fuest, is aot used. The Record Copy shall be
•load la the individual's file aalesa the iafomatioa baa beea exenpted fnoai disclosure
aee&aatiag. The Rep«rt Copy shall be placed ia the Privacy Act Reportiag file sad nay
be aaed ealy for INS official raportiag pttrpoaea.
10/1/80
FORM G-715
I. USE:
TO ACKNOWLEDGE RECEIPT OF AN APPLICATION OR OTHER COMMUNICATION.
II. ELIGIBILITY:
AUTHORIZED INS PERSONNEL.
III. REQUIREMENTS:
1. IDENTIFY THE ACTION RECEIVED.
2. ENTER THE DATE OF RECEIPT OF SIMILAR APPLICATIONS CURRENTLY BEING
PROCESSED.
4/1/81
Ti! 793
ADMINISTRATIVE HAHilA
Mppencnx I
G-715
DE°ARTMENT OP JUSTICE
I
Vt acknowledge receipt ol your application filed
We are presently processing applications received in
Your request will be jiven our attention a", soon JS possible.
District Dm-itot
IMMIGRATION & NATUKAUZAT10N SERVICE
FORM NO.
G-715
EDITION TITLE
REV 3-7-79 ACKNOWLEDGEMENT AND STATUS Of APPLICATIONS
SIZE
5X31/2
INSTRUCTION REFERENCE ^ ^ ^ ?
use
USED WHERE APPROPRIATE TO ACKNOWLEDGE STATUS OF APPLICATION
PRIOR EDITION HAY NOT BE USED ' SCMCDOIX B
4/1/81
FORM G-734
I. USE:
USED TO REFER "THIRD AGENCY" MATERIAL (RECORDS, INFORMATION, CONTAINED IN
INS FILES, BUT ORIGINATED BY ANOTHER OFFICE, COMPONENT OR AGENCY) TO THAT
AGENCY FOR ACTION IN RESPONSE TO A FREEDOM OF INFORMATION OR PRIVACY ACT
REQUEST.
II. ELIGIBILITY:
INS PERSONNEL PROCESSING FOIA/PA REQUESTS.
III. REQUIREMENTS:
1. ENTER' THE NUMBER OF DOCUMENTS BEING REFERRED, AND CHECK THE APPROPRIATE
BLANKS.
2. ON INS DOCUMENTS, OUTLINE IN RED THE NON-INS INFORMATION TO BE REVIEWED.
3. SHOW NAME AND PHONE NUMBER OF INS CONTACT PERSON.
4. MAIL TO THE ORIGINATING AGENCY, ATTENTION: FOIA/PA OFFICER.
4/1/81
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATSON SERVICE
Memorandum
TO : DATE :
PROM
SUBJECT: Referral of INS records relevant to the Freedom of Information Act/
Privacy Act request of ^_^
Enclosed are unclassified document (s) originated by your
agency. The document (s) are being referred for your review and
direct response to the requester. We will advise the requester
of this referral.
Enclosed are document (s) containing unclassified information
furnished by your agency. Please review your information (outlined
in red) and return the document (s) to us, making any deletions you
deem appropriate and citing exemption(s) claimed.
Enclosed are classified document (s) originated by your
agency. The document (s) are being referred for your review and
direct response to the requester. We will advise the requester
of this referral. Please advise us if the classification of the
document (s) is changed so that we may amend our files.
Enclosed are document (s) containing classified information
furnished by your agency. Please review your information (outlined
in red) and return the document (s) to us, making any deletions you
deem appropriate, citing exemption(s) claimed, and advising if the
information still warrants classification.
A copy of the request is enclosed for your convenience.
Please see the attached page(s) for additional information.
If you have any questions concerning this referral, please contact
on (FTS)
Enclosure(s) : Classified material attached
Form G — 734
(1-26-79)
I. USE:
USED TO RESPOND TO FOIA/PA REQUESTS WHEN UNABLE TO LOCATE OR SEARCH FOR
A RECORD DUE TO INSUFFICIENT INFORMATION.
II. ELIGIBILITY:
PREPARED BY INS PERSONNEL RESPONDING TO REQUESTS FOR INFORMATION ON
RECORDS.
III. REQUIREMENTS:
CHECK APPROPRIATE BLOCKS TO EXPLAIN TO THE REQUESTER THE REASON(S) NO
ACTION WAS TAKEN ON HIS/HER REQUEST.
ATTACH APPROPRIATE FORMS FOR REQUESTER'S USE IN SUBMITTING THE NECESSARY
INFORMATION.
4/1/81
7-57
IN 800
ADMINISTRATIVE MANUAL
•Appendix 1
6-747
United States Department of Justice
Immigration and Naturalization Service
File Name:
File No.:
Office/Unit:
SUBJECT: Freedom of Information/Privacy Act request dated
for records pertaining to:
In an effort to serve you as promptly as possible, we are using this
expedient method to respond to your request. Please refer to the
paragraphs checked below.
We have searched our local index for records related to your
request, but none were found.
We have searched our centralized Master Index of all INS records,
but none were located which related to your request.
If you believe that there may be a record related to your request
in another INS office, please submit your request to that office.
An individual seeking access to records pertaining to himself must
furnish signature, address, date and place of birth, alien or
identification number (if any), and one other identifier such as
a photocopy of a document bearing name, address, and signature.
If such identification is not available, the- enclosed Form G-652,
Affidavit of Identity, nay be used.
We have been unable to identify the records you want. If you can
give us additional information or describe tnt records you seek, we
will make another attempt to locate them.
A request for records about a person should include full name(s),
date of birth, place of birth, alien registration number (if
applicable), and approxima tt- da tos of the records.
Forms enclosed:
Sincerely,
IMMIGRATION AND NATURALIZATION SERVICE
FormG-747 (4-1-80)
FORM NO. EDITION
G-7^7 4-1-80
TITLE
FOI/PA RESPONSE
SIZE INSTRUCTION REFERENCE
8*5 x 11 AM 2414 Ex.2
OSE USED TO RESPONH TO FOI/PA FEWEST '-'HERE ^0 RECORD LOCATED, RECORD NOT IDENTIFIED ETC.
(3-part carbon interleaved)
3 -PART (CARBON INTERLEAVED)
SCHEDULE B
4/1
CHAPTER 8
8. INTERNAL USE FORMS OF WHICH A CONTACT REPRESENTATIVE SHOULD BE FAMILIAR
Form 1-60 - Form Letter re Extension of Time on Permit
to Reenter the Uni ted States 8-1
Form 1-72 - Form Letter Returning Deficient Applications
or Peti ti ons 8-2
Form 1-171 - Notice of Approval of Relative Immigrant
Visa Petition 8-3
Form 1-171 C - Notice of Approval of Nonimmigrant Visa
Petition or of Extension of Stay of Nonimmigrant
H or L Alien 8-5
Form I-171F - Notice of Approval of Nonimmigrant
Visa Petition for Fiance or Fiancee 8-7
Form 1-210 - Voluntary Departure Notice 8-11
Form 1-464 - Notice of Third or Sixth Preference Petition
Approved under Section 203a of the I&N Act, as amended. 8-12
Form 1-486 - Medical Examination and Immigration
Interview 8-13
Form 1-508 - Waiver of Rights, Privileges,
Exemptions and Immunities 8-18
Form 1-512 - Authorization for Parole or Conditional
Entry of an Alien into the United States 8-20
Form 1-546 - Order to Appear (Deferred Inspection) 8-23
Form 1-564 - Form Letter - Reply to General Inquiries . 8-26
Form G-22.17 - Workload Record - Records
Administration 8-27
. Form G-56 - General Call-In Letter 8-29
Form G-100 - Request for File on Loan 8-31
Form G-102 - File Routed on Loan 8-33
Form G-253 - Daily Register of Receipts 8-35
Form G-325B - Biographic Information 8-37
Form G-711 - Individual Fee Register Receipt 8-43
Form G-712 - Summary of Fees Recorded on Individual Fee
Regi ster Recei pts 8-44
Form G-714 - Receipt for Funds and Valuables
Transferred 8-45
10/1/80
ADMINISTRATIVE MANUAL
Append Lie I
1-60
UNITED STATES DEPARTMENT OF JUSTICE
Immigration end Naturalization Service
In connection with your desire to eacvie on extension of the validity of your Permit to Re*atet the United
States, your attention is called to the p_ra_roph(s) checked below:
£1) An eppIictEtJon fat m ascension on the Attached FOBS 1-131 may be Glad with theCZJ lanigrea'on aid
Natura-ualioii Service Office «» jDt with the Lj Amenesn Consular Officer «
, AN APPLICATION FOR EXTENSION ON FORM 1-131 MUST BE MADE BY
THE PERSON TO WHOM THE PEWIT WAS ISSUED; of. in the case of a child. the application must be made by
the parents of guaidiao in whose custody the child is while aboed, THE PERMIT TO REENTER MUST ACCOM-
PANY THE APPLICATION FOR EXTENSION.
_____ f2) A fee of S5.00 is required for each extension. The remittance, if sent from abroad, should be in the
form of t bank draft in the amount of five dollars, (15). United States currency, drawn on a bank located in the
United States; or en Express money aider, er an international money order drawn on the- postMSter in the city in
th« United State, to which your application is being sent, nade payable to the order of the "Inaigraiion and
Nnt-reli-atiem Service. Department o( justice." If an international money order is purchased of the type that cart-
not be mailed with the application, the city in the United States on which it is drawn, and the number end date
of your receipt for the money order, must be clearly shown near your signature on year application for extension.
(3) The fee which you submitted with your application will be retained by this Service pending the receipt of
a reply to this communication.
(4) Since your application was not filed prior to the expiration of jrour permit, an extension cannot be granted.
It is suggested that you apply to aa American Consul abroad for » visa whan yon are ready to retura to the Umtad
States.
_(5) Year tamtry pecait muat be rabaitted to this office baton an ezteaaioa can be considered.
.(£} Pemits way be ewendad for e period or periods not exceeding one year 10 the aggregate from the origisal
date of aapiraUoa shown thereon. Each applicau n tor an extension is ccasidvied open its narits.
(7)
Very truly years
Enclosures)
(R.«. 7- M-77)M
FORM
1-60
"N0. EDITION
TITLE FORM LETTER _ RE EXTENSION 0F TIME ON PERMIT
TO REENTER THE UNITED STATES
"CTZC INSTRUCTION REFERENCE
8 , „ 1/2 01 223.4; AM 2482 Ex. 1
° PROVIDES APPLICANT WITH INFORMATION CONCERNING PROCEDURE TO BE FOLLOWED WHEN
APPLYING FOR AN EXTENSION OF TIME ON A PERMIT TO REENTER THE U.S.
PRIOR EDITIONS MAY NOT BE USED
SCHEDULE A
10/1/8C
UNITED STATES DEPARTMENT OF JUSTICE
tt ANO ftJATUftAUSATlON SSflVICB
NAM* a*D AOOttOS
PLEASECOMPLV WITH THE BELOW CHECKED s INSTRUCTIONS.
Q 4. PtCAM ItMlOW |M Init'uCt'Om '
O 5. Pu"*'»h ih» ftqui'«* 1*4 o> S .
Q 7 Fu'niitt th* m*/f<«9« cert.f cat
3 8. Futniifi p'OOf of rtoatri ot Ic^j
B baan <iK*a*<l*d 10 your itlOfi
wh*cn j*» chKkM 09 >n red
u hjvt lufticiant lu'»d>
Q u YD.
a ia. vo
rocn»»d «;Kl will
ATTACHMSNT8 WITH
(ftCV 10-lS-ftOtV
•J CM£CK THIS ©OK WHfiN CO#Y WAI LEO TO ATTORNSV OR
1 *i
FORM NO.
1-72
EDITION
REV. 10-18-80
TITIJE
FOR« LETTER RETURNIN6 OEFICIEMT APPLICATIONS OR PETITIONS
size
8 1/2 X 11
INSTRUCTION RKTSKJEHCS
01 103.2 (f), 223.1. 245.1 {a)s AH 2482 Ex. 2. P. 1. 27S1.04. 2790.14, 2984.12; II Hbk 1-4.
5-4. 10-3; App 5-B. 10-J; GIB A-6 -,-„,-„-,
oss •
USED TO REQUEST ADDITIONAL INFORMATION OR DOCUMENTS FROM APPLICANT
Carbon-Interleaved (Original and two copies)
PRIOR EDITIONS NAY BE USED " | 8CHEOOUB
8
4/1/81
•AtuuutA'nc* t
'NOTICE OF APPROVAL OP He-LXflVE IMMIGRANT VISA f-c.
M o« »o\iM4 (hat «oen»m o< KM [»«!>«" jc
l out b«n«t<ci«>y »>HI tx» found «Jig*t4 tor was
cSaamwuM only •or
_
ct*(*m*n*a only wn*n
cencwnft« ava cotto
1. Q
STATES CONSULATE AT
5TATSS CON
BSUANCC. /
2.
uvxt thj bsniftciary if- 2ct»ti£>nAt» cfcAsrf'c»»o»i Tn* ts&erat carucSjiw
mtUMn to Tm 'Ona*<l Suvri or tomuar.*-.! ID tewtu! cv^msr^nl
«M*c*oon -nwiifw » mm* to < contorv W*M: * j-... ...cy lor oontejjfxi
HI m -in/afcon ofitcM ^Jic. c%«u no*« aw i(*n« totow « icn u*
T?^C>^AU(«TTO.^
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TKS I**TEC iTAr£S AH3 »N lili«C3*«T VSL« KA
BEN€='OA«Y. NOTIFV TMS OFmCS >»*ieD(ATa.Y OIVHQ The OAfE CF TOU^ NA7Ufi.V_iArO<i iT THE SAME nw»c f TH€ PFr nC.. WAS «
er . j= oc VQUR so* OB OAUOMTI-R. *tso »ivsg WI«TXEH THAT penacn 13 STIU. UXMAP«(£O TM* «iK*»*A.nc« MAY EJU>£O(TE twt
PtTItKX «X* P«£5SBO(C£ CLASSiFlCA'nOK AS 3M3VW< >6OVS. HAS MEX fO«V»AXt«D TO
AU. ACTOM 3Y
UJTSO STATU CO«U>T* At
.
O CO wmi TH« ACTUAl. ISSUANCE 0* VOA3. VrtSAS A«£ '^SU£0 ONLY 8Y UNITED STATES COM3m_3 V.HO ABE vff«£S
S OePARTWEXT OF STATE UHOfX THE LAW 3'*.Y « •MITfO NJMMH O^ VSAJ M».Y 0£ 'S3U50 8» TliAT C6««
THi O*C*OIOGCA1. OflO«« ». VA-.-)! flfmOMS *JS€ FWO FOfl
fffS T1>SN 1 RACH€0 ON TV* VISA WAiTwO LIST TM€ LN( ^0 STATS C
MM »MO COW5OO\ ISSUANCE OF TV« 'ISA. /
TV* fermoN STAITES THAT THE «N6FctAfly is IN TH< unmo SPATES ANO w\j. APPI.Y TO sscout A L>vwn n. PS?U*N€MT nesm&fl TX
EMCLOStO APnjCATWN FOB TVWS PUfl)»OS£ (FOPM I-**SI S-.OOU) t)€ COMPU6TEO AND 5Ua"HTE6 8Y TV* «N£FO»«f W1THN M OAYJ
IN ACCOOAMC6wrrHTViewSTBlX:TX3MSCONT».NEOTnefl£l« IIP TWc aCMtFIClABY HAO PftEVWOSt-Y StawTTEO HXM 1-W1S V«XM WA4
WTU«NeflTQH»« MB SHOULO R£S<J8*«r THAT FOflM VVTMW MOAY&I
M MAC€ ON HIS PEMOB-Xll APnXAIXM TO WCCU6 A I>H*VA. F«m.lAK-NT WSCEMT
rn&«o* HA<« B££:< UAM A
STATES TXAT THE BS^EFOWIY is IN THE UNTOD STATIS A)<o WKJL
MO¥«rvE«. AN IWM10RAMT V14A NUI«EH IS NOT PBCSSkfTLY AVAJl>aL£. TVtEKSFOM Ti
e-D
7. Q p*h^AlJ>gcy^WSSOeMTTiq«%JPfOBTC>f ^Cj^ femOH UMJfXXUftttSO tfr
8. D
IKSTfUCT 'iftSCW
UAiiD TO TMC ATTONNCY OX ftS^eStNTATT/E. »• AWT
FORM NO.
1-171 & 0
EDITION
REV. 6-12-RO
TITUS
NOTICE OF APPROVAL "
e P.FLATIVf- l^IRRANT VISA
PETITini
SIZE INSTRUCTION REFERENCE , „„ „, „,
01 103.8(e)(1), 204. 2(b), (c), (3), 204. 5(b), 204.3. 2t4.2(k)n); 24', 4 Ex. 2, 2761.02. .03,
8 X 10 1/2 2771.02-, II Hbk 1-9, 5-39, -45, -46, 10-29 Aoo. 5-8, -M
CSC
USED TO ADVISE PETITIONERS OF APPROVAL OF PETITIONS FOR RELATIVES: I-171D COPY USED TO REQUEST
POST-AUOIT OF CITIZENSHIP OF LAWFUL ENTRY AFTER APPROVAL OF PETITION
PRIOR EDITIONS MAY Be. USED
UNITED STATES DEPARTMENT OF JUSTICE
mumnnrTiriM AND NATURAJ.IZAT)OM SEXVKC
REQUEST FOR POST AUDIT OF CITIZENSHIP OR LAWFUL ENTRY AFTER APPROVAL
OF FORM I - 1 30 PETITION FOR RELATIVE
NAME AND AOOAESS Of pcrmoen
O>SSIFICATKX RLE NO
DATE PETITION Fll£0 | DATE OF APPROVAL
OF PETITION
Data:
THE FOLLOWING INFORMATION RELATES TO PETITIONER
IF NATURALIZED
1 . CERTIFICATE NUMBER
2. NAME IN WHICH PETITIONER NATURALIZED IF
DIFFERENT FROM NAME SHOWN ABOVE
3. DATE OF BIRTH '
4. COURT (TITLE and LOCATION)
5. DATE OF NATURALIZATION
IF CERTIFICATE OF CITIZENSHIP ISSUED
1 . CERTIFICATE NUMBER
2. NAME IN WHICH CERTIFICATE ISSUED IF DIFFERENT
FROM NAME SHOWN ABOVE
3. DATE OF BIRTH
4. PLACE OF ISSUE
5. DATE OF ISSUE •
IF LAWFUL PERMANENT RESIDENT
1 . ALIEN REGISTRATION NUMBER
2. NAME AT TIME OF ENTRY IF DIFFERENT FROM NAME
SHOWN ABOVE
3. PLACE OF BIRTH
4. DATE OF BIRTH
AFTER VERIFICATION — DESTROY THIS FORM
IF UNABLE TO VERIFY. STAMP THIS FORM "UNABLE TO VERIFY" AND RETURN TO ORIGINATING OFFICE
IF DATA IN FILE RAISES QUESTION OF PETITIONER'S STATUS
RETURN THIS FORM TO ORIGINATING OFFICE WITH COMPLETE FILE
4/1/81
8-5
tM 786
X-171C
UNITED STATES DEPARTMENT OF NOTICE
Immigration md Neutralisation Service
NOTICE OF APPROVAL Of NONIMMIGRANT VISA PEWTON OB
OF EXTENSION OF STAY OF NONMMJGRAWT II OR L ALIEN
U*m AMP AW»KS3 OP BssnOVBB O® rgAMHIl
euSSiU"
_»»»»
ctj»Mi«>itaTie«
S*llB HO.
I'A'XI^
S«^WTO— -
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TM( BEME'lCIARV WILL BE BOOMC- lltOISLE «>O9 VISA l&BlWnCC aBWItflOO To TMC UMITEO STATES OR CMOMIC O"
T»5 RCTITIOM «Ri D20W a«W«OveO AND POEB»APD£D TO TWg IWT2D STATES CCWSULiTE fiT eMCM TM( f3SK3PI-
eiAOV OB SKMBPICIACIttl KIIL.L AM>LV POO VISA I9£UJ\MC£. &»v mQU<UV COUCSmtlKO VI&A tUUBMSH gMOUkD BO
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IS
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'OawMeCMTME PETITION IS VA..ID OR AMV CHTEMSIOM OP 8TAV AUTMORIZED O" TMli BHOVICI.
O.
i VETITIO» u TCBMIMATCO scronE TMI CKBIRATION oc TME AUTMOnu^o BTBV m TMI UMITID STATUS Of THE
BtwePICIABV|lt»l.
0
BUKWIMATICIW BOOAROtWO BEMe(=»ClAH Vil OOP *KTl»»t &UD RffTUBW
DO NOT UAXC COnCS 0« TMIt KOTICt VOO M«v PORMtiw 'T TO ONLV ONE OF TME BBNrflCIABIEl W«C l» NOT l»
•OtUtllON O' A VAL.I& "-• 00 -^' v/l»« CND-WO DEIIIES TO Df'OT ceow AND nCTURM TO TMI imiTaD STATIt
TO «£1UM[ TMf tAMC EM»«.OVMEMT O« TRAINING OOI1IHG TMt H*IOO*O« WMICM T«t IMTTITION It VALID O«l>Oa
V.-.IC" «lt STAV to. TMn, COUtMTRV MAS BEEN AUTMOOI2EC £ &IMIU.AD POHM NCEOED "OR AMV^OTMEa^BaNEfjICIAav
• u»Nir»IMi; TME NAME O' TMI eiNC'ICIABV, riLCNuuaE" AND OAT1 O' APOBOVAL A& SMOWO ON TMIS 7OBU. I'
< •IMC«ICIA»V MAt AN -M- OB "L * VttA MMICH MA( EKMRCO. »( MAV A»*LV TO TMC Ol RECTO* . VISA OlWICt. 0«»A(«T.
KENT or tTATC WASMINSTO>- D.C. 'O* MEUALIDATIOM OC TMAT VIIA PBIOR TO OKoaUTUBa ANO UAV BUOMIV TMli
1 NOTICE W)TM TMAT ABDICATION. ALTIMMATIVELV. IP A «B«W VliA li BHQUIBIID, ME SHOULD BBIMWT TMI8 WOTICJ TO AW
1 AMfBICAM CONSUL A8MOAO ir "• l< CMtlx>T raou TMI VILA RlaUiaiMENT ME (MOULD VREUINT TMli NOTICE AT A
UNITED ITATE1 POBT Of 8NTBV .' TMt StNOCICIABV DILaiOtf TO BE1U»N TO TME SAME IM»LOVua«T OB TBAINIMG
AFTEH TME EKWBATIO*. Of TMI VALIDITV 0» THE PETITION O« AOTMOBIIiLD TSMWOKABV «TAV SMOWM 1« THIS »OBM.
A Ng» PTTITION »IL,U 8C BIOUIBEO TME BtME PICIAK V MAY BIREADMITTBO TO THIS COWTBV ONLV IP »OU«O AO-
«
faiT i'i.V»iv DliTRlCTDIBECTOR
!
i»i7 »'I.TT»V 7^,5 Qjpy JBQJ, IWTEBNAL RgVEWWE SSBVItS
i
TiJir i'J.Vnv THIS COr'Y TO BE MAILED TO TME ATTORNEY OH BEWIESSNTATIVE. IF AMY
l-ei-i 1.J1IC ^j CM8CK TMIS ®OK WHIN ecH>V MAILED TO ATTOUWSV OR BSfRSeSNtATlVi
IB« M-7TIV PlLECWY
roiut NO.
1-171C
EDITION
REV. 9-1-77
T1TJUE
MOTICE OF APPROVAL OF NOKItMICRANT VISA PETITION OR OF
EXTENSION OF STAY OF NONIM4H3WJ.T H OR t ALIEN
SI££
8 X 10 1/2
ENSTRUCTION mJCFCl
suaacx
.2fhK9D. .2C1K3}. .2(1)(4), 299.1; 01 214.2(h)(l). » ApP- AH 2482 Ex. 2;
COS
NOTICE OF APPROVAL OF MOHIW1GRANT VISA, PETITION
(Carbon-InterjMved) (Original and ttese copies)
PRIPR EDITION OF REV. 2-1-74 MA.Y BE
USED &CHS00L& «
ADMINISTRATIVE VUNUAi.
Appendix I
I-1-1F
Page 1
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
NOTICE OF APPROVAL OF NONIMMIGRANT VISA PETITION
FOR FIANCE OR FJANCEE
NAME AND ADOR6SSOF PETITIONER
••" B» >ou«>e «»«>D« Itr »**
D
noOCvJMtx'
HI TUBWIB
j J »e«j.»««4
IMPOHTAXT
' TKe tpprooil of IK» prutxm » c«wdiuon«i upon lh< b*ner>cury cucutinf i (Uurrwni *>t(ort the Amcncv
Conwl of ibUiiv uul mimi to conclude • rain) mamtf* with you wilhin 90 djyi ih«t trrrvxl m Uw LmimJ
Sum
Z Thcrt ire aiUched the ippbcauon for pcmrunmt rrodmce tutui torn wtix* mutt b« executed and Hiad b)
l>x betwficury pn>mpll> »lix »ou »n<l it<r o»«»r(ici«r» «rt lti«ll« iMfru^ lo »»ea ouxt Thit ixMict
mould br tuomi[ij«f miui cn«i application »i>c« II u filed.
." If Cor my iu*o«. you and tiw b*Acr>oary arc not (named lo cadi o<tMf witiun 90 diyi arur arnr*! m Uu
Unitad Suut. ptctw rt^an Uul fact to (ha oHk»
4 Sepjnie jpfriiaitioni (or prrm*n«ni rcuAtnct njiui must b* *wbmin«d bv or on ixhaif of any childmn »*o
ma> tuvf accompanied of failovcd IOJOMI the b
V«ty tnuy youn,
MST1UCT DHLECTDH
THIS COPY TO ti MAIIEO TO PfTITlOMnt
FORM NO.
EDITION
RI\. H'-H'-fr
TIT1JE
NOTICE OF APPROVAL Or NONIMMIGRANT VISA
FOR FIANCE OR FIANCEE
PETITION
SIZ£ ....
INSTRUCTION RJCrCJUCNCZ
o: :i -.:.•- : '. »>• :~i.o:-. r:
HVk. S-aZ, 10-oC, App. S-M
use
:::i ;: i~rk:--. ^. ;? SO\:^ICR.*.S": VISA PETITION FOR FIANCH OR FIA.SCEE
«raor- :r.:i-r . t 3vsi inj:nal ii J copies'
BE L-SEP
scwcoou: &
Paga 2
Appmdix I
UNITED STATES DEPARTMENT OP JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
NOTICE OF APPROVAL Of NONIMMIGRANT VISA PETITION
FOR FIANCE OR FIANCEE
MAUC AMD AOOMfcSS OF KT1T1ONEM
O* •IM4XC1
M U*«u 1um Cvpax* tor <MH ••<•*•• <
i u m* •imrmpmrnw oAoar lap. (
Dn.»»«Tif oMK^iiiM^-^cvt
MM^r.CIA'V WUL ««^.» 10* V.
OiMICTIOTO TM« OOWMJCA'l »f
D30CU««»1
««ru»N«t
D "M*"":
IMPORT AHT
1. TS» i^proni of tta p»ouo« • condiuoiMd upon U%« b«n«fio4ry •xwuonfi uiunMnlJMfon (Nt Ajmncm
Comui of *6«Jity uid uMmc to eoAdud4 * rtiid mwrufi wit* you vidun 90 eUyi i/u* umnj in thi Umud
tout.
2. Thm trt ttudMd OM tppMomon fix pctnuiwnt r«ad«nc« itanu fofrm whtdi mn«i b« ti*cu(«d wtd fDtrf by
Ik* Ixixft Mi) proMMly WUr ;<M l«d Ui« l>*»«(l«ury ir» !*f«lly iH»m«4 to racM <MJwr. T*i» mXtct
»utt«iu*i< «n*
J. If for MT ntan*. you iM lK« 9«n«rta»rr an not mwn*d (o-«»ch ocjwr withm 90 diyt tAcr tdml 01
Uniud SiM*. pim« wport iA»( f*ct t« ih« o/IVa*.
4. S*?mt« «^pfcaoom Tor p»rm»>ini r«ad«nca iutu» mun b« Bjfcmitx*d by or on Mutf of my ctuidm w*o
my hn« uxoopMiMd or follow*^ to JOIN UM boMl'wury.
V«ry tr«*y yown.
DBTTUCT OntBCTO*
THIS COPY TO BK MAJLEO TO TH£ ATTORNEY OR RtPRCSE.NTATIVC. IF ANY
TO/1/80
TM 770
ADMINISTRATIVE MANUAL
Appendix I
I-I71F
Pa*e 3
UNITKO STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SEHVICS
NOTICE OF AH»ROVAL OF WOMIMMIGRAMT VISA PETITION
FOR FIANCE OR FIAMCEE
HAME AND ADDRESS Of PETITIONER
••AMI Of BiwOtCIAtlT ~
"•""'«-
isx'zrssS?!?*'
ix tamme* w m> Lirutod Sun**
nitMMICIARV »H-L »I»LW JOB V
DIK(CTIDtOTM( CO««ULATt «.T
D DOCUMENT* «»MIC»" »OU BUWUITTID IW UJffOaJ Of »tX>* « TIT«O« »*»»» SI PrViD OUB FulOOU AMO AMI
ntTtlMMtO
I I MiUARIU
Check, appropriate block when appl><Jbk
ZD PoK-nudil of citizenship tus been requested.
ZD Copy nwiled to allorr»c> or rcprcscnutrvt.
DtSTIOCT WRJECTCW
THIS COPY TO BE: PLACED IN BENEFICIARY'S "*•• FILE
10/1/80
Page 4
ADMINISTRATIVE MANUAL
Appendix I
TM 770
UNlltO STATES QEPASTMIKT O? JUSTIC2
AM» MAfUaAiUAltOM USVSCI
RSOUiST FOS POST AUOJT OF CITIZENSHIP AfTEB AW50VAI
OF FOR* MWF P6TITIOW FOR FIA8CE OR f JAMCEE
AM AMO 4OO«ai3O OC
rwe FOUOWINO INKHMATWN »ei>tw TO
I? NATUSAllZfO
NO
1 NAME IN WHICH PETITIONER NATURALIZED IT
DIFFERENT FROM NAME SHOWN ABOVE . .....
i DATE or BIRTH .............
4 COURT (TTTU: <nd LOCATTONI . „ .
5. DATt Of SATtJRAUZATION
if CtSTIJTCAIJ Of CITIZ8NSMI? ISSUID
I. CERTinCATE NO
1 NAME IN WHICH CERTIFICATE ISSUED
FROM NAME SHOWN ABOVE -
1 OATH Or 9IRTH
4. Pl^CK OF ISSCTZ
J. DATE Of ISSUE
v£Atf»CArtoN - oisrtov THIS KXIM
\f UNASU TO VtRIFY. STAMP TWIS K>9M "UKAftU TO VCKtrT AMO 8STU8M TO OBIONATtNG
If DATA IN rit£ AAISSS QUSSTKJN OP PTTITVONSrS STATUS
THIS COAM TO oaiciNATiNO orricE WITH COMPUTC fiui
DISTRICT DIRECTOR
10/1/80
TM 800
ADMINISTRATIVE MANUAL
Aooendix 1
1-210
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and NaiursllMllon Service
igrant. Con«»qu«nlly.P«'rn'«'o
l,0m tr>* Un.led Slat.i *l your own e.p*
• - 1 in a
I _ | SH
• |
, ,o h>.< y«j. «.pii
USE THE ENCLOSED SELf ADDRESSED C»BO TO MOTIF* THIS °'" R f ,
ABBfcNGEMeNTS POST AGE IS NOT RE QUIRED M in. l.m. m ,01.. acpirtun do no - __ - .
94 tRHIV*L-O£PARTuR6 BECQRO '" <CCO»d»"C> <"<" rtnumlionl °" l">l lo'm
Very truly yours.
Port
, To .
FOB IMMIGRATION AND NATURALIZATION USE ONLY
1-91 ilamped d 1-530 juBmilted
1-161 pr«par«d d I-'** pr«P«'«d
ORIGINAL TO ALIEN
ATTORNEY'S COPY
FILE COPY
ISSUED BY IMMIGRATION OFFICER IN CASES HH«F WOUIHTAP*
DEPARTURE IS GRANTErt
(Carbon-Interleaved, orqinlal and 2 copies)
(Printed In Spanish)
" SCHIDOLJC
PRIOR EDITION OF 9-9-78 MAY RF '
L'.S. Department of Justice
immigration and Naturalization Service
NOTICEOt I I THIRD I I SIXTH PRUl-KRKSC K PETITION XPPROVKD I NDtR .SECTION 20J (a)
Ol-' THF. IMMIGRATION AND NATION AI.IT\ UT. \S AMFNDll).
IMPORTANT: IF THERE IS ANY CHANCE IN YOLR INTENTION
TO EVIPLOYOR BE EMPLOYED IN THE C -\PACI TV INDICATED
IN THE JOB OFF-E.R. NOTIFY THIS OK-'ICE IMMEDIATELY
HIIIM 0< gwullclsry ! "** NO-
Dow ol Wooca
Country ol DWW
Occupation ' D&b* Pvubon FUod
I VALIDITY Ttx (pprovil ol i Million Iw thud <M uitft pralerxKa cuuilteuion » .M4d lix el tong 0 llu oujMWUoy Mia' Bxuftco-
• 00« « vetta <nd umipind. pitn«»<l t»<» 11 no cMnfp in UM motcm inutnluxu at »» ixot«»c»x ompJoyOf and am bananeury
I ItUK llw IxKMllciHy wK M jmplorrt t>» th« «nplor« m U» capacity mhuuo «n Bw l
D
D
n
D
D
D
L S D*p*ftmerw ol SIAIC II t^< lwnclici<*rt i approved petition hji been 1 Of ^ »
Youi petition for preftrcrwt tl infwution hu been ippro^cd try ihc S<r\i
„ (. ndcr (he In* only & n
i (tU number of »tWi m^s ^<c su^
he United Stain ConsuUic ai
tNcn though the petition ititn tKi1 the bend
pcrmancni resident Under the U^ only * It
adjimmcnt ol'ilitu* to ttui of liwful pettiuneni feudemsm the United Suie* ot immt(r»m mu abroad V tsu are iwucd ttnaly mihe
Coniul will iniorm ih« bcrw!\cur> ind consider tuuance of the MM.
Although the petition ititn that thi beticficiary it in the 1; ruled Stitea jruJ *ul -ippty for idjuitmcnt ol status lo that of a lawful
permanent resident, a review ol the beneficiary's Hie reflects thai the her.et'iciarv m*v have :onimued m or AccepieO unauthorized
cmploYmenl after January I. 197? and poor lo filing an application I'or adjustment of status The bcneiVup. m*\ thcreiorc be lututonry
itamtorily ineligible lor adjuiiment of tutu* under tetnion 2*^cj of the Act, the ben<i\cury should file an application i'or adjustment of
status (Form I-W51. and tht approved voa petition will be returned to thu offvcc.
30 Jayi m accordance -*nh ihc instructions contained therein (If the tencfiCUA had previouily submitted Form 1-485 uhxh wu
returned to him hcf, he the should jubmil that form umhm }0 days )
The pttinon fua been approved The bcndicury will be informed of (he decision nude on the pending application 10 become a lawful
permanent resident iFortn f-JiJi)
Remarks
NAME AND ADDRESS OF PETITIONER
Very truly youn,
DISTRICT DIRECTOR
I I
U.S. SENATE
U.S. HOUSE OF REPRESENTATIVES
THIS NOTICE TO BE MAILED TO THE ATTORNEY OR REPRESENTATIVE, IF ANY.
DCHECK THIS BOX WHEN COPY MAILED TO ATTORNEY OR REPRESENTATIVE
FILE COPY
FORM NO. EDITION
I-464A-E Rev. 1-24-80
TITLE NOTICE OF THIRD OR SIXTH PREFERENCE PETITION APPROVED
UNDER SECTION 203(a) OF THE I4N ACT, AS AMENDED
SIZE INSTRUCTION REFERENCE 01 204.4(b)(2), .4 (h), 2*5.2(b-l); AM 2761.03 04;
BH x 11 II Hbk 5-23. -24, -25. 10-19. App 5 F-l. App. 5-F.2;
GIR A-8
OSE
REPORT TO CONGRESS OF APPROVAL OF THIRD OR SIXTH PREFERENCE
PETITION
(Carbon-fnterleaved, orglnal and 4 copies)
WIoU £6ITfoVtttYr'iffiT<lE UStt • •'" "1
1 8CH20ULJC
8
4/1/81
0-
UNlTtD STATES DEPARTMENT OF JUSTICE
l&Sa*GfiATtON ANO NATURALIZATION SEfWICE
FILE NO:
OATS:,
MEDICAL EXAMINATION AND IMMIGRATION INTERVIEW
INSTRUCTIONS FOR MEDICAL EXAMINATION
A m*oca» amnroniaion <» nacveury IB oart of your aootcation for adiualmant of status n oermanam rmmsnt if you h«v«
/our fiftoanin birthday you mu»< IMMEDIATELY oMam and bnnq wrt" you when you aoMW for your medical •xcmnanon a aerology
naoorf end 14" x 17" chasf X-/»y Mn wuh
By a
a iMMnawt 0ny»c)ar> >nMrenmn<i m« X-ray film Th« MTOIOOIC IMI mat M
tooeygo by a MM or toed h*a«n o»n«r»n«m Tha X-ray lint and aarolog« last lor
men WWi 3O day* OU VOUM MCDCAL EXAMMAnON CAMMOT BE COMtHJTCD WTTHOUT THE !1) SEROCOOtC RIEPORT |2) X-
«AY AND (3) nCAOMO OC T>« X-AAV FILM
not* *i«o f« oo»
'»qwa 10 ,'Our m»oicai
a
ANQTCUPHOM NUM80I
INSTRUCTIONS FOR IMMIGRATION INTERVIEW
AM JUMQMTUBNT HA> ALSO I
I MAM K3A AN l«TWVir« BefOW AM IMMOHATION 0**W AT
3ATS
T1M«
SAMQ WfTM YOU AT TV* TTM« Of iNTCMView TM« 'OU.OWXQ
M«t»d gnv*o«* lumthvd fa you Oy rh« onytietan «m LKK*orm«<i m« "nwscsi «««nimiion
a«Mewt and 'orm !•»« (Arrival ana Ooaanur* *«eardl
NOTE:
) KEEP THESE APf*OINTMENTS ANO TO MNO THE RCOUWED DOCUMENTS
MILL DELAY YOUR CASE. ANO MAY RESULT IN THE DENIAL Of VOUfl APPLICATION.
>Sf>ANOH LANOUAQC TXAN3LAT1ON Of ABOVE AKWCAM9 ON TO/ERSE 0* THIS »AOK)
rOJLMMO.
t-48* fc •
JUttT)OM/<j>..2.?-7«r TI7UC
uv. a* H"»r HDXCAL uMmuxiai MB DMnauxioM iwmvieu
UZB
8 X 10%
mnmocnaM acrcaa«cs
S Cm 23*. 2(o) (1). 299.1; OX 24S.3(«); II Hbk 10-4, -S, 10-9, -27, App. 10- A, -J; CIR A-8
USD TO norm POUKM or Dtaaunoii AMD OK MDICAL OUMIMUTIOH Arronmairrs
nlllM KIDITIUII uv Uv »-i-73 MAT u UBlo 1 •«^lviHfi» '
10/1/80
IVEASE At DORSO OE ESTA.PAG1NA LA DIRECCION. FECHA Y HORA RESERVADA PARA SU
RECONOCIMIENTO MEDICO Y ENTREVISTA)
INSTRUCCIONES PARA EL RECQNOCSMIENTO MEDICO
Como parte de su solicitud para modificar su status a uno de residente permanente, se exige un examen ffsico.
)\ ha cumplido usted 15 anos de edad debera obtener INMEDIATAMENTE. y traer consigg en el momento de presen-
arse al examen fi'sico. un informe sobre los resultados de un analisis de sangre y una radiograffa del t6rax de 14" por
7" (35,50 cm. por 43 cm.) con el informe interpretative de dicha radiograffa preparado por un medico autorizado. El
inalisis de sangre debera hacerse en un laboratorio autorizado por el Departamento de Sanidad de un gobierno local o
lei Estado. La radiograffa y el analisis de sangre para sifilis no deberSn haber sido hechos mas de 90 dfas antes de la
echa de presentacion. SU EXAMEN MEDICO NO SE PODRA COMPLETAR SIN (1) UN INFORM& SEROLOGICO, (2)
JNA RADIOGRAFfA Y (3) LA INTERPRETACION DE LA RADIOGRARA.
TENGA LA BONDAD DE FIJARSE TAMBIEN EN LA CASILLA MARCADA
A CONTINUACION EN RELACION CON SU RECONOCIMIENTO MEDICO.
SiVvase comumcarse immediatamente con el medico abajo mdicado o con uno de los m6dicos cuyos nombres aparecen en la lista adjunta, si se
adtunta una lista para 1) determmar que medidas deberS usted tomar para obtener un informe sero!6gico, una radiograffa y la interpretaci6n de
la radiograda antes de su examen medico, y 2) concertar una cita con el medico para hacerse el examen, el cual debera completarse antes
del
Todos los gastos relacionados con este examen deben ser sufragadog por usted.
Si'rvase mostrar esta carta a cualquier laboratono qua haga estns examenes Ademas. entregue las copias de la carta ai medico gue le examine.
•/ * rTie 3u nombre en presenoa del nnedico para que el mcluya su firma en el informe
INSTRUCCIONES ACERCA DE LA ENTREVISTA DE SNfWGRACiON
TAMBIEN SE HA CONCERTADO UNA ENTREVISTA ANTE UN FUNCIONARIO DE INMIGRACION EN:
DIRECCION FECHA- HORA:
AL COMPARECER PARA ESTA ENTREVISTA. TENGA LA BONDAD DE TRAER CONSIGO LOS DOCUMENTOS
SIGUIENTES'
1 EL SOBRE SELLADO QUE LE ENTREGO EL MEDICO QUE LLEVO A CABO EL RECONOCIMIENTO
2 SU PASAPORTE Y EL FORMULARIO I-94 (REGISTRO DE ENTRADASALIDA)
3 AOEMA'S DE:
ISO:
SI USTED NO HABLA INGLES. DEBE ACOMPAflARLO (A) UNA PERSONA DE SU SEXO QUE
SIRVA COMO INTERPRETS DURANTE EL RECONOCIMIENTO MEDICO Y LA ENTREVISTA DE IN-
MIGRACI6N
EL NO PRESENTARSE A LA HORA Y FECHA INDICADAS PARA ESTAS ENTREVISTA U
OLVIOARSE LLEVAR LOS DOCUMENTOS REQUERIDOS SERA MOTIVO DE QUE SU CASO SE
ATRASE.
TRAIGA SU PASAPORTE Y EL FORMULARIO I-94
10/1/80
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
FILE NO:
DATE:.
MEDICAL EXAMINATION AND IMMIGRATION INTERVIEW
1 INSTRUCTIONS FOR MEDICAL EXAMINATION
i A -neo'c.'ii •?' -itninaficn 13 necessary as part of your application for adiustment of status to permanent resident if you have reached
I v^ur "fte-jntr1 birthday vou must IMMEDIATELY obtain and jring vith you when you appear for your medical examination a serology
j report sr.i 14." «.' * 7" chest X-ray film with a reading by a licenced pnysician interpreting the X-ray film The serologic test must be
performed DY a laooratory approved by a state or local health department. The X-ray film and serologic test fo.- syphilis may not be
rno/e than 90 '.lavs .id VOUR MEDICAL EXAMINATION CANNOT BE COMPLETED WITHOUT THE (1) SEROLOGIC REPORT (2) X-
RAY aND O» READING OF THE X-RAY .-1LM.
Dlease "'v.te 3150 'he box cnecKec 2 below /vith regard ro your medical examination
I | Pi^ase rommumcate immediately *'tn m« below listed physician or with one of the physicians on the attached list >f a list is attached. ID to ascer-
'3in .vnat arrangements you should make to obtain a sefotogic reoort X-rav film and reading onor <o your medical examination and <2) to
yrjnqe 'or your medical examination by him which must be comoleted before
All e<oenses •" connection with this examination must be oaid by you
PHYSICIAN'S NAME ADDRESS AND TELEPHONE NUMBER
^'ease snow 'his 'etter to any laboratory oertorming tests Also aresent Tie cooies of this letter to 'he ohysician oerformmg 'he medical
Jtammstion and 'urnun mm //itti your signature written m his presence 'or inclusion with his reoort
TO PHYSICIAN PERFORMING THE EXAMINATION
PLEASE OBTAIN THE APPLICANTS SIGNATURE IN THE SPACE PROVIDED AND MEDICALLY EXAMINE HIM FOR EUGIBIUTY FOR AC
JUSTMENT OF STATUS IF THE APPLICANT IS FREE OF MEDICAL DEFECTS LISTED IN SECTION 212 (A) OF THE IMMIGRATION AN
NATIONALITY1 ACT. ENDORSE THIS COPY OF FORM 1-486A IN THE SPACE PROVIDED AND HAND IT TO THE APPLICANT IN
SEALED ENVELOPE FOR PRESENTATION AT HIS IMMIGRATION INTERVIEW. IF THE APPLICANT IS NOT FREE OF SUCH MEDICA
DEFECTS. DO NOT SIGN THIS FORM. INSTEAD WRfTE 'SEE FS-398' IN THE PHYSICIAN'S SIGNATURE BLOCK AND PREPAR
MEDICAL CERTIFICATE ON FORM FS-398 AND HAND IT TO THE APPLICANT IN A SEALED ENVELOPE TOGETHER WITH THIS COP
OF FORM 1 -486A FOR PRESENTATION AT HIS IMMIGRATION INTERVIEW, (IF EXAMINATION IS CONDUCTED BY A CML SURGEOf
INSERT IN ENVELOPE BOTH COPIES OF FORM 1 -488A. X-RAYS AND LABORATORY REPORTS AND TWO COPIES OF FORM FS-39
IF APPLICANT IS NOT FREE OF MEDICAL DEFECTS.)
DISTRICT DIRECTOR
CERTIFY THAT THE ATTACHED X-flAY AND SEROLOQY REPORT (BLOOD TEST! RELATE TO M6
SIGNATURE OF APPLICANT
PENALTY TM6 LAW WWVIOES SEVEWE PENALTIES PO
KNOWINGLY AND WHOLLY FALSIFYING 0« CONCEAUNO A MATERW
FACT OR UWNQ A»iY FAL3« DOCUMENTS IN CONNECTION WITH TH
APPUCATK3N. .
MY EXAMINATION. INCLUDING X-RAY. BLOOD SEROLOGICAL AND OTHER REPORTS. WHEN NEEDED. SHOW THE APPLICANT TO 8E FREE OF
DEFECTS. DISEASE OR DISABILITIES LISTED IN SECTION 212(AJ OF THE IMMIGRATION AND NATIONALITY ACT AS AMENDED.
SIGNATURE OF PHYSICIAN
TITLE
DATE
IMMIGRATION AND NATURALIZATION SERVICE
FILE NO:.
DATE:.
MEDICAL EXAMINATION AND IMMIGRATION INTERVIEW
INSTRUCTIONS FOR MEDICAL EXAMINATION
k -nj-.-j.r,:; >-<ami.->at'on >s necessary as oan of /our aDDiicauon for adiustment of status ro oermanent resident if you have reached
oui ••ree'jfn oir'naav vou must .MMEDIATELY obtain and r?nng *im you wnen you aooear for your medical examination a seroiogy
ecort an: i -i < 1 7" -nest X-rav film with a read.ng By a licensed ohvsician interpreting the X-ray 'ilm The serologic test must be
•erroTT.ec' v- a laboratory approved by a state or local health dooartment The X-ray film and serologic test for syphilis may not be
nore :han X) days old YOUR MEDICAL EXAMINATION CANNOT BE COMPLETED WITHOUT THE M) SEROLOGIC REPORT. (2) X-
3AY AND 3! READING OF THE X-RAY FILM
examination
D'tease communicate rnmenuteiv with 'he oeiow :«,teJ onvsician or with one of trie ohysicians on the attached list, if a 'ist is attached, M) to ascer-
"jm .vnai arrangernents vou should '"ake 'o octavo 3 serotoqic reoort X-^ay Mm and 'eading onor to your medical examination and '21 'o
jf.inqe 'or your medical examination Dv him which Tiusf be comoieted before
AM expenses n connection with this examination -nust Se paid by you
PHYSICIAN S NAME ADDRESS AND TELEPHONE NUMBER .
oio3se <;now ^is etter to anv 'aboratory Dertorminq tests Also oresent the cooies of this 'etter to the ohys'C'an oerfomnnq the medical
^.aminaitcn ar>o 'urrisn nitn with your signature written >n his oreaence for inclusion with his reoort
INSTRUCTIONS FOR IMSV88GRAT1ON INTERVIEW
AN APPOINTMENT HAS ALSO BEEN MADE FOR AN INTERVIEW BEFORE AN IMMIGRATION OFFICER AT
AODPESS DATE
TIME
BRING /VITH YOU AT THE TIME OF INTERVIEW THE FOLLOWING'
1 The sealed envetooa 'umished to you by the ohysician who
2 You; oassoort and Fcrm I-94 (Amval and Deoarture Record)
3 Other
the medical examination
TE:
IF YOU DO NOT SPEAK ENGLISH A PERSON OF YOUR OWN SEX WHO CAN ACT AS INTERPRETER SHOULD
ACCOMPANY YOU TO THE MEDICAL EXAMINATION AND IMMIGRATION INTERVIEW
j^- FAILURE TO KEEP THESE APPOINTMENTS AND TO BRING THE REQUIRED DOCUMENTS
WILL DELAY YOUR CASE. AND MAY RESULT IN THE DENIAL OF YOUR APPLICATION.
BRING PASSPORT AND I-94
I— 486
12-29-791Y
District Director
ATTORNEY COPY
10/1/80
IMMIGRATION AND NATURALIZATION SERVICE
FILE NO:
DATE:
MEDICAL EXAMINATION AND IMMIGRATION INTERVIEW
INSTRUCTIONS FOR MEDICAL EXAMINATION
A medical examination is necessary as part of your application for adiustment of status to permanent resident if you nave reached
your fifteenth birthday you must IMMEDIATELY obtain and bring with you wnen you appear for your medical examination a serology
report and 14" x 17" chest X-ray film with a reading by a licensed physician interpreting the X-ray film The serologic test must be
performed by a laboratory approved by a state or local health department The X-ray film and serologic test for syphilis may not b«
more than 90 days oW. YOUR MEDICAL EXAMINATION CANNOT BE COMPLETED WITHOUT THE (1) SEROLOGIC REPORT. (2) X-
RAY AND (3) READING OF THE X-RAY FILM.
Please note also the 3ox checked S below with -egan to /our Te&cai examination
Please communicate immediately with the below listed physician or with one of me physicians on me attached list, if a list is attached. (11 to ascer
tain what arrangements you snouid make to ootain a serologic recoil X-ray Mm ana reaatng onor to your medical examination and (2) tc
arrange for your medical examination by him. which must be comoleted before
All exoensas in connection with mis examination must be paid by you
PHYSICIAN'S NAME. ADDRESS. AND TELEPHONE NUMBER
Please show this letter to any laboratory o«rformtng tests Also present the copies of this letter »o -he onysician oerformmg rhe medical
examination, and furnish him with your signature wnttan in his oresence 'or inclusion with MIS reoort
INSTRUCTIONS FOR IMMIGRATION INTERVIEW
AN APPOINTMENT HAS ALSO BEEN MAO€ FOR AN INTERVIEW BEFORE AN IMMIGRATION OFFICER AT
ADDRESS DATE
TIME
BRING WITH YOU AT THE TIME OF INTERVIEW THE FOLLOWING:
1 The sealed envelope furnished to you by the physician who performed the medical examination
2. Your passport and Form I-94 (Arrival and Departure Record)
3. Other:
NOTE:
IF YOU DO NOT SPEAK ENGLISH A PERSON OF YOUR OWN SEX WHO CAN ACT AS INTERPRETER SHOULD
ACCOMPANY YOU TO THE MEDICAL EXAMINATION AND IMMIGRATION INTERVIEW
FAILURE TO KEEP THESE APPOINTMENTS AND TO BRING THE REQUIRED DOCUMENTS
WILL DELAY YOUR CASE, AND MAY RESULT IN THE DENIAL OF YOUR APPLICATION.
FORM 1-486
(REV. 12-29-T91Y
BRING PASSPORT AND I-94
District Director
RLE COPY
10/1/81
(Ualcr Swoon 34?(b) of UK Ismufreoon & KtaooaaJny Act)
Tht authority (of eotoceon of On m/onastson requited on «h» form n eontafewd to I
U S C. 1 2S7(H Subnusson of Uw m/ortniooo by in alto to request Out h* k* pwmliud
to reum nacut s> u imsujBTiBt bwfuBy ednuned (or pcmuaoil reads*** i> voluatwr.
The wbated mformtooo will b« uted pnnapaUy by the So-oot to determine wh«b«r O*
tatut of tht *lws applicant *a£ tea adjured u&d« th« provmotu of Kcooa W7<a) of the
Imnuannon uid hatiotuOjty ACL 8 U S. C 1157U). to Uu.: of t aoammwut u AMoibod
by wo>on 101(«i)(15i<A). fEl. or 'Giof tb< lmnu»r»t>oo »^d hboomtoy Act. S U. S. C
HOHaKlJXA). (El. 01 (Gi The mfornviuon wboio) m»> »lw. uaaatnr of toutme u»t,
be duclosed to otbc: ledernl, naic. local, at loru^n U^ eaioreenoit and rojutiiafy
BOTiijei, the tfejaxtrient of C»e)enB tndiwlini aay cornnon'tn thcrtof (tf tb« appluuit kuu
eawi! m UK Aniitd Fottat o: the United Suiet). tht Depiraoei' of Stttt, Ono«l toieJ-
lusnix A»«»C5'. iDierywi mil tndmduili wul orpjuuooni dunnj U>* oouite o.' mrnagaDoa
to eboi lunna nvloimaucn rexjunesl b> Uu; Sema to cam o«t iw foncooat. Failun «o
pnmilt »n> t» «li "f Uw soboted Daormiuon may i«alt tn the dwn'i ul/umntat of nanu
£>oin Uui of > l»»-fu; r*rm»nen: rwxlrr.' to tha: of a nomnxnupant ctajafKatxm Bade
parajrapbu 1S(A). 13ft) 01 15(G)cf wroor lOluioftht Immigratwo and lwi»oa»ity Act.
FORM ^i08 (Rn. *-:7-7S) N
ef'
tn**1 bdo" ««aita(| lorai)
WAIVER OF RIGHTS. PRIVILEGE?. EXEMPTIONS AND IMMUNITIES
'
X > w
y *
"" >"•"•• •«"
."7 F
1 '
1 I
tl«N»TU»l
M
I »O» OCv
Fora 1-JOE A (Re». 9-27-75) N
Form 1-SOJ A (*jn. 9-27-75) K
F|L£ COPY i
CENTRAL OFFICE INDEX COPY
Fora 1-506 A (Re* 9-27-75) N
STATE DEPARTMENT COPY
i
Fonn os A (R«. 27.7S; N
INTERNAL REVENUE COPY
FORM NO.
I-508A, B, C. D
EDITION
REV. 9- 27-75
TITIX
WAIVER OF RIGHTS
, PRIVILEGES, EXEMPTIONS AND IMMUNITIES
size
5 X 3
INSTRUCTION RJCFK
223.1, 21)7.1; AM 270^1
RJENCJC 8 CFR 223.1. 2l»7
(A; II Hbk )0-i»9, -50, 16-1
.11. .12(a), (b),
), -15
.13, 239
1; 01 2U.2(«), (g),
USX
EXECUTED BY ALIEN LAWFULLY ADMITTED
SECTION 101 (a) (15) (A) OR (E) OR (G)
FOR PERMANENT RESIDENCE WHO
OF THE UN ACT IN ORDER TO
HAS OCCUPATIONAL
RETAIN PERMANENT
STATUS DEFINED BY
RESIDENCE STATUS
PRIOR EDITIONS MAY NOT BE USED
SCHTDOLX B
10/1/80
FORM 1-512
I. USE:
USED BY THE IMMIGRATION SERVICE TO GRANT ADVANCED PERMISSION FOR
AN ALIEN TO REENTER THE UNITED STATES IN A PAROLE STATUS.
II. ELIGIBILITY:
TO BE DETERMINED BY AN EXAMINATIONS OFFICER.
III. REQUIREMENTS:
1. ORAL OR WRITTEN REQUEST
2. NO FEE REQUIRED
3. PRESENT EVIDENCE OF BONA FIDE NEED:
a. TELEGRAMS OR LETTERS STATING DEATH, ILLNESS OR
NECESSITY SUCH AS DEPARTURE FOR AN EMPLOYER.
4. THREE 2 X 2 PASSPORT SIZE PHOTOS, COLOR OR BLACK AND WHITE.
(NOTE: WHEN IN RECEIPT OF REQUEST AND THE REQUIRED PHOTOGRAPHS
AND EVIDENCE, REFER REQUEST TO PROPER EXAMINATIONS OFFICER.)
10/1/80
8-21
TH 805
ADMINISTRATIVE MANUAL
Appendix 1
1-512
horn- l-.«i:iR
-i i
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SMVICl
ik lounttwr' O«le:
AUTHORIZATION FOR PAROLE OR CONDITIONAL ENTRY OF AN
ALIEN INTO THE UNITED STATES
Mame of Alien: DateofBirlh!
•MM
Place nfRlrlh:
I.S.AddrtM!
Presentation of the attached duplicate of this document will authorize a transportation line to accept the
named bearer on board for (ravel to the United Slates without liability under Section 273 of the Immigra-
ion and Nationality Act for bringing an alien who does not hate a >isa.
Prr^m^iinn nf the rvriginal of ihii dncumtnt prior lo ,. , ,, w\H aulhonit in
mmierauon officer at a port of entry in the Unned States to permit the named bearer, whose photograph
appears hereon, to enter the United Slates:
CD as an alien paroled pursuant to Section 2l2(dM5) of the
Immigration and Nationality Act.
migration and Nationality Act.
Remarks:
! ARRIVAL STAMP |
1 !
PHOTOGRAPH ' '
|
1
i
i
i 1 i
,tA!<-.m ORIGINAL TO ALIEN
1
i« :.«.-. ..i< -^,» FlU COPY
1 F«m|.Ji:iRe> s-ij.-w TRANSPORTATION LINS
FORM NO.
1-512
EDITION
REV. 6-15-79
T1TIX AUTHORIZATION
AN ALIEN
FDR
INTO
PAROLE DR CONDITIONAL
THE UNITE" STATES
ENTRY
OF
SIZE
8X101/2
INSTRUCTION
.ll(h), .12(a)(c
19-1-4, -6.1-.3,
REFERENCES CFR
), 245.2(d)(4), .6(c1
App. 19-A; RIB A -8
212. 5(c),
; AM 2301
21fi
.06,
4,
.12
245.2(a)(l),
, 2482 Ex. 1
299.1
, P. 7
; 01 212.5(c),(d), 235.1(5),
, 2706.02; I/I."S Hbk 7-16,
use
INFORMS ALIEN HE WILL BE RRANTEn
THAT IT MAY BRINR ALIEN INTO THE
ENTRY OR PAROLE UPON ARRIVAL IN U.S.
U.S. WITHOUT LIABILITY UNDER SECTION
AND
273
NOTIFIES TRANSPORTATION
OF THF I & N ACT.
COMPANY
(Carbon- Inter leaved)
PRIOR EDITIONS MAY BE USED
| SCHEDULE B
/ft!
TM 779
ADMINISTRATIVE MANUAL
Appendix I
1-546
Page 1
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
Vnii
t
id
have not established conclusively that you are admissible to the United States: therefore, YOU ARE
ORDERED TO APPEAR IN PERSON AT THE BELOW INDICATED ADDRESS ON THE DATE
AND TIME CITED A finil determination will be made then concerning whether and under what
conditions you will tit admitted into thij country for the purpose you have indicated. FAILURE
TO APPEAR AS ABOVE ORDERED MAY RESULT IN YOUR BEING TAKEN INTO CUSTODY
BY AN OFFICER OF THIS SERVICE Q Your passoort has been retained It will be returned
to you in person when you report to the so dree indicated below.
Rtoonino Adorvu R«ooa.no D«« 4 Tim*
US. IMMIGRATION AND NATURALIZATION SERVICE
-
&o*ciftc A«tton<il lor Cntltttt o< IntcttClian
~< Documentary D*<>a«ncv 3 Pgnoon ^j Viu C3 form 1-151
P] N<xi-Oon»<i»« Nonimmigr«ni |S*« O*t«ili Oelowl
i— For M/S Bond f-on<ng (S*« OMtxIl txKxwl
DETAILS
ADDticantSaMiti
1
I
1
£
0^,.,^ DM. »M«««>0««.
-— — •--:• •••'•:.:
npR« ,.-.. ,
FORM i we m<~ e-e-T7iN
RETAIN-PORT COPY ,«OT. ,«,„«... » .««,,
FORM NO.
1-546
EDITION TITLX
REV. 6-9-77
ORDER TO APPEAR
SITE
8 X 10 1/2
INSTRUCTION REFERENCE
01 233.1. :3S.4(d);
II Hbk 16-11. -12;
GIB A-8
USED TO ORDER ALIEN TO APPEAR
(Also printed in Spanish)
PRIOR EDITION HAY NOT BE USED
SCHEDULE
INSTRUCTIONS
Upon final drsooscon of d«f«ml mit form n to oa rttumao to tn« iMuinq offic* wim
dupo*tion ee<M provided. U« cooing ivmtn at deagruud b«low and placi distortion
COM provided in tna oiock at th« bottom of tns inMt.
A Aamintd (ciaal
3. PVOM
C. invxcnon dafirrvd {alpha cooa of onward FCO or Qistrier)
0. Vitt/PP warv«l on 1-193 (INS) or Sut* ™co<nm«r«t«non iSunl
E. Aooliottan vnimdnwn on nftmd 1-275 - nonbomrfidw tcutxnrxe
P. H«ld (or txclution hsacmq
G. PwoteO for »ciuuon heennj
H HMd for Section 235IO Oanrmmation
I R*f«rrM to INS invwti^itioni for proatoition
J RP/ARC-i«v«0 1-193
K. Mainunanc* of rtiiu< and oxurturt bond po«t»d
L. Exdud»d and dtoorttd ov ord»r of Immigration JuOgt
M Affordta omtltgt of irfccnnq vo'unary d«o«rtun in IMU of
Exclud* & OKKVT ord«r ov immnyttio
N. OTHER ExoXin orufly
D
DISPOSITION CODE
Uoon rtcoipi of Onworrl Ottia Coov. duooution of can wilt b* nond on Port S*cond-
try 1.09. U» cofl» In 0roo«r SB*C« provided on Mcorxtiry 109.
N. OTHER: Expitin brirfly in Commant column on form 1-605.
Secondary Log
10/1/80
TO 779
ADMINISTRATIVE MANUAL
Appendix I
1-546
Page 3
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
Yon
have not established conclusively that you are admissible to the United States; therefore YOU ARE
ORDERED TO APPEAR IN PERSON AT THE BELOW INDICATED ADDRESS ON THE DATE
AND TIME CITED. A final determination will DC made then concerning whether anc under what
conditions you will be admitted into this country for the purpose you have indicated. FAILURE
TO APPEAR AS ABOVE ORDERED MAY RESULT IN YOUR BEING TAKEN INTO CUSTODY
BY AN OFFICER OF THIS SERVICE. QYour passport has been retained. 1: will be returned
to you in person when you report 10 the address indicated below.
Rtoortmg Address Reooninc Date & Tim»
U.S IMMIGRATION AND NATURALIZATION SERVICE
ATTACH ORIGINAL FORM 1-94 HERE
FORM < 5-46 iRev 69-77IN
• v
in/i /
I'NITED STATES DEMHTMEN'T OF JUSTICE
lanipraiiea ood Nalcralluitoi S*rvi«t
EriiiMiin it Mfci • Ma> u*&UV ofecb » m»»o»»d k; »«n*>pMl) .
V. Y» >kMU Mrf *« IMBMVIM M Ik* M«lM«4 km, Ott U T» ««* "• »••• >** «
1. A U*. cmwa oi« tount » nut Cfttato w M*u» nui «»o«ly »•
. llu« CM b*o hi «•*• >r cwi)ru< b.i kuU mubuu.
. Ttow *MOU>M
Huulj >t KM biidii •< k»
aiai.
4. BIBDIXT ALONS TIUVZLINC Oimffit THE UWTnTO 4TATEV TVt AJtM K<«
••• »•«> 1-111 kv
. PUBUC CUA1C!
MB,
<M U.
2UttHtD .1 *.
u. «Ad *!•» !• riw >•»!><• n«
*•> k. it *M likMf w MT I
( *. U* i/ k* «M ekx> Ont:
c. IUUUMI « ln«4t 10 «*« U-i. v>L unra ki> En^an. bck u«m«ce ur k< |i»~ ky MI *M4«ni W nv^Ml
mteinMl w AAantma Cvatalft. Tkt MKlaMd V»a 1*1>4 «**4 Vr feu «#«B«7 it fcilni »kit J •• fmu 0*i«tr •• •
jMrrtt w UBB« f*tt*0^Jy ta^oimd kv AAMOCOA Coa«al».
4. MCOKM Of ARRIVAL. TW »c»4> Hi wti»l u «k»* rn> w» ««»•»• ««U an M> xuliMi w fei cfb**. Y« «.J,
rouwNO.
1-3M
COITION TIT IX
Rev. i-i-r? FORT: LETTER -RIFLT TO GENERAL »Qumis
p;rg
« X 101
DUTR.UCT10M KJErOLCNCX
OSK
USED TO n»!!ISH IWORhATION IK HESPOKSE TO WQCTHIES RECEIVtD AS SERVICE OT7ICES
TtlOR EDITIONS HAY HOT BE USED 1 ICKBDOUB A
10/1/80
TM 805 ADMINISTRATIVE MANUAL G-22.17
Appendix 1 Page 1
!h5;
t- \ ' ' • • i • : i • ' • i ' ' , ' :
Si ! • . 1
1 : • .
i
s '\
UJ 1
t- 1
2
*: i ' ; ;
: 1
i • 1
T : :
, i
=ij
~ - >
! il §
0
-i j S
I I '
1 1
3
VII. ADMINISTRATION j HCCOHOS
UN
COHHESPONflfNCE
7U
(B) II.) it)
j
i :
j
•3
i * s
•yi £ O
^ '
I
5 '"
Z LJ _
a £
£ ' i
i'i
f • '
yNIFED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AMU NATURALIZATION SERVICE
tVOHKtOAO RECORD
z
Q —
- . (J O
z 5 s S
S x jj j 3
<c
i:
i::' • '; !
VERIFICATION
OF
ARRIVALS
& DEPARTURES
713
IB) (Cl (El
i ' ' i i
z
I
i;i ' ' ;.;.. ' :
r • ' ' ' ;
FORMG-2Z17K
O < > w
8-27
fORM NO.
G-22.17
EDITION TITLE
REV. 10-1-80 WORKLOAD RECORD - RECORDS ADMINISTRATION
SIZE
8 I/? X 14
INSTRUCTION REFEBXNCE
AM 2301 .02, .51 . .52
osc
USED BY THE FIELD TO ACCUMULATE DAILY DATA TO BE REPOSTED OH G-23 REPORTS
PRIOR EDITIONS MAY NOT 8E USED j SCHJCDUi-C A
4/1/81
INSTRUCTIONS iFORM G-22.17)
10, ai'.cJ isl Verification of Arrivals and Deartures.
Column 71 3lh) Received. l-nter the number of Bequests received from other than Service offices for verification of arrivals and
departures.
Column 71 Sfcjjpinpleted. Enter the number of requests completed. Arrivals and departures may be »enfied from records kepe
at the verification centers, from case files maintained at trie tilci control office, and (rom manifest records such as micro-
filmed Form 1-4 !£. I 34, l-95.and such records pending microtiirning.
Column 713!y) Prpflui'tive Hours. Enter the number of productive hours spent m processing the request (or verification of
arrivals and departures.
t). £0J£m.ni2_''5ul lnd !b!_fkllln Registration • Fingerprinting.
^"'HllL^LQ^ItlEltly!- Enter the number of persons fingerprinted.
Cokimn 71<ib) Productive Hours. Em •< the njmbtr of productive hours spent en fincjerpnntmg.
c- CoJL.-'-,ns 715(al jhfuunh (dl jncjuirnis.
By T. 'If pnone
tii)JurJLn ?'5!.sLl~2"l!l!£.t*£:- ^nlei ;ne nu-nber of requests for information received by telephone even though the call may be
referred i'i af^i'.ser district. iubottice.or station personnel. The number of req'ieTO snail be «qual to the number of calls.
not the r ju'lier of .-Hfrrent subiects covered.
JJJolunvi 71fii-' l''rodu--'.i>e Hours. Enter the number of product've man-hours spent in per'ro.-mmg work described in 715(a).
|ilf«S-..n
CciUjmn^V^lcljCcirri^ltied. Emor the number of requests for information received in person even thouyh the psison may be
referred to a-iother ilistr.ct. viboff'ce, or station personnel. The number of requests shall 4e equal to the numtwr of per-
sonal inquiries, noi tiie numtW: oi different subjecti covered.
Ccilumn ','ljtui P.-ciCuclive Hours Enter :lie number of productive man hours s,»nt m performing wovk described in 715lc).
rt. ColumnsJJG^Ibl^jc). .in'1 j," Correspondence.
Cqlyrnn 7 "Jlbj Received. Enter th.> nLmfe'r of letters arid memorar.dj requiring reply >vhich are received m the Records Adnvri-
iittafon and li\(-i:onation Sectic::.. Ojrr.pje;ed vetifications of 3rmal and Ucpartutt- tequrmg reply whether ihev are received
from ihe Verificjticm C'.'nter or vcn'ied within the oHice. will diso be received as correspondence.
?£!iI£L''1 ? -Glcl Cnniploted. Enter the numbe" of replies bv Records Administraiior. and Information Section personnel, which
disp<",cd of t*ie reci'i»ed correspon-.lence.
Cojupui '/ ICU'I Prodjct'»e Hours. Enter the number of man-hours sporir by Records Administration and Inform.ltion Section
peisor-iti m rr..-Mormaig work du"if:.ibed m 716lc). Time sp»nt on translating corresuondence should also be included
e. Columns 717|jl llv ..,i;n It I Mail • P^E^L?.' Ma:l
Incomiru snd ounx.-iny nuil shall be counted foe five consecutive work days in accordance with the following schedule:
First Ml
work wevk in
July
November
March
ocond full
o'k week in
August
December
Ann!
Third full
work week in
September
January
May
Last full
work week in
October
February
June
M titiply the da^ly ir"?rj/t' t;jsed on the sample week by the numb?r of work days in the month to arrive at monthly work units
INCOMING
(*H'u.'I!n_Z.!Z!Jl . d'v" "'•' ' ''"•'' :ne number of envelope-; or Pdckanc: u'ceivcd, regardless of the content or the number o' Dicces
r,( airr«sp'.vi.ls'i - •. • •-•••. i< •;• es'::'i envelope 0' iiacka:ii>, i'<rprjt mail from other off'Ce? o* the Service E^ch piece of
injii recen/ctl !!• •'•: • • service offices shad be counted jeoar?teiy, c«ceot that tiuntfles v^hich require a sngle rott'nrj action
shall be cou'ivvi •>, -.n<!. piece of 'n:,il. i.e., a tu"d'« o' l-53's, G-3C j'i. supplies, etc.. *!iall L.e counted as one.
?2!li!I!!l?J'i!liLi-.<iTI|PLl;!iS?- Enter tlir numlipr of fnvf;looes and packayes openfd anrj procsssec!
Column 717jcl_i Outgo '"'jjl|ai|. Cnter [he nur.iter of envelopes or pad' ages mailed, regdrdk1:: c.' the content or th? number of
pieces of corrtstcnd ",co or documents in each ei,"dop" or package, ei\cept mail to othiM ;,!fiCf5 of th<! Strvice. Each piece of
f»jil w .jther &''vu-.e office: rbail t.-- counted wp.iiatt^y. pxceot bundlas o< flocumemi that -n»v oe handled as a ;jnn
Cojumri 717le) F'oujcuvp Hours. Enter the number of croductive hours spent on mai1 as dif 'Pd aboue. including nai! cU!.sific.i-
tior and routing when; routmp is done in mail unit
Col-jmn 71g'al iivrommg. f-nio- -he number of telegraphic messages n»i:eived.
'"'?''.-.'.1;r!j' '^'b1 n'.i:jK>^ig. H^.i-r ^hp iKim^r of :elegraphir. m^ssaoes prepared and tianirrutied
V:?i. "~JL!l.VVi.IJj}!!llr:ll!!Ly2iJI5- Snte- ih? piuduciive lions iwnt in the leletyuc oroce«:s.
Ho u:"n 7!13lal Inqijifiei. Ente- the nur'-ser of mquirie; ciuenec1 to the automated Master Index System.
^illMI".". I t^lbi_i:'adi.,ciiVe Hon'<. S'nU'r tin- number of ma- <.c,u'i spsnt on work in Records Search via JUST.
4/1/81
TH 761
ADMINISTRATIVE MANUAL
Appendix 1
UNITED STATES DEPARTMENT OF JUSTICE
omd NaiminaSiseJioa Servfes
Pleaac cone to Ibe office cbowa balow at U>« liew aad ploee indicated in easuscUoB with aa official Matter.
omct
LOCATION
Bow No. DMT H*.
DATE AND HOUR
ASK FOR
RtA&flN 1P6S
APPOINTMENT
BRING WITH YOU
IT IS IMPORTANT THAT YOl' KEEP THIS APPOINTMENT AND BRING THIS LETTER WITH YO€.
If you are unable to do so, Mil* your reuon. ugn below and return lhi» letter lo Uiii offiee tt ooce.
i
01:.
1 am unable 10 keep the appointment BOCIUK:
\tr\ uruh voun.
TWi COfY TO IE MAIUEO TO THI AnORNJY O* RE«"R£SEMTATIVE, * ANY
D CHECK THIS BOX WMf N COMT MAILED TO ATTORNEY OR WfttSeHTATM RLE COPY
rOJCMNO,
G-56
EDITION TIT1X . !
REV. 5-1-73 5EHERAL CALL- IN- LETTER
SIZI
8 X )0 1/2
INSTRUCTION JLEFEJUCNCX
AM 2703.17; II Hbk 2-2, 8-4, 9-11, 10-52.1, App. 10-E; Inv Hbk 7-21
°$* USED BY SERVICE OFFICIALS TO NOTIFY A PERSON REGARDING AN INTERVIEW
(C«rbon-Inter)«8v«d) (Original and Two Copl«»)
(Also printed In Spanish *nd in Single Copy)
PRIOR
EDITIONS MAY NOT BE USED 5CHCDOUC A I B
10/1/80
TM 694
C-100
(OSni) lUrau <& Parana)
,. REQUESTED IY
J. <O«>» « Uwi)
TO
1. NAM O<*» U CAW
KM M«4dS«
4. FltE NUMBER
S. DATE OF SIBTH
Mo. Oar Y*»
6. DATE OF NATUflALliATION
Mo. Oar V.«
7. DATE OF REQUEST
Mo. Day Ymf
RLL IN ITEMS 1 THRU 12 IP FILE NO. fS NOT SHOWN A&OV6
ft. COUNTSV 6T IHttH
9. AaajVAt <E>sea) (PteOT) (O««)
10. PLACE 05s NAT'u'lAI.lZATlON
11. CERTIFICATE NO.
u. asMAKi
l». 'i'K NUMlEiu
i«. DATE K>*«ABDicX>
REQUEST POR RLE ON LOAN CPO tio.^t
fe»a> C-jes (£<». 13-l-SS)
CHARGE COPY
ORXGXKAL
(O*ca> lUixt er Pxraoa)
DELIVER TO
REQUEST FOR FILE ON LOAN « 8«»-w«
P«ra> C-100 (lUv. U-l-SSl
RLE ROUTE SLIP
COFf
FORM NO.
C-100
EDITION
REV. 12-1-58
TITLE
RSQUEST FOR FILE OK LOAN
SIZE
5 X 5
INSTRUCTION REFERENCE AM 2706.02, 2711. 02-. 03, 2713.01, .03, .06-. 07,
2723.02, 2765.07, 2770.02, .04, 2771. 01-. 02, 2799.06, .11; II Ebk 5-7,
App 5-M. 8»A. 19-Aj Inv Hbk 4.1-7, 13,1-4 thru 6
USE
USED TO REQUEST A FILE ON A LOAJf BASIS. THE "CHAICE COPT' IS FILED IK CONTROL OFFICE AS
A CHARGE ; THE "FILE ROUTE SLIP" IS USED TO ROUTE TEE FILE.
Carfexm lBt®ti®af (Original and 1 copy)
PRIOR EDITION MAY HOT BE OSSD
SCHEDULE B
' 10/1/80
TM 715
ADHXHISTRATIVE MAMUAL
I
G-102
Fill ROUTED ON LOAN
Ml* WL
Satovat
Te
lOOMt AU.I (Unk w P*o»a)
___
bwm <OOn> (Una « PMMB)
DOM Tiea
CHARGE COPY
PMM C-I82 CBm. 12-M8)
FILE ROUTE SUP
9«n G »«1 («M. IJ.|.M>
FORM
HO.
EDITION
TITUS
G-102
REV. 12-1-58
FILE
ROUTED
ON LOAN
SIZE
INSTRUCTION KKFERSNC!
AM 2703.01,
.02,
2710
.05,
.06,
8 X 10
1/2
2711.06, 2713.01, ,02
, 2760
.02:
II
Hbk 12-9,
App
5-A:
Inv Hbk 4.1-7
USE
USED BY CENTRAL OFFICE AND. FIELD TO TRANSFER
FILES WITHIN
THE
HOLDING
OFFICE
OR TO CHANGE THE CHARGE ON
FILES
TO BE LOANED
TO OTHER
OFFICES
SUBSEQUENT TO THE ORIGINAL CHARGE
OUT. "
FILE
ROUTE SLIPV
IS USED TO
ROUTE
THE FILE
PRIOR
EDITIONS MAY NOT BE USED
SCHEDULE
A
10/1/80
KST
IU1U REGISTER OF FEE RECEIPTS
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization S«rvice
?. Name el Applicant
fesnacuro
ll .VERiriEp-
TTH v ajsinjuaa Q nmoau CMIU i;
IMt .l»HI«UTIBMl
(l»».1.4-Tr)T fCw,ir»l) Office
Q Tycai o< 8 tanb 10. Application
Transit No Forni Nwtit
1. R«JiU»r NumMr
2. PBS«
Lait pravioui rvcuiD: numMr
JSSl"Nff jjP;*TlQh
11 C»t» Sifnstura
'Cuts ti§naOrf»
U. r^QtWABDEO
u t «ll*i. »«*' o»l«
Annch 10 Agency Copy of 8F 21S,
I >'
•"-I f
{fc».J-4-TT)T
File moaaricalty within
iioaiT o«w.« c of
toavkaQ toaaJkaa
FORM NO. EDITION
G-253 REV. 2-5-77
TITiX
DAILV REGISTER OF RECEIPTS
SIZE INSTRUCTION RJEFEJLENCE w,
fa X 10 1/2 Ex'
2610 Ex. 1, 2S7E Ex. 1. 29&4.03, .0:, .06 - .OS, .1C, . •;. ."i,
;. 2985.01. 2987.01. .05, Ex. 2; 11 HSK App. 1-A
DSC
USED TO LIST ANC ACCOUNT FOR
(Caroon-interleaf , origma1
APPLICATIONS AND FEES RECEIVED
and 2 copies)
PRIOR EDIT10K OF 5-1-76 4^
3L L'SEC
SCHEDOtii- r
Appendix i
uMITtO STiT«S D«#A«Tm£NT O* RUSTICS
f sri i UAC c -u ~rr '*2C* -x*e ^- ... ,. ia*>CAr i t*o !JY *' •»*" "lAt. "• • • .L *u/n4W
ALL 3rH£ff ft*aCS ^!CO<>nc'uti'ts '*•*« or tt'9**m*4t;>t$r& Zir* *
— • ; - •— — t-
. , — — 1-
**"V. - C*«r" J i»i*T &001C51 3ufSiOC *«£ Jii( **£ 3 S"r*r£l "•' wO*€ "•*•* OW/C i"C**
'*'.'__ __" ! _ """ ' -- ^ ".-' .„
f.x.. i««t mo *c;«{'.r:> [.Kn.-:«t» " _ "' :c:.j»>^:. ^m, s
SiSpy 6e/o»- I ftt dccup»ficm atimad il noi <hown atiove. Include all inlormaa}*
Q] N» '_•»!. I»«O- ~ 0»-t« M>l<f.
I ifATV4 *$ *€«A»«<Nr acsiGCftr
A 1 L ? 0*
CHKKS)
(.'NtTED STATES ARMY INVESTIGAHVE
RF.COKDS REPOSITORY
ATTN: ICIRR-A
FORT MEADE. MARYLAND lOTM
ATTESTtOS: I.I A15ON OFFICE,
IVOWCRAriON AND SATL'KAi.IZATK>N SEKVICE
!n«
iD1
"" !>'T1
TS^i 1 DOB* j
FORM NO.
8 X 10 1/2
EDITION
T1TLX
Ot 104.1, 105.3.. .4, .7, .8 .10(«). .I0(b), ?35.7, 335c.3; AM 2414 EX 1, P ' INV H3K
II RK 6-29, GIB A-4
08EO TO RZQCfEST KitCXJJRDS OF ACZHCIES OCTEtt THAW FST A»D CIA
lne«rl<u»v*4, original «nd oct* copy)
MSOf, EDTnOBa MAt »OT BK TOED
Tha rocante of Win
All orgenualtem, dub* «
{. [rt notvo, si
wrth ntlfMct to tn« tuto<«c« of your inquiry.
wi in (ha Umf«d Sretsss. or in any anWr ccw^iry, a< ™
wot a member at any )im<-, and
All atr«ait, cof«>icS»Gm, ditaplinory CKtiaAn, ccturf mcutial
inducing <ia»«4 a*d ratulta nWwcrf. (If non«, thaw 'Hoo«" )
r, and illagol <K immoral conduct in which >ub|ecf involved.
Dvtoilt o^ any oral or orman itatam«n(i, conduct, behavior or ouodafioni at »io sub|»<t which -nay indicata belief m, odvixrcxry
>>^ or p/Wsfemrtf or lymjscthy for CammufMwn or any orhitf foraign <d«0k>f|y mconMttwrt wiH« loyally >o *a Unilad Slated or fti« farm
oif g«»«rrwn««» of th« United Slates or attachment to i*-.e principles of tha Umta»d StatM Constitution (If rton«. ihow 'Mono" )
' certify that ih» inferrwsttofl h>x» given concerning rtvr: person nomed '* corrver according to thw n»cord> of
10/1/80
Do Mot R«move Carbons, if typewriter is not available, print toovilv in block l«t?®rs with ba(!-poim p®n. * u.S GOVERNMENT PRINTING OFFICE 1979 300-355
> Form G-3258 (Rev 5-l-79)N
liOGtAPHiC
IMFOBMATiON
UNITED STATES DEPARTMENT Of JUSTICE
Immigration and Naturali.uiS«>n Servica
IV b \;.
GFEMALE;
MATiCNA^.'Y i fiiE NUMBER
•A-
AL_ DTHEP NAMES ^SEOilncijflmj names By previous narnjges.
CITY AND COUNTRY OF 9iRTn
SOCIAL $E:'JRIT* ?o
FAMILY NAME FIRST NAME' DATE, CITY AND COUNTRY OF BIP7H M Known- CITY AN C COUNTRY OF RESIDENCE
FATHER
c
i If none, so stile* FAMILY NAME
F5< » fe. pve maiden owe1
FIRST NAME BIRTHQATE CITY 8, COUNT^Y Oc Bi?Th DATE OF MARRIAGE B_*:L "F
HUSBANDS OR *IV£S l» -wnt. so st»te; ,
FAMILY SAME • ca' *>>t ;-vt ijtoen mmt; ; F'RST NAME : BlRTriQATc QATE_i PLACE 3F MAR 91 ACE__ DAT£ AN_C P..ACE O^ TESMiNATips :" MAqq ACE
APPLICANT'S <>ES:OEHC£ wAS~ CIVE
LIST PRESENT ADDRESS
iT ANCMUM3ES
P°CVINCEOR STATE
APPLICANT'S u*ST ADDRESS OyTSiOE THE UNITED STATES Of MO»E ^MAM ONE YEAP
STREET AND
V1NCE OR STAT£
APOi_:CANr'S EMPLOYMENT LAST FiVE VE*»S. IIP NONE. SO STATE _ • S* PRESENT E
FJL. '.'AME AND ACCRESSOF EMPLOYES
OCCUPATION Soeoty MONT1- "EAP
ESENT IUE
Show below last occupation abroad if not shown above. (Include all information requested above.;
;j FORV. !3 Cu6MrTE: IN CONNECTIOM WITH APPLICATION FOR
NATURAL.. ZATON • | CTHEB .»PtCi'»'
STATUS AS PERMANENT RESIDENT
l( »«r/ing or <rv»t «»rv»d in »h« Arm«d Forces of »h» United State », compiat* tho
following :
Branch of Swvica Rank S*rvtc« Nutnb«f
INS USE
Office Code
Typ» of Case
Dote
(Office of Oig
To Other Ag»ncy: P)«os« furnl»K on the r«v»r*» of this form, or-by anaehmant hereto,
any derogatory information that may be contained In your records concerning the abovo
perton, forji« in connection with con*id«rolien of obcv« application ana return to
U. S. Immigration a.id Naturafi zation Service.
BOTHER AGENCY)
•I
i '-..^L SJA:-
S? ' ,T".'vE5<.' ' >t
(ALL DEFENSE CHECKS}
MAIL TO:
DIRECTOR,
UNITED STATES ARMY INVESTIGATIVE
RECORDS REPOSITORY
ATTN: ICIRR-A
FORT MEADE, MARYLAND 20755
ATTENTION: LIAISON OFFICE,
IMMIGRATION AND NATURALIZATION SERVICE
: • r"i -v
;i ! r™! •!-,-
, . I i '-at.
• ^—^
J • [H RA^K :
D
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(USAfJ
D
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STATJ r^*niTorMM ! d; C: Vi;a:
IP.M ; IS.T.) i orMI!R . |-i s. v,ra •
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MAJiMC ACKMCSS
• - • • seo.i. toi.4 | U Jk>A 1
COS *WUNG AOO«£U ' |
COSM G-3259 ^
i n /i /or\
s<s e-ttconit of this Oatp®f»m@nt sWw H* falkwsrag with *»&£N»et to As wbpct of your inquiry:
Al! organisation*, cldtw ®r s©ci«ti®s in fhs Uni>®d $tofr®s, ®r en o«y oth®r emtntiy, of which subject was a m. mbw ffl any
Aj! arrwstE, convietimu, diseipiinaxry etdiera, eovrt martial precs^distgar, and iil@gol 0r immoral conduct in which au
tncluding d0?®s and rasults thMroef. (M !5®n®, shew "N©r»<t".)
Detoiu s'' ony oral or written s«a1®m^nti, conduo, behavior or emaciations of tno &ubj@d which may mdicute b@!ietf in. oci^ix
o< or p?tj!;ar@r)CD or sympathy for GxrHDuniem or any other foreign ideology inconsielvnt with loyalty to tfa& United Skikti or >h« f
of $be Unit»«3 $ie$®t or «ftoehm«n} to the pfincipbft of th« United Statm Consrituiian. (H fMrvt, show "Mono".)
i-naf »f.»» infarme^icn
» «»rr*d «»cca>«Jiing to the rwewds of
(Mama ef Depor*m«i« or
Official signotur«.
10/1/80
and Natural i&ati&n
F'ts; -are1
\\iM\t ia
GiPn<OATE'Mo.-03;/-n.> ( NATIONALITY
i RLE NUMBER
'A-
Ll OTHER NAMES USED . including names by previous marriages*
, CITV AND COJNTRYOr BIRTH
| SOCIAL SECURITY NO.
I'll any
FAMILY NAME FIRST NAME DATE. CITY AND COUNTRY OF BIRTH If
CITY AND COUNTRY OF RESIDENCE
>,ER
Raided name
:S3AND i II none, sc stale' FAMILY NAME
OR Fot *il«. gm mi den name1
w| p t
FIRST NAME BIRTH DATE CITY J COUNTRY OF &RTH GATE OF MARRIAGE PLACE CF MARRIAGE
RMER HUSBANDS OR WIV'ETITnone. so state' ~ "
MILY NAMEiFoi *ile. gwenaiden name' I F'RST NAME ' 3IRTHDATE j DATE & PLACE OF KAP3IAGE" DATE ANC PLACE OF TERMINATION OF MARRIAGE
CANT'S RESIDENCE LAST ciVE YEARS. LiST PRESENT ADDRESS
7TRLET AND NUMBER
CITY
"cOViNCEOS STATE
COUNTRY
YEAR -*.?ATw
PRESENT TIME
PLiCANT'S LAST ADDRESS OUTSIDE THE UNITED STATES OP MORE THAN ONE YEAR
STREET AND NUMBER
CITV PROVINCE OR STATE COUNTRY WCNT*
' v£.AR A") NTH
YEAR
1
PL
CANT'S EMPLOYMENT LAST FIVE YEARS. (IF NONE. SO STATE.1 LiST PRESENT EMPLOYMENT FIRST .. | F^Q
V TO
NAME AND ACCRESSCF EMPLSVEP i OCCUPATION •Soecifv- MONTH
; Y£*p MONTH
YEAR
; • PRESENT TIME
i • i
;
i
i
Show below last occup
tation abroad if not shown above. (Include all information regue
sted above.)
HIS FORM IS SUBMITTED IN CONNECTION WITH APPLICATION FOR
| NATURAL: z * Tien I j OTHER is^tcirn
"j STATUS AS PERMANENT RESIDENT
v t>i3t»inq or t-vstr served in thft Armed Forc*S of the United States, eomp!ef« th«
follov.'ing .•
Branch of Serwices Renk SwnrJc* Numb«r
INS USE
Office Code
Type of Case
Date
(Office of Origin)
To 0?h«r A^amcy: Ploose kifnish on th» r«v*rs* of this form. Of by attaeiimartt Rsw«no,
5r»y dwogatoiry infisrmcrtfon Hiat may b* contained tn your records Concerning th« above
2»f;:,on, fofu»a in conrt»etion with conild«r«rtlon of above- apoli cation <md return to
J. S. Immigration and Nature! j z of ion Swl<«»
(OTwer A«wcy)
FOt SIAJI
wi&ruBn wz
r^JLL DEFENSE CHECKS)
MAIL TO:
DIRECTOR,
UNITED STATES ARMY INVESTIGATIVE
DDQDnD
g » o ? s %
1 < < » *
s 1
D
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D
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(OSNJ
SAIL
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AftASV
D
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G-2
a
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MAB.
RECORDS REPOSITORY
ATTN: ICIRR-A
FORT MEADE, MARYLAND 20755
ATTENTION: LIAISON OFFICE,
IMMIGRATION AND NATURALIZATION SERVICE
STATE
STATE
(S.Y.I
arms
Wt OJ. 333.! FO(t
MAILING AflMKU
&ff O.I. 103.4
FCMt MASUNG AJDO«£U
v********-***-,*.
'o®* G-3351 I
"^7"""
ir, r. ., ,
to tho subject of ycx
;:c*xJ» of *i«i D®piartTwwrt slvow th* folbwing wiH»
l organizations, clubs or sa*i«Ji@* in th« United Stert®«, or in ony other co^nt-/, -f which --S«nr-' ••«:•$ a
ih*.iof. (1^ nom,
.j
'., convichcxw, disciplinary actions, court wartial procacdingr, and iil»v»c or
<lcrt** and rauiltt tharvof. {H norm, show "Noo«".)
-•••toiii cf o ••';• f:r--il of written stot»m»oH, conduct, behavior ot QMocictior'.t c; .-.- > zubjvcl •* • . mdicoia b-
t oi- yref jf«nc« ex tympothy for Communism or any ortvor foreign id*oiogy iricor-.mtjint viith . ..• rhe United
f govxtfnmcirt of tK« United St<^@j or attachment to th« prtnciplai of tS® Unitwd Stnt«-5 Gsiisr ,'if none, i
.-w,) in ••-rr-.'Jtioo oc referonces.
;ing th©
corwct cjjiording to ;.r... ;Uk^,
vn of OwjioftnwiU -. •.•i\':wintotio*i)
Official signature
10/1/80
TM 779
ADMINISTRATIVE MANUAL
Appendix I
G-711
DEPosrr CXJPY
COPY
FILE COPY
Individual Fee Register Receipt
imrrto*T»Tu of»A»m«Ki o Jusnu
• MM"!** " O'XI* T«A1H *«M<
APPLICATION FOAM NUMBER
lUOCLf
IK UK A I-WO S S"
!».« 1 »* B I-K-) S MO
i-i:; •> we
n: i ».
MCMITTANCC PC
UO • twO C !
FORM NO.
G-711
sirs
4X6
C01TKW
7-1-77
INDIVIDUAL FEE REGISTER RECEIPT
D4STKUCT1OM HXTCUCNCC
AM 2941.01, Ex. 2
USED TO RECORD AND ACCOUNT FOR APPLICATIONS AND FEES RECEIVED
SCHCDOUC B
SI M&1ASY OF FEES
RECORDED ON INDIVIDUAL FEE REGISTER RECEIPTS
UMTED STATES DEPARTMENT OF JUSTICE
IsmigrBiten end Naturalisation S*rvnM
Sat l call ructions tiwJvi Ml 5NW.
1. L«calii9n
2. Dot*
4 Fe-* Paid NurateM
S. Twal R»c«»pts
4.. Vt>»fi«!
7. Farar.c4^
Dei«
SlCMIUI*
Dai?
5,«««.
8 Drfctxii!
9 Virni.m . F.na^TT'^ZrTc^^To^r™111^
Dole
Numti-f
P..,
S,,MMW
Foi»G-7I2 TO
(70-771
Fern G-715 TO
("•> ~1
am 0-7U
- I •??)
10 Agnwry Cow W SET 21 S.
T»eii«
5
willu*
Ki Sjmtol
1 roKM NO.
1 C.7V
?;'DIT/ON 2 TITU:
| SUMHAJIY OF FEES RECOKOED OK 1?®1V!DUAL FEI REGISTER RECEIPTS
7-J-7' -1
SIZ£
a x E
INSTRUCTION mjSFJOtKMCS:
*M ?«B; Ex. 2, 2984.05, Ex. S
OSJC
USED TO ACCOUNT FOR REMITTANCES AND INDIVIDUAL' FEE RECJSffiR RECESfTS ISSUED FOS FEES
SCKXDDUC B
10/1/b-U
i c
1 5
„?§ E
r. c. 3
</>*•»
FORM NO.
C-714
COITION TITiJC
REailT TOR RWDS AND VAUJABLES TMNSFERRED
(UUC
8 X 12 1/2
INSTRUCTION KSUTEJUMCE
osr
USED TO DOOltCVT TRANSFERS OF ACCOUNTABILITY AND RESWNSIBIL1TY FOR FUNDS AND VALUABLES
SCHXDOJJC A
10/1/80
IHAPIhK 9
9. OTHER FORMS OF IMPORTANCE
Form 1-53 - Alien Address Report 9-1
Form 1-94 - Arrival Departure Record 9-2
Form 1-134 - Affidavit of Support 9-3
Form 1-196 - Application for U.S. Citizen
Identification Card 9-9
Form G-62 - Reauisition for Federal Textbooks
on Citizenship 9-13
Form G-325 - Biooraphic Information 9-14
Form G-325A - Biopraphic Information 9-15
TM 805
ADMINISTRATIVE MANUAL
Appendix 1
1-53
majT' IM1DDW
i. Anumss IN rut i; v ii\cirt imnit itm IWAU/ ..
.1 ilHt-WUW ADDBUS IN MEXICO OR CANADA «E ITEM HI
°K TOWN "iTATi ilr CODE I CHIC* HERJ TP
__^ I AOOREU It CL-attSNT
CARD4 *° 'R°M *LUN ' MACE ENTERED THE US h WHEN EM EBED L S (MO DAY, YR) |l «£
ircorr,-«o,mTH ,.' Mflo».,arS u cUsT.vo.cu.uMH.. rirTgr^^ll1
- I .MooAYYuj I I nmN™NU1
" |*OCUlL-]i^'-'1'TJNS l',r i^lU" >0* COVtHNUtNl HE ONLY ' ^^
i5li3JinT____T_
IMAIN JOa'l* "0!r Rt<-l.vr OCCLP4TION IS LJ TTt TYfi OF flRM OR Dl5!\t« Ot ?*tlEST OB UOrr
I »eC£.NT HIPUOYHENr l«AIN J0»l •'""•"•""
Afp»OP«IATt »OX, WHEN DID VOt RECEIVE VOIR 1-BliEM IMSIICHATION JTATt7J3
'MO DAY VR,
J^SSss^r.r; :HS::-^^— -^
!•. I CtRTirv 1HAT THE STATEMENT, ON TH|» CA«D A«E ^rrrO-^rigroF MY KSOWLEOCE^^1-
;_ ^^TLKt ilF LVOER l< YtAKS OtO. ilCNATt-'KE OF P^IUST l)» CL4XDIAM
I' t (If PARTMtNT OF HSI l(,l
IMMIGRATION AND NATLRALI/ATIlIN MRVlCt
. n c ZOMS iv, -a, _ ..i ,n,.»._^H_,. MJICl 1W
*^«,.rt b. v< IM UN A,, n i. s r uoi, d.u .op..,.,«,« (£/o?T.i7«;.i HAW HCtt
iiwludtng wxial erenrilf numbft u^d bt INS foi '
uiT,?."!,;^ I'iTVj'iiV^ \£ rf,Vo,^^!,?'o«'?,.1, «. «»vict
Addrro WIU. HOT
b, 6« M ,»„„«,„. siirvrt
U. S. Immijration 4 Naturalizstion Service
Arlington, Va. 222 IS
FORM NO.
1-53
EDITION
REV. 1-1-81
TITIJE
ALIEN ADDRESS REPORT
SIZE
6X41/2
INSTRUCTION REFERENCE 8 CFR 265.1, 299.1; 01 265.1; AM 2050.08, 2113.02, 2301.56.03,
2482 Ex. 2. P. 1, 2711.07, 27,45.01, 2745.01, .02, 2780.04, 2782 Ex. 8, P. 9, 2787,02, 2793.23,
2798.03; II Hbk 16-21; Irw. Hbk 9-6, -7, 10-6, App. 9.2-A; GIB A-6
USE
ANNUAL ADDRESS REPORT CARD SUBMITTED EACH YEAR DURING JANUARY BY ALL ALIENS IN THE UNITED STATES
PRIOR EDITION MAY BE USED
SCHEDULE
s PRINT CIEA&V. i
; EOTN COMB MUST ££
39 ;llio.> nea. »««-!,., 1 .....io.
• (DO nor us? «wcrJ f
k Ihi I "*' itwiwiafonla I
J and P«tin«B«al fiasl- >i..^_.
K doni Alien* complil* t^oi
P IOD lou> I'M* only. i
Con be losolsd.
| FoiAfri.olinU.S. ( **" ""*%™ ' **'*''
i BV H.S. IMHMMATIW
« & NATURALIZATION
a SERVICE.
•a (oo wor fOiol
144
f Mil K»B» Mlijlo toluol
o o Peaaaegei 8ee««o<f
. DOB ceil Veer o) Sit*
IMPORTANT NOTICE
> '»?. •" • satmii in .out .ictsM'*1-*
'IB v*'--.;iJ <M>:t ol ,'-!« "-sa dot i ml 'tan
/••>•. rA. • • iCt.i^si-,/ . r»—*''i in in* u '- lor
• n it ••
i, -»j • it . -now t/4 t»>t .isf & lor '.n 'his
.-',„.-, r>,i.. im-rogiattci" jurthooitai .(, a
V/Mf-S i:;ij LgAWE THE UNITED ST* ?K,
• Qv sw u> air. awtgnaai :nis pafini! to '-ais-
. Cvp CaOMian uotd*' i r-ai'.d9r this pif.r . to
Canadian unmigration ijl! -,ai
'jj"_ Mf- an btirdsr surrender Ilia permit 10
i.'-iica SiH'8', immiar«ian O'fictr
RECOWW BCT£NSK>MS
. OillC©
, 0«ie®
Office
KWWUM ttlCOHQ
Pon.
Offito.
Carrier:
To:
uNirgrj sraes me&m^nm of JUSTICE
1-94
REV 6-1-
AttWAL-BEP/RTURE RECORD
SU£
5X3
8 am
01
t 103.
'31.1. .
735.6<i>)
735.15.
.3.
.10
103.8(«t)(4), 105.'
(Is), (f )(•»), 935.4. •'4<1.5<»)(3),
P.l, 990.1, .3, ,4g 4'
•}5.in(it)(b). '3S.ll(c),(e),(f),(i).(h). »35.l'(d).(f),(l), .14(r),(b).(e)a>,
.1C®), (b), '47.10 (b) <!),(£). 943.5. 944.3, <>45.4(s.)(4). 945.r(»)(f). nS.SH).
1.- 748.1(b),(d). 751. 3(c), ?f.4.1,..7t .F, 580.1. "90.5(1), .*, 341.3. '0 CFt
7'Cni f-3'.ln(*), f»3.l4(f),(g), S3.7'(b)(l), (*)(il). (b)(4)(lt). 41.1n5(f)(')(D.
, «3.7?(b)(l),('), M.77(b)(4), 9QCFR 4K.904(»): AH 7301.05. .0.'. ' .Of .03. .5*. 01,
9313.W, .07B .09, .11, 9M4.07, .91, .97, 7414 Ex I, '414 EJS 9, T/Of-.O*1, .OX 7719.03, .OF.
.07. 974S.01, 9?7«}.@'>e ?788.0«, '790.01, .09, .07.03. .01, .05, .0*. .08, .0«. ,11. .1*, .13,
.14, .IS, .18, .19, .90, .n, .93, .-94. .95. .?*. .31. .33, .35, .36.. rm Es? I, '794.01.
.07, .03, '798.03. ,0ft, .«, .170, .131, .139, '799.01, .03, .Of, '•937 Kst 1, *9*4 Bw 9,
7984 fix 4: XX Hbk. ft-548 -55, T-15, -'0, -'0.1, 8-17, -14.7, -14. 3, -14. 4, -14. S, 5.. -5. .-.R
9-7,-7ji,.3.-4,-5,-8.l,-9,"10-,-lO.',-tl,-l7.-l4.1,-l6.-18> 10-10,-13,-14.18.1,-19,-71,
-95,-301-3l,-44,-49,-30.-5l,-S4,-5f,-57.-58.i;-*3. 13-?. 1, 13-6.1, U-fi.-'S. 16-3, -4.
•=!P,,-i?,-489~19,-?©,-9®s-?f,-33, 17-8,-17,-'»0,-'l."'3.-'4,-"-,-'9,-30,-31,-35, 18-11*, 19-'
-6.3,-8,-9,-10,-ll,»l',»l3, 70-4, -5, -f, -P. I, "-4, ?3?4, App 8-A, I'-C, 19-^A' 3tW Hbk
t.y -f, 14-8.-10, 71-17, 7?-l9, ?4B 97, 7'-78,-99,-30,-31.-3', A|i» "-D- B3P ' HhV. 18-8. -10
SIB 'TsZ3iZ£«ZiL_^ESI°(:»"'5P: BO Hbk 15-8. -9, 94-', 95-1, A»p: 17-18
mm
EXECOTTO FOE ETOW WTOlMGIUHt MEnOOED TO JTOSOT A VISA, EXCEPT CRBJKAK. OEICIHAt
HOHiMMiCTAirr UKm DEPAKOIE. ram usro pot KVEKT ALHH EOTEIIHG AHD DEPARnmj VIA
Mo Carbon P®ip®r ( OrigJw®l aerf I csswy) Al-o cviilloblc In -ingle cm»y.
»Y SOCH
Lj>ngu«g® trsn^latieai for
mwlli4» in
lt*lim,
a.
Sfiimi-h.
& Dutch
mem EDmons MAY BE usra
10/1/8C
9-3
FORM 1-134
I. USE:
TO EVIDENCE SPONSORS INTENT TO PROVIDE ECONOMIC ASSISTANCE FOR ALIEN
BENEFICIARY OR APPLICANT.
II. ELIGIBILITY,:
ANYONE WHO HAS ADEQUATE RESOURCES TO PROVIDE ECONOMIC ASSISTANCE AS
SET FORTH ON 1-134. CARRIES MORE WEIGHT IF SUBMITTED BY SOMEONE
WHO HAS A LEGAL OBLIGATION TO PROVIDE SUPPORT.
II. REQUIREMENTS:
1. MUST BE NOTARIZED OR SIGNED BEFORE AN IMMIGRATION OFFICE IF IN THE
UNITED STATES.
2. OUTSIDE UNITED STATES MUST BE SWORN TO BEFORE AN IMMIGRATION OR
CONSULAR OFFICER.
IV. EVIDENCE:
1. THE DEPONENT SHOULD SUBMIT IN DUPLICATE, EVIDENCE OF INCOME AND
RESOURCES, AS APPROPRIATE:
a. STATEMENT FROM AN OFFICER OF THE BANK OR OTHER FINANCIAL INSTITUTION
IN WHICH YOU HAVE DEPOSITS GIVING THE FOLLOWING DETAILS REGARDING
YOUR ACCOUNT:
(1) DATE ACCOUNT OPENED
(2) TOTAL AMOUNT DEPOSITED FOR PAST YEAR.
(3) PRESENT BALANCE.
b. STATEMENT OF YOUR EMPLOYER, PREFERABLY ON HIS BUSINESS STATIONERY,
SHOWING:
(1) DATE AND NATURE OF EMPLOYMENT
(2) SALARY PAID
(3) WHETHER POSITION IS TEMPORARY OR PERMANENT
c. IF SELF-EMPLOYED:
(1) COPY OF LAST INCOME TAX RETURN FILED OR,
(2) REPORT OF COMMERICAL RATING CONCERN
d. LIST CONTAINING SERIAL NUMBERS AND DENOMINATIONS OF BONDS
AND NAME OF RECORD OWNER(S).
10/1/80
9-5
TM805 ADMINISTRATIVE MANUAL I-134
Appendix 1 Pa9e '
UNITED STATES DEPARTMENT OF JUSTICE f°trn W'0?.'1,*,*
Immigration and NaturaliiMioa S<rvi« OMB No '»>-«'»>
AFFIDAVIT OF SUPPORT
(ANSWER ALL ITEMS; FILL IN WITH TYPEWRITER OR PKINT IN BLOCK LETTERS IN INK.)
I . residing it
(.Snt.jcl (Siren »nd Numlxl)
(Gt,, (SUM I <ZIP Codt if in U.S.) (Counlrrl
BEING DULY SWORN DEPOSE AND SAY:
(Duel (Cr») (Couwnrl
If you are not a native born United States citizen, answer the. following as appropriate:
c. If United States citizenship was derived by some other method, attach a statement of explanation.
2 That t im years of i^e and have resided in <hc Uni'"' <^»« tinet (date) ,
5. That this affidavit is executed in behalf of the following person:
(N^Kk (S"" 'A'"
(Cliwn of - Countrv) (Minul SI.IMI (R.luumiH.i, w OspoMnll
(Prt»tnll;t«idn .1 — Sire* uidNunlwl (Cm) (Sum (Couniry)
4. That this affidavit is made by me for the purpose of assuring (he United Slates Government that the person named in
item 3 will not beiome a public charge in the United States
V That 1 am willing and able to receive, maintain and support the person named in item }. That I im ready and willing to
deposit » bond, if necessary, to guarantee that such person will not become a public charge durinp his or her stay in the
United States, or to guarantee that the above named will maintain his or her nonimmigrant status if admitted temporarily
and will depart prior to the expiration of his or her authorized stay in (he United States.
6. That I understand this affidavit will be binding upon me for a period of three (3) years after entry of the person named in
item 3 and that the information and dooimenation provided by me may be made available to the Secretary of Health and
Human Services.
(T»p« oJ bu.innil (Nirnt of wncnii)
at
(Sirw uxi NuoiUr) (Ctrl (Suit) <ZIP Cod.)
I derive an annual income of (if self-employed. I have attached a copy of my last income tax
return or report of commercial rating concern which I certify to be true and correct to the best of
I have stocks and bonds with th« following market value, as indicated on the attached list which
I rrrtify to he fntr »nd CfKKrt to thr best of my kn'v1<r<i£f >id b*''''- $
WiHi a ""ash ^iirrcnd'c vslut of $ —
I own nr>l estate va)ued ?t $
With mortgage or other encumbrances thereon amounting to $
Whirh is lnrirr<4 it
(SUM <md number) (Clr) (StaM) (ZIP Codo
Pom I-U4
tst*t. 9-a-ati} N
FORM NO. EDITION TITLE
!.134 REV. 9-30-80 AFFIDAVIT OF SUPPORT
SIZE INSTRUCTION REFERENCE
8 1/2 X 11 8 CFR 103.2(b)(l), 299.1; 01 103. 2(h), 248.7; AM 2482 Ex. 1, P. 5; GIB Hbk P. 30, App. 7, 55
USE
AFFIDAVIT OF SUPPORT BY RELATIVE OR SPONSOR OF ALIEN
PRIOR EDITIONS HAY NOT BE USED J SCHEDULE A
That the following persons are dependent upon me for support: (Place a check J in the appropriate column to indicate
whether the person named is- wholly or partially dependent upon you for support.)
NAME OF PERSON
WHOLLY
DEPENDENT
PARTIALLY
DEPENDENT
AGE
RELATIONSHIP TO ME
j
I
1
9. That I have previously submitted affidavit(s) of support for the following person(s). If none, state none.
10. That I hive submitted visa petition(s) to the Immigration and Naturalization Service on behalf of the following per-
son(s). If none, state none.
Dan i at mint J
11. ( Complete this block only if the person named in item 3 will be in the United States temporarily.)
That I Q do intend £] do not intend, to make specific contributions to the support of the person named in
item 3. (If you check "do intend", indicate the exact nature and duration of the contributions. For example, if you intend
to furnish room and board, state for how long and, if money, state the amount in United States dollars and state whether
it is to be given in a lump sum, weekly, or monthly, and for how long.)
OATH OR AFFIRMATION OF DEPONENT
/ jiifji (afftrrn) that 1 knou the contents of this affidavit signed by me and the statements are true and correct.
Signature of deponent ...
Subscribed and sti'orn to (affirmed} before me this day of , 79
at My commission expires on
Signature of Officer Administering Oath
Title
If affidavit prepared by other than deponent, please complete the following:
I declare that this document u-as prepared by me at the request of the deponent and is based on all information of which
t hare any knoidedge.
(Signature)
(Address)
(Date)
4/1/81
(Please tear off this sheet before submitting Affidavit)
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization Service
AFFIDAVIT OF SUPPORT
INSTRUCTIONS
I. EXECUTION OF AFFIDAVIT.
A separate affidavit must be submitted for each person. You must sign the affidavit in your full, true, and correct
name and affirm or make it under oath. If you are in the United StMes the affidavit may be sworn or affirmed
before an immigration officer without the payment of fee, or before a notary public or other officer authorized to
administer oaths for genera! purposes, in which case the official seal or certificate of authority to administer
oaths must be affixed. If you are outside the United States the affidavit must be sworn to or affirmed before a
United States consular cr immigration officer.
II. SUPPORTING EVIDENCE.
The deponent should submit in duplicate evidence of income and resources, as appropriate:
A. Statement from an officer of the bank or other financial institution in which you have deposits giving the
following details regarding your account:
1. Date account opened.
2. Total amount deposited for past year.
3. Present balance.
B. Statement of your employer, preferably on business stationery, showing:
1. Date and nature of employment.
2. Salary paid.
3. Whether position is temporary or permanent.
C. If self-employed:
1 . Copy of last income tax return filed or,
1. Report of commercial rating concern.
D. List containing serial numbers and denominations of bonds and name of record owner (s).
III. SPONSOR AND ALIEN LIABILITY.
Effective September 30, 1980 amendments to section I6l4(f) of the Social Security Act and Part A of Title
XVI of the Social Security Act establish certain requirements for determining the eligibility of aliens for
Supplemental Security Income (SSI) benefits. These amendments require that the income and resources of
any person who, as the sponsor of an alien's entry into the United States, executed an affidavit of support
or similar agreement on behalf of the alien, and the income and resources of the sponsor's spouse, shall be
deemed to be the income and resources of the alien under formulas for determining eligibility for SSI benefits
during the three years following the alien's entry into the United States.
An alien applying for SSI must make available to the Social Security Administration any documentation
concerning his or her income or resources or those of the sponsor which were provided in support of the
. application for an immigrant visa or adjustment of status. The Secretary of Health and Human Services is
authorized to obtain copies of any such documentation from other agencies.
The Social Security Act also provides that an alien and his or her sponsor shall be jointly and severably
liable to repay any SSI benefits which are incorrectly paid because of misinformation provided by a sponsor
or because of sponsor's failure to provide information, and any incorrect payments which are not repaid will
be withheld from any subsequent payments for which the alien or sponsor are otherwise eligible under the
Social Security Act.
These provisions do not apply to an alien who becomes blind or disabled after idmission into the United States for
permanent residency. They also will not apply to aliens admitted as refugees or granted political asylum by the Attorney
General.
IV. AUTHORITY/USE/PENALTIES.
Authority for the collection of the information requested on this form is contained in 8 U.S.C. 1 182 (a) (15),
Il84(a),and 1258. The information will be used principally by the Service, orby any consular officerto whom
it may be furnished, to support an alien's application for benefits under the Immigration and Nationality Act
and specifically the assertion that he or she has adequate means of financial support and will not become a public
charge. Submission of the information is voluntary. It may also, as a matter of routine use, be disclosed to
other federal, state, local and foreign law enforcement and regulatory agencies, including the Department of
Health and Human Services, the Department of State, the Department of Defense and any component thereof
(if the deponent has served or is serving in the armed forces of the United States), the Central Intelligence
Agency, and individuals and organizations during the course of any investigation to elicit further information
required to carry out Service functions. Failure to provide the information may result in the denial of the alien's
application for a. visa, or his exclusion from the United States.
Foim J-1J4 For wile by the Superintendent of Document*, U.S. Government Printing Offlc.
(Rev. 9-30-80) N Wellington. D.C. 20402
4/1/81
FORM 1^.
I. USE:
APPLICATION FOR U0S. CITIZEN IDENTIFICATION CARD,
II. ELIGIBILITY:
MUST BE CITIZEN OF THE UNITED STATES* EITHER BY BIRTH OR BY
NATURALIZATION, OR MUST HAVE DERIVED U.S. CITIZENSHIP AFTER BIRTH
III. REQUIREMENTS:
1. ONE PHOTOGRAPH PER INSTRUCTIONS ON FORM,
2. PROPER FEE,
3. IF APPLICANT BORN IN THE UNITED STATES* SUBMIT BIRTH CERTIFICATE.
4. IF BORN OUTSIDE THE UNITED STATES:
a. CERTIFICATE OF NATURALIZATION;
b. CERTIFICATE OF CITIZENSHIP.
5. IF PREVIOUSLY ISSUED A UNITED STATES CITIZEN IDENTIFICATION CARD;
a. OLD CARD MUST BE ATTACHED, OR;
b. STATEMENT EXPLAINING DISPOSITION OF THE OLD CARD.
c. IF FOR A CHANGE OF NAME, A CERTIFIED COPY OF MARRIAGE
CERTIFICATE OR A COURT DECREE CHANGING THE NAME MUST BE
ATTACHED.
(NOTE: DO NOT PICK UP CERTIFICATES OF NATURALIZATION OR
CITIZENSHIP. INDICATE ON FORM 1-196 THE CERTIFICATE NUMBER,
DATE AND PLACE OF ISSUANCE AND ALIEN REGISTRATION NUMBER* IF
AVAILABLE, AND NOTE "NATURALIZATION CERTIFICATE SEEN AND
RETURNED", WITH DATE AND INITIALS OF CONTACT REPRESENTATIVE.)
-1-
10/1/80
IV. EVIDENCE:
1. CERTIFICATE OF NATURALIZATION;
2. CERTIFICATE OF CITIZENSHIP;
3. BIRTH CERTIFICATE INDICATING BIRTH IN THE UNITED STATES.
-2-
10/1/80
P MO T;C"* 1*^*5 0«« ' ti K»xiiofl*6uP» I
AUK* *•— < Dew 0-e Oo -xrt g'ta c»w«
SUPPCA~.*tG OCCUUENTS fiTTh Cfi
<r>*ent t)» cnacn 3* monav oaO«
i*1** «fxJ >* o*veu-« <n U"-t«J S'
Da p«vH>« to tt« *Tre«turar G
.
l«r«l a' 85 00 «•(( BO .mOO«Xl it * Cf<«C« <n C
» 52 OOOof mo»mnvtj *
FORM NO.
1-196
EDITION
Rev. 10-2E-79
T1TL£
APPLICATION FOR U.S. CITIZEN IDENTIFICATION CARD
SIZE
5X3
INSTRUCTION REFERENCE 8 CFR 235.10(c), 299.1; 235. 2(b), 290. 5(i); A* 2301.07,
2482 Ex. I, 2799.03, 2984 Ex. 2, Ex. 4; II Hbk 8-27, -28, -29, -30; Inv. Hbk 6.2-7; SIR A-7
USE
APPLICATION FOR IDENTIFICATION CARD - FORM 1.197
(Carbon-interleaved, original and 2 copies)
PRIOP EC:~::N c~ =?E
i/. 9-9-78 MAY BE USED ] SCHEDULE q
4/1/81
NAME (LMtmcacal
PRESENT HOME ADDRESS
BIRTHDATE
BIRTHPLACE
HEIGHT
PT, IN
HAIR
EYES
WEIGHT
LHS.
MARKS
FATHER'S NAME IN FULL
MOTHER'S MAIDEN NAME IN FULL
I claim to be a citizen of the United States for the reason ihown below. I have never to the best
of knowledge lost my United States citizenship, in any manner. I Q have Q have not b<wn
previously issued a United States citizen identification card, tlf you avar had such a card, s»a
instruction 2.)
D Birth in United States Q By own naturalization Q
D Naturalization of my parent (s). Q Birth abroad of U.S. citizen parem(s).
In support of my application, I submit the following documents:
I hereby make application for a U.S. citizen identification card, and furnish tha abova infor-
mation under oath.
Signature of Applicant
APPLICATION FOR U. S. CITIZEN IDENTIFICATION CARD
Upon basis of supporting documents and other evidence as follows:
I am (am not) satisfied that the applicant is a citizen of the United States.
Imm. officer
(Signature and title)
FEE STAMP
Application
Form 1-1 97 #
Issued on
at
Granted
D<mied
DATE
OF
ACTION
DD
OFFICE
Signature and title .
4/1/81
NOTICE.:— This font, whea properly emeeuted, 8M»uld b*
re turned to the Immigration cnsj N®8u«slntMjon Sarvjee
office S&OWB boSow. Any o£ the titles o^iterod tuhieh at®
HOI laelasisd on shipnmt ere eat in st&ek— WAIT 3
MONTHS BEFORE RE0RDESWG.
RgOUISITlOH
FOR FEDERAL TEXTBOOKS
OH CITIZENSHIP
(SuW»il so duplisete)
r
TO:
L
J
1 request copies. SB ordamd balow. of th« FEDERAL TEXTBOOKS ON CITIZENSHIP which, under statutory
limitMKMM. ate distribute trae only to fc&adid«ti>a tor United Sut>« citizenship who are altendtn^gubiic school
claaa«a or classes undo the pupsrvisaen of tha public
=d
BECOMING A CITIZEN SERIES
Book 1. Our American ft ay of Lik (H-161)
Booit 2, Ou: United States (U-162)
Book 3. Our Cov@nment (M-163)
Toucher's Gusde (M-264)
OUR coNsrnnmow AND GOVERNMENT
Our Constitution @nd Govsmitt«at, Rogulaf Editkm (M>7)
Our CoBKtitvrtioa end Covaniaiiajil , Swapiiljad Edition (M-B)
EnUf|j«<l Charts (s«rt of IS) (For use fey instructors ooly) r«pn>dijce«J hocn Our Constitution and
GowwnEKtnt (y-9)
HOME STUDY COURSES
Our Constitution end Covemmamt (M-39) (Use with M«8)
Our Constitution and Govarnraeot. Sugiitatioas for th* Help«r sni Fina! Tests (IMO)
Section 1. EnglBBh and Home and Cosamuaity LH«, Fof Ibe Studanl (M-41)
Section 1. English and Home and Coramoaity Lif«. Fertile Helper (M-42)
Section 2. Ejiglmh and FcdataJ Goveroiiufit, For tb« Student (KM3)
Section 2. English and Fadsial Goveia@«flt, For the Haipar (&M4)
Section 3. English and State Govanwwnt. For the Stud&at (U-4S)
Section 3. English and Siole Governateol, F(» Che Helper
TEACHERS' AH)
Aids for Citizenship Teachers (M-35)
CERTIFICATION: — I canify that asie^iolE oavsmd by Slut Above requisition «all be distributoii (re* of
charge to candidatES for United Stetea citisonahip for thaif uos in public school citizenship tlaasas. ot
clast»*j helti unoejjlhe_j»i£ejvi«iio^^
SICVgO IN«K» o»d tOlalal till* «/ oi£u>o ttrozlan; (Ploeexl sn-lsK Mils)
APPWOVgD BY (Bl4tioiw»» s»4 a(fl<l&! tltlo of xspravifqt ee&eal autlMHllr) (Ploaca p»re« II>U)
UM1TED STATES
OF JUSTICE -
end Naiu^k.iaiim,
G-62
Rav. 7-25-68
MQUISmOK FOR FEDESAL TEXTBOOKS OM CZTUZHSHIP
8 X 105 AM 2482.0801; MAT Hbk 14-13
REQUISITION FOR TEXTBOOKS ON
PRIOR EDITION MAY NOT BE USED
BtOORAPHSC
MFOIMATION
UNtretJ STAJO OEPAtfTMSMT Of JUSTICE |r™ &KWW«^
^^^^ £^ S^!^^££i^i9 3&ti&9
'"*"* i"""'1 """""""cfii*
IMtXDAnilM.4«-nj
utmMifT
»u mraett
A-
uaiiiiiHHiiaioii.MiiM.tiiM.MiNM unwott
iaaiB» w Biflm
»SECutolw
FiWVB&M
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INS USE (Otiica oi OriQin)
OW ICE COOS:
TYPE W CASE:
DATE;
asawo
ftSBBS
0..4M |2] R*
K. BS,
FORM NO.
G-325
EDITION
REV. 5-1-79
TITLE
BIOGRAPHIC
INFORMATION
SIZE
8 X 10
1/2
INSTRUCTION REFERENCE 01
212. 7(a) (1) (i), 214. 2(b), 235.
235. 9(f) (1); AM 2301.27, -30.02
103. 1(c)
12(1). W
, 2792.15;
'Hi
II
105.10(a) thru (
. W (f), W (3
Hbk 6-7, -10, ADP
f), 204. 3(b) (3), 212.3,
), 249. l(a), 335C.5, 6; 8
10-E; Natz Hbk 1-15. -33,
CFR
-34
USE
USED TO
CHECK FBI RECORDS
Carbon-Interleaved (Original
and 1
copy)
PRIOR KDmOH OF «V.»-l-7* »t M OSTO
|_SCHEIX;IJ:
B
4/1/81
App*ndi3r I
UNITED STATES DEPARTMENT Of JUSTICE Onl U. 4M4M
BIOGRAPHIC
INFORMATION
Oeoi'iy MIM! (htii «o«.) f»M4» MHO- lD*Ali TUfHnMllMo.-Oot-*' ) NATIONALITY ALUM tt<W»ATtOSI UO.
DHMAlt|
All Of HE! NAMIS IBU IUKWM* M-M M M«w. H»M«n) CITY AMI COONTtT Of MJ1H ~ ~ SOCIA1 StCUtmr HO
tAMIlf NAM flCI MMi MIL OTT AND COUNTItT Of XtTH(H kM»«) OTY AMD COUNTIY
FATMCI
IMOTHftlMoxtoo IK»II><
KUSBUiDlitwM.MiWM) fAMHY NAMi HKT HAW UBIMUnn CITY I CtXWtrf OF IUTM C+Tl U MMttkAU HAd Of MMSUZT
|IC*MI* HUIIAHU M «nV|II>t MW.U IMM)
|>AMIU UAMt ll» -I., f- -^»t. M~r' I ntTT MAMi BISTMMTt DAT! i •_HJO_U UWJWAOIJ MTl^)(D PIAO ^0« TJRMMATttN Of HMMACt
L
APPLICANT'S MESIOENCE LAVT PfVC YftA
AP'LlCAMT'S LAST ADDMCSS OLTTIIOC THE UNrTCD STATBS O» UOIf THAN ON( VtAM
errr
A»UICAHT-t »MPI.OVU1NT LAST fl«t VIAHS H> MO»H. »O STATt I U«T P>»»tMT EMPUOYMEMT »IKST T ffQM F T(T
fUU NA>« AMD ADOUU CV IMftOYIt OtCUPATIO»l»»«cirti MOUTH TtAI MOKTK TtAt
Mmm T»H
I 111
THIS FOKM U SUtMinU IN CONNlCMON WltH A^PULATICN fOt
D »»TU.AL,»Vo. O AOJU.T«HT »F .TATU.
Q YM
A~nV>! IO A KIT' BE SURE TO PUT YOUR NAME AND ALIEN REOIST»UTION NUMBER IN
Ai r LILrAlX 1 . THE BOX OUTLINED BY HEAVY BORDER BELOW.
(OTHER AGENCY USE)
POOM O-OMA
Ml
"' -
INS USE (Otftca of Origin)
omcteoo&i
FORM NO.
G-325A
EDITION
WJV. 10-1-74
TITIX
noGKApfficc nrroiMAnoir
size
8 X 10
USX
INSTRUCTION WCrER£NCr 8 en J45.2U)(2), >49.2, 299.1; 01 104.1, 105.1U), .2(«), .9(6)
106.1, .2, 204.8, 212. 4(«), .5(e), 223.1, 233.7, 243.4, 24S.l(a), .2(4)(1) thru
3(b), .40>), .3(e), .8(e), 249. 1(»), 132. 4{a) , .4(e); II Xbk 1-26, 3-35, f-2£,
-29, -38, 6-7, 10-4, -4.2, -3 thni -7, -9 thru -11, -15, -22, -27 thni -29, -61, 1»-6.1, AvplCHL
-r; Rat Hbk 1-li, -33. -34 ^
imroiMATIOH OBTAUOCD VTTB APFUCAnOR
(C»rboT>-iBtBrle«.v*d, orig & 3 copies)
mar Mincm or RTV. 8-27-72 MAT R csn>
8CHXDOI4:
10/1/80
IU. IMM lUKMLlArtl 1U1N & Ul
General Information and Charts 10-1
Form N-300, Application to file Declaration of
Intention 10-6
Form N-470 - Application for Preservation of Residence
for Naturalization Purposes 10-9
Form M-132 - Information concerning Citizenship
Education to meet Naturalization Requirements 10-20
Form N-4QO - Application to file Petition for
Naturalization 10-25
Form N-40QB - Supplement to Application to File
Petition for Naturalization 10-39
Form N-336 - Application for 30 Day Waiver -
Naturalization 10-43
Form N-455 - Application for the Transfer of the
Petition for Naturalization 10-45
Form N-604 - Application for Child's Certificate of
Citizenship Submitted by Parent 10-55
Form N-402 - Application to File Petition for
Naturalization in Behalf of Child 10-61
Form N-458 - Application to Correct
Certificate of Naturalization 10-70
Form N-565 - Application for a New Naturalization
or Citizenship Paper 10-73
Form M-600 - Application for Certificate of Citizenship 10-79
Form M-7 - Our Constitution & Government 10-103
Form M-8 - Our Constitution & Government - Simplified
Edition 10-104
Form M-35 - Federal Textbook on Citizenship 10-105
Form M-39 - Our Constitution & Government 10-106
Form M-40 - Our Constitution & Government 10-107
Form M-41 - English, Home & Community Life 10-108
Form M-A3 - English & Federal Government 10-109
Form M-45 - English & Federal Government 10-110
Form M-74 - Gateway to Citizenship 10-111
Form N-17 - Naturalization Requirements & General
Information 10-112
Form N-315 - Declaration of Intention 10-113
Form N-405 - Petition for Naturalization 10-117
Form N-407 - Petition for Naturalization 10-121
Form N-408 - Application to take Oath of Allegiance .^
and form of such Oath 10-125 •*&'
Form N-426 - Request for Certification of Military
or Naval Service 10-131
Form N-430 - Request that Applicant Appear with
Witnesses 10-135
Form N-461 - Notice to Produce Witness 10-138
Form N-462A - Interrogatories in Deposition of
Wi tnesses \ 1 0-1 39
Form N-550 - Certificate of Naturalization 10-143
Form N-560A & AA - Certificate of Citizenship 10-1*5
Form N-561 - Certificate of Citizenship 10-148
Form N-570 - Certificate of Naturalization 10-149
Form N-577 - Application for a Special Certificate of
Naturalization to obtain Recognition as a Citizen of
the United States by a Foreign State 10-151
Form M-578 - Special Certificate of Naturalization .... 10-154
Form N-580 - Application for a Certificate of
Naturalization or Repatriation 10-155
4/1/81
GENERAL INFORMATION
CITIZENSHIP MAY BE ACQUIRED AT BIRTH, AFTER BIRTH, OR BY NATURALIZATION. AT
BIRTH, A PERSON'S CITIZENSHIP IS DETERMINED EITHER BY (A) PLACE OF BIRTH, (B)
THE CITIZENSHIP OF HIS PARENTS OR (C) A COMBINATION OF BOTH OF THE ABOVE. ON
THE; OTHER HAND, NATURALIZATION is THE JUDICIAL PROCESS THROUGH WHICH A PERSON
ACQUIRES CITIZENSHIP OF A NEW STATE AFTER BIRTH.
THE FORMS DISCUSSED HEREIN ARE THE MOST COMMONLY USED IN THE CITIZENSHIP AND
NATURALIZATION PROCESS.
10/1/80
CHART NO. 1
-2
r determining whether LEGITIMATE CHILDREN born outside the US acquired US citizen-
p at birth.
:RIOD
PARENTS
— — RESIDENCE REQUIRED OF ~~
USC PARENT CHILD
EP 1
STEP 2
STEP 3
STEP 4
lect
riod in
lien
ild was
rn.
Select
applicable
parentage
Measure citizen parent's residence
against the requirements for the
period in which child was born.
(The child acquired US citizen-
ship at birth if, at time of the
child's birth, citizen parent had
met applicable residence
requirements.)
Determine whether child
has since lost US citi-
zenship. (The child lost
on the date it became
impossible to meet
necessary requirements
—never before age 26.)
ior to
24/34
Father
citizen
Citizen father had resided in
the US. (Only father could
transmit in this period)
None
i/after
24/34
orior to
13/41
Both parents
citizens
One had resided in the U.S.
None
One citizen
& one alien
jparent
Citizen had resided in the US.
5 years residence in US
or its outlying posses-
sions between ages 13 &
21. (NONE, if at time
of child's birth, citizen
parent was employed by
a specified US organi-
zation. But this exemp-
tion is not applicable if
parent transmitted under
1 or 2 opposite) - or -
2 years continuous phys-
ical presence in the US
between ages 14 £ 28
(IV (2)/ (5V
Vafter
13/41
prior to
/23/S2
One citizen
& one alien
parent
Citizen had resided in U.S. or
its outlying possessions ten years,
at least 5 of which were after age
16, or if citizen parent served
honorably in US Armed For cess
1) Between 12/7/41 and 12/31/46,
5 of the required 10 years may
have been after age 12 - or
2) Between 12/31/46 & 12/24/52,
parent needed 10 years physical
presence, at least 5 of which
were after age 14.
Both parents
citizens
One had resided in the US or its
outlying possessions.
None
n or
ter
724/52
Both parents
citizens
One had resided in the US or its
outlying possessions (3)/
None
One citizen
& one alien
parent
Citizen had been physically present
in US or its outlying possessions
10 years, at least 5 of which were
after age 14. (3)/
2 years continuous
physical presence in
in US between ages 14
& 28. (l)/(2)/(4)/(5)/
OTESs (1) Absences of
less than 60 days in the aggregate will not break continuity of
lysical presence for this purpose. Honorable service in US Armed Forces counts as residence
physical presence for this purpose.
(2) No specific period of residence is required if alien parent naturalized before
tild reaches 18 years and child admitted for LPR prior to 18th birthday.
(3) Physical presence abroad of dependent unmarried son or daughter as member
household of a person serving honorably in US Armed Forces or employed by US Govern-
ent or international organization may be counted as physical presence.
(4) A person who came to the US prior to 10/27/72 may elect to comply with
e retention requirement of 5 years continuous presence between ages of 14 & 28 years.
Dsence from the US which totals less than 12 months in the aggregate will not break
e continuity of the 5 years.
(5) The retention requirement was repealed by Act of 10/10/78 (P.L. 95-432).
arsons who had not on 10/10/73 already failed to retain are relieved from having to do so.
4/1/81
10-3
CHART NO. 2
For determining whether ILLEGITIMATE CHILDREN born outside the US acquired US
citizenship as of the dates of their births.
PART 1 - Child not legitimated
PART 2 - Child legitimated by an alien father
PART 3 - Child legitimated by a US citizen father
PART 1
CHILD NOT LEGITIMATED
Prior to
12/24/52
Mother was a US citizen who had resided in the US or its outlying
possessions prior to birth of child.
EXCEPTION; A child born before 5/24/34 did not acquire US citizen-
ship until the Nationality Act of 1940, effective 1/13/41, bestowed
citizenship retroactive to date of birth.
On/after
12/24/52
Mother was a US citizen who had been physically present in the US or
its outlying possessions for a continuous period of one year prior to
birth of child.
PART 2
CHILD LEGITIMATED BY AN ALIEN FATHER
An illegitimate child did not acquire US citizenship through its US citizen mother if it
were legitimated by an alien father, and all three of the following elements were
present:
1. Child was born before 5/24/34
2. Child was legitimated before age 21, and
3. Such legitimation was before 1/13/41.
PART 3
CHILD LEGITIMATED BY US CITIZEN FATHER
Date of
child's birth
If the child did not acquire citizenship through its mother, but was
legitimated by a US citizen father under the following conditions, apply
the law pertinent to legitimate children born in a foreign country.
(Chart No. 1)
Prior to
1/13/41
1. Child legitimated at any time after birth under law of father's
domicile.
2. Father had the required residence at time of child's birth.
3. No residence required for child to retain US citizenship.
On/after
1/13/41 and
prior to
12/24/52
1. Child legitimated before age 21 under law of father's domicile.
2. Father had the required residence at time of child's birth.
3. Child complies with residence requirements for retention.
On/after
12/24/52
1. Child legitimated before age 21 under law of his father's domicile.
2. Father had the required residence at time of child's birth.
3. Child complies with residence requirements for retention.
4. Child must be unmarried.
during an indicated historical period while the child was under statutory age, the speciiied
•ent(s) naturalized as US citizens, and the child was lawfully admitted for permanent resi-
ice, the child derived US citizenship upon the completion of these two actions, except as
ted in the REMARKS column. It is immaterial which of the actions occurred last.
riod in
ich last
ndition
s fulfilled
Statutory age
before which last
condition must be
fulfilled
Immigration
status of
child
Naturalization
of parent(s)
Remarks
[or to
24/34
21 years
LAWFUL
ADMISSION
OF THE
CHILD TO
THE UNITED
STATES FOR
PERMANENT
RESIDENCE
Either parent
or after
24/34 and
or to
L3/41
21 years
Either parent
US citizenship began 5
years after child began
to reside permanently
in US.
Both parents (1)
i or after
13/41 and
or to
/24/S2
18 years
Both parents (1)
Illegitimate child did
not derive in this
period. (2)
L or after
/24/S2
16 years
.Both parents (1)
Marriage bars deriva-
tion in this period.
i or after
/5/78
18 years"
Both parents
(1) (3)
Marriage bars deriva-
tion in this period.
3TES:
i Includes the surviving parent; the parent having legal custody of the child where there
has been a legal separation of the parents; the alien parent when the other parent is
a US citizen; or, except during the period 1/13/41 to 12/23/52, inclusive, the mother
of an illegitimate child.
i The illegitimate child who did not derive in this period derived US citizenship on
12/24/52 if under the age of 16 years on that date, and if the two necessary
actions still existed.
i After 10/5/78 adopted children can derive in the same manner as natural-born children
if they were adopted by alien parent(s) while under age 16 and are residing in the
custody of their adoptive parent(s) pursuant to a lawful admission for permanent resi-
dence when their adoptive parent(s) are naturalized.
4/1/81
DECLARATION OF INTENTION
I. USE;
USED BY AN ALIEN TO DECLARE HIS INTENTION TO BECOME A CITIZEN OF THE
UNITED STATES AND QUALIFY TO BE EMPLOYED IN CERTAIN OCCUPATIONS.
II. ELIGIBILITY;
ALIEN MUST BE (A) AT LEAST 18 YEARS OF AGE, (B) A LAWFUL PERMANENT
RESIDENT.
III. REQUIREMENTS;
(A) $5.00 FEE PAID TO DEPUTY COURT CLERK IN CITIZENSHIP SECTION.
(B) 3 PHOTOS (2X2 INCHES).
(C) PROOF OF LAWFUL ADMISSION.
(D) NOT NECESSARY IN ORDER TO FILE A PETITION FOR NATURALIZATION.
- (E) DOES NOT CONFER CITIZENSHIP RIGHTS.
(F) NOT REGARDED AS EVIDENCE OF ALIEN'S LAWFUL ADMISSION FOR PERMANENT
RESIDENCE.
(G) ORIGINAL DECLARATION RETAINED BY COURT; COPY GIVEN TO APPLICANT.
10/1/80
UNI'
inUon «nd Nolu»U««tlo« »4nrt
ALIEN REGISTRATION NO.
APPLICATION TO FILE DECLARATION OF INTENTION
Take or Mail lo-
1MMICHATIOX AND NATURALIZATION SERVICE,
Date . 19
(TO APPLICANT. -Read carefully and follow the instructions on page 2)
(1) My lull name is — [ MJ>> — — —j— — — -jjj^j
(2) Mv olace of residence is — — ^ ——•»——— ——^^^—— — — — ~«— _«_ — ^-~— —
"' ' P (Apt. No.) (Numb.r «nd ttr.ot) (City or loom) (County) (SUt«) (ZIP Cod.)
»»» l «" b<"n " (iKnTKj fiS.75 f*SZ "
(Clly Of town) (County, dilute I. provtnci or St«t«) (Country)
14) 1 i i am 2TI "" "ol ">a"i*|li •«« name ol ray wife or husband u _
(5) .My Uwlul admission (or permanent residence in the United Stales wai at '.
(City or town) (St.l.)
under the name o( __^^^_^_______^^__^.^_______. on ——^^—————
(Month) (Day) (Y«»r)
and I arrived on (Vm .r«...l o, ...., .«.,.y....i *
(6) Since my lawful admission for permanent residence I have not been absent front the United States for a period or periods of HI'I
months or longer, except a» follows:
DEPARTED FROM THE UNITED STATES RETURNED TO THE UNITED STATES
Dot* V«n«l or Olh.r _ _ Dot* V.««»lorOUi
(7) My '»th«y» full name U/wam _
(8) My mother" maiden name was _ ,
(9) I dei.r» to declare- my Intention to become a citizen of the United States In the _
rrlan* of eotut)
Court at .
(City or <•«•) (aut.)
lhat the above statement of facts is true to the beat of my knowledge and belief.
I declare that this document was prepared by me at the request
of applicant and is based on all information of which I have any
knowledge.
Signature Add
(Slat.)
(ZIP Co*.)
Form N-300
(ReT.10-15-79)N
FORM NO.
N-300
EDITION
Rev. 10-15-79
TIT1X
APPLICATION TO FILE DECLARATION OF INTENTION
size
8 X
INSTRUCTION REFERENCE
8 CFR 332a.2, 334a.l, 339.2, 499.1; 01 334a. 1; AM 2301.27, .28, .29, .30.02; AM 2414
Ex.1. DQ 9 GIB A-10
USE
SUBMITTED BY EACH PROSPECTIVE DECLARANT TO THE SERVICE
PRIOR EDITIONS MAY NOT BE USED
| SCHEDULE A
4/1/81
1. A declaration of intention is not required for the purpose of filing a petition for naturalization or to become a citizen of the United
States. You must be over 18 years of age to file this application.
2. Show your Alien Registration number in the box at the top of page 1.
3. PHOTOGRAPHS .-You are required to send with this application three identical photographs of yourself taken within 30 days of the
date of this application. They may be in natural color or in black and white, but black and while photographs which have been tinted
or otherwise colored are not acceptable. These photographs must be 2 by 2 inches in size, and the distance from top of head to
point of chin should be approximately 154 inches. They must not be pasled on cards or mounted in any other way, must be on ihin
paper, have a light background, and clearly show a front view of your face without hat. Snapshots and gtoup or full-length portraits
will not be accepted. All of these photographs must be signed by you on the margin and not on the face or the clothing.
4. DATE OF YOUR ARRIVAL.-If you do not know the exact date of your arrival in the United Stales, or the name of the vessel or
port, and you cannot obtain this information by consulting your family or friends who came over with y_ou, give the tacts of your
arrival as you remember them in the appropriate blank spaces on the first page of this form. Your Immigrant Identification Card or
your passport, snip's card, or baggage labels, if you have them, may help you to answer these questions.
If the date of your arrival in the United Stales was on or before June 29. 1906, you shpuld submit with this application docu-
mentary evidence of your residence in the United States prior to that date. Such documents may be family Bible entries, deeds of
record, wills or other authentic legal documents, life insurance policies, bank books and records, employment records or other
documents showing that you entered the United States on or before June 29, 1906. Do not submit such documents if your arrival
in the United States was after June 29, 1906.
5. FEE.— Please be prepared to pay a fee of five dollars ($5) when you appear before the Court Clerk for your copy of the declaration
of intention.
f potential violation of law, whether civil, criminal or regulatory in nature, may be referred, as a routine use, to the approprii
gency, whether federal, state, local or foreign charged with the responsibility for investigating, enforcing or prosecuting; sue
lolations. Failure to provide any or all of the solicited information may affect approval of your application to file a dectarati
f intention to become a citizen of the United States.
TO APPLICANT-Do not write below this line.
For use in searching Records of Arrival
RECORDS EXAMINED RECORDS FOUND
Card ind'ex .
Index books
Manifests _
Place
Name
Dale
Manner .
TO APPLICANT.-Do not write below this line.
Marital Stalus
(Signature of per • on making acarch)
IMMIGRATION AND NATURALIZATION SERVICE.
To Clerk of Court:
. Authorization is hereby granied for the issuance of declaration of intention to the applicant named above, who has established that
he is residing in the United Stales pursuant to a lawful admission for permanent residence, as alleged in the application.
(Title)
(Signature)
(Thle form thould be attached to the du
been directed to appear at your office within
S*rVlC*°
t» declaration and returned at the end of the oont)
daya to make the declaration. If applicant doea not
H your report on Form N-4, The applicant hat
.-ear within 90 day*, return thla form to thli
SPO : 1979 0 - 301-660
4/1/81
N-470
APPLICATION FOR PRESERVATION OP RESIDENCE FOR NATURALIZATION PURPOSES
USE;
USED BY AN APPLICANT FOR NATURALIZATION TO PRESERVE KIS RESIDENCE FOR
NATURALIZATION PURPOSES BEFORE THE APPLICANT HAS BEER ABSENT FROM THE
UNITED STATES FOR A CONTINUOUS PERIOD OF ONE YEAR.
ELIGIBILITY:
(A) MUST BE AT LEAST 18 YEARS OF AGE, (B) MUST BE AN ALIEN LAWFULLY
" ADMITTED FOR PERMANENT RESIDENCE.
REQUIREMENTS; • '
SECTION 316(B), LSN ACT, STATES IN PERTINENT PART THAT AN ABSENCE FROM
'*HE UNITED STATES FOR" A CONTINUOUS PERIOD OF ONE YEAR OR MORE DURING THE
PERIOD FOR WHICH' CONTINUOUS RESIDENCE IS REQUIRED FOR ADMISSION TO
CITIZENSHIP (LAST 5 YEARS OR 3 YEARS AS THE CASE MAY BE) SHALL BREAK THE
CONTINUITY OF SUCH RESIDENCE. THUS, UNDER THE ABOVE SECTION, AN
APPLICANT WHO IS OUTSIDE OF THE UNITED STATES FOR MORE THAN ONE YEAR
WOULD HAVE TO WAIT AT LEAST 4 YEARS AND 1 DAY (316(A), I&N ACT) OR 2
YEARS AND 1 DAY (319U), I&N ACT) BEFORE HE WOULD BE ELIGIBLE TO APPLY
FOR NATURALIZATION. SAID APPLICANT WOULD HAVE CONCLUSIVELY BROKEN THE
CONTINUITY OF HIS RESIDENCE UNLESS THE ABSENCE OF ONE YEAR OR MORE
HAD BEEN APPROVED BY THE SERVICE.
' 10/1/80
THE FOLLOWING CONDITIONS MUST BE SATISFIED^
(A) AFTER BEING LAWFULLY ADMITTED FOR PERMANENT RESIDENCE* THS APPLI-
CANT MUST HAVE BEEN PHYSICALLY PRESENT AND RESIDING IH THE UNITED
STATES FOR AN UNINTERRUPTED PERIOD OF AT LEAST OME YSAR. HOWEVER.
UNDER THE GUIDELINES OF ROSENBERG V. JIBUTI, A BRIEF ABSENCE DURING
THE ONE YEAR PERIOD WHICH IS NOT SIGNIFICANT AND DOES HOT
MEANINGFULLY INTERRUPT THE ALIEN'S PHYSICAL PRESENCE MAY BE
PERMISSIBLE.
(B) THE APPLICANT MUST BE EMPLOYED IN ONE OF THE FOLLOWING*
1 . BY OR UNDER CONTRACT VITH THE GOVERNMENT OP THE UHITED STATES.
2. BY AN AMERICAN INSTITUTION OF RESEARCH RECOGNIZED AS SUCH BY
THE ATTORNEY GENERAL.
3. BY AN AMERICAN FIRM OR CORPORATION ENGAGED IN WHOLE OR IH PART
IN THE DEVELOPMENT OF FOREIGN TRADE AND COMMERCE OF THE UNITED
STATES OR A SUBSIDIARY THEREOF, MORE THAN 50 PER CENTUM OP WHOSE
STOCK IS OWNED BY AN AMERICAN FIRM OR CORPORATION.
4. BY A PUBLIC INTERNATIONAL ORGANIZATION OF WHICH THE UNITED
STATES IS A MEMBER BY TREATY OR STATUTE AND BY WHICH THE ALIEN
WAS NOT EMPLOYED UNTIL AFTER BEING LAWFULLY ADMITTED FOR
PERMANENT RESIDENCE. FOR EXAMPLE, UNITED NATIONS, NORTH
ATLANTIC TREATY ORGANIZATION.
(C) PRIOR TO THE EXPIRATION OF ONE YEAR OP CONTINUOUS ABSENCE FROM THE
UNITED STATES, THE APPLICATION FOR BENEFITS UNDEB THIS SECTION MUST
3S FILED WITH THE SERVICE; A PEE OP $10 IS TO BE SUBMITTED VITH THE
APPLICATION.
10/1/80
10-11
(D) APPLICATION MUST BE FILED TIMELY TO BE SATISFACTORY.
(E) THE EVIDENCE SUBMITTED IN SUPPORT OF THIS APPLICATION SHOULD BE IN
THE FORK 0? AN OFFICIAL COMMUNICATION FROM THE APPROPRIATE OFFICER
OF THE DEPARTMENT OF THE U.S. GOVERNMENT, AMERICAN FIRM OR CORPORA-
TION, PUBLIC INTERNATIONAL ORGANIZATION OR AMERICAN INSTITUTION OF
RESEARCH. SAID COMMUNICATION SHOULD BE SPECIFIC AS TO THE FACTS OF
THE APPLICANT'S EMPLOYMENT AND THE PERIOD OR PERIODS OF ABSENCE TO
BE CONSIDERED.
(F) THE APPROVAL OF EXTENDED ABSENCE DOES NOT RELIEVE THE APPLICANT
(EXCEPT THOSE EMPLOYED BY OR UNDER CONTRACT WITH THE u.s. GOVERNMENT)
OF BEING PHYSICALLY PRESENT IN THE U.S. FOR PERIODS TOTALLING AT
. LEAST HALF OF THE REQUIRED PERIOD OF RESIDENCE AS SET FORTH IN SEC-
TIONS 316(A) OR 319(A), I&N ACT.
(G) APPROVED BENEFITS ARE PERSONAL AND ARE NOT TO BE ASSIGNED TO OTHER
FAMILY MEMBERS.
(H) APPLICANT SHOULD 'BE ADVISED TO APPLY ALSO FOR A REENTRY PERMIT
IN ORDER TO BE ABLE TO PRESENT A VALID IMMIGRATION DOCUMENT FOR
REENTRY -INTO THE U.S.
(I) APPROVAL OF THIS APPLICATION WILL BE ONLY FOR THE EMPLOYMENT AND
CONDITIONS STATED. ANY CHANGE OF EMPLOYMENT MUST BE APPROVED BY A
NEW APPLICATION.
(J) THE APPLICANT NEED NOT APPEAR FOR AN INTERVIEW. HE IS NOTIFIED BY
MAIL OF THE SERVICE DECISION IN HIS CASE.
SPECIAL CLASSES
MISSIONARIES - SECTION 317, IAN ACT
ANY KISSIONARY OR PERSON WHO IS AUTHORIZED TO PERFORM THE MINISTERIAL OR
PRIESTLY FUNCTIONS OP A RELIGIOUS DENOMINATION HAVING A BONA FIDE ORGANIZATION
WITHIN THE U.S., WHO IS ABSENT FROM THE! U.S. IN HIS RELIGIOUS CAPACITY WILL BE
CGi;s:ir£RBD AS BOTH PHYSICALLY PRESENT, AND RESIDING IN THE u.s. DURING SUCH
AF.SE1,C3 FOR NATURALIZATION PURPOSES, IF HE CAN ESTABLISH:
1. THAT HE HAS BEEN LAWFULLY ADMITTED TO THE U.S. FOR PERMANENT
RESIDENCE.
2. THAT AT ANY TIKE THEREAFTER AND BEFORE FILING A PETITION FOR
NATURALIZATION, HE HAS BEEN PHYSICALLY PRESENT AND RESIDING
WITHIN THE U.S. FOR AN UNINTERRUPTED PERIOD OF AT LEAST ONE YEAR.
THE UNINTERRUPTED ONE YKAR /3RIOD OF PHYSICAL PRESENCE IN THE U.S.
SUBSEQUENT TO A LAWFUii ADMIJSION FOR PERMANENT RESIDENCE IS
MANDATORY. HOWEVER, lu TH1> SPECIAL CLASS, THE PERIOD MAY BE
ESTABLISHED BEFORE OR AFTER THE APPLICATION FOR RELIEF OR ABSENCE,
OR BOTHV PROVIDED IT 1? COMPLETED PRIOR TO THE FILING OF THE
PETITION FOR NATURALISATION-
10/1/80
10-13
3. THAT HIS ABSENCE FROM THE U.S. WAS TEMPORARY TO PERFORM RELIGIOUS
DUTIES ONLY.
4. THE EVIDENCE SUBMITTED IN SUPPORT OF THIS APPLICATION SHOULD BE IN
THE FORM OF AN OFFICIAL COMMUNICATION FROM AN APPROPRIATE MEMBER OF
THE RELIGIOUS DENOMINATION BY WHOM THE ALIEN IS EMPLOYED. SAID
COMMUNICATION SHOULD BE SPECIFIC AS TO THE FACTS OF THE APPLICANT'S
EMPLOYMENT AND THE PERIOD OR PERIODS OF ABSENCE TO BE CONSIDERED.
5. APPROVAL OF THIS APPLICATION WILL BE ONLY FOR THE EMPLOYMENT AND
CONDITIONS STATED. ANY CHANGES OF EMPLOYMENT MUST BE APPROVED BY A
NEW APPLICATION.
6. THE APPLICANT NEED NOT APPEAR FOR AN INTERVIEW; HE IS NOTIFIED BY
MAIL OF THE SERVICE DECISION IN HIS CASE.
10/1/80
TM 793
ADMINISTRATIVE MANUAL
Appendix I
N-470
Page 1
umtta mm OVMTMIXT OF IUJTICS
im»ij(«i«M M4 Natunluitu* S«v««
APPLICATION TO PRESERVE RESIDENCE
FOR NATURALIZATION PURPOSES
lltator JccttM HMt) «r J17. \aa»&atea tat MattawMy fen
INSTRUCTIONS
The evidence submitted in support of this application should be m the form of an official communication from
•,he appropriate officer of the department or agency of the United States Government, or the public international
organisation, or affidavit or affidavits executed hv the appropriate administrative oftVi.il of the American institution
or reliirioui denomination or interdenominational minion bv whom alien is. wa>, or will be employed or with whom
he entered into the contract; or by the appropriate adminuintwe ..rrkial of the American tirm or corporation, or
subsidiary thereof, by whom the alien n. or will be employed. Where affidavit with respect to employment bv such tirm
or corporation or subsidiary is made it should stale:
•t\ ihr ml« at the oKcial makine tie affidavit, tbi name of ike firm or nrponww m wnka b* holdi oAce. aad -aether
hv haa accni la the nrcorda of tbr sane.
••1 wMtther HM naplotint; organization a an American firm or eocpoeauon melted in tht development of (omen tnd* and
CMunrrec of ihe United Suiei, or u a lubudian- thereof.
ih* uiun ai the buu
which it conduoi-d b» ihe tmp4o>ii>« arfumaiM*. ckwRk. rtlifwvi drnoamwtxia, or inw-
• i) il it
thai
ornoeauon. (he name of the Stale
«trni.
the law of which u wma
41 if u u A wbauiUrr 'wntthrr Xmencan or fomvn) gtf tn -\mcnckn lirm or corporation, rn^tevd ui ih« <k<nicp«>nn of
Tamr* tn«r >nd roramrrtr of thr Cnurd Suici. the lAdivii ihould be rvrcutcti by an appoonAlc adjiMfiiMvmbvr aAruJ
of the Mrrni orfinnnon ind ihould line the (acu ol mmenkip ind/or CMitnl o/ th* lubtwiitrr. 4«d Uw ruct pcrctnuet
Of tlOCfc «wiwd bv ItM [Mtrflt Or^AAIUIIOn.
nee to tx oeKornwd bv Kim. dunnf iJi< pmod i
'> the facu of ihe applicant'! rmolovmnt. .ncfudmv ine natun ol the
penodt of abwiKe to oe conudcred.
i II whether the applicant will be rnneed m the dcvrlopment of foreign trade and commerce at the L'niitd Staen. or the
atlplicani i abwncr from the L'ntied Statn wal or will be nreewary 'o the protection ol the property n«hia abroad of
th« emplo<i«f 1am or corporation or luovdurv dunnf the pcnod or DC nodi of jbwncc 10 be cenantond. oe wirlv in Ka
or hrr capacity as a rrvularlv ordained clere^man. miMionarv hmthrr, nun. or niter: and in the caae of one employed
bv a public international organisation ihr dale when and place whtre applicant wma nni emplovod.
FEE— A fee of ten dollars [110) mutt be paid for filing thn applicauon. It cannot be refunded re^ardlea of
ihe action taken on the application. DO NOT MAIL C.ASH. ALL FEES MUST BE SUBMITTED IN THE EXACT
AMOUNT. Pavmem bv check or monev order must he drawn on a bank or other institution located in the United
Statt-i and be pavable in United Stain currency. If applicant resides m the Vjnpn Iilands. check or monev order must
be pavable to the "Commissioner, of Finance of the Vinpn Islands." If applicant rrsida m Guam, check or money
order must be payable to the "Treasurer. Guam." All other applicants must make the check or money order payable
to the "Immigration and Naturalization Service." When cheek is drawn on an account of a penon other than the
applicant, the name of the applicant muit be entered on the face nf the rheck. Personal checks are accepted subject
to collettibility. An uncollectible check will rrnder the application and anv documents utued pursuant thereto invalid,
(f payment ta nude bv the tvpe of international monev order that cannot be mailed, the monev order must be drawn
on the postmaster of the citv in '.he United States to which the application will he maaicd. and thai city, the money
order number, and the date must he shown clearly on the top margin of the application form.
An alien admitted for permanent residence, who claimed or rlaims nonresident alien status under the income tax
laws, may he regarded* as having abandoned htr residence in :he United States and ai haung ost hit immnrrant status
under the immigration and natural. mion laws. AJ a rnnseqiienre he mav be or became ineligible for naturalization
or for preservation of residence. If you have claimed nontesidcnt alien status, submit full explanation on a separate sheet.
(REV, i 1-27-75) Nl
FORM NO.
M-470
EDITION
REV. 3-30-79
T1TLX
APPLICATION TO PRESERVE RESIDENCE FOR NATURALIZATION PURPOSES
size
a x 10
1/2
INSTRUCTION HCTCRCNCZ
2482 Ex. 1, 2984 Ex. 2, Ex. 4;
8 CFR 316».21(»), (b). 499.1; 01 103
HAT HBK-7-1 thru 7-4
.8(e)(7), 319.1; AM 2301.30.
DSC
SUBMITTED TO THE SERVICE BY AN APPLICANT FOR
U.S. FOR CONTINUOUS PERIOD OF ONE YEAR
NATURALIZATION BEFORE THE APPLICANT
HAS SEEN ABSENT FROM THE
PRIOR EDITIONS HAY NOT BE USED
| SCHEDULE A
10/1/80
ADMINISTRATIVE MANUAL
Appendix I
TM 793
IMPORTANT
An applicant n not eligible unleti (II he or the hat been physically promt and residing in the United SUM:
for an unitMftrupltd period (that it. without any absence whatever^ of at )eut \ y*ar after lawful admtfiuofl for
permanent residence, and (2> the application is subrnittfd to the Immigration and Naturalisation Service bdere the
applicant has been absent from the United State* for a continuous period of I year When fumiihinf informatiofi regard*
ins absence* in item 3 the applicant MUST SHOW EACH DEPARTURE AND RETURN to th* United State*, m-
cludmg absences to forntm contiguous countries no matter how short. However, an applicant who hu been abteni
or is to or abwnt from the United States solely in his or her capacity of ckrgvman. missionary, brother, nun. or sister,
may complete the I vcar of uninterrupted physical pretence after the period of absence and may submit the application
even after an absence of more than I year.
The Immigration and Nationality Act alto requires an applicant for narurali*alion to hav« been physically pratnt
within the United SiateJ for at least one-half of thr period of 5 yean 'or 3 vean, if the applicant qualifies under the
citi/en-jpouie lectinn immtdiaiclv preceding the date of filing a petition for naturalization The grantine; of this applica-
tion dors not rdicvf the applicant for naturalization from thu phvtiral presence requirement durine the 5- or 3-year
penod Hou-ever. persons who arc employed bv. or under contract with, the Government of the United States, and
persons absent in their capacities as clergymen, missionaries, brothers, nuns, or sisten. are considered as physically
present m thr United Stain durtn? the period of approved absence for the purpose of the 50% requirement (but
not for thr 1 vear of physical presence referred to in the paragraph immediatelv above). The. granting of this applica-
tion also does not relieve the applicant from the necessity of pros-ing to the satisfaction nf the court in which he files
hu petition for naturalization that his absence from the United State* has been for the purpose stated in the application.
Approval of (hit application will be only for the employment and conditions stated. Any chanfes of emptoynMnt
must be approved by a new application.
Approval of this application will not relieve you of the requirement to present a valid dorumant for reentry into
the United States.
Authority for collection of the information requested on thin form ii contained in Section* 3)6. 317 and 532 of
the Immigration and Nationahtv Act '8 U.S.C. 142*. 1428 and 1443). Submiuiofl of the iniomtation it voluntary.
The principal purpose for requesting the information u to determine whether an alien, who intends to be abeam from
the United States for a continuous period of a year or more, it eligible to preserve residence for naturalization paivpoeei.
The information requested may. as a nutter of routine use. be disclosed to naturalization courts and to other federal,
state, local or foreign law enforcement and regulatory agencies, the Department of Defense, including any component
thereof, the Selective Service System, the Department of State, the Department of the Treasury, the Department of
Transportation. Central Intelligence Agencv. Interpol and individuals and organizations in the processing of any
application or petition for naturalisation, or durine; the course of investigation to elicit further information required by
the Immigration and Naturalization Service to carry out its functions. Information solicited which indicates a violation
or potential violation of law. whether civil, criminal or regulatory in nature, may be referred, as a routine uss. to the
appropriate agencv. whether federal, state, local' or foreign, charged with the responsibility of investigating, enforcing
or prosecuting such violations. Failure to provide all or any of the requested information may result in denial of the
application to prtterv* reudence for naturalization purposes.
10/1/80
TM 793
ADMINISTRATIVE MANUAL
Appendix I
N-470
Page 3
uwrrto STATES ocpuTMiirr OF iusn«
Immigration and Nituraliiitian S«rviC4
OMB No. 4J-4004«
APPLICATION TO PRESERVE RESIDENCE j F^"^ i
FOR NATURALIZATION PURPOSES
(Iteritr Section Jl«bl «r 117. Imnuptffan md NititaaMy Ad) |
(H«Ut ,,f4 i»Hr*eMin an T,o,r,,\
Take or mail to:
IMMWBATION AND NATUHAUXAno* SMVICI
1. My full irue name ii ."
2. My home addrcu in the United Stalct u ..
(dlif W UMI <&•») (ail «•**)" "
My foreign addmt : G '• G *'" be"
(dur «• IMI WMM
3. I am an alien. I w,ii lawfully admitted to the United Statci for permanent residence at
under the name -if . ...
on on the vewel
(UMtttl (Dot 'Yawl 'II MJOTHM MM* «HMI iat» «a»«a» W Html)
I havr mided in and have beirn phvuully pment in me United Statei for in •jiunterruoted penod of it lent — vear(»
liner luch lawful entry. Since the dale of mv lawful -ntrv [ have been ibwnt from the L'mica Stales at followi 'include date of, Ijut
departure if now abroad, and if neceaary attach j.n niJiuonal the«( to ihow M jOJcncei i
O«tt of ««vanur< 0«l< mna port i< rwucn N»m« o( v«i»i PunxxM a' tnp
:====.] : '
4. Since becoming a permanenl rcudent, haw you ever filed in income tax return u a nonrendcnt alien or othrrwiie claimed or received
benefit! u a nonrettdenf alien under (he income tax lawi? G Ve< G •N(O
3. I (G u». D wiU b«, G wai) emploved u, or under contract u
by
INwn ri ia»M>«r)
^ddrru . .
(NMM» tat riNM) !Clr» v tn>) tltxttt O)» <rt(l
Such employment of contract will neceunatc ' mv umence m
6. My abtcnce from the United Stain lor tuch penocii iQ u. G Wl" °<< G wax •
Q on behalf of the United Statei Government.
Q for the purpote of carrvint; on tciennfic research on behalf of an American inacilution of mearcb.
Q for the purpote of ennijin^ in the development of foreign trade and commerce of the United. State] on behalf of an American
firm or corporation or a tubtidiarv thereof enlaced m the aevelopmenl of men iracir and commerce.
G neceuarv to the protection of the property nfhti abroad of an Amrnca^i lirm or Corporation enc;a^ed in the development of
foreign trade and commerce ol '.he United States.
G on behalf of a public international organization of which the United State* n a member, by which I wai fint employed on
13
G tol«ly in »y opacity at a • ! cl«rgym«n. ; | mittiontry. (~~l brother, ^""^ nun, or . : titter.
7. In tuppon of the foregoing lUirrnenl of facu I lubmil the following document!
1. 1 reipectfully requett that you And mv abwnce under the above-ititcd condinoiu to be in comoliance with the provision! of See. 3lb(b)
or 31? of i he Imioivraiion and Nationality Aci.
SlfjM«tiir* •! r*
tiMrini fwm. If <Xh«» Thin
f 4«clM« Out tkn Jacu«i«nc wu pr.o.rrd by m.
r«tw »-«70(R«v.J_JO-79)N
»UC4fiMAU arv trvr and
coMPirrc SICMATUM or Apniunr
v. ttrfM. till. SUU. iM llf UM OATt
10/1/80
Page 4
Appendix I
EXAMINER'S REPORT
I have invettinwd ihU application (or benefit* under Section (U)C(b)) (31?)) of the •mu«rau<M and Nationality Act and
find (hat:
1. The applicant (wai) (wai not) lawfullv admitted (or permanent reudence. Uu MoMM (having) (MM having) chaAfed.
2. Q Applicant for benefit* of Section 3l*<b):
(«) (Hai) (Hai noil rriided in and been ph>iically present in ike United Stain let an uainlerrupied period o/ at Uail
on* year alitr lawful admiuion for permanent rnidcncr.
(») (Hat) (Hai not) filrd ike application before b-mj iWnt from ihc United States for a eontinuotti period of oew y«r.
(t) [(It) (h not) (Will be) (Wilt not be)] iraplovrd or under contract ai allefed in tfcii application; and the employer
or contractor named in thu application (11) (is not) entMed in'tnc type o/ buwncu d«»eribed in Section 3l6(b).
3. O Applicant for tKe benefit* of Secuon 31 7:
(t) (Hai) (Hu not) been phyucalK pretrni and retidint m Uw United Suiei (or an uninlerrupied period of at leait one
year after lawful admiuion (or permanent reiidence.
(») [(It) (U MI) (Will be) (Will not bej (Wai) (Wai not)] abeent Mlely for the porpoee alleied in tkit application; and
the denomination or orpniraiion named in thii application (u) (ii not) of the cUat dctcribed in Section 317.
4. Supplemental report or order (it) (U not) attached.
1. I recommend tnal the application be ((ranted) (denied).
"Ami'
ORDER
It it Ordered thai the within-named applicant be enated the
ibienre fraea the Uniud Stain from the date Mated therein to an indcfaut* dale thenailcr i
and M abtcni for the purpoaa allefed therein.
far in thfe applkane* to cover
a* (i)be umaini in the eaployoent
"tinf.
10/1/80
INFORMATION CONCERNING CITIZENSHIP EDUCATION TO MEET NATURALIZATION
REQUIREMENTS
I. USE:
USED BY APPLICANT FOR NATURALIZATION DESIRING INFORMATION CONCERNING
CITIZENSHIP EDUCATION, CITIZENSHIP TEXT MATERIALS AND HOME STUDY
OPPORTUNITIES.
II. ELIGIBILITY;
ALL PERSONS WHO DESIRE INFORMATION REGARDING THE EDUCATIONAL REQUIREMENTS
FOR NATURALIZATION (SECTIONS 312 AND 332(B), I&N ACT).
III. REQUIREMENTS;
(A) NO FEE; (B) REQUEST IN WRITING FOR FORM; (C) PART OF N-400 PACKET
MAILED OR HAND-DELIVERED BY INFORMATION SECTION TO ALIEN APPLICANT FOR
NATURALIZATION.
10/1/80
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization S«rrice
INFORMATION CONCERNING CITIZENSHIP EDUCATION
TO MEET NATURALIZATION REQUIREMENTS
A person who is applying lor naturalization u a citizen of the United Slates generally 13 required to show ihal
they have some knowledge and understanding of the English language and of th« history anj fonr, of government of
the United Sutev Certain persons are exempted from the English requirements and may become citizens even
though they cannot read, wnte or speak English. The exact requirements, and the exemptions from them, are stated
below:
). The applicant has to be able to speak, read and write simple words in everyday use in the English language.
ExceptioM: A person who is physically unable to speak, read or wntc English isexsmp;. The w.tin exemption
is given lo a person who is over fifty years of age on the dale of the examination, and has been a liv.ful
permanent resident in the United States for at least twenty years on that date
2. The applicant has to be able to sign his name in English.
Exception* Those who are over fifty years of age on the date of the examination, and have been a lawful
permanent resident in the United States for at least twenty ytfars on tha: date are permuted to sign their name!
in a foreign language.
3. The applicant has to be familiar with the Constitution and the more important historical farts in the
development of the United States, and with the form and principles of our government.
Exceptions; With the exception of certain former United Slates citizens and children, all applicants have to
show that they have this knowledge. The> may show thii in a foreign language if th*y are exempt from
freaking, reading and writing English under paragraph NY> 1 above.
The test lo determine whether the applicant has the required knowledge of English, history and government is
given by a naturalization examiner when the applicant appears before him with his two witnesses to file his petition.
The ICM 11 given orally. The questions asked are in simple English and cover only subjects with which anyone who
has made * reasonable effort to learn should be familur
Applicants who are interested m receiving instruction to prepare themselves for the examination and for good
citizenship may receive help in citizenship classes. These classes are conducted by public schools in many
communities, in cooperation with the Immigration and Naturalization Service. This instruction is generally provided
without charge. Interested persons may obtain information regarding these classes from either a local office of the
Immigration and Naturalization Service, the clerk of a naturalization court, the Department of Public Education in
(heir city or stale, or from a school in (he community Public school certificates issued to applicants who have
attended these classes, showing the applicant's attendance and progress in his studies of the Constitution and the
history and government of the United States, are given consideration and weight by naturalization examiners in
determining the applicant's educational qualifications for naturalization, provided the courses of instruction, teaching
methods, and examinations of the public schools issuing such certificates have been approved by the Immigration and
Naturalization Service and the naturalization courts
Persons who cannot conveniently attend citizenship classes may find it possible to prepare themselves through
correspondence courses in citizenship education conducted by educational institutions. The names and addresses of
such institution* arc contained- on the last page. Full information concerning these courses may be obtained by
writing to any one of the institutions.
Those who cannot arrange to attend classes or participate in a correspondence course through an educational
Institution, and can be helped by someone it home, may study from textbooks prepared for that purpose which are
listed on page* 2 wnd 3.
In addition lo the citizenship classes and courses which are available to persons preparing for citizenship, the
Immigration and Naturalization Service publishes textbooks on citizenship, in several parts, listed on page 2. These
books are issued without cost to public educational institutions which conduct citizenship classes for aliens preparing
for naturalization. These institutions may obtain the books from the appropriate regional office of the Service, listed
on page 4, by submitting, in duplicate. Form G-62. "Requisition for Federal Textbooks on Citizenship." The books
arc also available without charge lo aliens who are preparing for naturalization under the supervision of public
educational institutions. Other schools, organizations, or aliens not eligible to receive the books without charge may
purchase them if they wish from the Superintendent of Documents, Government Printing Office, Washington, DC.
20402. Orders for the purchase of the books should be sent to that office, not to the Immigration and Naturalization
Service. These purchase orders should state clearly the particular book desired, including the form number listed, and
should be accompjinird by cash (at the sender's risk) or a money order or check payable to the Superintendent of
Documents. Postage stamps are not acceptable.
FORM HO.
M-132
EDITION
REV. 7-10-80
TIT IX
INFORMATION CONCERNING CITIZENSHIP
NATURALIZATION REQUIREMENTS
EDUCATION TO MEET
?HX
8 1/2 X 11
INSTRUCTION
AM 2482 Ex. 1,
REFEJLENCE
P. 8; GIB A-10
GIVEN TO ALL NATURALIZATION APPLICANTS AND PERSONS DESIRING INFORMATION CONCERNING CITIZENSHIP TEXT MATERIALS
PRIOR EDITIONS MAY NOT BE USED
SCHCP
10-22
M-132
Page 2
ADMINISTRATIVE MANUAL
Appendix 1
TM 803
CITIZENSHIP TEXT MATERIALS
The Immigration and Naturalization Service publishes the following Federal Textbooks on Citizenship:
1. OUR CONSTITUTION AND GOVERNMENT
REGULAR EDITION (M-7). This book is written for advanced students. It deals with she Constitution and
the governmftnt of the United States. Price S5.00 each S/N 027-002-00191-5
SIMPLIFIED EDITION (M-8). This book is a simplification of the REGULAR EDITION, at a considerably
lower language level. Price 53.75 each S/N 027-002-00132-0
2- CHARTS (in sets of 18) (M-9). Reproduced from OUR CONSTITUTION AND GOVERNMENT. These are
fold-over charts; over-all measurement 17" x 23". Only one set may be sent to a class. Price $4.95 a set
S/N 027-002-00152-4
3. BECOMING A CITIZEN SERIES
OUR AMERICAN WAY OF LIFE, BOOK 1 (M-161). This Book is a beginning-level literacy reader, designed
to meet the educational needs of the student who has little knowledge of English. It employs a visual association
between words and objects, stresses adjustment to community life, and gives elementary treatment to history and
government. Price $3.00 each S/N 027-002-00166-4
OUR UNITED STATES, BOOK 2 (M-162). This book is designed for those having a fair command of English.
Literacy skills are developed, as well as citizenship responsibility, history, and government. Price $4.75 each
S/N 027-002-00135-4
OUR GOVERNMENT, BOOK 3 (M-163). This book is written at an advanced level, but below the level of
OUR CONSTITUTION AND GOVERNMENT, SIMPLIFIED EDITION. It is planned to meet the needs of
ituderts in a position io absorb a greater knowledge of matters relating to government, the Constitution, and
citizenship responsibility. Price $3.50 each S/N 027--C02-OOS36-2
TEACHER'S GUIDE (M-164). This book contains general suggestions for conducting citizenship classes, as
wel! as directions for presentation of the text material in each of the three books of the BECOMING A CITIZEN
SERIES. Price $1.00 each S/N 027-002-00100-1
4. HOME STUDY COURSES
OUR CONSTITUTION AND GOVERNMENT. FOR THE STUDENT. (M-39). This material is planned for
the candidate who cannot attend public school classes but who can read and understand English. It is a study guide to
be u:>ed with OUR CONSTITUTION AND GOVERNMENT, SIMPLIFIED EDITION, listed under Item No. 1.
Price S3. 50 each S/N 027-002-00206-7
TM 803 ADMINISTRATIVE MANUAL M-132
Aooendix 1 Page 3 IU~'
OUR CONSTITUTION AND GOVERNMENT. FOR THE HELPER. (M-40). This test booklet contains
suggestions for the person who helps the student. It is used with the study guide listed. (M-39). Price $3.25.
ENGLISH. HOME AND COMMUNITY LIFE. FOR THE STUDENT. (M-41). This book is for persons
who speak English but who have a limited ability in reading. It contains a vocabulary relating to home and
community living and material for practice writing. Price $3.25 each S/N 027-002-00209-1
ENGLISH. HOME AND COMMUNITY LIFE. FOR THE HELPER. (M-42). This book is planned so that a
person who reads English can assist the student with his home study. Price S2.40 each S/N 027-002-00019-6
ENGLISH AND FEDERAL GOVERNMENT. FOR THE STUDENT. (M-43). This book is a study of the
Federal government. It explains the work of the three branches of the Federal government and how our Constitution
grows to meet our needs. Price $3.75 each S/N 027-002-00106-1
ENGLISH AND FEDERAL GOVERNMENT. FOR THE HELPER. (M-44). This book is planned so that a
person who reads English can assist the student. Price $3.00 each S/N 027-002-001 18-4
. ENGLISH AND STATE GOVERNMENT. FOR THE STUDENT. (M-45). This book deals with state and
local governments, their relation to the Federal government, and the responsibilities of the citizen in his community.
Price $3.00 each S/N 027-002-00137-1
ENGLISH AND STATE GOVERNMENT. FOR THE HELPER. (M-46). This book is planned so that a
person who reads English can assist the student. Price $1.10 each S/N 027-002-00133-8
5. AIDS FOR CITIZENSHIP TEACHERS (M-35). This is a resource unit for teachers. It considers such topics
as meeting student needs in citizenship classes, activities which will make the teaching of citizenship more effective,
and how to judge the effectiveness of teaching. Price $.55 each S/N 027-002-00090-1
NOTICE: Prices are quoted following the description of each item. All prices are subject to change without
advance notice. A discount of 25 percent is allowed for quantities of 100 or more of one title sent to one addressee.
Home Study Opportunities
The following public educational institutions have cooperated with this Service in setting up correspondence
courses. Some have found it necessary to charge a small fee for handling the paper work involved; however,
textbooks are furnished free of charge upon enrollment in the course.
r.'-INTIHO CFnCE : 190a 0 -
Alabama
Michijjan
ttegr>n ,
Continuation Eitsnsion Division
Co.TeupjniJcnce Study TieipaUAettt
Offlfiral Eiteniion Divmo.i
University of Abbama
Univctsi-.- of Michigan
Oregon Stale System of Sdjltsr
P O Boz :787
412 Miyna;j Slrecl
Education
University. Alabama 354S6
Ann Artwt. Mtchijan 48104
Eugene. Oreftixi ^7401
Amona
Minrnau
PrctuvtviiMx
Corresponderi-e Division
Correspondence Study Department
CofireapoaMleTic.- instruction Dept
I'hoenii L'mo.> Hijh School
llnivemiy ot' MmneMU
PciiMylvoiiia Sute Ufiiverssty
111 N 7lh Si .
Minn.-ir*>!u. Minr.ewia 5S4QO
l.-niwenity Pfcrk, PcaJftSj'tvaiua
phoenu. A.num> «5000
IftGOl
Arlamat
Director DrrtftT'cnenl of
?jjg»e> Rteu
General Eaicntion Division
Independent Study
DepartnwMl of tTuiwnahip Training
University 01" Arkansas
University of Southern MujiMipp
OerirnsJ EstcnsHin LIVKKWI
FayetleMllc. Arkansas 7 27CI
Hattmburg. Miuistipfii 39401
University o.F Florida
CJwrvoville. Bonda 12601
Ca'iiornia
Missouri
CorTesp,.,ndi:not Infraction
Centc-r for Independent Slwly
t-'.M.nlc Island
Eatcnwui Division
Through Correspondence
Rhode Island Chief of D- vmaa of
Universnv of Califcimu
L'rtitccuty of Mt%ioun*Colutr.bui
Adull Educsl^i
terteley. California 947W
514 South r'tflh Slreit
Slate Department nf Education
CnluTbia. Miuoun 6S:il
Roger WilUmi Bids Hay« St
ColoraJii
Providence. Rhode Island 02«OS
Bureau of Correspondent.*
Uepariment of Public Instruction
South Coruhns
Eatemion Division
CapiK 1 Building
EticntHKi Div^uw
I'mveiMly of Colorado
Helena Montana SW3I
University of &vjSh Caioltna
IiouMcr. Cjlorado 80101
Columbia. South Carolina I'JOO
FUindu
Nehrwkj
South Dakota
Dtpanmenl of CiliJcnihip Triifiine
Correspondence Instruction
Univenif, ofNebraika
nmension Division
University of Florida
Gainesville. Flondl 32601
Lincoln. Nebrasda 68509
University of Soulh Dakota
Vtnniliion. South Dakota iTO&'i '
Nirvjt^i;
Oeorgia
Ind'fxmlenl Study
T.'TOSaS.
University Syilcm of Georgia
t.nte:ided Prcgrai-.u tuxl Continuing
Ealpn-uon Division
Divuton of General Extension
Education
Univenity of Tenr;cs4er
Athens. Georgia XfcGI
Viniveruty of Nevada. Hew
Eon »S«. UniveiMty Stuinn
Reno. Nevada »«S7
Knoavillc. Tirnr.oact 379i6
Idaho
Correspondence Stud)
Ncy.yiej.jCO
Teiaa
University of Idaho
Moscow. Idaho 13843
Correspondence Dtviswn
Phoenu Union High School
Eitenaiun DIVUKHI
University of Tema
Illinois
525 N 7th St
Au:tin. Texu 71712
Phoenix. Aniona SWOO
Extension Division
lUaJh
Untruly of Illinois
Champ»ign. Illinois 6IMO
Nf v. Vort
Eatcnsion Division
University of Utah
Jiorif Siady Unit
Salt Lake City. Utah MIDI
Huieau of Special Cmtinumg
i'tvr:i.fx idcftce Study
lldncalgoa
Virginia
PC bo* 42
State l-ducaiional Department
— ft —
Albany. Keu. York 12124
Division of Guidance am.1 Adull Ed
State Dcranmcnl ul' Education
North Carolina
Richmond. Virginia 2i2l'i
fciueiiu of Correspondence Study
Bureau of Crvcrnpcidente
Virgin IsUiuU
7 ill.-Ai.ir Divnion
(.•nner.it. oIKansu
:..v.r.-ntc. Kuiu> 6MU4
University of Nuth Carolitja
Chaptl Hill. North Oral™ J7i|4
Det^arlnveni of Ciliztmhip Trumng
Cxmi.ral Eilension Division
University of Flnmia
Qcinclvllk. Flortdl. 32601
rii'r'iiclA
Nonh Ditnta
i
Eiiension Division
Washinpon
'.Initcnny nf Kentuck)
Uiiveruty r.-f Not.ri Dakota
Sl«'.,- Department of Education
I Let- ujion. fceniiKky 40521
G-aiid Forki. '•lonn Dakoiii 1SMI
Otd f.'apiioJ Building
LouiMan i
WjlO
Olyrnpui, Wwihingioii 98501
' IT'irec'.tii . Adnvni.tralion and
Divic-oi 31 Ci>fitt!iLiiid£ £ducat»on
\Vut Virginia
| Slele .'ler i>'<men1 of £^<^;alion
Bnon Rii^e.:. L.n-iuana 70«fM
24«! Olcnianjiy Riv« RcwJ
1 he Otic ?ialt l.ln: -tnity
Coluwbus. Oiiio 4)210
Americaniulion Progrun
MirihrJI University
Hunimpon. Weal Virginia 2)701
Sis!" 0-;-s-.-fj; of Guidanco an.1
••/Sfcihoa,,
Wyoming
f In - ("3>Kallon
Ea'iTotriTi 0tvnuon
Orrreupoadencff Sludy
Suic r*p..-ir.-«nt uf Lduui'iu:
Un verurv of OkUlKMna
llnivertity of Wyoming i
r\ufi»:a. 1 -tine 04 W-
Now.-in. CAIah-ma 730«
Lanuroe. Wyorntng SMTti j
5 Regional offices of the Immigration 3nd N^'wuraltzation Service arc located a?:
t Fcijerrl tickling
Fea«»t Building 120) Elm $<tr«. Rial V,'&
Tnmuul tiiaod
: Burtincioo. VT 05401
Fort Snelltti-. PillM, TX 7S270
Sun Pedro. CA 10731
5
Twin Cities, Mfi 55111
4/1/81
N-400
APPLICATION TO FILE PETITION FOR NATURALIZATION
I. USE;
USED BY AN ALIEN AS THE PRELIMINARY APPLICATION FOR NATURALIZATION.
II. ELIGIBILITY;
1. ALIEN MUST -BE AT LEAST 18 YEARS OF AGE BEFORE HE CAN APPLY FOR
NATURALIZATION. EXCEPTION: MILITARY APPLICANT CAN APPLY AT ANY
AGE (SECTION 329(B) (1), I&N ACT).
2. ALIEN MUST BE LAWFULLY ADMITTED FOR PERMANENT RESIDENCE.
EXCEPTIONS: (A) NONCITIZEN NATIONALS (SECTION 325, I&N ACT);
(B) MILITARY APPLICANTS (SECTION 329U), I&N ACT,)
III. REQUIREMENTS;
A. SECTION 316(A), I&N ACT ~ GENERAL NATURALIZATION SECTION OF LAV.
1. THE FOLLOWING DOCUMENTS MUST BE SUBMITTED WITH EACH APPLICATION;
(A) 3 IDENTICAL PHOTOS, (2X2 INCHES).
(B) FINGERPRINT CHART;
(C) BIOGRAPHIC INFORMATION (FORM G-325).
2. INTERVIEW
(A) ALIEN MUST BE ACCOMPANIED BY 2 CITIZEN WITNESSES,
WHO WILL VERIFY THE PETITION AND
DURING HIS PERIOD OF RESIDENCE; THAT HE IS A PERSON OF GOOD
MORAL CHARACTER, IS LOYAL, AND IS ATTACHED TO THE PRINCIPLES
OF THE UNITED STATES CONSTITUTION.
(B) ALIEN MUST PRESENT PROOF OF LAWFUL ADMISSION.
(C) A $25 FILING FEE, PAID IN CASH ONLY, IS REQUIRED AT THE TIME
THE ALIEN FILES THE EPTITION WITH THE CLERK OF THE COURT.
(NOTE: IN SOME OFFICES, WITH THE DEPUTY COURT CLERK IN
THE CITIZENSHIP BRANCH.)
FURTHER, ALIEN MUST HAVE;
(1) LAWFUL ADMISSION FOR PERMANENT RESIDENCE.
(2) RESIDENCE IN THE UNITED STATES FOR AT LEAST FIVE YEARS;
PHYSICALLY PRESENT AT LEAST HALF OF THAT TIME.
(3) 6 MONTHS STATE RESIDENCE.
(4) FILED PETITION WITH PROPER COURT (JURISDICTION)
(SECTION 310(A), K&N ACT).
(5) NO CONTINUOUS ABSENCE FOR ONE YEAR OR MORE DURING
5 YEAR PERIOD' UNLESS APPROVED PURSUANT TO FORM N-470
(APPLICATION FOR PRESERVATION OF RESIDENCE FOR NATURALIZATION
PURPOSES) (SECTION 316(B), I&N ACT).
(6) INTENTION TO RESIDE PERMANENTLY IN THE U.S.
(7) GOOD MORAL CHARACTER DURING 5 YEAR PERIOD. BURDEN OF
PROOF ON ALIEN (SECTION 316(E), I&N ACT)
4/1/81
10-27
(8) LOYALTY - HAS TO RENOUNCE HIS FORMER ALLEGIANCE AND
TAKE AN OATH OF ALLEGIANCE TO THE U.S. (SECTION 337U)
IAN ACT).
NO COMMUNIST PARTY MEMBERSHIP OR AFFILIATION DURING
LAST 10 YEARS (SECTIONS 31 3U) AND (C), I&N ACT),
UNLESS INVOLUNTARY MEMBERSHIP (SECTION 313(D)t LSN
ACT.).
(9) MENTAL COMPETENCE TO TAKE OATH OF ALLEGIANCE.
(10) LITERACY •• ABLE TO SPEAK AND UNDERSTAND SIMPLE ENGLISH
AS WELL AS RiAD AND WRITE THE SAKE.
EXCEPTi::MS: (A) PHYSICALLY UNABLE TO COMPLY; (B) 50
YEARS OF AGE AND A LAWFUL PERMANENT RESIDENT OF THE U.S.
FOR 20 YkJAHS AS OF THE DATE OF THE FILING OF THE PETI-
TION.
ALL_ APPLICANTS MUST PASS ORAL EXAMINATION ON U.S. HIST-
ORY AND GOVERNMENT.
(11) NO DEPOHTABILITY (SECTION 318, I&N ACT).
(12) NO PERMANENT INELIGIBILITY BECAUSE OF RELIEF FROM
MILITARY SERVICE "(SECTION 31 5 (A), I&N ACT).
FINAL NATURALIZATION HEARING (OATH TAKING IN COURT) AND
ISSUANCE OF CERTIFICATE OF NATURALIZATION WILL OCCUR NO
SOONER THAN 30 DAYS AFTER PETITION WAS FILED WITH COURT,
UNLESS GRAKTSD PUBLIC INTEREST WAIVER UNDER SECTION 336(C) ,
I&N ACT.
10/1/80
B. SECTION 31 9 (A), I&N ACT - MARRIAGE TO U.S. CITIZEN SPOUSE
ALL REQUIREMENTS AS SET FORTH UNDER THE GENERAL SECTION OP THE LAW
(31 6 (A)) EXCEPT AS FOLLOWS:
1. RESIDENCE IN THE U.S. FOR AT LEAST 3 YEARS; PHYSICALLY PRESENT
AT LEAST HALF OF THAT TIKE.
2. NO CONTINUOUS ABSENCE FOR ONE YEAR OR MORE DURING 3 YEAR PERIOD
UNLESS APPROVED PURSUANT TO FORM N-470 (APPLICATION FOR
PRESERVATION OF RESIDENCE FOR NATURALIZATION PURPOSES).
3. GOOD MORAL CHARACTER DURING 3 YEAR PERIOD.
4. LIVING IN MARITAL UNION WITH CITIZEN SPOUSE FOR AT LEAST 3
YEARS.
5. SPOUSE MUST HAVE BEEN A CITIZEN FOR AT LEAST 3 YEARS.
6. AFTER THE FILING OF THE PETITION AND BEFORE THE FINAL HEARING,
ALIEN IS INELIGIBLE IF MARRIAGE IS TERMINATED BY FINAL DIVORCE
DECREE OR DEATH OF CITIZEN SPOUSE.
EVIDENCE REQUIRED AT THE TIKE OF INTERVIEW
(A) PROOF OF SPOUSE'S U.S. CITIZENSHIP (BIRTH CERTIFICATE OR
NATURALIZATION OR CITIZENSHIP CERTIFICATE).
(B) MARRIAGE CERTIFICATE OF THE PARTIES.
(C) TERMINATION OF PRIOR MARRIAGES OF EACH PARTY.
(D) TESTIMONY OF BOTH U.S. CITIZEN WITNESSES THAT PARTIES HAVE BEEN
RESIDING IN MARITAL UNION DURING THE ENTIRE 3 YEAR PERIOD.
(E) ALL CERTIFIED COPIES OF DOCUMENTS MUST BE PRESENTED.
10/1/80
10-29
C. SECTION 319(B), I&N ACT - MARRIAGE TO U.S. CITIZEN SPOUSE REGULARLY
EMPLOYED ABROAD
ALL REQUIREMENTS AS SET FORTH UNDER THE GENERAL SECTION OF THE LAW
(316(A) EXCEPT AS FOLLOWS:
1. SPOUSE MUST 3E U.S. CITIZEN REGULARLY STATIONED ABROAD, EMPLOYED BY
(A) THE GOVERNMENT OF THE U.S., OR
(B) AMERICAN FIRM OR CORPORATION ENGAGED IK THE DEVELOPMENT OF
FOREIGN TRADE AND COMMERCE OF THE U.S., OR
(C) AMERICAN INSTITUTION OF RESEARCH RECOGNIZED BY THE ATTORNEY
GENERAL, OR
(D) A PUBLIC INTERNATIONAL ORGANIZATION IN WHICH THE U.S. PARTICI-
PATES BY TREATY OR STATUTE, OR
(E) A RELIGIOUS DENOMINATION HAVING A BONA FIDE ORGANIZATION IN THE
U.S.; PERFORMING MINISTERIAL FUNCTIONS OR ACTING AS A
MISSIONARY.
2. NO PARTICULAR PERIOD OF MARRIAGE.
3. NO SPECIFIC PERIOD OF RESIDENCE OR PHYSICAL PRESENCE IN THE U.S. OR
IN A STATE AFTER LAWFUL ADMISSION FOR PERMANENT RESIDENCE.
4. PETITION MAY BE FILED IN ANY NATURALIZATION COURT REGARDLESS OF
JURISDICTION.
3. NO PARTICULAR PERIOD TO ESTABLISH GOOD MORAL CHARACTER.
6. 30-DAY WAIVER TO ALLOW EXPEDITIOUS NATURALIZATION USUALLY GRANTED
PURSUANT TO SECTION 336 (C), I&N ACT.
7. AFTER THE FILING OF THE PETITION AND BEFORE THE FINAL NATURALIZATION
HEARING, ALIEN INELIGIBLE IF MARRIAGE IS TERMINATED BY CITIZEN
SPOUSE'S DEATH OR FINAL DIVORCE DECREE.
8. APPLICANT MUST INTEND TO JOIN CITIZEN SPOUSE ABROAD IMMEDIATELY
AFTER NATURALIZATION AND UPON COMPLETION OF CITIZEN SPOUSE'S EMPLOY-
MENT ASSIGNMENT, MUST INTEND TO RETURN TO THE U.S. AND RESIDE
PERMANENTLY THEREIN.
EVIDENCE REQUIRED AT THE INTERVIEW
(1) COMPANY LETTER SETTING FORTH TERMS AND CONDITIONS OF CITIZEN
SPOUSE'S EMPLOYMENT AND THAT APPLICANT WILL JOIN CITIZEN SPOUSE
ABROAD AT PLACE OF EMPLOYMENT UPON COMPLETION OF NATURALIZATION.
(2) MILITARY DEPENDENTS USUALLY FURNISHED D. D. (DEPARTMENT OF
DEFENSE) FORM 1278 INDICATING THAT TRANSPORTATION EXPENSES
OF ALIEN SPOUSE ARE TO BE PAID BY MILITARY AUTHORITIES. DD FORM
1278 ISSUED MORE THAN 90 DAYS IN ADVANCE OF THE ALIEN
DEPENDENT'S AUTHORIZED DEPARTURE DATE IS UNACCEPTABLE BY
REGULATION,
(3) PROOF OF SPOUSE'S U.S. CITIZENSHIP (BIRTH CERTIFICATE OR
NATURALIZATION OR CITIZENSHIP CERTIFICATE).
(4) MARRIAGE CERTIFICATE OF THE PARTIES.
(5) TERMINATION OF PRIOR MARRIAGES OF EACH PARTY.
(6) TESTIMONY OF BOTH U.S. WITNESSES THAT PARTIES HAVE BEEN RESID-
ING IN MARITAL UNION.
(7) ALL CERTIFIED COPIES OF DOCUMENTS MUST BE PRESENTED.
D. SECTION 329(A) - PERSONS WITH ACTIVE DUTY, MILITARY SERVICE , DURING
SPECIFIED PERIOD OF HOSTILITIES
ALL REQUIREMENTS AS SET FORTH UNDER THE GENERAL SECTION OF THE LAW
(316(A)) EXCEPT AS FOLLOWS:
10/1/80
10-31
1 . IN ADDITION TO N-400 PACKET, ALI3N MUST SUBMIT (A) BIOGRAPHIC INFOR-
MATION, FORM G~325(B); AND (B) REQUEST FOR CERTIFICATION OF MILITARY
OR NAVAL SERVICE, FORM N-426.
2. ALIEN MUST SERVE HONORABLY IN AS ACTIVE DUTY STATUS IN THE ARMED
FORCES OF THE U.S. DURING ONE OF THE FOLLOWING PERIODS:
(A) WVI, BEGINNING APRIL 6, 1917 AND ENDING NOVEMBER 11, 1918.
(B) WWII, BEGINNING SEPTEMBER 1, 1939 AND ENDING DECEMBER 31, 1946.
(C) KOREAN HOSTILITIES, BEGINNING JUKE 25, 1950 AND ENDING JULY 1,
1955.
(D) VIET NAM HOSTILITIES, BEGINNING FEBRUARY 28, 1961 AND ENDING ON
OCTOBER 15, 197S BY EXECUTIVE ORDER 12081.
3. IF THE ALIEN WAS IN THE U.S., THE CA.KAL ZONE, AMERICAN SAMOA OR
SWAIN'S ISLAND AT THE TIME OF HIS ENLISTMENT, REENLISTMENT OR
INDUCTION, HE IS EXEMPT FROM THE REQUIREMENT OF LAWFUL ADMISSION FOR
PERMANENT RESIDENCE.
IF NOT IK THE ABOVE AREAS AT THE TIME OF ENLISTMENT, REENLISTMENT
OR INDUCTION, HE KUST SUBSEQUENTLY HAVE BEEN LAWFULLY ADMITTED TO
THE U.S. FOR PERMANENT RESIDENCE.
NOTE: THE PHILIPPINES
THE PHILIPPINE ISLANDS WERE AN OUTLYING POSSESSION OF THE U.S. UNTIL
JULY 4, 1946. ALIENS WHO SERVED DURING WVI I IN THE PHILIPPINE
SCOUTS OR OTHER GUERILLA UNITS AS COMPONENTS OF THE ARMED FORCES OF
THE U.S. ARE ELIGIBLE FOR NATURALIZATION IF THEY WERE SUBSEQUENTLY
LAWFULLY ADMITTED FOR PERMANENT RESIDENCE. AN ENLISTMENT OR
INDUCTION IN THE PHILIPPINES IS NOT CONSIDERED THE U.S. FOR
PURPOSES OF EXEMPTION OF THE LAWFUL PERMANENT RESIDENT REQUIREMENT.
QUESTIONS HAVE ARISEN CONCERNING THE LEGAL RIGHTS OF FILIPINOS WHO
SERVED DURING WWII. IN THE MATTER OF NATURALIZATION OF 68 FILIPINO
WAR VETS CASE, A SAN FRANCISCO DISTRICT COURT HELD THAT FILIPINOS
DURING WWII WERE DENIED DUE PROCESS OF LAW SINCE THE U.S. GOVERNMENT
WITHDREW ITS NATURALIZATION OFFICER IN THE PHILIPPINES AND DID NOT
AFFORD FILIPINOS THE OPPORTUNITY TO PURSUE NATURALIZATION THEREIN.
THEREFORE, A FILIPINO WHO SERVED DURING WWII IN THE PHILIPPINES WITH-
OUT LAWFUL PERMANENT RESIDENCE MAY SUBMIT AN N-400 AND CONTEND THAT
HE IS ELIGIBLE FOR NATURALIZATION PURSUANT TO THE ABOVE CASE. THE
SERVICE WILL HAVE TO ADJUDICATE EACH CASE OF THIS NATURE ON ITS OWN
MERITS, CURRENTLY, MANY OF THESE CASES ARE PENDING IN THE COURTS OK
APPEAL.
FURTHER REQUIREMENTS IN A MILITARY CASE ARE AS FOLLOWS;
(A) THERE IS NO SPECIFIC PERIOD OF RESIDENCE OR PHYSICAL PRESENCE Ii,
THE U.S. OR IN A STATE.
(B) PETITION MAY BE FILED IN ANY NATURALIZATION COURT REGARDLESS OF
JURISDICTION.
(C) THERE IS NO PARTICULAR PERIOD TO ESTABLISH GOOD MORAL CHARACTER.
(D) THERE IS AN AUTOMATIC 30-DAY WAIVER OF THE NATURALIZATION WAITING
PERIOD (329(B)(5), IAN ACT).
(E) THE ALIEN MAY BE NATURALIZED REGARDLESS OF AGE (SECTION 3?9(B)
(1), I&N ACT.
(F) NATURALIZATION KAY BE PERMITTED EVEN IF DEPORTABLE (SECTION
329(B)(1), IAN ACT.
(G) ALIEN IS INELIGIBLE IF DISCHARGED BECAUSE OF ALIENAGE.
(SECTION 329(A)f I&N ACT.)
10/1/80
ADMINISTRATIVE MANUAL
Appendix 1
N-400
Page 1
UNITED STATES DEPARTMENT Of
APPLICATION 10 FILE PETITION FOR NATURALIZATION
INSTRUCTIONS TO THE APPLICANT
(Tteu.- all il".j'i iaiiruction dbe« turfoc* filing mu ttu* form)
You faint be at teasi 13 year* olJ to file 3 pention for naturalisation. U<:ng ink or a typewriter, atuwcr every question in the
application form, whether you are male or Jtm^lc It you need more sp«c for an amwcr. write "Continued" in your answer, then
fitmh your answer on a sheet of paper thu sue. giving the number a( the question.
YOU WILl Bf EXAMINED IfNDFR OATH ON THF ANSWERS (N THIS APPLICATION WHEN YOU
APPEAR FOR YOCR NATURALIZATION EXAMINATION.
If you wiih to be called for nammiiion at the \une time as a relative who i» applying for naruriliiation is culled. attach a
separate sheet so stating, and ihow tht name mil the Alien Reguiraium Number of that relative
1. *©U MUST SINO WITH THIS APPLICATION THE FOllOWINO ITEMS (I). (1). (33 AND (4):
(1) ^holographs of your Face:
a. Three identical ungl.^ed copin, me 2x2 inches only.
b. Taken with in the las? \Q dayi
c Distance from (op of head Cfi pomr of chin m be 1W irwhet
<L On thin paper, with light background. ihuwing fron: vie* without hat.
e. ]a nj>ai/al color or hlaik and white, and not machine made
I. Uruifned (but write Alien Regiitratum Number lighily in fwtKil in center of reverie side).
(J) Fingerprint Chart — Complete the personal data items such u narrw. alitsej. weight, date of birth, etc. Write in your
Alien Regiitraium Number in the Jpite irurked "Miscellinsoui No. MNO" or "Yo«ir No. OCA" and tak* the chart with
these irutructiouj to any police suuou. liienrl i oiTice. or oifice of the Immigration and Naturalization Service for fingcrpnntmK.
You must then tign the chart m the presr:i:e ot the officer taking the hn^erprmn arid have him -her si pi his/her name and
title and fill in the due in the ipico provided. DO NOT hf.VD. FOLD OR CREASE THE FrNGERPRIVT CHART.
(3) Biographic Informant n. — Complete every item in the llmguphic Information form furnished you with thu appli-
cation and ugn your name »ii the line provided H vnu have rvrr served in the Armed Fon.es of the Unitvd States, obtain
and complere iN> an e»ira yeljiw sheet of the form, bearing tl.e number G-J2JB.
(4) U.S. Military Service.— Ii your application o based on vour military service, obtain and complete Form N — 126.
"Request for Certification of Military or Naval Service"
2. PSS. — DO NOT SF.ND any fee with this application unless you are also applying for a certificate of citircriship for a
child (ete Instruction 6).
}. ALIEN REGISTRATION RECEIPT CARD.- I >O NOT SEND u-ur Alien Reputation Rcicipt Card with this application.
4. EXAMINATION ON GOVERNMENT AND LITERACY. — Fvery person applying for njrurali/.uion mujr show rhjt he or
she has a knowledge and iidilertt.iinjinii •_•( the hf-tnty. principle';, and turm nf ^nverninent of the I'mrcd States TUVRI: IS
NO EXEMIT1ON IKOM THIS KI.QflKl Mi-.NT. atu! you will therefore he etamincii on ihrse lul-icits when you appear
before the examiner with your wicncucs
You will also be examined on your ability to reid, write and speak English If on the date of your examination you are
more then 50 yean of aj;c and hive been i !a«>f-! permanent resident ot the United Stares for 2CS or more years, you will
be exempt lium the fn^li.th hnguagc rrcjjircincnn uf rhe Liu If you jre exempr, you nuy tjke the examination in any
language you wish
3. OATH OF ALLEGIANCE.— You will be required to tike the following oath of allegiance to the United States in order to
become a citucn.
FORM NO.
N-400
EDITION
REV. II -| -
T1T1X
APPLICATION TO FILE PETITION FOR NATURALIZATION
SLUE
8X10 1/2
trss
INSTRUCTION REF&MNCa 8 CFR 103.7(b)(l), 324.11, 327.1, 330.1, 335.11(b), 341. l(b),
499.1; 01 334. 5(b), 335c.3, 341.5, .5(b), .5{q); AM 2301. 25. .26, .28. .29, .30, .30.02,
2303.06, 2304.07, 2482 Ex. 2, 2713.06, 2720.02, 2750.31. 2799.05, 2984.13. Ex. 4; Nat Hbk
1-2.1, -6, -11, -26, -27, -29, -40. -43, -48, -49, 2-3, thru -6, 4-17. -20, 8-1, 12-1, App. II-2,
AjBJ5_.JJ-£k^^
USED BY A PERSON DESIRING TO FILE A PETITION FOR HATURALIZATION
PRIOR EDITIONS MAY NOT BE USED
SCHSDOUB B
4/1/81
1 hereby declare, on oath, that I absolutely and entirely renounce jn I abjure M ailr.;uru.e and fidelity to any foreign
prince. pDienfate. lute ur ••nvcreigmy, of »ncu:> ur which I line hcret.jlotc been a »ub|c-cf or cid/cn, that 1 will support jnJ
defend the diminution and laws u! the United Stato ul Ammca a.-imit ail cncmi«. turc-ii'ti .1.1.' .li.mestic. that i » ill brat true
faith and xliciiiancc to the tame. (Jut I will bear arms on behalf ot tne l,'n.:cd Sratci when required by rhe law. ih;t I will per-
form nuniiiirLutant service in the an;>e.| lurces ,.t •<:: United States when required by the |j» ;^at I will f«ert.irm »..rk of
national importance under i:vi!un i!irn.tion wnen required by the law. and that 1 talc chit ubi.i^aiiun freely wittvjui any
mental tewrrvatiun ur purpose ul evai.un. so help me Got).
If you cannot ptomrie to bear arms or perturm noncunibatant service became of religious training and belief, you miy umil
choae promises when caking tnc oath,
"Religious mining and belie/' mrjns j perion s helie/ in a .-eUriun ro i Supreme Being involving Juries superior to those
anting from any human relation. bu( dues not include ruentudly puliraal. sucu.lu^tcal. or philiiiuphical viewi or a merely pervurui
monlcode.
6. THIS BLOCK AmiES ONLY TO APPLICANTS WHO HAVi FOSEICN-BOiN CHILDREN WHO AKE UNDER 18
YSAJtS Of AO&
Suoie or aJl ot your out furrif(n-born children 'Not Step-Children) «ho are rxx yet cimem may pouibljr become
United State: cituera automaiically when you ut niruralitcd. Thif will happen
(1) If <Se child 19 a lawful permanent resident of the United Sum anj Mill under Irl yean o( age when you are
naturalized, end
(2) The chiU'» other pjtrtm u already « citucn or bpc'imn a iituen before oc at the 'jme time that you become
naruraliied. If. h.mever, the ihilJ i ut!<rr parent it ucxeaicvj. ur if vuu are divorced and have custody of the child.
then it make! nu diffetente ttut the OliiiJ \ nther parent wii or n an alien
(3j If yuur child u illegitimate and yiiu arc me mother, tinly ( I ) abme applies.
<4) If lite child u iJnpicJ. an.; »aj ajupted r» S'HC :ti Itun birthday and n in y.xir cuitodv
If ynu wuh. >IHI tan tpplv :>>r a ( c ni.ufe i>l C ti.-cn 'in Mr anv .« thevr children, which will <how that they are United States
Cititeni If yiiu Jo niM want «jth al erufuatr. wtne IV I NOT" in ijumi'in i lo>. pajte 5; if you do want «ach a C*rtil"ii.aie. "tile
'DO in QueiiKKi (to), p^v t. and x.nd ihc I,.I|,,».,,IK with this urnluaium
(1) Fee. Fifteen dollan (JM) for each child • r whom a. certificate is dnired. DO NOT SfND CASH FNTHE MAtL
ALL FEES ML'ST ill. SL'fiMITTt'D IN I HI EXA< T AMOl/NT If niu mail v-Kir application, attxh a money
order or cho.it, pavable to /r"n<»"Jl""i ^iJ Vji«»i.iiJ/i''« Ar'i 1. 1, DiCarimtit ,n l*<n,r (Exceptions If you
tonic in the Virgin KUIKM. femittanif t:::iit be paviL'.e to (.ummiuiuncr ul F.njmc. V ti<in Ulandl. and if in
Guam, to Treoju.-er. Cuani i IVr««ul ki.'«.iu are aii.e-.iii.il «ubn\t M iollevrihiii:y An untoilectiblc chcil \tdl
render the application and any Jixumcnn iiucd pursuant lhe:ct>i invalid. A ct.arxe nf S*i 'XI will be imposed it a
check in payment il a ffc n not honored :w the tun* on wnich it u drawn The tec will be refunded if lor any
reutxi you are not nacuralited in lime or :':c child dt>e> nut qualify tur the certilKate
(2) Personal Docription Furrn. — A completed Form N-'iiM tor each ^hilJ
(i) Otcumenu. — Tl'.c document apnlic'ahle '•> vnur i-aie I stej in the bKx.ki below If vou »ant any of the i'Ti,(in.il
dtXTjment) returnol to TC». and i! the la» .Jixi rk-t pmliibit tfie in.ikin/< of copies. J p.'iot.Mipy of the dixument
should be )«nc uith tne original document
Any documcr.t in a foreign ian^ua^'- -nust be acuimpinied bv a summary translation in Cnglish. A summary
translation is a n.t-..l:nu!ion or atitrait . t' the d>x:umcnt s tent. The translator must certify rhat he is competent to
tramlaie an 1 that tlir translation is accurate
(4; Photograph*.— Fi'llow instrucn.in No . • •• • 1 ) and send three I * ' pliotographs ot r«h child Write the child s
Alien Regiitraticm Number un the ba^lc i>> tV- rhot.ittaphs. lichtly HI pont'il
1. Child's bn
1. Yoar mtr
3. If you or
DOCUMENTS RH.U'lRhO WITll T11IS APPLICATION
decrrc ihowinft the-
V If the chilJ i other [Mrtni
awl. or if you are
the child » other parent, tht death
6 If the ihil.l i. adopted. > l.-ption do
ohci
is'tlARV FVIDFNCF
nt pfcwntcd. t.i(tetner »,(rt i «.n
I. Riplxmtl tri,t\,*ir—\ «rt
I. .?(•*«„/ •ttnri—f, letter froi
OR J.tc ind plait t
i prtferahlv <h« hi
and pl«.r\ of birth . I p
3. If vou or the «htr r'"'"
v if \hown in thr uh.xil rr\ords.
Intnl.
4/1/81
Appendix 1
Page 3
IPPUMTION TO FILE PETITIOM FOR HATUfMLIZATKJH
Mill <u ukt to I •
IMMIGRATION AND NATURALIZATION SERVICE !
<5« INSTRUCTIONS BE Stm.E YOU UNDERSTAND FACH
QUESTION BEKJRE YOU ANSWLft IT. PLEASE PRINT OR
TYPE)
AHEM BESISTRATIOH
( Shntv th* »*.< tp*l!i*c tit four ***** M n *pt**ri tyi r«*Ji iltm N«itt/»ooa
r*.rtpi (nd. and UM nutntttr »f ?otU <Ud If *ou did ft« fcjtitwr. to Wax I
Us
S«aioo of LAW
( 1 ) Mr lull tr« wvt cornet
U) I BOW live a
()) t »«i bare on
(Month I 'D»i I V»t
(4) t rcqucM iKii rn» rum* b* cruinnd to
(» Other fumti I I <v« utfd tit:
(6) Wg» your father or nwxkn e»«c a United Sum eioceci? D Y« 0 No
(If ~W. nplaia fully)
(7) C*n you »e»d end wri» En^liih' O Yo Q No
(8) Csn you spoik En«l.«h? D V«* O No
(5>) Can you »ijcn your ruaM in Ennliih' D V«| O No
(10) Mf Uwful edro.inon foi permanent renders wm ea - -..- undcr.ttw Mint of
(Mo«k) (On) (Yew)
(11) SiiKt that dan I hart raided commuovnly m the United Statti »nd conimurxuly in ihe 5«re ol whent 1 now
li»« tine*.... During the bit n«t ye»n I hj«e St-cn phynolly pretcnt m the United State! for a toal of juanihi.
(12) Do you intend to tend* prrounently in the United Staiei* Q. Vn Q No If "No." eipiaiai
(D) In what plait! it. the United Sta>r« h>vr you lived dutintt the tut 1 vnu' lilt prtwni .
FtOM.
"TO'.
~' ST.FITAK.MU " "
I ITT AND ST ATI
(»}
19
PRESENT TIME ..
(t)
19
19
(t)
19 _.
19
(J)
19
19
H4) (>) Hive you Wen out of 'he I'n.teil SraKi since your lawful aiimiiuun a • permanent rriiilent? • •
If "YeT fill in the fnllnwin/i informaii-m fnr every abiente .if tut ih*: 1 noniti. no nutter h.« ilu-rt it '
D Yet O No
DAT» DcrAirin
(b) Since your lawful admution. h*ve you b«n out of the United Sraret for » penixJ of t> maitiii
If "No", mte "None". If "Yei", fill in mlliming inlormatinn lor cvtr>' ah^enct ol mote than 6 mnnihi.
DATS DurAarrn DATB
Vn D No
4/1/81
(2)
(li) The l«» provide! th«t you may not be regarded si qualified for naturalization, if you knowingly committed certain oderue* or crimei. even
tbougb you may not have been armted. Have you ever, in or outside the United Sum:
(4) knowingly committed any crime for whuh you have not been arrested' Q Y« n No
(A) fcren arreired. cited, charged, indicted, convicted, lined nr imprisoned for breaking er violating any Uw or ordinance.
including traffic regulation*.' .. Q Yei D No
If yew answer 'Yei' ro U) or (A), give the following information tu to nun incident.
V/ntn UHIIB iCiyi (Suui iG*u>in> NATuat or OrrrNM OVTCOUI or CAU. Ir AM
(fl „ _
f» .,. ....
(16) list your present end pur, membership in or affiliation w(rh every oreaniutioa. ai&ociarioft. fund, fourtdarina. party, dub. sociery or iimilor
group in (he United State* or in any other country or place, and your foreign military service. (If none, write * N'one.")
(a) _ _.._.._ „ _ _.._ „..„.._ .._....„_ 19... „. re 19
(c) m. „ .„..„ .' . 19 ID 19
(4) _..___„ _ _.. ._._.«..._._ . _. .._ 19 n 10
ft) ..._ ,.„.._ _.._ _ _ „ _.._ _ ^ 19_ n jo
lit ~., - ~ - — _ 19...- to 19 '.
it> ._.. ..::; .,19 101°
(I/*1 (») Ate you now. or have you ever, in the United Stares or m «n» other pine. Seen a member of, or in :nv other way con-
nected or asKXiated with -he Communist Fairy' (II 'Yis . innh full eiplinatinni Q Ye. Q No
{t) Hive you ever knuwing'y aided ur siijipotieil the Communist Patty ditectlv. ot indirectly thioutth an-.iher oixanuarton,
Uroup or person' (If ' Ye.". iiv,;h (ullciplinatumi . . Q Ye. Q No
(e) Do you now or luve you ever ajv.xired, taught, believed in. or knowingly supported or furthered the inwrein ol
Communism.' (If "Ye«". atrath lull explanation) Q Ye. Q No
(ID During the period March it. 19M to May «. IV4.V d>d you serve in. or were you in any aililmted with, either directly or indirectly.
any military unit, paramil.ury unit, police unit, tell defense un.i. vigilante unit, cnuen unu. unit 1.1 the Nui P»ny nr SS. government
agency or office, entermmauon camp, concentration camp, prisoner m war cam?, prison, labor camp, dctenticm camp or uwuit camp.
under the control of ot ainliaied with.
(«) *e Nati Government of Germany . - O Y«« O No
(b) any Government in any Area occupied by, allied vith, or established with the autatance or cooperation of. the Nuu
Government ol' Germany.' Q Yet O No
(19) During the period March J». t»» to May B, IMV did you ever order, incite, aunt, or otherwise participate m the persecution erf any
penon because of race, religion, national origin. 01 political opinion' O Yo CJ No
(20) Have you borne any hereditary title or hive you been or «ny urder ol nobiiirr in «ny foreign irate.' • Q Ye» Q No
( Jt) Have you ever been declared legally incompetent or have you ever been confined a* a patient in • mental institution? D Ye» Q No
(22) Are deportation pnx'-e.l.nni pending IK'""' you, or have you ever been deponed <it ordered deponed, or have yu ever applied
foriuipeniic.noi'deporuiion' Q Yei Q No
(n> (t) My Ian Fedetil intome ra« return was tiled '»«" Do you ow» any Federal tastes.' ...,™,. Q Ye» Q No
(i) Since becoming t permanent tcsident of the United Stain, hive you:
— Sled an income us return is a nonrendent' O V«» O No
— failed to file an income tan return becuse you legitded yourself a» i nonrendent? O Ye» O No
(If. you aniwer "Yei" to (<> or (i) eiplam fully.)
( N ) Have you ever claimed m writing, or in any other way, lo be a United States cimen? O Yei O No
(25) (*) Have you ever Jcierted from the military, air. or nivil forces of the United States1 Cl Yel D No
(») If male, hive you ever left the Unue.l iuiei to avoid bem«. drifted into the Aimed hutces of the United Stales.1 Q Yes H No
(X) The liw provide! thai you may inr be rtvjrdcJ » qualified for n»nir»bi«non if, n jtt time JunriE the period for which
you are requited to pmve ««\l moral chiiictr-r, v.m hive been i liiSnuil Jtunkitd. ^nminitie,! ijnlierv. ajvtxjiej or ptacticed
United Staiei ille^allt. hive been an illicit tuihiket m narcotic JUKI or mitijuani hive iccrived )i>ur income mostly from illegal
gambling, or hive Riven filse resrimony for (he purpose of obiiimng any bencnrs under this Act. Hive v«*u ever, ftiteotft.
been «uch a petson or committed any of these iiti' i If you snswef yes to any oi tneie. attach full e«planation t D Yei Q No
(27 1 Do you believe in the Constitution and fotm of jiovernment of the United Staiei' Q Ye» Q No
(M) Are you willing ro tike the full cwth o( illegiince ro the United SMtei? (See Instruction!) Q Yei Q No
(29) If the li»i rcc|Uires it, ne you willing:
<<) to bear arms on b«h«lf ol th«- United State.? (If "No", arta.h full explanation) Q Ye> n No
(4) ro perform noncombatant seivices m me Armed Fotcei of the United Sires.' (If "Nn", attach full explanation) O Ye> O N>'
U) to perform w.vik ol national impoicance under civilian direci.^n' I If 'No'", aiuch lull eRflannion i Q Yej Q No
(30) («) If male, did you ever register under United Sum Selective S^rvue laws or draft liw«J . O Y" O No
If "Yes 'give Jitr Selective Setvicc No , Lixii UtMrd No. ... . Piesent classification
(4) Did you ever api'ly 'or exemption from military service because of alienage, conscientious obrecttoni. or other reasons? Q Yei Q No
If "Yet," eiplam fully
4/1/81
TK*'
10-37
ADMINISTRATIVE HANUAL
Appendix I
N-400
(J)
(»l ) If Kniim of evet Mrvid in the Aimed" Force* of the United Sum, live hr»nch ;
«rom ... . 19 ..to _. 19 and from . 19 to 19
Q inducted ot Q enliued at _ ; Service Na 4
tit* of JiKhufC... —........: ; nnk « Jucluiie.. _..__... .'... „ ;
muon lac ditcluige „ _ _
Q Rexrve or Q National Guild from ' „. w.. . «... ,. 19 to .«—_.... ...
< JJ) Mf occupation 11 „ „_ _ _ _ _ „ _.._.„__..„ „.._
Lid rfce name*. addre«i«. and accu|»iiont (oc ryp» o( IMUIMU) of yaui employer* during d* lui 5 yean? Ml tnM.-viiie "None.")
Ll« promt employment FIRST.
PM
To-
lurLomi I NAMI
AD6UI1
ocru'ATioN oi Trn
or H IIMU>
/«;
19
PMUNTTlMl
(*>
,19 ..
„. „ .. , 19.
/ i
„ 19........
.„. _ , J9_
M -...
19
19
-
())) CamplM* ihw black il you art or k»vt
The &fU name oi my hutband m wile it (»«»).,
V« were warned on .. _ u. .—_... — ___ — — - H* or the wai born a( „_ _ ..___
_._. M ., „.. . Me oe the eourrd the United Suie» -i (place). ___
...... . — _ on (date) _._.__, — iv ptroianeni rendext aad Mw reaidet Q with mt
Q ftpan Irojn tte at _.._.._ «..„.. '„ „.._ ««,*..««.»« ... ,
(•>•* Kill n«iin rf •« tin* wuk m.)
He or <he >u ururalired on _ _ tt ; Certificate No...
or became a cuuen by Hu or her Al«n Ke^iuraiton No. u
<M > Mow B*nr time* lu*e you b«n mirried? How ftunr limet tut rour huib*n4 or «i<e been nuirM? U citlier o( rou bit
Wen nuriied tnoit itun nrxc. All in the lollowin* informiuon for cxh pmiout rrutrunt.
DAT* MAMIIP
D*Tt MANIAC* tNMB
NAMI or M»»OM TO WHOM HAtun
J«s
ICk«» O..I
rritnNMAMiroVAl
.ttlllMQ ALIUtQ
Ho* MAIIIACI
(NDCD
ft) _
O D
/ft)
"
O.n
f«) .
Q ... _ Q
r^
n a
children: (Comi.icir columni (<) to (h) «i to exh child. U child lives with you, IKK "with me" in colu
».Ur) W|M I1TI jjt,, ,0J s»«e of shild'i retidence. I
ih), other-
(.) drniNuM
Ik) Sn
(c) ritnlora
/Councrrl
lit Dor
fern
HI DM
tl titirr
ill **ittli*n
in Al««
Xm.uKr.uA Mo
<k) No. li.,^«.
(M) READ INSTRUCTION NO. 6 BEFORE ANSWERING QUESTION (J6)
!_„._ _ _...»»nt nrofcatet of cititeiuhip foe tbote of my children who we in the U.S, tnJ «r« under ««f IS ynn that >rc muwJ below.
(Do) (Do Not)
(EadoK |1) foe etdi child foe whoa f«u want certificate*, odxrwiic. tend ax> (Mewf wild (fail applioMion.)
(Wn« *Mm «l lK.Ul«n i»U« •«• III Tnn <nd «h« Mr '« llw I' S (of «Koo> ran »uii uniluiinl
U proetu ipouie it not the parent of the childicn named tbove, M»e parent'! nime, date ind plact of niruril.udcm. and Dumber of nutnatet
Signature of penon preparing
form, i/ mber than applicant.
SicMAru»e of APPUCANT
1 declare thai rhit document «u
plicut and u bued oo all inform
SlGNATUiI
prepimi by me >i the rniunt ot ip-
atiua ol which I have any lu»owled*e.
AUWIIU AT WHICH APPLICANT RlCHVEJ MAIL
AOOUM:
DAT*:
APPUCANT'STBUIPMONI NUMUEH
TO APPLICANT
: OO NOT FILL IN BLANKS BELOW THIS
LINE.
NOTE CAREFULLY — Tfcii application BUM be iwora to be/on an officer of (he Inuaigniiaa and Naturaliutioa Sefrice at ibe liinc you
tppeu btfoct web oActr (at euaunanaei oft itut application.
AFFIDAVIT
I do *WMT thai I JCAO* the cooKna of thii application (aaipmiag
Biftct I 10 4, indium, tad the supplemental form thereto. Nod).
_.„ _„__ _.._ „._._.._ nibtrnbtd 10 bf mr.
llul dw um< Ht UMt » rtvt br>( ol air knowl»d« ind bclirf; thM
axtKtiaiu oumbcml ( ) to ( ) «ct* made ot mt oc •( my
W)U(M. aiul iKit U>i> ipplttMion «u »««*4 by n» «mh m» full, »ui,
tad (orrwt n*nu. SO HELP ME COO.
Subttntxii ind ivora w btfon nv br applicuu at the preliminary
ihit d.yo( ,19
I certify thai brfon VMification the above applicant uitrd in my pVncnct
that h*/iht K*d (hcaid) mJ Ihc loicKOing applioiton, cottrmona
lbM»ui and lupphnwul form(i) and umknlood rii* conienu Ibetwf.
"" '
rCtwnpUt* »«d trirf n4<«M«rt ttt *P^M*AI>
« N*ruralii«>Mt rumtiwr)
(9** eitNMMUf*
KM Ol 4pplltMWI tMi'T "' *"•• Cf^llth)
Occu no«>
NooAlcd ..-. ^ «*.... . — ..
( DMI. Kt ftiom >
NOTICE TO APPLICANTS:
Authority for collection of the information requested on thii form and those forms mentioned in the instructions thereto U
continued in Sections US. 329. i*2. W. }}5 ot VU ot the Immigration and Nationality Act of 19)2 (8 U.S.C 14^9, 1 MO. l<t-U.
144}, 1446 or 14)^ ). Submisiiun uf the mfotmatinn is voluntary inumuth as the immigration and nationality laws of the United
Sute* do not require an alien 10 apply for nituralu.uion. If your Sixul Sctunty number is included on a form, no nchr. benefit or
privilege will be denied for your Uilure to provide such number. However, as military records are inilcxnj by such numbers, verifi-
cation of your military service, if required tn establish eligibility for naturalization, may prove difficult The principal purposes for
soliciting the information ate to enable designated officers of the Immigration and Naturalization Service to determine the admis-
sibility of a petitioner for natur.iluanon and to make appropriate recommendations to the naturalization courts. All or any paic of
the information solicited may, as a matter of routine use, be disclosed to a court exercising naturalization jurisdiction and m other <
federal, state, local or fnreign law enforcement or regulatory agencies. Department of Defense, including sny component thereof,
the Selective Setvicc System, the Department of State, the Department of the Treasury, Central Intelligence Agency. Interpol anJ
individuals and organizations in the processing of the application or petition tor n.truralizarion, or during the course of invcMi^.iriun
ro elicit further information required by the lmmi«r.inon and Naiuraliaation Service to carry out its Tuncti.m. Information solicited
which indicates J violation or potential violation ot law, whether civil, criminal or regulatory m nature may be referred, as routine
use, to the appropriate agency, wherher federal, state. Kx.il or foreign, charged with (he responsibility of investigating, enforcing
or prosecuting such violations. Failute to provide any or .til of the solicited mfnirrution may result in an advene recommendation
to the court as to an alien's eligibility for naturalization and denial by the court of a petition for naturalization.
Tar Mb by ||M 8up.rtnnn.tant o( bocufMMi. V.I. Oo»«
Wulitnitoa. D.C. 2MU (per 100)
U 1 GOVERNMENT (HINTING OFTICt IWi l»-»ll
4/1/81
10-39
TM 578
ADMINISTRATIVE MANUAL
Appandix I
N-400B
Page 1
SUPPLEMENT TO APPLICATION TO FILE
PETITION FOR NATURALIZATION
(Bra i
NtJM
No.
ALIEN REGISTRATION
(To APPLICANT.- F«u+a t
1. My full, tn«t and correct Mm* is
2. My pr*a«at r»atd*ne« is
r«*«f«< kiftof)
...... (ll»>l) (ClITI (»«*<•) 'HP C«*«
3. 1 claim roeidoocc Md phync*! ptMMae* in tb« United StaiM hy vtnu* of ray Mrvic« on Ui« follo
ing veao«la:
(A) Ve«»«l» Op«f*tad hy thf UniUd Sut*a
o* VMM!
Pwiod of Sorvica
.. To..
Bbow OwMtaUp <rf lh* V««o«l
(B) Privately Qwn«d Ve
N«o» of VMM*!
Pariod of S«mea
Fro. . . To . .
8fco»
BOM Part
4. la ••pport. of my claim I »«hrait th« foUowip
FORM NO.
N-400B
EDITION
Rev. 1-1-66
TITLE
SUPPLEMENT TO APPLICATION TO FILE PETITION
FOR NATURALIZATION
SIZE
8X10 1/2
INSTRUCTION REFERENCE
H r-TR \30L1; OI tl* - 1 ..^ . . —
USE
SUBMITTED TO SERVICE BY A SEAMAN, UNDER SECTION 330 OF THE IlcN ACT
Page 2
Appendix I
INSTRUCTIONS TO APPLICANT
USE OF THIS FORM-This form ia a supplement to the Application to
File * Petition For Naturalization (Form N-400) and must be us«d if you
have been lawfully admitted to the United States (or permanent residence
and ar« claiming residence and physical presence in th« Unitad Sutesby
reason of aubsequenl service on (A) a vessel operated by the Unitad
States or any agency thereof, the full legal and equitable title to which is
in the United Stales, or (B) * vessel whose home port is in the United
States and which is either registered under the laws of the United Sutes
or the full legal and equitable title thereto is in a cititen of the UniUd
Stales or a corporation organized under the laws of any State.
This form must be filled out in ink of on a typewriter and should be at-
tached to the Form N-400. Both forms, together with the document* herein-
after described, should be brought or mailed to the office of the Immigra-
tion and Naturah ration Service shown on the Form N-400.
REQUIRED DOCUMENTS - tf you claim service on a vessel operated
by the United Sut.es, you must submit with this form & duly authenticated
copy of the records of the executive department or agency having custody
of the records of such service, and showing that the vessel was so
operated aad was fully owned by the United States; the dat«s of each
period of service; and the nature of your conduct daring each period of
service.
If you claim service on a privately owned vessel, you muet submit a
certificate from the master, or an officer of the firm or corporation owning
the veesel, or tae individual owner of the vessel, or an officer of the
vessel who is certified by the owner of the vessel as having be*n in a
position of authority aboard the vessel and as having actual knowledgeof
your service and conduct. This certificate must show the Hag, nationality,
and home port of the vessel upon which the service was performed; whether
the vessel is registered in the Unitad States or whether the full UUe is in
a cititen of the United Slates or a corporation organised under the laws of
a State; toe. dates of each period of service; and the nature of vow con-
duct during each period of service.
ALIEN REGISTRATION DATA - Show your A lien Registration number
aad your name exactly as they ate shown on your Alien Registration
Receipt Card, in the box at the top of the other .side of this form.
If additional space is retired U> furnish the infonaation which awrtbe
set forth on tie other side of this form, continue your answer* on another
sheet the sice of this form aad attach it to this form.
10/1/80
FORM N-336
APPLICATION FOR 30-DAY WAIVER - NATURALIZATION
I. USE:
USED BY A PETITIONER FOR NATURALIZATION TO OBTAIN A WAIVER OF THE 30-DAY
FINAL NATURALIZATION HEARING WAITING PERIOD REQUIRED BY SECTION 336(c) OF
THE IAN ACT.
II. ELIGIBILITY:
ALL PETITIONERS FOR NATURALIZATION WHO ARE ELIGIBLE TO BE NATURALIZED
MUST ESTABLISH THAT THE WAIVER, IF GRANTED, WILL BE IN THE PUBLIC
INTEREST.
III. REQUIREMENTS;
1 . WRITTEN REQUEST TO THE DISTRICT DIRECTOR.
2. REASONS FOR WAIVER -
EXAMPLES: (A) MILITARY CASE; (B) SPOUSE OF U.S. CITIZEN GOING OVER-
SEAS; (C) CHILD OF U.S. CITIZEN PARENT GOING OVERSEAS; (D) EMPLOYED
BY AMERICAN FIRM UNDER CONTRACT WITH U.S. GOVERNMENT.
3. $5 FEE PAID AT THE INFORMATION SECTION AND RETURNED TO PETITIONER
FOR ADJUDICATION BY THE CITIZENSHIP BRANCH.
10/1/80
Application for 36 Day Waiver - Naturalisation
SEE INSTRUCTION ON REVERSE
I.-
Petition Number.
. , in the.
Section .
.of the Immigration and Nationality Act.
filed
i*i
Court
.under the provision of
I request the Attorney General of the United States waive the 30 day waiting period between the
filing of my petition for naturalization and the date of the final hearing. In support thereof I
state chat such waiver will be in the public interest in che following respects:
Dated
Signature of Petitioner
ORDER
A full and complete investigation having been conducted and in reliance upon the representations
set forth in the aforementioned statement and the petition for naturalization filed with the court,
a.id a determination having been made that such waiver is in the public interest, IT IS HEREBY
ORDERED that the 30 day waiting period between the filing of the petition for naturalization
and the date of the final hearing be and hereby is waived, in accordance with Section 336 (c) of
the Act.
Dated this.
.day of.
19-
Form N-336
(Rev.ll-26-79)N
District Director
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization Service
FORM NO.
N-336
EDITION TITLE
Rev. 11-26-79
APPLICATION
FOR 30 DAY WAIVER -NATURAL I ZAT I OH
size
8ij X 11
INSTRUCTION REFERENCE
01 336. 5(b)
OSE
USED TO APPLY FOR A WAIVER OF THE THIRTY DAY WAITING PERIOD REQUIRED BY SECTION 336(c)
OF THE I 4 N ACT
| SCHEDULE A
PRIOR EDITION MAY NOT BE USED
A fee of five dollars ($5) must be paid for filing this application. It cannot be refunded
regardless of the action taken on the application. DO NOT MAIL CASH. ALL FEES
MUST BE SUBMITTED IN THE EXACT AMOUNT. Payment by check or money order
must be drawn on a bank or other institution located in the United States and be pay-
able in United States currency. Please make check or money order payable to the
"Immigration and Naturalization Service". Personal checks are accepted subject to
collectibility. An uncollectible check will render the application and any document
issued pursuant thereto invalid. A charge of $5.00 will be imposed if a check in pay-
ment of a fee is not honored by the bank on which it is drawn.
4/1/81
10-45
FORM N-455
APPLICATION FOR THE TRANSFER OF THE PETITION FOR NATURALIZATION
I. USE:
USED BY PETITIONER FOR NATURALIZATION WHO HAS MOVED FROM THE JURISDICTION
IN WHICH HIS PETITION IS PENDING AND WISHES TO TRANSFER HIS PETITION TO
A NATURALIZATION COURT IN HIS NEW AREA OF RESIDENCE OR TO ANY OTHER
NATURALIZATION COURT IF HE WAS NOT REQUIRED TO FILE THE PETITION IN THE
PLACE OF HIS RESIDENCE.
II. ELIGIBILITY;
ALL PETITIONERS FOR NATURALIZATION.
III. REQUIREMENTS.;
1. 210 FEE PAID WITH SUBMISSION OF APPLICATION AT THE INFORMATION
SECTION.
2. SUBMITTED IN QUADRUPLICATE TO THE I&NS OFFICE IN THE AREA WHERE THE
PETITION WAS FILED.
3. APPLICATION MAY BE EXECUTED BEFORE AN I&NS OFFICER OR NOTARY PUBLIC.
4. APPROVAL BY BOTH COURTS AND I&NS IS NEEDED.
5. I4NS MUST INDICATE ON EACH COPY WHETHER OR NOT IT CONSENTS TO THE
TRANSFER. I&NS FILES ALL SUCH COPIES WITH THE CLERK OF THE COURT
IN WHICH THE PETITION IS PENDING. IF I&NS DISAPPROVES THE TRANSFER,
PETITIONER IS NOTIFIED OF THE REASONS OF DISAPPROVAL.
in/i
FACTORS TO BE WEIGHED HE CONSENT OR DISAPPROVAL ARE:
(1) CONVENIENCE TO THE PETITIONER.
(2) PROTECTION 0? THE BEST INTERESTS OF THE SERVICE.
(A) IS INVESTIGATION PENDING?
(B) ARE THERE COMPLEX ISSUES OF LAW AND FACT TO BE RESOLVED
BY Q&A?
ORDER OF COURT OK TRANSFER APPLICATION IS ENTERED ON THE ORIGINAL
COPY OF THE FORK WHICH IS FILED WITH THE NATURALIZATION COURT.
IF APPROVED, 2 CERTIFIED COPIES ARE SENT TO THE TRAKFEREE COURT AND
THE OTHER CERTIFIED COPY IS SENT TO THE I&NS.
IF THE TRANSFEREE COURT APPROVES THE TRANSFER APPLICATION, THE CLERK
OF COURT IN WHICH THE PETITION WAS FILED FORWARDS A CERTIFIED
COPY OF THE PETITION AND THE ORIGINAL RECORD IN THE CASE TO THE
CLERK OF THE COURT TO WHICH THE PETITION IS TRANSFERRED.
PROCEEDINGS ON THE PETITION SHALL THEREAFTER CONTINUE AS THOUGH THE
PETITION HAD BEEN ORIGINALLY FILED IN THE COURT TO WHICH TRANSFERRED
EXCEPT THAT THE COURT TO WHICH THE PETITION IS TRANSFERRED KAY IN
ITS DISCRETION REQUIRE THE PRODUCTION OF 2 CREDIBLE U.S. CITIZEN
WITNESSES TO TESTIFY AS TO THE PETITIONER'S QUALIFICATIONS
FOR NATURALIZATION SINCE THE DATE OF SUCH TRANSFER. (SECTION 335 (l)
(2), I&N ACT).
THE MEMORANDUM TRAKSXITTING THE SERVICE FILE TO THE TRANSFEREE I&NS
OFFICE SHALL BE PREPARED BY A NATURALIZATION EXAMINER AND ALL
RELEVANT ISSUES ARE TO BE DISCUSSED BY HIM.
^
10/1/80
71 791
ADMINISTRATIVE MANUAL
Appendix I
N-455
Page 1
ORIGINAJL
UNITED STATES D£PA«TJWMT OF JUSTICE
IMMIG9ATION AM MATUDAIIZATION JHVItt
OKI No. 41-JOH4
APPLICATION FOR TRANSFER OF PETITION FOR NATURALIZATION
(Under Swctiwi iW(i). Itaaiffralioa a*d Nitionililr Acl)
No.
To the Honorable,
of
th« Court
at
.. now residing at
• Slrftl Mid •uivtorri
having filed petition for naturalization
in this Court on
iMoMil
i Owl
, and having1 removed
from the jurisdiction of said Court on . hereby make application
<M<MM lOiTl (Ytwl
for the transfer of my petition to the • ...Court
»' . . ... in accordance with the provisions of
section 335<i) of the Immigration and Nationality Act
Subscribed and sworn to before me by the above-named petitioner at
day of
19
[SEAL]
TO APPLICANT;
ucntt rtiH iooUc.no. >• 4u4n»<kau. UCB i»4 b. mn lo It Tte i»»4k«fc» m*i ba nmarf Men <• older of tlM
IT
b*fon a MKmrr IMblk. cUrk of cowt. at aOnr offlcv uttoruMl u xiaiam*r <MdM far t*mtnl pwpoM*, uri dM tut at UH Mary. d*rt or
otter oflktr not W laivraMa wb«n iMU«to4. S«k«irt tte n»<k»ao. to OM tffln o/ lk« ind«nd<M u« NwwiUatfM Swrta tb»a««
**K* r<m KM row »rt«o«. A mntauta at ua MUn (1101 nan •OCMI^UT )wv «>^t«rto«. Th« f«. u r««wW for fflkf tto x^katioa
od li MM noimDi* r*«>nU*M <W tk. K&oa taku dMrm. DO NOT MAIL CASH. Pirant by CMMk or <MMT <x+a sot o«' Own <M «
bMk or «tk«r indniikM looted (* UM U«io»d SIMM* u4 b* p*ro*U In Cited Stm* cwmcr. Itictfikw: U 7<w »«tido« for —~— "— •**-
n* <1U4 U tk« Virtu Uittfa. draw rraURwc* u <»Mtr of -CaauuiamMr of Fluan, Vlr^a liUudt*; tad If !• Cuim. n ^TrMHrtr. CMB").
AU otter tffUcmim mmn moht tte cteck or IMMT onltr *^^Mt to Ite -linal^iUM tmt NmniliMto* S*ni«." WhM cttttk l« ilrmi «•
ui tcnuM ol * BCTWW Mter iku tin .MUICMC. tte BMM at tW >wikwu •«! b* wttrad <M tb« (»n o* tfct cteck. Pmo«J ctecki in
tcnvMrf! nbtKt ta coitectibtJirr. An ••coilmM* eteek mU ruiitu ite nplir.«rt«»« <ad ur doeoMitl b»*d pwxuM tterrw ImiM. A
cteri* o/ U.OO •ill b« in>o.«d I/ • ctecfc U DtrmM of • ta ta MM hoond br tte bMk M wMck U ta dnm. I&M r*t«rM <rf IM B^t ter
oo NOT wRire tsLQ» THIS t.i.vr
Investigation haying fully established that the applicant has removed from the jurisdiction of the
Court as alleged in his application, approval of the transfer of tha petition for naturalization is hereby
given.
.. , 19 _
rm K^l| IDonm Ointtf* at O*Vt> M Cku«, InwujmxHi u4 NiranbiUHn W»K»
: • • '?'.-. NO.
} :• • •»
EDITION
REV. 12-1-78
TIT IX
APPLICATION FOR TRANSFER OF PETITION FOR NATURALIZATION
INSTRUCTION REFERENCE 8 CFR 332a.2, 334.17(a) thru (e), 499.1; 01 103.8(e)(7): AH
2482 Ex. 2, 2984 Ex. 2, Ex. 4; Nat Hbk 4-25; GIB A-10
SUBMITTED 3Y A PETITIONER FOR NATURALIZATION TO THE DD OR QIC
'RIOR EDITIONS MAY NOT 3E USEJ
SCHEDULE g
10/1/80
rtppencnx
ORIGINAL
In the
at
ORDER OP TRANSFEROR COURT
Court of .
Upon consideration of the foregoing application and approval of the transfer by the Immigration
and Naturalization Service, it is hereby Ordered arid Decreed that the application be
granted, and that the pending petition for naturalization No
filed in this Court shall, upon approval of the transfer by the Court
of at
be transferred to said Court.
By the Court, this . — _ day of _ , 19
INSTRUCTIONS TO CLERK OF TRANSFEROR COURT-
1. If the Court approves the transfer: (a) the original Order above should be filed with the petition
record, (b) the duplicate and triplicate copies, attested and certified, sent to the Court to which the
petition is to be transferred and (c) the quadruplicate copy, attested and certified, sent to the
Immigration and Naturalization office which sent you this application.
2. If the Court does not approve the transfer, file the original with the petition record and return the
three copies to the Immigration and Naturalization office which sent you this application.
3. When the Court to which the petition is to be transferred approves the application, the triplicate
copy of the order of that Court, attested and certified, will be returned to you for filing. Upon receipt
thereof, send to that Court a certified copy of the petition filed in your Court, together with the origi-
nals of all documents filed therewith, and notify the Immigration and Naturalization office which
originally sent you this application.
4. If the Court to which the petition is to be transferred disapproves the transfer, notify the Immigra-
tion and Naturalization office which originally sent you this application.
10/1/80
ADMINISTRATIVE MANUAL N.455
Appendix I Page 3
DUPLICATE Font wrml.
OMB No. 4V-ROH4
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGftATIOM AND NATURAUZATION SERVIC!
APPLICATION FOR TRANSFER OF PETITION FOR NATURALIZATION
(Undar Soction 335(0. Immicration and Nationality Act)
No.
To the Honorable, the Court
of „ _ at
I, _ — now residing at
tCwuuvl iSou«)
(Stnct ud
., having filed petition for naturalization
No. ..... _ ........... _ ............ in this Court on ..................................................................... and having removed
vMonih) ,D«v) lYewl
from the jurisdiction of said Court on .................................................................. hereby make application
Monihl iOvl >Y«ri
for the transfer of my petition to the ..................................................................................................... Court
at ......................................................................................................... in accordance with the provisions of
(Ciy *0d Soul
section 335 (i) of the Immigration and Nationality Act.
Subscribed and sworn to before me by the above-named petitioner at
iGiy tad SUM)
this day of „ 19
[SEAL]
Investigation having fully established that the applicant has removed from the jurisdiction of '.he
Court aa alleged in his application, approval of the transfer of the petition for naturalization is hereby
given.
, 19 _ „
( OiMfta DlncMr or Officer i« Quift, Unmi(n<te» ud Nuunluuum Snvwc:
(IUv. ll-l-TDW
DUPLICATE
ORDER OF TRANSFEROR COURT
In the _ Court of .._
at
Upon consideration of the foregoing application and approval of the transfer by the Immigration
and Naturalization Service, it is hereby Ordered and Decreed that the application be
granted, and that the pending petition for naturalization No
filed in this Court shall, upon approval of the transfer by the Court
of at
be transferred to said Court.
By the Court, this _ ~. day of _ _., 19
Judft.
ORDER OF TRANSFEREE COURT
In the _ Court of _
at _ _
Upon consideration of the foregoing application, the approval thereof by the Court in which the
petition is pending and by the Immigration and Naturalization Service, it is hereby Ordered and De-
creed that the transfer to this Court of petition for naturalization No filed in the
_ Court of at
_ „ :.. is hereby approved.
By the Court, this _ day of .
... 19.
JuAgt.
INSTRUCTIONS TO CLERK OF TRANSFEREE COURT:
When the Court approves or disapproves the transfer:
1. This copy (duplicate) of the order should be filed in your Court, and the triplicate copy, attested and
certified, should be returned to the transferor court.
2. When the certified copy of the pending petition and the record is transferred to your Court, further
action shall be taken in accordance with section 334.17 (e) of Title 8 of the Code of Federal
Regulations.
10/1/80
TM 791
ADMINISTRATIVE- MANUAL
Appendix I
N-455
Page 5
TRIPLICATE
OMB No. 4J-aoJ44
STATES DIM8TMINT OF JUSTICI
AMD NATUUUJZAIION siivia
APPLICATION FOR TRANSFER OF PETITION FOR NATURALIZATION
(U«4or SactMtt MS<i). Isataigratios and Maltesialit; Act)
To th« Hooomblb,
of ..................... _
I,
(Nwaa of opptkuu)
(Cky)
the _________________ .................... _________ .......... Couit
at ............ __________ ...... _____________ ....................
, now
, having filed petition for naturaiisatioa
No
in this Court on ...................... ............................... „ ................ , and having removed
(Moa*> (Day) (Y«w(
from the jurisdiction of said Court on ..................... ............................................. , hereby make application
(Day) (Yw)
for the transfer of my petition to the ....................... - ............................................................................. Court
at ............................ ____ ....................................................................... in accordance with th* provisions of
(Qiy awl tea)
section 335 (i) of th« Immigration and Nationality Act.
Subscribed and sworn to before m« by the above-named petitioner at
thia ........................................ d&y of ------- ..... - ...................... __ ......... 19 ........
[SSAL]
fuller established that th« appUomt has removed from th» joriadktkm of tho
€«mrt MI mlkt«<l in to application, approval of th® transfer off the petition for mtomiiaatioa
, IS.
|Ba>. U-I.1SIN
10/1/80
TRIPLICATE
ORDER OF TRANSFEROR COURT
In the Court of
Upon consideration of the foregoing application and approval of the transfer by the Immigration
and Naturalization Service, it is hereby Ordered and Decreed that the application be
granted, and that the pending petition for naturalization No
filed in thia Court shall, upon approval of the transfer by the Court
of at
be transferred to aaid Court.
By the Court, thi* day of _ „ , 19
Jvttgs.
ORDER OP TRANSFEREE COURT
In the Court of _ _ _...
at „ _
Upon consideration of the foregoing- application, the approval thereof by the Court in which the
petition is pending and by the Immigration and Naturalization Service, it is hereby Ordered and De-
creed that the transfer to this Court of petition for naturalization No „ filed in the
_ _ ™__. Court of ..„ „ at
— U hereby — . approved.
By the Court, this __ day of .
19,
Judge.
10/1/80
Appendix I
Page 7
QUADRUPUCATE
Porta ippxmd.
OMB No. 4J-RQJ44
UWITID STATES DEPARTMENT OF JUSTICE
IMMiGRATIOM AK0 NATUiAUZATJON SSIVICI
APPLICATION FOR TRANSFER OF PETITION FOR NATURALIZATION
(Undar S»eti«a 333 (a). In»ifrati«it and Nationality Act)
No
To the Honorable, tb« , Court
of at _
I now residing at
(NanM of apf&BMl (Straa UK) number)
_ having filed petition for naturalization
,Gr») iCnuatv) (Srnra)
No. in this Court on _ and having removed
(Maul.) i Day) (You)
from the jurisdiction of said Court on hereby make application
jMoMb) (DoT) ,Year)
for the transfer of my petition to the Court
at , in accordance with the provisions of
(Car and Sun)
section 335 (i) of the Immigration and Nationality Act.
ol
Subscribed and sworn to before me by the above-named petitioner at _
(Or aad SUM)
this day of _ _ 19
_ _ [SEAL]
jiruij
Investigation having fully established that the applicant has removed from the jurisdiction of the
Court as alleged in his application, approval of the transfer of the petition for naturalization is hereby
given.
. 19
(DisswM DtmcM* or OSScur m i
fan, N-4JJ
10/1/80
Appendix I
QUADRUPLICATE
ORDER OF TRANSFEROR COURT
In the _ Court of
at _
Upon consideration of the foregoing application and approval of the transfer by the Immigration
and Naturalization Service, it is hereby Ordered and Decreed that the application be
granted, and that the pending petition for naturalization No
filed in this Court shall, upon approval of the transfer by the Court
of at ,
be transferred to aaid Court.
By the Court, this day of _ 19
Judgt.
To APPLICANT:
The authority for collection of the information requested on this form is contained in Sections
332 and 335 of the Immigration and Nntionality Act (8 U.S.C. 1443 and 1446). Submission of the
information is voluntary. The principal purpose for requesting the information is to determine whether
a petitioner for naturalization is eligible to transfer his or.her petition to another court. If the District
Director exercising administrative jurisdiction over the place where the court in which the petition is
filed approves the transfer, copies of the form will be forwarded to the court wherein the petition is
filed and also the court to which the petition is to be transferred for their approval. The. information
requested may. as a matter of routine use. be disclosed to federal, state, local or foreign law enforcement
and regulatory agencies, the Department of Defense, including any component thereof, the Selective
Service System, the Department of State, the Department of the Treasury, the Department of Trans-
portation, Central Intelligence Agency. Interpol and individuals and organizations in the processing of
any application or petition or during the course of investigation to elicit further information required
by the Immigration and Naturalization Service to carry out its functions. Information requested which
indicates a violation or potential violation of law, whether civil, criminal or regulatory in nature, may
be referred, as a routine use, to the appropriate agency, whether federal, state, local or foreign, charged
with the responsibility of investigating, enforcing or prosecuting such violations. Failure to provide
all or any of the information may result in disapproval of the application.
1979—626-826
10/1/80
10-55
N-604
APPLICATION FOR CHILL'S CERTIFICATE 0? CITIZENSHIP SUBMITTED BY PARENT
I. USE;
USED BY AN ALIEN PARENT OR PARENTS TO APPLY FOR AN ADMINISTRATIVELY
ISSUED DERIVATIVE CERTIFICATE OF CITIZENSHIP FOR A MINOR CHILD.
II. ELIGIBILITY;
1. CHILD MUST BE LAWFUL PERMANENT RESIDENT ALIEN UNDER 18 YEARS OF AGE.
2. CHILD MAY BE BLOOD OR ADOPTED.
III. REQUIREMENTS:
1 . FORM SUBMITTED WITH THE N-400 APPLICATION.
2. S15 FEE PAID AT THE TIME OF SUBMISSION OF EACH APPLICATION.
3. 3 IDENTICAL PHOTOS, 2X2" ONLY.
4. ORIGINALS AND PHOTOCOPIES OF ALL DOCUMENTS SHOULD BE SUBMITTED SO
THAT ORIGINALS MAY BE RETURNED TO PARENTS. ANY DOCUMENT IN A
FOREIGN LANGUAGE MUST BE ACCOMPANIED BY A CERTIFIED ENGLISH TRANS-
LATION.
5. ORIGINALS MUST BE CERTIFIED BY A NATURALIZATION EXAMINER ONLY.
6. FORM N-600 (APPLICATION FOR CERTIFICATE OF CITIZENSHIP) MAY BE SUB-
MITTED IN LIEU OF N-604 BUT MOT AT THIS TIME, AND ONLY AFTER PARENT
OR PARENTS ARE NATURALIZED.
7. GOOD MORAL CHARACTER OF CHILD IS NOT AN ISSUE.
10.
11.
IF BOTH PARENTS ARE APPLYING FOB NATURALIZATION, THE FOLLOWING
DOCUMENTS ARE TO BE SUBMITTED:
(1 ) BIRTH CERTIFICATE OF CHILD.
(2) MARRIAGE CERTIFICATE OF PARENTS.
(3) TERMINATION OF EITHER PARENTS' PRIOR MARRIAGES.
(4) IF THE CHILD IS ADOPTED, ADOPTION DECREE.
IF ONE PARENT IS APPLYING FOR NATURALIZATION, THE FOLLOWING DOCU-
MENTS ARE TO BE SUBMITTED!
(A) BIRTH CERTIFICATE OF CHILD.
(B) MARRIAGE CERTIFICATE OF PARENTS,
(C) IF OTHER PAREKT IS A CITIZEN, BIRTH CERTIFICATE; CERTIFICATE OF
NATURALIZATION OR A CERTIFICATE OF CITIZENSHIP OF OTHER PARENT
SHOULD BE SUBMITTED AT THE TIME OF INTERVIEW ONLY.
(D) IF OTHER PARENT IS DECEASED, DEATH CERTIFICATE OF THE OTHER
PARENT.
(B) IP DIVORCED FROM OTHER PARENT, DIVORCE DECREE AND PROOF THAT
PARENT APPLYING HAS LEGAL CUSTODY OF CHILD.
CHILD BORN OUT OF WEDLOCK (ILLEGITIMATE) MAY DERIVE THROUGH MOTHER
IF PATERNITY NOT ESTABLISHED BY LEGITIMATION.
IF CHILD IS ADOPTED, ADOPTION MUST OCCUR PRIOR TO AGE 16 AND CHILD
MUST BE IN CUSTODY OF ADOPTIVE PARENT OR PARENTS AT THE TIME OF
PARENT OR PARENTS NATURALIZATION.
10/1/80
10-57
SECONDARY EVIDENCE USUALLY CONSISTS OF
(1) BAPTISMAL CERTIFICATES.
(2) SCHOOL RECORDS.
(3) CENSUS RECORDS.
(4) AFFIDAVITS OF WITNESSES.
INTER VIEW
1 . CHILD MUST BE PRESENT. INTERVIEWED SIMULTANEOUSLY AT THE TIME
OF PARENT OR PARENTS' NATURALIZATION INTERVIEW.
2. PROOF OF CHILD'S LAWFUL PERMANENT RESIDENCE MUST BE SUBMITTED.
3- PARENT OR PARENTS MUST BE NATURALIZED BEFORE THE CHILD REACHES
ACE 18.
4. FEE IS REFUNDABLE IF FOR ANY REASON PARENT (S) IS NOT NATURALIZED
IN TIME.
5- CHILD IS NOT REQUIRED TO APPEAR IN COURT.
6. THE OATH OF ALLEGIANCE IS ADMINISTERED TO THE CHILD BY THE
NATURALIZATION EXAMINER. THE OATH IS WAIVED IF THE CHILD IS
UNDER 14 YEARS OF AGE.
7.' UPON PROOF OF NATURALIZATION OF PARENTS OR PARENTS,
CITIZENSHIP SECTION WILL ISSUE CERTIFICATE ADMINISTRATIVELY.
.«*•
TM 800
ADMINISTRATIVE MANUAL
Appendix 1
H-604
UNITED STATES DEPARTMENT OF JUSTICE *o.m Appro**
Immigration and Naturalization Service OM9 No- •«•"<»«*
TO BE COMPLETED IF YOU ARE APPLYING FOR NATURALIZATION AND WANT A CERTIFICATE OF CITIZENSHIP FOR YOUR
CHILD (READ t\STR UCT/O.\S O\ RCVERSt SIDE CAREFULL Y)
A.ddr«s of Child
Alien Registration Number A-
CHILD'S PERSONAL DESCRIPTION FORM
ITypr or Prinrl
. nunl.il status
Issue child's certificate in the name of:
Fom N-604
(R*r.6-15-79)N
(OVER)
INSTRUCTIONS
1 . If you are an alien who is applying for naturalization and you stated in answer to question (36) on
page 4 of your application that you also desire to have a certificate of citizenship issued to one or
more of your children, complete this form.
2. If more than one child is to receive a certificate of citizenship, you must complete a separate one of
these forms for each child.
3. The completed form or forms should then be Tiled by you with your own application for naturalization.
FORM NO. EDITION
N-604 Rev. 6-15-79
TITLE
CHILD'S PERSONAL DECRIPTION FORM
S1ZE mSTRUCTION REFERENCE
8*£ 2414 Ex.1
USE
CHILD'S PERSONAL DESCRIPTION FORM FOR CERTIFICATE OF CITZE1;-
SHIP
PRIOR EDTT1W MAY "OT RF USED- 1 SCHEDULE A_J
4/1/81
10-61
N-402
APPLICATION TO FILE PETITION FOR NATURALIZATION IN BEHALF OF CHILD
I. USE;
USED BY A U.S. CITIZEN PARENT OR PARENTS OR ADOPTIVE PARENT OR PARENTS
TO FILE PETITION FOR NATURALIZATION IN BEHALF OF CHILD; NOT A DERIVATIVE
CLAIM TO CITIZENSHIP.
II. ELIGIBILITY:
GENERALLY, THIS FORM IS SUBMITTED WHEN ONE PARENT IS A U.S. CITIZEN BY
BIRTH OR NATURALIZATION AND THERE IS NOT A DERIVATIVE CLAIM TO CITIZEN-
SHIP; AND THE OTHER PARENT IS AN ALIEN WHO AT THIS TIME DOES NOT WISH TO
PURSUE NATURALIZATION.
1. CHILD (BENEFICIARY) MUST BE LAWFUL PERMANENT RESIDENT UNDER is
YEARS OF AGE RESIDING WITH PARENT OR PARENTS.
2. CHILD MAY BE BLOOD OR ADOPTED.
3. ONE OR BOTH OF THE CHILD'S PARENTS (PETITIONER OR PETITIONERS)
MUST BE A U. S. CITIZEN AT THE TIME OF FILING PETITION FOR NATURALI-
ZATION.
4. CHILD MUST BE NATURALIZED PRIOR TO 18TH BIRTHDAY.
III. REQUIREMENTS;
THE FOLLOWING DOCUMENTS WILL B3 SUBMITTED WITH EACH APPLICATION:
1. 3 IDENTICAL PHOTOS 2X2 INCHES.
2. IF OVER 14 YEARS OF AGE, FINGERPRINT CHART; AND
3. BIOGRAPHIC INFORMATION, FORM G-325
10/1/80
INTERVIEW
1 . PETITIONING PARENT OR PARENTS AND CHILD MUST BE ACCOMPANIED BY 2
U.S. CITIZEN WITNESSES.
2. PROOF OF LAWFUL ADMISSION OF CHILD MUST BE PRESENTED.
3. A $25 FILING FEE PAID IN CASH ONLY IS REQUIRED AT THE TIME THE
PETITION IS FILED WITH THE DEPUTY COURT CLERK IN THE CITIZENSHIP
BRANCH.
4. NO PARTICULAR PERIOD OF RESIDENCE OR PHYSICAL PRESENCE IN THE U.S.
OR STATE IS REQUIRED.
5. CHILD DOES NOT HAVE TO COMPLY WITH EDUCATIONAL AND LITERACY REQUIRE-
MENTS.
6. IF CHILD IS OF TENDER YEARS, HIS GOOD MORAL CHARACTER AND LOYALTY
ARE PRESUMED. IF OVER AGE 14, THERE IS NO ESQUIRED PERIOD OF TIME
TO DEMONSTRATE GOOD MORAL CHARACTER.
7. AT THE FINAL COURT HEARING, PETITIONING PARENT OR PETITIONING
PARENTS MUST APPEAR, AS WELL AS ALL CHILDREN OVER 14 YEARS OF AGE.
THE COURT MAY WAIVE THE PRESENCE OF ALL CHILDREN UNDER 1 4 YEARS
AGE.
6. ADOPTED CHILDREN MUST HAVE BEEN ADOPTED PRIOR TO
AGE 16 AND MUST NOW BE IN THE CUSTODY OF THE ADOPTIVE PARENTS.
SVIDENCS TO BE SUBMITTED AT INTERVIEW '(ALL CERTIFIED COPIES)
1. BIRTH CERTIFICATE OF CHILD.
2. IF ADOPTED, ADOPTION DECREE.
3- PROOF OF U.S. CITIZENSHIP OF PARENT OR PARENTS; BIRTH CERTIFICATES,
NATURALIZATION OR CITIZENSHIP CERTIFICATES.
10/1/80
10-63
4* MARRIAGE CERTIFICATE OF PARENTS,
5. TERMINATION OF PRIOR MARRIAGES OF PARENTS.
6. 30-DAY FINAL NATURALIZATION HEARING WAIVER PURSUANT TO SECTION
336(C), IAN ACT, MAY BE GRANTED TO CHILDREN OF CITIZEN PARENT OR
PARENTS WHO ARE REGULARLY EMPLOYED ABROAD BY THE ARMED FORCES
OF THE U.S.
10-65
TO 793
H-402
Pa§« 1
S vie er fe« gita a a sag «• jnu M ectfe*. to or tfe« a^ A m. ®
M iW. IT it&V K TO 1M
WW 1MB
i£jB3cj es? «e ESS^J 13 eaja ef tea djis «? aw
ESS «a to eaa
mto Sto «Md'a fifca ssas
«a ^a «| yn *^ « *• «w owaw. aa^ *^ KM el tto
v n« e M n« Misr MLW K
d3 tt»
KM efeSfl EBSSS maa £*a mas te tt® psssssas •( m*
tefes fessa ®JS ate
i ft»4»-« to «M 5?aa E&®B is, mm «> gsiss i ms a tto w^sr^igis tea
mm «M MM Ssi t3 « a M» act Ml «® w M M mn &£m
fcs «f iMX <• ULtjC. S48S. 1441. S«4i wl I4tfi.
M fwr Is M a M e? gswlsga •« te ««W ter y«w> » ®»®«®
"
tea^fe*fei®Tag*iass^Sar3iL*^^tege^
trnftssa. «^ to M » 6^ t» Sia t*^» ««twai. etetei. teas or towga. ^^^18 «*s 68®
w s!3 s? Ste
a&
K-402
"^HiW™"^^™^^^
RCV. 11-27-78
APPLICATION
V OflLS)
TO FILE PET1TIW FC« IttTUiWLllATIW 18 IE
WJF
ms&
d X 10 1/2
i era ita.i
imt i». i.
, 332«.2. 499.1; 81 334.S(c), (<J»s M 1301
2?t8.@2; Nat U»k 1.48. -49; SIB P. 31. A»
.IS.
p. 10
suwzrra TO $ro?i£E BY u.s. CITIZEN
W M
RBTS OR WXJfTOg PAREMT OR PA8IMTS
won EDITIOHS mv NOT si use \®£mm$M A
UNITED STATES DEPARTMENT OF JUSTICE . *>»"
IMMIGRATION AND NATUHAUZATVOW SBWOE . OMB No. 43-UOOSI.
APPLICATION TO FILE PETITION FOR NATURALIZATION IN BEHALF OF CHILD"
Urofef Section 322 of ttw liwrtswtfcwt and Nattonaatsr ««t
Take or Mail to:
IMMIGRATION AND NATURALIZATION SERVICE.
CHILD'S NAJME AN& AUEN RE@!STRATK>N NUMBER
NarrM
nO. ..•*.....•
Oat* .i-.j-.^— .L..+L-. .: . 19
I (We), the undersigned, desire that a potition-for naturalization ti* filed in bahalf of my (our) child in tha
__. .__...„„ .„. Court 'at ......._... , , , . ., _._ ......
(NuMofcmn) ' (Gr»(or to»o) ' ( (Stan)
(1) My full. true, and correct name in — - ^ • •- — «-
- •' .... (Fall, bw'Mflu ef titinn pamnof ciliwe adoetra pum. vttaow abbnmauom)
(2) My present place of rowdanca l« ,. r.....^- ,. ,-.-..
(AptTNo.) (Natter aad root) (Cry «c lows) (Couasy) (Sute) (ZIP Code)
(3) I am « citizen of the United States of America end was bom an „ in
(Mmb) -tDay) (Yiu) • •• (Q>r. Scab. iad Couotry)
(II not a nctive-oori citizen) I was naturalized on —.__ at . . ,, ,
(UoMB) (Oft) (You) (Dry and Son)
certificate No. _ or •! became a dttMn of tha United States through ___._.._ . „.._: „_„—._....___..
(Is the child's other parent a citixan of the United State*' O Yea D Mo) •
(Complete (la) to (3a) only If aeeond parent warns to Join In aipeiicatlon)
Cla) My full, true, and comet name la.._ — ~ — __ ,
(ML BW aaot ef teooed oat** two* or aeaae. acne*** BUCK, vtdm* tkenvutioei)
(2ft) My preaent place of rvatdonpa kft .«. .. , __„_«—« , , , - - , ,,, -.,„..„.,.,,„, ,«.. - _- .„.
1 (AM. No.) (Naaaw «nl wen) (C«T«rvm> (OwuHrl CSotal (ZIP Cede)
fj») I em « ertiten of tha United States of America and wa» bora on , .,,. — In ^
(Mendi) (D«y) (Ycu) • (Cn. '•
(If net a native-born cttinn) I was naturaliz»d on -. at _-
(M«aa) (D^p) (Yor)
certificate No. — _.. or I baeama a citixen «f tha United Stotsu threul
(4) I am (W« are) tt» Dfir«nt(s) of .. „_„..__. .„„_.___. ---...
(»«U. irwt urn «( dull -MboM *baienwioa>)
in wno*9 behalf this application for naturalization is Wad.
(5) The said child now resides with me (us) at
(Apt. No.) (Nwktr aad «twO (City or i
.._ - _ _ is — ^ and to a cttizan. subject, or national of .„
( County ) (Sum) (ZIP Code) (Uanud) (Sunk)
(6) The said child was bom on . « „.. ... « . „».«.».... In — . ».». ,, n ,..,
(Monttil (Day) (Ytu)
(7) Ths said child was lawfully admitted to the United States for permanent residence on
. . „,.. __. ._ . . under the name of L .,.., „,„..!. «— .».
(Gry> (Suit)
on the _ _ „ ; „ and does intend to raside permanontly In the United State*.
(Name of xtwl o» other mam o< coovtnoa)
(8) I (We) desire the nirturalizatian court to ehar*a the nama of the chHd to J
- ' . . (0iw fejj „„, jaij^ ndmat Mminumu) . .
(9) If application it in batwtl of <n adopted child: '
I (Wa) adopted said child on — in the
(Month) (Day) <Y>u) (Nut of court ' ' '
at _ „ ___ before (»)he was 16 year* of age.
(Ciryortow*) (Sot*) (Cooatr.)
The Mid child has resided continuously in the United States with me (us) in my (our) legal custody tinea
(MaMB) (Day) (Yuri
(D
10/1/80
TM 793
ADMINISTRATIVE MANUAL
Appendix I
N-402
Page 3
(10) Sine* sawh child's toiu! admission to tha United Stata* far permanent nasictoaea, (s)h® has not tmn absent from th®
United Ststw at any tiwwi ®»«®p« as follows (M BOB®, state "Sten®"):
magtm mm m mam SWOTS
itCTuMD TO run unfits suns
wm
mis.
enm. em. VIM
mm ca CTTOEB tsaasss or
eauMYMici
rosr
DATE
<xoKm. Mr. vun
vma oa emu Mim ®
eomttYMta
.
,
(11) rtes weh child ewer bawi a patten* in a rants! iiMtitution, or aw«w baan treated for a mtntal illn«»? Q Yas Q No
(12) Tha tew pfevkSta&tteJ a ^non may mrt bs rtgantod as Qisalited for naturalization under certain conditiona. if th« psrsoci
teswjfsgty etMmnitt^l certain oflsases or crinte. avan though not arrested thsrafor. Has suefi child ew in or outsid® th«
UnSted State:
(a) Knowingly committed swy crima for wiiich (e)h« has not bsan arrested? ........ Q Y«a n N°
(bj B«m sfrasted. chargsd with vtoiatk>a trf sny kw or ordinance, summoned into court as a defendant, convicted, fined.
impnwmd. or pteesd on probatton or parots, or torMted collateral for any act invotving a crima. misdamsanor. or
8w»ch of ®ny law or ordinanc*? .................... g Yw Q No
M tha wawar to fa) or f b) it "Y«8," on a aeparati »h®®t. gw® tte to4lo«nng information as to «®ch irecidowt: whan and Brfma
offurtiu ima$wJ. and outecm® of casa if any.
(13) Ar® d®portatiof« pracMdings pending agamst such chiid or has such child ever been deported or ordarad d«port®d. or
has ssseh child war applied tor suspension of doportati&n or for prwxaniination? ...... Q Y« Q No
(14) List th® ehiSd's nmnbarship in tw®ry organization, assodation. fund, foundation, party, club, society, or similar group
in th® United States and in any ottatr pfeca. during tha past tan years, and his foreign military atrvica. (If none, write
-Non®.")
(a)
(W —
._ to 18..
... to 19-
_ ta 19..
... to 19_
(15) Has such child m®r s<Mvsd in the Arm®d Forces of the United States? Q Yes Q No
(16) (Answw only it tte cntM is of an untdarstonding ago.) If the law requires it. is the chiid willing to bear arms or perform
noraunbatant wvic® in tha Annsd Fwcas of the United States or perform work of national importance under civilian
direction? If "Mo" aspiain fully on a separata sheet of pap*r Q Yes Q No
(17) Sine® th® child's lawful admission to the United States for permanent residence, my vrif® (husband) and I haws been
absent from the United States as follows (if no absences, state "None"):
(18) My wife (husband) ami I have bsem married as follows (give information as to ssch msrriafa):
(Us® astra strnt of papar if n®c*ssary.)
store tuasns
(2)
10/1/80
(19) A partition for naturalization hat — heretofore been filed on behalf -of said child on
<•*> (Metth) (D.T) (Ym)
(Ctrl (Coua<7> (Sna)
and denied.
(Si^anon ol In pama)
(A44KB el 111 mural)
(Teltplmw No.)
SIGNATURE OF PERSON PREPARING FORM, IF OTHER THAN APPLICANT(S)
I declare that this document was prepared by me at the request of the applicant(s) and is based on all information of which I
nave any knowledge.
TO APPLICANTS: DO NOT WRITE BELOW THESE LINES
AFFIDAVIT
I do swear (affirm) that 1 know the contents of this ap-
Subscribed and sworn (affirmed) to befor* me at the
plication comprising pages 1 to 3. inclusive, subscribed by preliminary investigation (examination) at
me; that the same are true to the best of my knowledge and
balief; that corrections number ( ) to ( ) were made by
me or at my request; and that this application was signed by
me with my full, true name. SO HELP ME GOO.
ol la
this day of , 19
I certify that before verification the parant(s) stated in
my presence that he (she they) had re»d the
dwud)
foregoing application and corrections therein and under-
stood tNr contents thereof.
(Coeptat tad uuc mature ol U nraM )
(1st witness) ..
. residing at
Occupation
(Act. No. J (Stum i44nu,cMY«r to*». &tu« ud ZIP Oak)
(2d witness) ...... .............. Occupation .„_ __„.„„.
residing at
(Aw. No.) (Sowtiadmi. otj at ton. SUM ud ZIP Code I
U.S _ Physical presence _ months. . — _„.„ (Naturalization Examiner)
Nontiled
(DiM, natoe. tad CUOWKC'B
(3)
10/1/80
mr
K-458 ^ -fjf
•sis'
APPLICATION TO CORRECT CERTIFICATE OP NATURALIZATION
I. USE:
USED BY A NATURALIZED PERSON TO REQUEST THAT THE COURT CORRECT AN ERROR
THAT HAS BEEN MADE ON THE ISSUED CERTIFICATE.
II. ELIGIBILITY;
ALL NATURALIZED PERSONS.
III. REQUIREMENTS;
1. NO FEE
2. NATURALIZATION CERTIFICATE SUBMITTED WITH THE APPLICATION TO THE
CITIZENSHIP BRANCH.
3. DESCRIPTION OF THE ERROR APPEARING ON THE CERTIFICATE.
4. IF DEFECT OR ERROR CAN BE CORRECTED WITHOUT MUTILATING THE
CERTIFICATE, IT WILL BE CORRECTED BY THE CLERK OF COURT WITH A CERTI-
FIED EXPLANATION ON THE REVERSE OF THE CERTIFICATE AND RETURNED BY
MAIL TO THE APPLICANT.
5. OTHERWISE, A NEW CERTIFICATE WILL BE FURNISHED WITHOUT FEE BUT
APPLICANT WILL HAVE TO SUBMIT 2 NEW PHOTOGRAPHS.
10/1/80
**
I
10-71
TH 758
ADMINISTRATIVE MANUAL
Appendix I
Paga 1
UNITED STATES DEPARTMENT OF JUSTICE
liSEugisaioa tad Natnralisauoa S*cvic«
OUB Ma. «>n*M
APPLICATION TO CORRECT CERTIFICATE OF NATURALIZATION
(SEE OSTWCTIONS ON REVERSE]
Take or mail to—
IMMIGRATION AND NATOULUATION Srnnat,
1 hereby apply for correction of my certificate of naturalization.
1. My njajana is __„. ,,. , . .. ,
2. I now reside at _
tau.^rattraiteuM.1
.*«M*m (Sif».ii ,citr
3. I waa naturalized on „ . 19 , in the ..
-_^_. —,-,-, . . Court 4tt
1 (*UK) [ZIP C«4»|
and w&a isau*r{ eortf Acat* of nftt^mJfr^Mofl No. _ ..
I request that the clerk of court be authorized to correct my said certificate to conform to the facts
shown on my petition for naturalization, or to iaaua a new certiftc&te to me in the event that correctioa
cannot be made without mutilating the certificate.
Font N-J50
<R««. 9-27.75) N
TQRMW3. XSSTION Tm-B APPLICATION TO
H-%58 REV- 9-27-75
CORRECT CERTIFICATE OF NATURALIZATION
8 X 10 1/2 3 CFR 332a.2. 338. 1*, *99- 1
SUBMITTED BY A NATURALIZED PERSON TO THE DISTRICT DIRECTOR
CERTIFICATE
WHENEVER AN ERROR HAS BEEN HADE IN HIS
PRIOR EDITIONS MAY NOT BE USED
IfCHSOOUB A
10/1
ADMINISTRATIVE MANUAL
Appendix I
TH. 758
«r
TO THE APPLICANT
1. This form is for Use use of a naturalized person whose certificate of
natural! izalion does nol conform lo the facts shown in the petition for naturalization
or whrre a clerical error was made in the preparation of the certificate.
2. \ou must submit your certificate of naturalization with this application.
3. Describe in item No. 4 the exact defect or clerical error appearing in your
ecru fi cate of naturalization.
4. if the defect or error can he corrected without mutilating the certificate of
naturalization it will be corrected by the clerk of court and appropriate!} endorsed
to explain the correction; plberwisc it will bo necessary to issue a nen certificate
to you. in which evmi you will be requested to furnish new photographs.
5. Aulhonu for collection of the information requested on this form is contained
in Sections 103. 332. and 338 of the Immigration and Nationality Act '8 V * C 1103
1443 and 14491 and Section 338.16 of Title 8 of the Code of Federal Repulsions
Submission of the information is voluntary. The principal purpose for requesting the
mfonnalion is lo dclrnninf .f a certificate of naturalization conforms to ihe facts
shown in the petition for naturalization of if a clerical error was mad,, in the pre-
paration of the certificate. The information requested mav. as a mailer of routine
use. be disclosed to naturalization courts and lo other federal, stale, local or
(oreipr. law enforcemenl and repulalory agencies, the Department of Defense in-
dud^ any component thereof, the Selective Service System, the Deparimenl'of
Slate the Department of the Treasury, the Departmenl of Transportation C«
Intelligence Agency. Inlerpol and individuals and organizations in the pn
±:r ^rr petvion for —«»»«-, « **., the „„*, Ofpi,
r r 7 * ~
' 10/1/80
N-565
APPLICATION FOR A NEW NATURALIZATION OR CITIZENSHIP PAPER
I. USE:
USED BY A PERSON WHO HAS BEEN ISSUED A DECLARATION OF INTENTION OS NATUR-
ALIZATION OR CERTIFICATE OF CITIZENSHIP, WHICH HAS BEEN LOST, MUTILATED
OR DESTROYED, OR BY A PERSON WHOSE NAME HAS BEEN CHANGED, IN ORDER TO
OBTAIN A REPLACEMENT OF THE APPROPRIATE DOCUMENT.
II. ELIGIBILITY:
ALL PERSONS WHO DESIRE A REPLACEMENT OF AN ISSUED DOCUMENT FOR THE
REASONS SET FORTH ABOVE.
III. REQUIREMENTS!
1 . 2 PHOTOS 2X2 INCHES.
2. S10 FEE PAID AT THE TIKE OF SUBMISSION OF APPLICATION. MILITARY
APPLICANT WHO SERVED DURING SPECIFIED PERIODS OF HOSTILITIES DOES
NOT PAY FEE. HOWEVER, HE MUST SUBMIT PROOF OF HONORABLE DISCHARGE.
3. APPLICANT MUST SUBMIT PROOF OF CHANGED NAME, AS WELL AS PROOF OF
. CHANGE IN MARITAL STATUS. IF CHANGED SINCE CERTIFICATE WAS ISSUED,
APPROPRIATE MARRIAGE CERTIFICATE, DIVORCE DECREE, DEATH CERTIFICATE
.OR COURT DECREE SHOWING CHANGE OF NAME OR MARITAL STATUS IS REQUIRED.
4- IF ORIGINAL DECLARATION OF INTENTION OR CERTIFICATE OF
NATURALIZATION OR CITIZENSHIP IS AVAILABLE, IT MUST BE SUBMITTED.
INTERVIEW
1 . IF A PERSON WAS NATURALIZED IN HER MAIDEN OR MARRIAGE NAKE,
A NEW CERTIFICATE TO REPLACE THE LOST, DESTROYED OR MUTILATED
ORIGINAL CERTIFICATE KAY BE ISSUED TO HER, AT HER OPTION,
IN THE NAME UKDSR WHICH SHE WAS NATURALIZED EVEN
n it inn
THOUGH HER NAME HAS BEEN LEGALLY CHANGED SUBSEQUENT TO NATURALIZA-
TION.
2. NATURALIZATION EXAMINER MUST DETERMINE WHETHER:
(A) CITIZENSHIP HAS BEEN LOST (EXPATRIATION) SINCE APPLICANT BECAME
A CITIZEN.
(B) LONG ABSENCES FROM THE COUNTRY SINCE ISSUANCE OF ORIGINAL
NATURALIZATION CERTIFICATE SHOW LACK OF INTENTION TO RESIDE PER-
MANENTLY IN THE U.S. (SECTION 340 (D), I&N ACT).
(C) FACTS REGARDING LOSS INDICATE FRAUD OR ILLEGAL USE BASED UPON
THE UNUSUAL NUMBER OF REPLACEMENT CERTIFICATES IN FILE.
(D) INVESTIGATION OR FURTHER Q<SA MAY BE NECESSARY.
IF ALL REQUIREMENTS ARE MET, APPLICANT IS ISSUED ADMINISTRATIVELY
THE APPROPRIATE REPLACEMENT DOCUMENT.
10/1/80
TM 779
ADMINISTRATIVE MANUAL
Appendix I
N-S6S
Page 1
(Taor oil (Ma atnx>< AWo«j ««ecwm0 Hfwlicsiilml
\PPLICVriON FOR * NE* SVFl IULIZATION OR CITUKNSHIP P\PER
INSTRUCTIONS TO THE APPLICANT
(This aealicatiofl it tar use by o person «4io haa boan
s aeacaofl t ar use y o person «io aa oan aa
or Gtiienthip or Repatriation Certificate which has boon loaf, naifilo^KJ or destroyed, «r by a person wh
nemo hos boon changed, after the certificate wen issued, by morrio^e or by court order end who daiires a
new certificate in the changed noaej
a Declaration of Intention, a Natural I sstion
or destroyed, «r by a person whose
-Subsnit two identical photae^hg tofcea within »h©pe«t 3) days, in ealof, or in Mock
and white which it neither tinted nor colored, 2 by 2 inches ovwdl, lo^ ef he*d ra jKii.it 9} chin 1'4 inches,
en thin paper, light background, full front view ol fese without he?. They must rest be machine weds ar
inapahort, and not naunt«d in any way. Os not sign the ghafagrejiiia but print yauf n«sa li^irly on the
bsdt with a pencil.
MUM. -Attesh your mcvriege Ccr»iflcff3s3 at <x>w<t d@er«@ changing fQW nene.
M«. original Certificate of.Natvraiistituw or CtiiaatiaAtfi of Kapa(fi&tim, which
you itill hoVe.
Su&mit Proof of Cka&ya in your Marital Status, it it haw
iieuod.
sinea rtts certificate w«a
JTtf*. .A filing foe of fiva dollort (IS, "hich it not mhmdeUe, mtM ba paid. 00 NOT MAIL
CASH. Pay by chadi or money oroW drawn on a banli or ortn«w inatitutiiM in rite United Slates aid pay-
able lo the "Immigration and Natural ixotion Sarvics." When cheek ia (Jfown on en eecount of e porfion
ether then tho opplicont, the name of the applicant must be cmtenr&d on riie face of the checii. An un-
cellectiMe chock will render the application and any dscu merits i»sued isorajrajt th*?at» .invalid, and
a choro» of 55.00 will be impoied.
No fee ia re^iirod if your declaration of intention ar certificate of natural isoJion was lest, mutilated, ar
deilroyod and you terved honoroMy in the Armed Fnjcoa of the Uni)»tJ SteM» during a time of war or at
anytime after Seotombw lo, 194). If yew M tervod, Mjferait your homwcbia di&charoe certificate.
Authority for collection of th« infarmation re^vo»t»dan thia fo»« is contained in section 332 of the
iMwioratlort and Nationality Ad ( ft U.&C 1443 and 1454) Submiaaiom of the inbrraeiiofl ia voluntary.
The principal purpoaa for requeatina; tho informatioA is for USB by <s* asfiifned officer of the Imniofation
end Naturalisation Service M determine applicant'! eligibility fa? mtgletement of or for a n«w natural-
ization ar citlxenthip certificate in a chonaed name. Tho mbrmorion relented may, ea a matter of
routine uae, be disclosed to natural ixation courts end to other Moral, irete, toed or foreign law enforce-
ment and rooulatory a««Acios, tho Oepartrwmt of Doisns®, including any component thereof, the Selective
Service System, the Oeoartmentof Stata. tho Department of th® Treasury, the Degortwwmt of Tronaportetien,
Central Intelliaemce Agency, Interpoi end individual « CBwIorgasiisWiengiB th@ pfocuraoing of «n applketiea,
or during (he course of investigation to «lrcit funh&r i«f«m<^ran ratfuiirtjd by the Imnigratiofl <atdNatur^-
itotian Service hi carry out ita functions. Informetien solicited which indicates a vial attar) ef potential
violation of law. whether civil, criminal ar regulatory in n«ur@, m«? U tafatmd, S3 a routine use. to the
appropriate agency, whenW federal, srota, lecd, at Soiroig«, dunged with th® ronpoflsibilir)' of invea
enforcing, or prosecuting such violojiona. Failure re provide dl ar any «( the revested in$»nnatian may
result In disopaxovol of tho application.
Penm H-MS («.v.«-l«-rT)H
(REV. 1 1-26-73) N
FORM NO.
N-S6S
COITION fillX
REV. 9-19-77 APPLICATION FOR A HE* NATURALIZATION
OR CITIZENSHIP PAPER
SIZJC
8 X 10 1/2
INSTRUCTION UTEUNCX 3 CJ:R l03.i(o)C«. 343a.l(b), .2. 499.1
343a.l. .2; AH 2301.30, .30.01; Nat Hbk 7-1. -4, .6, -7; GIB A-9
01 103.8(«)(7),
FILED BY A PERSON WHOSE PAPERS HAVE SEEN UDST^.'IJLTIUTEO OR DESTROYED, OR WHOSE NAME
HAS BEEN CHANCED
PRIOR EDITIONS MAY NOT BE USED
1 SCHSOOUC A
10/1/80
N-S65
Page 2
ADMINISTRATIVE MANUAL
Appendix I
TM 779
ram APP«»«I!
OMB No. 4I-ROOV9
UNITED STATM DtPAKTMSXT Or JUJTJC*
iMifraUM end NuiuratauliM Mrvitt
No..
APPLICATION FOR A NE« NATURALIZATION OR CITIZENSHIP PAPER
Faa Stamp
Take or mail to
IMMIGRATION AND NATURALIZATION SERVICE,
I hereby apply for a new: [3 Certificata of Citizenship ^] Certificate of Naturalisation £2 Certificate of Repatriation
^Declaration of Intention.
(IXt) My full, true mine ia
(b) The name in which my paper was issued was.
(c) Other names I have used *r»
(2) I aow reside at.
(3) I was born at
TCIty «r turn)
(4) I arrived in the United States at .
(Apt. N«.) (MM**r M* MTMI) (City er «•««)
(Caumr)
(Slots) (lie Codo)
(Cliy «r t*wi)
(Stole)
(Sa) My personal description is: Sex ________
color of hair ______; height feet
maika
; complexion
(Menlh)
; color of eyes.
_
(Day) fY.or)
(Sb) Country of which I was a citizen, subject, or national.
(6) The naturalization or citizenship paper was issued to me by.
.inches; weight pounds; visible distinctive
marital status
("IinsUgralion & NaturalKctian Sorvic*" or now. a/ ceivt)
on
(City or town) ((.Many) (Mats) (ttoMh) (D»y) (Yaw)
(7) (If applicable) Since becoming a citizen. I ^ have Pj have not lost my citizenship in any manner.
(8) Since the dale the naturalization or citizenship paper was issued to me I have not been absent from the
United States for more than six months, except as follows: (If none, state "none.")
DEPARTED FROM THE UNITED STATES
BJBTUHWBO TO THE UNITED »TAT_8
P-,
(Month. Day. Y«»r)
V*Mol. or Olhef ttowu
Pan
Oat.
(traath. Day. Yoor)
W (11 applicable) Such paper became FJ Lost P_] Mutilated P] Destroyed on or about
at .
(Month) <D«y) (V««r)
(City or IOM)
under the following circumstances :
inawer (10) Only if You Are Applying For a New Paper in a Changed Name
(10) My name was changed to my present name by -
Slfn.rure of unon pfepafint (»rm. » ,th«. than a>Rl|canf
10/1/80
Appendix I
Page 3
AFFIDAVIT
[ do swear chat I know the concent of this application signed by me; chat the sane are true
to the best of my knowledge and belief; and that corrections numbered ( ) to ( ) were
made by me or ut my request. -
(Signature •< applicant)
Subscribed and sworn co before me by the applicant ac
day of 19
(Offl««t'« ilgnaturo an«t title)
.this
EXAMINER'S REPORT
I have investigated this application and I am satisfied that the applicant is the person to whom the
oiiiiMl record relates and that the applicant has become expctriauJ subsequent to acquirini Umted States
citizenship, and that the naturalization or citizenship paper described in the application has been
The naturalization ot declaration nas_ — „ been verified.
Supplemental report is attached helreto.
I recommend that the application be __ granted.
Approved, •
New
. 19.
.No..
issued on.
(On*)
(Dlairici DinctaM
(Oa<*>
<MiT> »iinMur«)
received by me
10/1/80
x7'
N-600
APPLICATION FOR CERTIFICATE OF CITIZENSHIP
i- USB*-
USED BY A PERSON WHO CLAIMS TO HAVE? (A) DERIVED U* S. CITIZENSHIP
THROUGH THE NATURALIZATION OF A PARENT OR PARENTS, OR (B) DERIVED U.S.
CITIZENSHIP THROUGH THE NATURALIZATION OR CITIZENSHIP OF A HUSBAND, OR
(C) ACQUIRED U.S. CITIZENSHIP AT BIRTH ABROAD THROUGH A PARENT OR
PARENTS, AND UNDER SECTION 341 OF THE I&N ACT IS APPLYING FOR AN
ADMINISTRATIVELY ISSUED CERTIFICATE OF CITIZENSHIP.
II. ELIGIBILITY;
ANY APPLICANT WHO MEETS SPECIFIC STATUTORY REQUIREMENTS RELATING TO
ACQUISITION AND DERIVATION OF U.S. CITIZENSHIP.
III. REQUIREMENTS.;
1 . $15 FEE SUBMITTED WITH EACH APPLICATION.
2. 3 PHOTOS 2X2 INCHES ONLY.
3. APPROPRIATE DOCUMENTS - ORIGINALS AND PHOTO COPIES SHOULD BE
SUBMITTED SO THAT ORIGINALS MAY BE RETURNED TO APPLICANT OR PARENT.
ANY DOCUMENT IN A FOREIGN LANGUAGE MUST BE ACCOMPANIED BY A
CERTIFIED ENGLISH TRANSLATION. NATURALIZATION OR CITIZENSHIP
.CERTIFICATES SHOULD BE PRESENTED AT THE TIME OF INTERVIEW ONLY.
4. BURDEN OF PROOF IS ON THE APPLICANT TO SHOW HIS CLAIMED CITIZENSHIP
BY A PREPONDERANCE OF THE EVIDENCE.
5. GOOD MORAL CHARACTER IS NOT AN ISSUE.
6. CERTIFICATES OF CITIZENSHIP ARE NUMBERED IN TWO SERIES. THE
SINGLE "A" SERIES RELATES TO THOSE WHO DERIVED CITIZENSHIP
THROUGH NATURALIZATION. THE DOUBLE "AA" SERIES
10/1/80
DERIVATION OF U.S. CITIZENSHIP SUBSEQUENT TO BIRTH BY ALIEN CHILD
THROUGH THE NATURALIZATION OF PARENT OR PARENTS.
(A) DERIVATIVE CITIZENSHIP CAN BE GAINED BY A CHILD THROUGH THE
NATURALIZATION OF HIS PARENT OH PARENTS ONLY IF THE CONDITIONS
SET FORTH BY STATUTE ARE SATISFIED.
(B) DERIVATION OF CITIZENSHIP APPLIES ONLY IF CITIZENSHIP WAS NOT
ACQUIRED AT BIRTH.
(C) THE CHILD MUST KAVS BE5N LAWFULLY ADMITTED TO THE U.S. FOR
PERMANENT RESIDENCE.
(D) THE NATURALIZATION OF THE PARENT OR PARENTS MUST OCCUR SUBSE-
QUENT TO THE CHILD'S BIRTH.
(E) UP UNTIL OCTOBER 5, 1978, THE CHILD HAD TO BE A BLOOD CHILD IN
ORDER TO DERIVE CITIZENSHIP. SINCE OCTOBER 5, 1978 BY RECENT
AMENDMENTS TO THE I&N ACT OF 1952, ADOPTED CHILDREN CAN NOW DER-
IVE CITIZENSHIP THROUGH THE NATURALIZATION OF THE ADOPTIVE
PARENT OR PARENTS.
(F). PRIOR. TO THE I&N ACT OF 1952, A MARRIED CHILD COULD DERIVE
CITIZENSHIP. NOW, SECTION 101(C)(O, I&N ACT PRECLUDES THE
DERIVATION OF CITIZENSHIP BY A MARRIED CHILD.
(G) IN APPLYING THE VARIOUS STATUTES DEALING WITH DERIVATIVE CITIZEN-
SHIP, THE BASIC RULE IS THAT THE DATE ON WHICH THE LAST EVENT
TAKES PLACE (NATURALIZATION, LAWFUL RESIDENCE, SO FORTH)
DETERMINES THE APPLICABLE LAW.
THE STATUTORY SECTIONS ARE SET FORTH AS FOLLOWS:
1* PRIOR TO KAY 24, 1934
(A) NATURALIZATION OF EITHER PARENT BEFORE THE CHILD
REACHES THE AGE OF 21.
10/1/80
(B) LAWFUL ADMISSION OP THE CHILD TO THE U.S. FOR PERMA-
NENT RESIDENCE BEFORE IT REACHES THE AGE OF 21.
AN ILLEGITIMATE CHILD CAN DERIVE ONLY THROUGH THE MOTHER?
A LEGITIMATED CHILD CAN DERIVE THROUGH THE FATHER.
2. BETWEEN MAY 24, 1934 AND JANUARY 12f 1941
(A) NATURALIZATION OF EITHER PARENT BEFORE THE CHILD
REACHES THE AGE OF 21.
(B) LAWFUL ADMISSION OF THE CHILD TO THE U.S. FOR PERMA-
NENT RESIDENCE BEFORE IT REACHES THE AGE OF 21, AND
5 YEARS RESIDENCE IN THE U.S. COMMENCING DURING
MINORITY, WHICH PERIOD MAY BE COMPLETED AFTER
MAJORITY AND AFTER JANUARY 12, 1941.
(C) 5 YEARS RESIDENCE IS NOT REQUIRED IF -
(1) BOTH PARENTS ARE NATURALIZED, OR
(2) SURVIVING PARENT IS NATURALIZED, OR
(3) DIVORCED PARENT HAVING LEGAL CUSTODY IS NATUR-
ALIZED.
NATURALIZATION UEDER (1), (2) AND (5) ABOVE MUST TAKE
PLACE DURING CHILD'S MINORITY.
AN ILLEGIMATE CHILD CAN DERIVE ONLY THOUGH THE
MOTHER; A LEGITIMATED CHILD CAN DERIVE THROUGH THE
FATHER.
3. BETWEEN JANUARY 13, 1941 AND DECEMBER 23 , 1952 -
NATIONALITY ACT OF 1 940
(A) THE NATURALIZATION OF THE ALIEN PARENT IF THE OTHER
10/1/80
PARENT WAS A U.S. CITIZEN WHEN THE CHILD WAS BORN
AND NEVER CEASED TO BE A CITIZEN AND BEFORE THE CHILD
REACHES AGE 18.
(B) THE NATURALIZATION OF BOTH PARENTS OR SURVIVING
PARENT OR PARENT HAVING LEGAL CUSTODY OF THE CHILD IF
THERE WAS A LEGAL SEPARATION OF THE PARENTS BEFORE
THE CHILD REACHES AGE 18.
(C) LAWFUL ADMISSION OF THE CHILD TO THE U.S. FOR PERMA-
NENT RESIDENCE BEFORE IT REACHES THE AGE OF 18,
(D) ILLEGIKATE CHILD DID NOT DERIVE UNLESS LEGITIMATED
BEFORE REACHING THE AGE OF 16.
4« FROM DECEMBER 24, 1952 TO PRESENT
(A) THE NATURALIZATION OF THE ALIEN PARENT IF THE OTHER
^
PARENT WAS A U.S. CITIZEN WHEN THE CHILD WAS BORN AND
NEVER CEASED TO BE A CITIZEN AND BEFORE THE CHILD
REACHES AGE 16. (AMENDED TO AGE 18, EFFECTIVE
OCTOBER 5, 1978 - NOT RETROACTIVE.)
(B) THE NATURALIZATION OF BOTH PARENTS OR SURVIVING
PARENT, IF THE OTHER IS DECEASED, THE NATURALIZATION
OF THE PARENT HAVING LEGAL CUSTODY OF THE CHILD WHEN
THERE HAS BEEN A LEGAL SEPARATION OF THE PARENTS,
OR THE NATURALIZATION OF THE MOTHER IF THE CHILD
WAS BORN OUT OF WEDLOCK AND THE PATERNITY OF THE
CHILD HAS NOT BEEN ESTABLISHED BY LEGITIMATION AND
BEFORE THE CHILD REACHES AGE 16. (AMENDED TO AGE
10/1/80
18 EFFECTIVE OCTOBER 5, 1978 - NOT RETROACTIVE.)
(C) LAWFUL ADMISSION OF THE CHILD TO THE U.S. FOR PERMA-
NENT RESIDENCE BEFORE IT REACHES THE AGE OF 16.
(AMENDED TO AGE is, EFFECTIVE OCTOBER 5, 1978 - NOT
RETROACTIVE.)
ADOPTED CHILD
THE AMENDMENT OF OCTOBER 5, 1978 EXTENDS DERIVATIVE RIGHTS
TO CHILDREN ADOPTED PRIOR TO AGE 16. HOWEVER, UNLIKE
NATURAL BORN CHILDREN, ADOPTED CHILDREN MUST SATISFY
VARIOUS CONDITIONS BEFORE THE NATURALIZATION OF THEIR
ADOPTIVE PARENTS IN ORDER TO DERIVE CITIZENSHIP.
(1) ADOPTION MUST OCCUR PRIOR TO AGE 16.
(2) CHILD MUST BE A LAWFUL PERMANENT RESIDENT OF THE U.S.
(3) CHILD MUST BE IK THE CUSTODY OF THE ADOPTIVE
PARENT(S) AT THE TIKE OF THE PARENT OR PARENTS
NATURALIZATION.
(4) PARENT OR PARENTS KU5T BE NATURALIZED BEFORE THE
CHILD REACHES THE AGE OF 18.
IF CLAIMING CITIZENSHIP THROUGH BOTH PARENTS, THE FOLLOWING
DOCUMENTS MUST BE SUBMITTED WITH THIS APPLICATION.
(A) BIRTH CERTIFICATE OF THE APPLICANT.
(B) PARENTS' PROOF 0? U.S. CITIZENSHIP, (BIRTH CERTIFI-
CATES). EXCEPT THAT PARENTS' NATURALIZATION OR CITI-
ZENSHIP CERTIFICATES SHOULD BE PRESENTED AT THE TIMS
OF INTERVIEW.
10/1/80
(C) MARRIAGE CERTIFICATE OF PARENTS.
(D) TERMINATION OF EITHER PARENTS PRIOR MARRIAGES.
(E) IF THE CHILD IS ADOPTED, ADOPTION DECREE.
(F) MARRIED WOMAN SHOULD PRESENT HER MARRIAGE
CERTIFICATE.
(G) DEATH CERTIFICATE OR CERTIFICATES OF PARENT OR
PARENTS.
IF CLAIMING CITIZENSHIP THROUGH ONE PARENT, THE FOLLOWING
DOCUMENTS MUST BE SUBMITTED WITH THIS APPLICATION:
(A) BIRTH CERTIFICATE OF THE CHILD.
(B) MARRIAGE CERTIFICATE OF PARENTS.
(C) IF OTHER PARENT IS A CITIZEN, BIRTH CERTIFICATE.
CERTIFICATE OF NATURALIZATION OR CERTIFICATE OF
CITIZENSHIP OF OTHER PARENT SHOULD BE SUBMITTED AT
THE TIME OF INTERVIEW ONLY.
(D) IF OTHER PARENT IS DECEASED, DEATH CERTIFICATE OF
THE OTHER PARENT.
(E) IF DIVORCED FROM OTHER PARENT, DIVORCE DECREE AND
PROOF THAT PARENT HAD LEGAL CUSTODY OF CHILD.
(F) IF CHILD IS ADOPTED, ADOPTION DECREE.
(G) MARRIED WOMAN SHOULD PRESENT HER MARRIAGE
CERTIFICATE.
CHILD BORN OUT OF WEDLOCK, ILLEGITIMATE, MAY DERIVE THROUGH
MOTHER IF PATERNITY NOT ESTABLISHED BY LEGITIMATION.
INTERVIEW
1. THE APPLICANT AND THE PERSON OR PERSONS THROUGH WHOM
10/1/80
HE IS CLAIMING CITIZENSHIP SHALL BE EXAMINED UNDER
OATH. WHEN THE PERSON THROUGH WHOM CITIZENSHIP IS
CLAIMED IS UNAVAILABLE, ANOTHER WITNESS SHOULD
TESTIFY AND COVER THE MATIRHS WHICH WOULD ORDINARILY
BE COVERED BY THE PERSo.; x'HROUGH WHOM CITIZENSHIP IS
BEING CLAIMED.
2. PROOF OF LAWFUL PERMANENT RESIDENCE MUST BE SUBMITTED
OR THE SERVICE MUST VERIFY LAWFUL PERMANENT
RESIDENCE.
3. THE OATH OF ALLEGIANCE IS ADMINISTERED TO ALL APPLI-
CANTS OVER AGE 14 BY THE NATURALIZATION EXAMINER.
THE OATH IS WAIVED IF THE APPLICANT IS UNDER 14
YEARS OF AGE.
IF THE CLAIM IS SUBSTANTIATED, AN ADMINISTRATIVELY ISSUED
CERTIFICATE OF CITIZENSHIP WILL BE ISSUED BY THE SERVICE,
BUT ONLY IF THE APPLICANT IS AT THE TIME WITHIN THE U.S.
DERIVATION THROUGH MARRIAGE
A WOMAN WHO MARRIED AN AMERICAN CITIZEN HUSBAND PRIOR TO
SEPTEMBER 22, 1922 AUTOMATICALLY DERIVED U.S. CITIZENSHIP.
1 . ALIEN WOMAN DID NOT HAVE TO BE ADMITTED TO THE
U.S. FOR LAWFUL PERMANENT RESIDENCE.
2. SUBSEQUENT TERMINATION OF THE MARRIAGE DOES NOT DES-
TROY DERIVATIVE STATUS.
INTERVIEW
THE FOLLOWING DOCUMENTS ARE TO BE SUBMITTED BEFORE A
10/1/80
CERTIFICATE WILL BE ISSUED.
1. PROOF OF HUSBAND'S U.S. CITIZENSHIP? HUSBAND'S BIRTH
CERTIFICATE OR NATURALIZATION OR CITIZENSHIP
CERTIFICATE.
2. APPLICANT'S MARRIAGE CERTIFICATE.
3. PROOF 01 TERMINATION OF PRIOR MARRIAGES OF THE
PARTIES.
4. IF APPLICANT'S MARRIAGE TO THE HUSBAND THROUGH WHOM
SHE IS CLAIMING CITIZENSHIP HAS TERMINATED, DEATH
CERTIFICATE OR DIVORCE DECREE SHOVING SUCH TERMINA-
TION.
OATH OF ALLEGIANCE IS ADMINISTERED TO THE APPLICANT
BY THE NATURALIZATION EXAMINER. CERTIFICATE WILL BE
ISSUED ADMINISTRATIVELY TO THE APPLICAKT.
ACQUISITION OF AMERICAN CITIZENSHIP AT BIRTH ABROAD
THROUGH A U.S. CITIZEN PARENT OR PARENTS
1. THE CLAIM TO U.S. CITIZENSHIP DEPENDS ENTIRELY ON
STATUTE.
2. THE PARENT OR PARENTS THROUGH WHOM CITIZENSHIP IS
CLAIMED MUST BE CITIZENS OF THE U. S. WHEN THE CHILD
IS BORN.
3. ALL STATUTES REQUIRE THAT THE PARENT OR PARENTS MUST
HAVE RESIDED OR HAVE BEEN PHYSICALLY PRESENT IN THE
U.S. PRIOR TO THE CHILD'S BIRTH.
4. IN APPLYING THE VARIOUS STATUTES DEALING VITH
10/1/80
ACQUISITIVE CITIZENSHIP THE BASIC RULE IS THAT THE
DATE OF THE BIRTH OF THE CHILD DETERMINES THE
APPLICABLE LAV.
5. ONLY BLOOD CHILD CAN ACQUIRE U.S. CITIZENSHIP AT
BIRTH.
6. "UNITED STATES" DEFINED - AS OP JANUARY 12,
1941, THE TERM U.S. INCLUDED THE CONTINENTAL
MAINLAND, HAWAII AND ALASKA. ON JANUARY 13, 1941,
PUERTO RICO AND THE VIRGIN ISLANDS WERE INCLUDED.
ON DECEMBER 24, 1952 GUAM WAS ADDED.
7. "OUTLYING POSSESSION OF THE U.S." DEFINED -
AS OF JANUARY 12, 1941, AMERICAN SAMOA, SWAIN'S IS-
LAND, GUAM, AND THE PHILIPPINES (THROUGH JULY 4,
1946) CONSTITUTED OUTLYING POSSESSIONS OF THE U.S.
FROM DECEMBER 24, 1952 TO THE PRESENT; ONLY AMERICAN
SAMOA AND SWAIN'S ISLAND ARE CONSIDERED OUTLYING
POSSESSIONS.
THE STATUTORY SECTIONS RELATING TO ACQUISITIVE CITIZENSHIP
AT BIRTH ARE SET FORTH AS FOLLOWS:
LEGITIMATE CHILDREN
A. BIRTH PRIOR TO KAY 24, 1934
1. FATHER, A CITIZEN OF THE U.S., WHO RESIDED
IN THE U.S. PRIOR TO THE BIRTH OF THE CHILD.
B. BIRTH BETWEEN MAY 24, 1934 A&D JANUARY 12, 1941
1. BOTH PARENTS CITIZENS OF THE U.S., ONE OF WHOM
10/1/80
RESIDED IN THE U.S. PRIOR TO THE BIRTH OF THE
CHILD, OR
2. ONE PARENT, A U.S. CITIZEN, WHO RESIDED IN THE
U.S. PRIOR TO THE BIRTH OF THE CHILD - THE
OTHER AN ALIEN.
RETENTION REQUIREMENTS;
APPLICABLE ONLY -
A. TO BIRTHS AFTER MAY 24, 1934 OUTSIDE OF THE U.S.
B. WHEN THERE ARE 2 PARENTS; ONE A CITIZEN AND THE
OTHER AN ALIEN.
C. NOT APPLICABLE WHERE THERE ARE TWO U.S. CITIZEN
PARENTS.
IN ORDER TO RETAIN U.S. CITIZENSHIP, A
CHILD BORN ABROAD TO A CITIZEN PARENT AND AN
ALIEN PARENT MUST TAKE-UP RESIDENCE IN THE U.S. OR ITS
OUTLYING POSSESSIONS FOR A PERIOD OR PERIODS TOTALING 5
YEARS BETWEEN THE AGES OF 13 AND 21 YEARS.
D. BIRTH BETWEEN JANUARY 13, 1941 AND DECEMBER 23,
1952 - NATIONALITY ACT OF 1940
1. BOTH PARENTS CITIZENS OF THE U.S., ONE OF WHOM
RESIDED IN THE U.S. OR ITS OUTLYING POSSES-
SIONS PRIOR TO THE BIRTH OF THE CHILD.
2. ONE PARENT, A CITIZEN, THE OTHER A NON-CITIZEN
NATIONAL. THE CITIZEN PARENT MUST RESIDE IN THE
U.S. OR ITS OUTLYING POSSESSION PRIOR TO THE
BIRTH OF THE CHILD.
3. EITHER PARENT A CITIZEN, THE OTHER AN ALIEN.
10/1/80
10-89 -
(A) CITIZEN PARENT BEFORE THE BIRTH OF THE
CHILD MUST HAVE RESIDED IN THE U.S.
OR ITS OUTLYING POSSESSIONS 10 YEARS, 5 OF
WHICH WERE AFTER OBTAINING AGE 16.
(B) IF CITIZEN PARENT HAD SERVED HONORABLY
IN THE ARMED FORCES OF THE U.S. BETWEEN
DECEMBER 7, 1941 AND DECEMBER 31, 1946; 10
YEARS RESIDENCE REQUIRED PRIOR TO BIRTH
OF CHILD AS ABOVE, 5 AFTER 12 YEARS OF
AGE; OR
(C) IF CITIZEN PARENT HAD SERVED IN THE ARMED
FORCES OF THE U.S. BETWEEN DECEMBER 31,
1946 AND DECEMBER 24, 1952, 10 YEARS
PHYSICAL PRESENCE REQUIRED PRIOR TO BIRTH
OF CHILD AS ABOVE, 5 AFTER 14 YEARS OF
AGE.
"PHYSICAL PRESENCE" INCLUDES HONORABLE U.S.
MILITARY SERVICE.
RETENTION SAME AS BIRTH BETWEEN MAY 24, 1934 AND
JANUARY 12, 1941. HOWEVER, IF CITIZEN PARENT WAS
AT THE TIME OF THE CHILD'S BIRTH RESIDING ABROAD
IN THE EMPLOYMENT OF U.S. GOVERNMENT, RETENTION
REQUIREMENT IS NOT NECESSARY.
(D) BIRTH FROM DECEMBER 24, 1952 TO PRESENT.
1 . BOTH PARENTS CITIZENS, ONE OF WHOM
HAD RESIDED IN THE U.S. OR OUTLYING
2. ONE PARENT CITIZEN, ONE NON-CITIZEN
NATIONAL. CITIZEN PARENT PHYSICALLY
PRESENT IN THE U.S. OR OUTLYING POS-
SESSION FOR A CONTINUOUS PERIOD OF
ONE YEAR BEFORE BIRTH OF CHILD.
3. EITHER PARENT A CITIZEN, OTHER AN
ALIEN. CITIZEN PARENT BEFORE BIRTH
OF CHILD MUST HAVE BEEN PHYSICALLY
PRESENT IN THE U.S. OR OUTLYING POS-
SESSION FOR A PERIOD OR PERIODS TOTAL-
ING 10 YEARS, 5 OF WHICH AFTER
OBTAINING AGE 14. PERIODS OF
HONORABLE SERVICE IN THE U.S. ARMED
FORCES MAY BE COMPUTED IN PHYSICAL
PRESENCE REQUIREMENTS.
RETENTION
SECTION 301 (B) , I&N ACT -
CHILD MUST COME TO THE U.S. PRIOR TO
OBTAINING THE AGE OF 23 YEARS; AFTER
THE AGE OF 14, AND BEFORE THE AGE OF 28,
MUST BE CONTINUOUSLY PHYSICALLY PRESENT IN
THE U.S. FOR AT LEAST 5 YEARS. ABSENCES
FROM THE U.S. AGGREGATING LESS THAN 12
MONTHS WILL NOT BREAK THE CONTINUITY
OF THE RESIDENCE REQUIRED TO RETAIN CITI-
10/1/80
10-91
ZENSHIP. THIS SECTION IS RETROACTIVE.
(D) 1972 AMENDMENT -
THE PERIOD OF REQUIRED CONTINUOUS PHYSICAL
PRESENCE IN THE U.S. BY THE CHILD WAS RE-
DUCED FROM 5 YEARS TO 2 YEARS. THEREFORE,
SINCE OCTOBER 27, 1972 THE CHILD MUST COKE
TO THE U.S. BETWEEN THE AGES OF 14 AND 2S
AND DURING THIS PERIOD OF TIKE BE CONTINU-
OUSLY PHYSICALLY PRESENT IN THE U.S. FOR
TWO YEARS. (CONSEQUENTLY, THE CHILD MUST
COME TO THE U.S. BEFORE AGE OF 26). AB-
SENCES FROM THE U.S. AGGREGATING LESS
THAN 60 DAYS WITHIN THE PRESCRIBED 2 YEAR
PERIOD WILL NOT BREAK THE CONTINUITY OF
CHILD'S REQUIRED PHYSICAL PRESENCE IN THE
U.S. IF THE ALIEN PARENT BECOMES NATURAL-
IZED WHILE THE CHILD IS UNDER 18 AND THE
CHILD BEGINS RESIDING PERMANENTLY IN THE
U.S. BEFORE OBTAINING THAT AGE, RETENTION
IS NOT REQUIRED. THIS AMENDMENT IS RETRO-
ACTIVE.
(E) 1978 AMENDMENT -
CONGRESS REPEALED THE STATUTORY PROVISIONS
RELATING TO RETENTION EFFECTIVE OCTOBER
10, 1978. THIS AMENDMENT
LOST HIS/HER CITIZENSHIP BY FAILURE TO RETAIN. ANYONE
WHO HAD NOT ON OCTOBER 10, 1978, ALREADY FAILED TO RETAIN
IS NOW RELIEVED FROM HAVING TO DO SO; I.E., ANYONE UNDER
26 ON THAT DATE, OR IF BETWEEN 26 AND 28 HAD ALREADY
COMMENCED THE NECESSARY RESIDENCE.
ILLEGITIMATE CHILDREN
(MO RETENTION REQUIRED)
1. PRIOR TO MAY 24, 1934 OR FROM MAY 24, 1934, TO
JANUARY 12, 1941, OR FROM JANUARY 13, 1941, TO
DECEMBER 23, 1952, A CHILD BORN OUT OF WEDLOCK
ACQQIRED CITIZENSHIP AT BIRTH THROUGH A CITIZEN
MOTHER WHO RESIDED IN THE U.S. OR OUTLYING
POSSESSIONS PRIOR TO THE CHILD'S BIRTH.
2. PRIOR TO JANUARY 13, 1941, THE CHILD COULD NOT
ACQUIRE THROUGH THE MOTHER IF PATERNITY WAS
ESTABLISHED DURING THE CHILD'S MINORITY BY
LEGITIMATION OR ADJUDICATION OF A COMPETENT
COURT.
3. AFTER JANUARY 13, 1941, THE CITIZENSHIP STATUS
OF THE CHILD WAS NOT AFFECTED BY THE
ESTABLISHMENT OF PATERNITY.
a. FROM DECEMBER 24, 1952, TO THE PRESENT
(SECTION 309(C) I&N ACT) CHILD BORN OUT
OF WEDLOCK ACQUIRED CITIZENSHIP AT
4/1/81
BIRTH THROUGH A CITIZEN MOTHER WHO
HAD BEEN PHYSICALLY PRESENT IN THE
U.S. OR OUTLYING POSSESSION CONTINU-
OUSLY FOR ONE YEAR BEFORE THE BIRTH
OF THE CHILD. THE CHILD'S STATUS WAS
NOT LOST BY SUBSEQUENT ESTABLISHMENT
OF PATERNITY.
DOCUMENTARY EVIDENCE
IF CLAIMING THROUGH BOTH PARENTS OR THE
FATHER, THE FOLLOWING DOCUMENTS SHOULD BE
SUBMITTED:
1. APPLICANT'S BIRTH CERTIFICATE.
2. MARRIAGE CERTIFICATE OF THE PARENTS.
3. TERMINATION OF PRIOR MARRIAGES OF
THE PARENTS.
4. IF APPLICANT IS A WOMAN AND HAS EVER
BEEN MARRIED, HER MARRIAGE
CERTIFICATE OR CERTIFICATES.
5. PROOF OF APPLICANT'S PARENT
OR PARENTS U.S. CITIZENSHIP.
BIRTH CERTIFICATE OR CERTIFICATES;
NATURALIZATION OR CITIZENSHIP
CERTIFICATE OR CERTIFICATES SHOULD BE
SUBMITTED AT INTERVIEW.
6. THE DEATH CERTIFICATE OR CERTIFICATES
10/1/80
OF APPLICANT b FAKEHT UK
IF CLAIMING THROUGH MOTHER, SUBMIT THE
FOLLOWING:
1. APPLICANT'S BIRTH CERTIFICATE.
2. MARRIAGE CERTIFICATE OR CERTIFICATES
OF APPLICANT'S MOTHER.
3. IF APPLICANT IS A WOMAN AND HAS EVER
BEEN MARRIED, HER MARRIAGE
CERTIFICATE OR CERTIFICATES.
4. PROOF OF MOTHER'S U.S. CITIZENSHIP,
BIRTH CERTIFICATE OF MOTHER;
NATURALIZATION OR CERTIFICATE OF
CITIZENSHIP SHOULD BE SUBMITTED AT
INTERVIEW.
5. DEATH CERTIFICATE OF MOTHER IF
DECEASED.
THE FOLLOWING TYPES OF DOCUMENTARY EVI-
DENCE ARE GENERALLY ACCEPTABLE TO PROVE
THE FACTS LISTED.
FAC7i-: PRIMARY EVIDENCE SECONDARY EVIDENCE
BIRTH OR AGE OFFICIAL BIRTH BAPTISMAL RECORD
CERTIFICATE FAMILY BIBLE INDEX
SCHOOL RECORDS
FS-240, REPORT OF
BIRTH ABROAD CENSUS RECORDS
(STATE DEPT. FORM)
HOSPITAL RECORDS AND
PASSPORT OR VISA RECORDS
4/1/81
MARRIAGE
DEATH
OFFICIAL MARRIAGE
CERTIFICATE
OFFICIAL DEATH
CERTIFICATE
CHURCH RECORDS
BIRTH RECORDS OF CHILDREN
NAMING PARENTS
FAMILY BIBLE INDEX
CENSUS RECORDS
PASSPORTS OR VISAS
DEEDS
LEASES OR WILLS
CEKETARY RECORDS
HOSPITAL RECORDS
NEWSPAPER CLIPPING
DIVORCE
FINAL DIVORCE DECREE
CONTINUOUS RESI-
DENCE OR PHYSICAL
PRESENCE IN U.S.
OFFICIAL IMMIGRATION
RECORDS RELATING TO
ARRIVAL AND DEPARTURE
STATEMENT OF PRIOR MARITAL
STATUS ON EITHER MARRIAGE
LICENSE OR MARRIAGE CERTIFICATE
SCHOOL OR CHURCH RECORDS
CENSUS RECORDS
BIRTH RECORDS OF CHILDREN.
EMPLOYMENT RECORDS, BANK
RECORDS, RENT OR INSURANCE
RECEIPTS. AFFIDAVITS OF
WITNESSES.
4/1/81
INTERVIEW
BY REGULATION THE PERSONAL APPEARANCE OF THE PERSON THROUGH
WHOM CITIZENSHIP IS CLAIMED IS NOT REQUIRED, NOR IS THAT OF
ANY OTHER WITNESS. THE ONLY EXCEPTIONS ARE:
1. WHEN SPECIFICALLY REQUESTED AT THE EXAMINER'S OPTION
2. WHEN THE PERSON THROUGH WHOM CITIZENSHIP IS CLAIMED
APPEARS FOR OR WITH AN UNDERAGED OR INCOMPETENT APPLICANT,
EXPATRIATION
(LOSS OF AMERICAN CITIZENSHIP)
AS INDICATED PREVIOUSLY, CITIZENSHIP RIGHTS VEST AT THE
TIME OF THE CHILD'S BIRTH. THUS, IF THE PARENT OR
PARENTS AT ONE TIME WERE U.S. CITIZENS BUT LOST THAT
STATUS BEFORE THE CHILD WAS BORN, THE CHILD MAY
NOT ACQUIRE U.S. CITIZENSHIP AT BIRTH.
THEREFORE, THE ISSUE OF EXPATRIATION IS THE
SUBJECT OF CAREFUL INQUIRY BY THE NATURALIZATION
EXAMINER WHEN IT IS CLAIMED THAT U.S. CITIZENSHIP WAS
ACQUIRED AT BIRTH ABROAD TO AMERICAN PARENTS.
THE OATH OF ALLEGIANCE IS ADMINISTERED TO ALL APPLICANTS
OVER THE AGE OF 14 BY THE NATURALIZATION EXAMINER. THE
OATH IS WAIVED IF THE CHILD IS UNDER 14 YEARS OF AGE.
IF THE CLAIM IS SUBSTANTIATED, THE CERTIFICATE WILL BE
ISSUED ADMINISTRATIVELY BY THE SERVICE BUT ONLY IF THE
APPLICANT IS AT THE TIME WITHIN THE U.S.
4/1/81
TM 800
ADMINISTRATIVE MANUAL
Aooendix 1
N-600
Page 1
10-97
APPLICATION FOR CERTIFICATE m8TA"f
OF CITIZENSHIP
Take or mall thie application to:
IMMIGRATION AND NATURALIZATION SERVICE
Date _
(Print «r typt) «« —
(Full. Tn» Nun>. witkout AbtnrvUilloiu) (N>UM MUM, I/ Mr)
ALIEN REGISTRATION
izipr«*>i No
(SEE INSTRUCTIONS. BE SURE YOU UNDERSTAND EACH QUESTION BEFORE YOU ANSWER IT.)
I hereby apply to the Cemmiuioner of Immigration and Naturaliiation for a certificate thowing that I am a citisen of the
Unlud Statei of America.
(1) I waa born in on
(CllF) (»UW «r •nnlrr) (M««ia> (Out (»«••!
(1) My penonal deacription ia: S«x ; complexion ; color of ayes ; eolor of hair ;
helcttt fact ... . Inchei; weight . . pounda; viiible diatinctivc marki
Marital itatui: Q Single; D Married; D Divorced; D Widow(tr).
(3) I arrived in the United Statei at on
(Cilf »«* SUU1 IMMUI |D.>) IVw)
under the name by mean* of
(KUlM »l thlf w MK>r (Mm *> trrl»ll
D on U.S. PaMport No i»ued to me at on ;
D on an Immigrant VUa. q Othtr (apeclfy) „ .'*".'?.'
(4) FILL IN THIS BLOCK ONLY IF YOU ARRIVED IN THE UNITED STATES BEFORE JULY 1. int.
(a) My last permanent foreign retidenet «ru
(6) I took thaahip or other conveyance to the United Stateaat
1 I0t») I
(t) IwMcommgto at
{Htm, .r »mM !• \k» U»IM tteMI iCIlj uJ 9UU «k«. Ul> xrw
(rf) I traveled to the United SUUa with
S) Have you been out of the United State* ilnce you flrat arrived? D Yea D No. If "Yea" All in the following information
for every abeenc*.
' NAMI » AI>UNI. on OrHn MUNI t'tiD To RrrutN TO Po« or RrtL'is n TKI Uxirn ST»T«
1
(6) I Ji>»^'J... it •-'-•.".»! 1.. Aled a petition for naturalitation.
(If "have", attat/t full explanation.)
TO THt <kr>yt.lCAMT.— De i»»t »rlte bet»oen «h» «mH« Utoa heteo. Centlnua xi nert Kg*.
ARRIVAL RECORDS EXAMINED ARRIVAL RECORD FOUND
Card index Plate Dale
Index booVi ' Name
ManifeeU
Manner
Marital atatua A«e
r*rm H-4OO (R.v. J1-26-791N
(1)
JTORM NO.
N-600
EDITION
Rev. 11-26-79
TITJ-E
APPLICATION FOR CERTIFICATE OF CITIZENSHIP
size
8»s x 11
INSTRUCTION REFERENCE 6 CFR 103.7(b)(l), 341.1(a).. 5.499.1; 01 341. 6; AM 2301.28.30 2414
Ex. 2 2713.01, 2720.01, .02, 2750.01.2794.04, .05, 2984 Ex. 2; Nat. Hbk 1-42, 2-13.1, 8-1 -2 -3
.5. -12. -16. -17. -27. thru -29: SIR P. 33. &-Q fl-^ ' ' '
DSC
APPLICATION SUBMITTED TO THE SERVICE RY A PERSON WHO DERIVED CITIZENSHIP AND, UNDER SECTION
341 OF THE ISN ACT, IS APPLYING FOR A CERTIFICATE OF CITIZENSHIP AS EVIDENCE THEREOF
PRIOR EDITIONS MAY NOT BE USED
SCHEDULE
4/1/81
raye e.
Appendix 1
(CONTINUE HERE)
(7) I claim United States citizenship through my (check whichever applicable) D father; Q mother; G both parents;
D adoptive parent ( g) D husband
(8) My father's name ia '..; he was born on
at - ; and resides at
(Month) (Day) (Year)
(City) (Suu or country) (Street addreu, city, and State or country. If dead, write
He became a citizen of the United States by D birth; D naturalization on
••dMul" and d«U of death.)
in the - Certificate of Naturalization No.
(Name of court, city, and State)
D through his parent(s), and i»S2.....<*5!.2£U issued Certificate of Citizenship No. A or AA .
(Month) (Day) (Year)
(If known) His former Alien Registration No. was
He '"*«)( DM not) ]ost United States citizenship. (// citiienihip lost, attach full explanation.)
He resided in the United States from to
(Y*ar) (Year)
from to ; from to ;
(Year) (Year) (Year) (Year)
from to ; from to ; I am the child of his marriage.
(Year) (Year) (Year) (Year) (let. 2d. Id. etc.)
(9) My mother's present name is _ ; her maiden name was
she was born on ; at — ; she resides
(Month) (Day) (Year) (City) (8UU or country)
at _ _ _ She became a citizen of the United States
(Street addrtu, elty. and Slat* or country. If d«td, writ* "dead" and date of death.)
by D birth; D naturalization under the name of _
on in the
(Month) (Day) (Year)
(Name of court, city, and State)
through her parent(i),and ...... ixSfL..ix».ssa ....... issued Certificate
Certificate of Naturalization No
of Citizenship No. A or A A .................................... (If known) Her former Alien Registration No. was ..............................
SheOiMl.JhM.ntfMost United States citizenship. (If citizenship lost, attach full explanation.)
She resided in the United States from ........... to ...... ____ ; from ........... to ...... ___ ; from ..... ____ to ...... ____ ; from ...... ____
(Year) (Year) (Year) (Year) (Year) (Year) (Year)
to -------- ; from -------- to -------- ; I am the child of her ______________ tnarriaee.
(Year) (Year) (Year) (lit. td, ad. etc.)
(10) My mother and my father were married to each other on ........................ at
(Month) (Day) (Year)
(11) If claim is through adoptive parent (s) :
(City)
(State or country)
I was adopted on in the
(Month) (Day) (Year)
(Name of Court)
at before I was 16 yean of age by my
(City or town) (State) (Country) (mother, father, parenta)
.(12) My l!£*«'.l i»!S«Ti served in the Armed Forces of the United States from
(Dat.)
to and ..lxtf}.....l*M.ns& — honorably discharged.
(Date)
(IS) I <.^.rt»*.«.!»>WoBt my United States citizenship. (If citizenship lost, attach full explanation.)
(14) I submit the following documents with this application:
Nature of Document Name* of Person* Concerned
(2)
4/1/81
M 800
ADMINISTRATION MANUAL
Appendix 1
10-99
N-600
Page 3
(16) Fill in this block if your brother, ..tfter, mother or father ever applied to th« Immigration Service for
a certificate of citizenship.
NAME or RZIATIVK
u.itm r..»» of Birth W«BN APPLICATION CSttTinCATS NO. AKB FlUI No.. If
NSHW Bute of B.rth SUBMITS AND LOCATION of Omc«
I I
(16) Fill in (hi* block only if you are now or ever have been a married *oman. J have been married timed), M
followa: "• »• '• •"•'
Ir M*""*'* HA» BUM TMIHMATM;
DAW MAOMCO NAUC or HUMAMD I ClTitaNSHt? or HUMANO j,^ jjorrl»«» Ho* Marriage Ended
Ended (Daatk or ii»ort«)
(17) Fill in this block only if you claim citizenship through a husband. (Marriage must have occurred prior to September £*,
1822.)
Name of citizen husband ; he was born on
(Giv« full and complete name) (Month) (Day) (Year)
at ; and resides at _
(City) (State or country) (Street addreea. city, and Slate or country. If dead. »rlu
He became a citiien of the United States by D birth; D naturalization on _
"dud" and daw of death.) (Month) (Day) (Year)
in the Certificate of Naturalization No ;
(Name of court, city, and State)
C through his parent(s), and .A**"'.....'""'.?."'.'... issued Certificate of Citizenship No. A or AA
He ...!!'.V.L...<.£??..n.<*>.... since lost United States citizenship. (It citisenehip lost, attach lull explanation.)
I am of the race. Before my marriage to him. he was married time(s), as follows:
(1. |. i. ett.)
Ir MA««i*oa HA» BCTN TmxiNATto-
DATI MAKHICD NAMK or Wir«
Date Marriage folded How Marriage Ended (O««U or iiroret)
(18) Fill in this block only if you claim citizenship through your stepfather. (Applicable only, if mother married UJS. Citizen
prior to September £2, 19S2.)
The full name of my stepfather is ... ; he was born on _..
(Month) (Day) (Year)
at ; and resides at
(City) (Suite or country) (Street addre*i. city, and State or country. If dead, write
He became a citizen of the United States by Q birth; D naturalization on
"dMid" and date of dentil.) (Month) _ (Day) (Year)
in the Certificate of Naturalization No ;
(Name of court, city, and State)
D through his parent (s), and ..'*?.•' <.?»•..'!??!.... issued Certificate of Citizenship No. A or AA
He ...!h»»l....(.l}^.P°t).. since lost United States citizenship. (H citizenship lo»t, attach full explanation.)
He and my mother were married to each other on at
(Month) (Day) (Year) (City and Statt or country)
My mother is of the race. She ir""i.-iSH.»2.l>. issued Certificate of Citizenship No. A
Before marrying my mother, my stepfather was married time («), as follows:
(1. 1. 1. etc.)
Ir MAMMA!* Hut Ban TianiMATTO:
MAWICD NA.MC or Wire — : " ' ".""'~~ ~ — ; _ . . ,_ — 77 — T
Date Marriaj* Ended i Ho* Marriage Ended (Diftli. or Jirortt)
(19) I J!!'.v.e2_._(J>»iiJfi)- previously applied for a certificate of citizenship on , at
(Date) (Ofll«)
(20)6lm»turt of peraon preparinc form. If other than applicant. I declare
th*i Oiir document wt» prepared by me at the reoueit of the applicant
and It bated on all information of which I have any knowledfe.
SIONATUOE:
ADORIM: DATS;
(SIGN HERE)
(Simitar* of applicant or parent or guardian)
(S)
AmiCAMT.~ft. M, M fa „ ,
AFFIDAVIT
"tion,
P»*es num-
« are true to the
wer*m.^ i. co"ections num-
were made by me or at my requ«t.
-this
»nd continued solely for
and that (s)he .ih«j.(h« not)
thi. .Pplication be(r
h»ve been examined:
Supplementary Report (,) No.(.)
""-cur in the recommendation.
X^a^-W^
4/1/81
TM 800
ADMINISTRATION MANUAL
Appendix 1
N-600
Paqe 5
APPLICATION FOR CERTIFICATE
OF CITIZENSHIP
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATL'«AUZATION Stnvict
INSTRUCTIONS
(Tear off this instruction she«t before filling out this form)
This form is not for children adopted by United States Citizens. It may be used for children adopted by alien
parents who were later naturalized. It must be completely filled in. Print the answers in ink or use a typewriter. If
you do not have enough room for any answer or if the instructions tell you to use a separate sheet of paper, use
another sheet this size, giving1 the answer the same number as the number of the question, and attach it to the
application. You will later be notified to appear for examination before an officer of the Immigration and Natural-
ization Service with the person (s) through whom you claim citizenship, if living; or some other identifying
witness, if deceased.
AGE OF APPLICANT. — Applicants 14 years of age or over must sign their full names, but only in the space
provided on page 3 of this application. If under 14 years, only the parent or guardian must sign his or her name,
and only in the space provided on page 3.
FEE. — A fee of fifteen dollars ($15) must be paid for filing this application. It cannot be refunded regardless of
the action taken on the application. DO NOT MAIL CASH. ALL FEES MUST BE SUBMITTED IN THE EXACT
AMOUNT. Payment by check or money order must be drawn on a bank or other institution located in the United
States and be payable in United States currency. If applicant resides in Guam, check or money order must be payable
to the "Treasurer, Guam." If applicant resides in the Virgin Islands, check or money order must be payable
to the "Commissioner of Financq of the Virgin Islands." All other applicants must make the check or money order
payable to the "Immigration and Naturalization Service." When check is drawn on account of a person other than
the applicant, the name of the applicant must be entered on the face of the check. If application is submitted from
outside the United States, remittance may be made by bank international money order or foreign draft drawn
on a financial institution in the United States and payable to the Immigration and Naturalization Service in United
States currency. Personal checks are accepted subject to collectibility. An uncollectible check will render the
application and any document issued pursuant thereto invalid. A charge of $5.00 will be imposed if a check in
payment of a fee is not honored by the bank on which it is drawn.
PHOTOGRAPHS. — You are required to send with this application three identical unglazed photographs of
yourself taken within 30 days of the date of this application. These photographs must be 2 x 2 inches in size and
the distance from top of head to point of chin should be approximately 1 \\ inches ; must not be pasted on a card or
mounted in any other way ; must be on thin paper, have a light background, and clearly show a front view of your
face without hat. Snapshots, group, or full-lenjrth portraits or machine-made photographs will not be accepted.
YOUPv PHOTOGRAPHS MUST NOT BE SIGNED, but you should print your name and alien registration number,
if any. in the center of the bark of each photograph lightly with a soft lead pencil, taking care not to mutilate the
photograph. They may be in natural color or in black and white, but black and white photographs which have been
tinted or otherwise colored are not acceptable. '
FACTS CONCERNING ARRIVAL IN THE UNITED STATES.— Detailed information should be given in
Statement 3 regarding your first arrival in the United States for permanent residence in this country. The
information regarding the number of the passport and date and place of issuance does not need to be given unless
you traveled on a United Sttttes passport at that time. If you do not know the exact date of arrival or name of the
vessel or port and cannot obtain this information, give the facts of your arrival to the best of your ability. If you
have an alien registration receipt card, immigrant identification card, ship's card, or baggage labels, they will help
you to give this information.
NAME TO BE SHOWN ON CERTIFICATE.— The certificate will be issued only in a name that you have a
legal right to use.
DOCUMENTS. — If your birth abroad, or the birth abroad of any person through whom citizenship is claimed,
was registered with an American Consul there, submit with this application any registration form that was issued.
If any required documents were submitted to and RETAINED by the American Consul in connection with such
registration, or in connection with the issuance of a United States passport or in any other official matter, and
you wish to use such documents in connection with this application instead of submitting duplicate copies, merely
list the documents in Statement 14 of the application and give the location of the Consulate. If you wish to make
similar use of required documents contained in any Immigration and Naturalization Service file, list them
in Statement 14 and identify the file by name, number, and location. Otherwise, the documents mentioned in the
box on page 6 applicable to your case (see over) must accompany your application and, for any required document
not furnished, you must explain why; what efforts you have made to get it; and, if possible, enclose a statement
from the official custodian of such records showing that the document is not available. You should also forward
for consideration, in lieu of that document, a record or the affidavits described under SECONDARY EVIDENCE,
on the reverse of this page.
If any person through whom citizenship is claimed became a citizen through his or her parent (s), but does
not have a certificate of citizenship (with a number preceded by an A or AA) in his or her own name, communi-
cate with the Immigration and Naturalization Service for information as to additional documents which must be
submitted.
form N-600 (R«v. 11 -25-79) N
4/1 /
INSTRUCTIONS (Continued)
Any document in a foreign language must be accompanied by a summary translation in English. A
summary translation is a condensation or abstract of the document's text. The translator must certify that
he/she is competent to translate and that the translation is accurate. Do not send a Certificate of Naturali-
zation or Citizenship and do not make any copy of such a certificate. An interview in connection with your
application will be scheduled before an officer of the Immigration and Naturalization Service, and any Certifi-
cate of Naturalization or Citizenship may be presented in person at that time. If the law does not prohibit the
making of copies send in a legible copy of any document which you submit with the application, but bring the
original of any submitted copy with you to the interview. The original will be returned to you and the copy
retained. You may be called upon to present proof of a parent's residence or physical presence in the United
States.
tr CLAIMING CITIZENSHIP THROUGH FATHER (OR BOTH PARENTS)
1. Applicant'! birth certificate.
2. Marriage certificate of applicant'* parent*.
3. If applicant'! |*renl« were married before their marriage to each other, death certificate or divorce decree ahowinf
the termination of any previous marriage of each parent.
4. If applicant it a woman and hai ever been married, her marri««-e ecrtifteate(i).
i. If applicant'* parent (i) became citiiend) it birth, birth certificated) of partnl(i).
6. Death certificate)*) of applicant'* parent!*), if deceased.
7. If applicant i* an adopted child, applicant'* adaption decree.
IF CLAIMING CITIZENSHIP THROl'GH MOTHER
1. Appjieant'i birth certificate.
1. Marriage Certificated) of applicant'* mother.
3. If applicant it a woman and hat ever been married, her rnamaxe certificated).
4. If applicant'* mother became a citiien of the United Slate* at birth, mother'* birth certificate.
5. If applicant i* claiming citiienihip through mother** marriage before September 22, 1922, to applicant'* atcpfather,
dulh certificate or divorce decree t how ing termination of any previoua marriace(*) of mother and *tepfather.
6. If applicant i* claiming cititcn*hip through mother'* marriage before September 22, 1922, to applicant'* stepfather
and ttepfather became a citiun of the United State* at birth, •tepfather's birth certificate.
7. Death certificate of applicant'* mother, if deceased.
IF CLAIMING CITIZENSHIP THROUGH HUSBAND
(NOTE: APPLICABLE ONLY IF MARRIAGE OCCURRED PRIOR TO SEPTEMBER 22, !«*,)
1. If hoiband through whom cititcnship it claimed became a cititen of the United State* at birth, husband'* birth
certificate.
2. Applicant'* marriage certificated).
3. If either applicant or the hutband through whom the i* claiming eHixenahip wa* married before their marriage to
each other, death certificate or divorce decree ihowing the termination of each tuch prior marriage!*).
4. If applicant'* marriage to the hu*band through whom ahe i* claiming citiunahip ha* terminated, death certificate
or divorce decree ihowing >uch termination.
SECONDARY EVIDENCE
If it it not pouiblc to obtain any one of the required doeumente or record* «hown above, the following may be submitted
for consideration:
I. Btptinnnl trrlifmlt.—k certificate under the teal of the church where the baptism occurred, showing date and
place of the child'* birth, date of baptism, the name* of the child'* parent*, and name* of the godparent*, if known.
8. iV/.ouf rrr«rrf — A letter from the school authorise* having jurisdiction over achool attended (preferably the nnt
*chool), »howing the date of admitaion to the school, child'* date of birth or age at that time, place of birth, and the
name* and place* of birth of parent*, if *hown in the school record*.
3. ("«•«*» ncoril.—Sltu or Federal censu* record ahowing the najne(s) and place(i) of birth, and dated) of birth or
age(t) of the penond) luted.
4. Affiilaril* — Not* rued affidavit* of two permoni who were living at the time, and who have peraonal knowledge, of
Ihc event you are trying to prove — for example, the date and place of a birth, marriage, or death. The person*
making the affidavna may be relative* and need not be citiien* of the United Stetea. Each affidavit ahould contain
the following- information regarding the person making the affidavit: Hi* (Her) full name and address; date and
place of birth; relationship to you, if any: full information concerning the event; and complete detail* concerning
how helshe) acquired knowledge of, the event.
Authority for collection of i..«! information requested on this form is Contained in Sections 332 and 341
of the Immigration and Nationality Act (8 U.S.C. 1443 and 1 452) . Submission of the information is voluntary.
The principal purpose for requesting the information is for use by an assigned officer of the Immigration and
Naturalization Service to determine the applicant's claim to United States citizenship. The information
requested may, as a matter of routine use, be disclosed to naturalization courts and to other federal, state,
local or foreign law enforcement and regulatory agencies, the Department of Defense, including any component
thereof, the Selective Service System, the Department of State, the Department of the Treasury, the Depart-
ment of Transportation, Central Intelligence Agency, Interpol and individuals and organizations in the
processing of an application or petition for naturalization, or during the course of investigation to elicit
further information required by the Immigration and Naturalization Service to carry out its functions.
Information solicited which indicates a violation or potential violation of law, whether civil, criminal or
regulatory in nature, may be referred, as a routine use, to the appropriate agency, whether federal, state,
local or foreign, charged with the responsibility of investigating, enforcing or prosecuting such violations'.
Failure to provide all or any of the requested information mnv result in a denial of the application.
. i. !•.,!.> «[« PUKTJVC :rr:cc : ist? c • 3;;.i?i.
4/1/81
AHMINISTRATIVE MANUAL
Appendix I
10-103
FEDERAL TEXTBOOK ON CITIZENSHIP
Our Constitution
and Government
FORM NO.
M-?
EDITION
REV. 1978
TITLE
FEDERAL TEXTBOOK ON CITIZENSHIP
OUR CONSTITUTION AND GOVERNMENT
size
5 3/4 X 9 1/8
OSE
l',VRT 01- THI-: CITULNSHIP TEXT MATERIAL ISSUED BY THK SKRVICE
PRIOR EDITIONS WAV NOT BE USED
SCHEDULE B
TM 719
ADMINISTRATIVE MANUAL
Appendix 1
M-8
FORM NO.
M-e
size
53/4X9 1/8
USE
EDITION
REV. 1973
TITLE
TEXTBOOK ON CITIZENSHIP - OUR CONSTITUTION
AND GOVERNMENT - SIMPLIFIED EDITION
PART Of THE CITIZENSHIP TEXT MATERIAL ISSUED BT THE SERVICE
PRIOR EDITION OF REV. 1971 MAT BE USED
SCHEDUJJt B
4/1/81
10-105
ADMINISTRATIVE MANUAL
Appeuuix 1
FEDERAL TEXTBOOK ON
CITIZENSHIP
Aids For Citizenship Teachers
A Resource Unit
•ir -i- -tr
FORM NO.
EDITION TITLE
M-;?
REV.. 1971 FEQEKAL TEXTBOOK ON CITIZENSHIP AIDS FOR CITIZENSHIP TEACHERS
SIZE
i 3/«* X 9 i/d
USE
FACT CF TEE CITIZENSHIP TEXT MATERIAL ISSUED BY THE SERVICE
PRIOF EDITION OF IJuB MAY BE USED j SCHEDULE E
Constitution
T1TLJD
INSTRUCTION JUJnatCNc
PRIOR EDITIONS HAY NOT BE USED
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FINAL TESTS
FORM NO.
M-40
EDITION TITJJC FEOERAL TEXTBOOK ON CITIZENSHIP - HOME STUDY COURSF-OUR *
Rev. 1978 CONSTITUTION AND GOVERNMENT FINAL TESTS
SIZE
7 7/8 x 10\;
INSTRUCTION REFERENCE
USE
PART OF THE CITIZENSHIP TEXT MATERIAL ISSUPEDBY THE SERVICE
PRIOR EDITION MAY NOT BE USED SCHEDULE <J
4/1/81
HUPUNlblKAl IVt MANUAL
Appendix 1
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SECTION
for the STUDENT
FORM NO.
;-t-4i
EDITION
REV. 1978
T1TUD
FEDERAL TEXTBOOK ON CITIZENSHIP - HOME STUDY COURSE - ENGLISH,
HOME AMD COMMUNITY LIFE - SECTION 1 FOR THE STUDENT
SIZE
7 7/8 X 10 1/2
INSTRUCTION REFERENCE
AM 2482 Ex. 2; GIB A-10
CSC
PART OF THE CITIZENSHIP TEXT MATERIAL- ISSUED BY THE SERVICE •
PRIOR EDITION OF REV. 1971 MAY BE USED SCHEDULE B
4/1/81
Appendix 1
^•'/^'•.'.•'.•''(^•'Siy'-'K ~ ''•'-'- ' ;'•:• : •
f^JttllB^
SECTION '
idr the STUDENT
FORM NO.
M-43
EDITION
Rev. 1971
TITLE FEDERAL TEXTBOOK ON CITIZENSHIP - HOME STUDY COURSE -
ENGLISH AND FEDERAL GOVERNMENT - SECTION 2 FOR THE STUDENT
SIZE
7 7/8 x 10i
USE
PART OF THE CITIZENSHIP TEXT MATERIAL ISSUED BY THE SERVICE
PRIOR EDITION OF REV. 1970 MAY BE USED
SCHEDULE
4/1/81
TM 720
ADMINISTRATIVE MANUAL
Append ir I
M-45
FORM NO.
M-45
EDITION
REV. 1973
TITLE
FEDERAL TEXTBOOK ON CITIZENSHIP - HOME STUDY COURSE -
ENGLISH AND STATE GOVERNMENT - SECTION 3 FOR THE STUDENT
SIZE
7 7/8 X 10 1/4
USE
PART OF THE CITIZENSHIP TEXT MATERIAL ISSUED BY THE- SERVICE
PRIOR EDITION HAY NOT BE USED
SCHEDULE
4/1/81
ADMINISTRATIVE MANUAL
Apoendix 1
10-111
U.S. DEPARTMENT OJF JUSTICE ~
IMMIGRATION AND ^ATURAUZ.^TIC»f ^BiyiCB^
FORM NO. EDITION
M-7: 1979
TITLE
GATEWAY
TO CITIZENSHIP
SIZE INSTRUCTION REFERENCE
5 3/4 X 9 1/8 AM 2-114
Ex. 2, Pq 2; NEG 4-10
USE
nESICiNFP TO ASSIST IN ADDI^r, TO THF DlfiNITY OF THE CEREMONIES SliRROtlNnjNfl THE
APMISSION TO CITIZENSHIP AND IN FMP»ASZ1NR THE SlfiNFICANCF AND IM°ORTANCF OF
CITIZENSHIP
PRiriR EDITION OF REV. 1971 MAY BE USED
| SCHEDULE 8
I .S. Department of justice
lnin-::y.'iiiiiin and Niilurali/jnmi Serucc
Naturalization Requirements
and General Information
FORM NO.
N-17
EDITION
Rev. 2-7-80
TITLE
NATURALIZATION RETIREMENTS AND GENERAL INFORMATION
SIZE
3 3/4 x 7»s
INSTRUCTION REFERENCE
AM 2414 Ex. 2; GIB A-10
USE
INFORMATION PAMPHLET REGARDING NATURALIZATION REQUIREMENTS AND PROCEDURE
Printed in Enolish and Spanish
PRIOR EDITIONS MAY NOT BE USED
I SCHEDULE
4/1/81
TM 679
ADMINISTRATIVE MANUAL
Appendix 1
N-315
Page 1
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
Alien Registration No.
(To be retimed by
Clerk of Court)
DECLARATION OF INTENTION
(Thin declaration in not evidence of Uwful
admission for permanent residence)
(1) My full, true, and correct name is
• llhoul ftM>r«vi*tk>n. i
um« which h«* b«*n UMd. raiut «pp«*r h«r«)
(2) My preient place of residence i>
(Nu«b«r *ni I
(Citj "ir uwv) (Counlyl ISuu) (IIP Coi«)
(3) 1 am over the age of IB yearn, have been lawfully admitted to the United States for permanent residence
and am now residing in the United States pursuant to such admission.
(4) I hereby declare my intention in good faith to become a citizen of the United States, and I certify that the
photograph! affixed to the duplicate and triplicate hereof are a likeness of me and were signed by me.
I do swear (affirm) that the statements I have made and the intentions 1 have expressed in this declaration of
intention subscribed by me are true to the best of ray knowledge and belief: SO HELP HE GOD.
Subscribed and «wom to (affirmed) before mt by the above-named
declarant in the office of the Clerk of uid Court, thii
day of 1»7 — I hereby certify that
authorization for the issuance of this declaration h»« been received by
me from the Immigration and Naturalization Service, and that the
photographs affixed to the duplicate and triplicate hereof are a likeneu
of the declarant.
Clerk of the
By
Deputy Clerk
[BBAL]
Form N-316
(Rev. 2-1-71 )Y
FORM NO.
H-315
EDITION TITLE
REV. 2-1-71 DBCLARATIOK OF UrTENTIOH
SIZE
8 X 1C>£
INSTRUCTION REFERENCE
8 era 33"*».i
USE
EXECUTED BY
AN ALIEN UHDER OATH BEFORE THE CLERK OP COURT
PRIOR BDITICN OF 7-1-70 MAY BK USED. SCHEDULE i
4/1 /81
MANUAL
Appendix I
TM
UNITED STATES DEPARTMENT Of JUSTICE
IMMIfiRATION AND NATURALIZATION SERVICE
DECLARATION OF INTENTION
&"M-^ s
0%^M.^^d*p^
(SECURELY AND PERMANENTLY
AFFIX PHOTOGRAPH HERE)
4/1/81
TM'679
ADMINISTRATIVE MANUAL
AppandU I
N-315
Page 3
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
Alien Registration No.
TRIPLICATE
(To be ghtn to
declarant when
originally iaitued)
DECLARATION OF INTENTION
(Thin declaration U not evidence of lawful
admission for permanent residence)
(1) My full, true, and correct name is
r t\»m« wMch K*A b«*n ut«4, mutt ti>p««i h«r«l
(2) My present place of residence is
(Number «nd itrwli
(Cltr or UWBI Ifoimtyl (Suul (ZIP Code)
(3) I am over the age of 18 years, have been lawfully admitted to the United States for permanent residence
and am now residing in the United Stale; pursuant to such admission.
(4) I hereby declare my intention in good faith to become a citizen of the United States, and I certify that the
photog raphs affixed to the duplicate and triplicate hereof are a likeness of me and were signed by me.
I do swear (affirm) that the statements I have made and the intentions I have expressed in this declaration of
intention subscribed by me are true to the best of my knowledge and belief: SO HELP ME COD.
IT IS A VIOLATION OF THE U S CODE
(AND PUNISHABLE AS SUCH) TO COPY. PRINT
PHOTOGRAPH, OR OTHERWISE ILLEGALLY USE
THIS DECLARATION v18 USC 1426(0)1
Subscribed and sworn to (affirmed) before me by th* above-named
declarant in the office of the Clerk of said Court, this
day of , 197 I hereby certify that
authorization for the issuance of this declaration has been received by
me from the Immigration and Naturalization Service, and that the
photographs affixed to the duplicate and triplicate hereof are a likeness
of the declarant.
(SECURELY AND PERMANENTLY
AFFIX PHOTOGRAPH HERE)
[SEAL]
Form N-315
(ReV. 2-1-7DY
Clerk of the
By
Dtputv Clerk
4/1/81
--,
Page U
Appendix I
A Declaration of Intention is not required as a basis for filing: a petition
for naturalization or for naturalization.
This Declaration of Intention shall not be regarded as conferring or
as having conferred upon the person to whom issued United States citizen-
ship or nationality or the right to United States citizenship or nationality;
nor shall such declaration be regarded as evidence of such person's lawful
admission for permanent residence.
tt v i. covdwimT MIKTMC wnct i«n-o-<;i-'.T)
4/1/81
794
ADMINISTRATIVE MANUAL
Appendix I
N-405
Page 1
ORIGINAL
(To to retained
by Ctorfc of Court)
To the Honorable
Th«
UNITED STATES DEPARTMENT OF JUSTICE
Immigration *nd Na1urall»tlon S^rvlca
UNITED STATES OF AMERICA
PETITION FOR NATURALIZATION Ko
This petition for natv
Immigration and Nati
(1) My full, true, ajid c
(I) My present place ol
ralization, hereby made and filed under flection
onality Act. respectfully shows:
orrect name ia
residence i«
nOml aik»n— «>«»)
i»rt) lC.li, «r COT.)
(3) I was li.'m t.n
(Stt.1
(Z/J» C...I
(<) I request that n:y name be changed to
(fii I was. lawfully ailmi'.
(fil i If ).. i.;,, n filed urn
<•-. .u:m; ••-!•:}• in tlip f-
pvtm.T. ai-.i! -fui m>
f . r a li a.«t onr-half t
ed to the United Stoles for permanent rcsiil. nee and ha^
e r.ol abandoned such residence.
;ale in which this petition is made for at Irani six months, immit'.iitcly preceding the dale of this
lawful admiibiun for permur.pnl residt-nri-, nuti ! have U-en phyaicully present in the United Staua
f such five year periM. irtntlni»d ov.ri
AFFIDAVIT OF WITNESSES
Th« folk.winf wllntaM*, «ach being arrtrally. duly, and r««p«li»»lv aworn. d«|>oa« and aayi
4« M4 «MM«| (CMy •* i*»«J
ISU..I
("•-
U, ~J ...... I Itu, .. ,.-.1
I5lal.l
** "
(V_,M ID.,
in whl.-h .h> HI it. on u (tied d
• oil haot.nn* of IB. tlniud S
riav at Uait tht laat 4 mootha. 1 have i^rimnitJ bnowl«4ltf« that t
• [xlilioMr la. and dorm? all aurb ptrlodl hai
n lor nauiraliuilun >uU<riWd by rnt arc trui lo
Ib. test ..fir, ....... :..:<> M d la
""' *" """ M- U"d
WHEN OAT H ADMINISTERED BY CI.EKK OH I'EPUTV WHEN (IATH ADMINISTERED DY DESIGNATED EXAMINER
CLERK Of COURT
SabarriM and ..orn, lo l.fflrm«ll Ufor. 01* hy abovt-najn»<l frt.. ,,^"\'"'.!^1 A^L'?'.0.,'?!,"' "M™"'} ^'"'i m.\, *? '•""-""nul MU-
tlon.r and • llneaan in id. rrtntriiYf forrtu of oath .hown In aaid in l.tinr. llann and witnraMa In th> reiprctlve tomn or oalb ihown in aald petition
.... .. 19.
lat (Jbt (ora«olai patitlon (or natvir«llullon waa by
lin CM In tki lOet of th. clark of aald court
• «. -• tliU day o/
1 inuiv ntnrv TV
By ...
<:i»ri.
form N-40} (Rev. 11-27-7DN
K.pvl. CUrt.
By
Cta*.
DtftOjf CUrfc.
FORM NO.
N-405
EDITION TITJLX .
REV 11-27-78 PETITION FOR NATURALIZATION
SIZE
8 X 10 1/2
INSTRUCTION REFERENCE 8 CFR 319.11, 324.11, 327.1, 328.3, 329.2, 330.1, 332a.2, .13(e),
334.13, 499.1; AM 2303.06, 2304.07, 2482 Ex. 2, 2720.03
USE
FILED BY AN APPLICANT FOR NATURALIZATION WITH THE CLERK OF COURT
PRIOR
EDITIONS HAY NOT BE USED SCHEDULE B
4/1/81
(7) (If petition filed under Section 319(a).) I have resided continuously in the United States in marital union with my
present spouse for at least three years immediately preceding the date of this petition, and after my lawful admission for
permanent residence, during all of which period my said spouse has been a United States citizen, and have been physically
present in the United States at least one-half of such three-year period. 1 have resided continuously in the State in which
this petition is made at least six months immediately preceding the date of this petition.
(8) (If petition is filed under Section 319 (b).) My present spouse IB a fitizen of the United States, In the employment of the Government of the
U in Led Suits, or of an American mtlitution of research recognized u such by the Attorney General, or an American nnm or corporation engaged in
whole or in part in the development, of foreign trjule and commerce of the United States, or subsidiary thereof, or of a public international organiza-
tion in which the United States participates by treaty or statute, or i> authorized to perform the ministerial or priestly function! of c religious
denomination having a bona Me orRir.ization wUhin the United SUtas, or is enmged solely a* a missionary by a religious denomination or by an
interdenominational mission organization having a bona fide organization within the United Stales, and such tpouae ia regularly stationed abroad in
such employment. I intend in good faith upon naturalization to live abroad with my apouae and to resume my residence within the United States
imnuxliauly upon Urminbiion of such employment abroad.
(9) (If petition is filed under Section 3?.!).) 1 have served honorably in the Armed Forces of the United States for a period or periods aggregating
three years. I have never been separated ilrr.m the Artncd Forcys of the United States under olhcr than honorable conditions. If not still in service,
my service terminated within sue months of the filing of my petition.
CIO) fjf petition is filed under Section 32?.) WV'le an alien or nonclliten national of the United States. I served honorably in an active-duty status
In the military, air. or naval force* of the United Stales during either World War I or during a period beginning September 1, 1939, and ending
December 31, 164C. or during a period beginning June 25, ISbO. and ending July 1. 1066. or during a period beginning February 28, 1981. and eadine
October 15. 1978, or during « period t..'Rinn'.nR - >!> and ending 19 . or 1 wns rlisrhnrKed after
five ywirs of servicn unuVr UK- Art ei June 3'). l.'ifl |IM.. 507. hist Confrn-ss). If »ejmrat«l from «urh acrvice. 1 WHS separated under hnnor.-.blc condition!".
At the time of inlmtment. rernliHlnu-iii. or imluiiiiin I was en the United StHtea. the Cnnnl /one. Ainertrnn SHmon. or Swains Island. If not in any of these
places. 1 was lawfully lulmitlvd to the United t-.tutea fur j» rmunent residence subsequent to enlistment or induction. 1 wna never sriiEmti-tl frnm Mich service
on Rcr-ount of ftlimi.Kt1. 1 v.*as iu»t R ronpriontious objector who performed no military, uir. or nftval duty whatever or refused to wear the uniform, I have
not previously twen naturalm-d on the batui of the taane period of service.
(11)
(12) I am not and have not be«n, within the meaning of the Immigration and Nationality Act, for a period of at least 10 yean immediately preceding
the date of this petition, a member of or affiliated with any organization proscribed by surh Art. or any section, subsidiary, branch, affiliate or sub-
division thereof, nor have I during such period believed in, advocated, engaged In, or performed any of the acts or activities prohibited by such Act.
( 13) I am, and have been during all the periods required by law, a person of good moral character, attached to the principles of the ^institution
of the United States and welt disposed to the good order and happiness of the United Suites.
(14) It is my intention in good faith to become a citizen of the United Stnte* and take without qualification the oath of renunciation and allegiance
prescribed by the Jmmlgistion and Nationality Act, and to reside permanently in the United States. 1 am willing, when required by law, to bear
arms on behalf of the United SLates. to perform noncombatant service in the Armed Forces of the United States, and to perform work of national im-
portance under eivl'.an direction (unless exempted therefrom).
(15) I am able to read, write, and ipealc the English language (unleu exempted therefrom), and I have a knowledge and understanding of the funda-
mentals of the history, and of the principles and form of government of the United Stales.
(16) Attached hereto and made part of this, my petition for naturalization, are the affidavits of at leot two verifying witnesses required by law,
and supplemental affidavit on Form N ...
(17) Wherefore J request thnt I may be admitted a citizen of the United States of America. I nwenr (affirm) that I know the .content? of this petition
for naturalization subscribed by me. and that the samp are true to the best of my knowledge and belief, and that thla petition is signed by me with
my full, true name. So Help Me God.
(full. Name, Without Abbreviation)
OATH OF ALLEGIANCE
I hereby declare, on oath, that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign
prince, potentate, state, or sovereignty of whom or which I have heretofore been a subject or citizen; that I will support and
defend the Constitution and the laws of the United States of America against all enemies, foreign and domestic; that I will
bear true faith and allegiance to the same;
that I will bear arms on behalf of the United States when required by the law;
that I will perform noncombatant service in the Armed Forces of the United States when required by the law,
that I will perform work of national importance under civilian direction when required by the law;
and that I take this obligation freely without any mental reservation or purpose of evasion : So Help Me God. In acknowl-
edgement whereof I have hereunto affixed my signature.
(Sianaturt of Petitioner)
NOTE.— In renunciation of title or order of nobility, add the following tn the oath of allegiance before it Is signed: "I further renounce the title of
((five till* or titles) which I have heretofore held." or "I further renounce the order of nobility (give the order of nobility) to which I have heretofore,
belonged."
Petition granted and Certificate No. .
Petition denied: List No
. issued.
4/1/81
10-119
794
ADMINISTRATIVE MANUAL
Appendix I
N-405
Page 3
DUPLICATE
(To accompany
monthly report on
Form N-4)
UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization Service
UNITED STATES OF AMERICA
PETITION FOR NATURALIZATION
To the Honorable
The Courtfor the
No. _
A.R. No
at
This petition for naturalization, hereby made and filed under section
Immigration and Nationality Act, respectfully shows:
(1) My full, true, and correct name ia
(2) My present place of residence is ..
(Aft. No.)
(fvti, true name, vnthcmt abbreviation )
INtimbtr and ttittt) (Cilv or (own)
(County) (State)
(3) I was born on , in
(ZIP Code)
(4 ) I rccjucst that my name be changed to
(5) 1 was lawfully admitted to the United States for permanent residence and have not abandoned such residence.
(6) (If petition filed under Section 316(a).) ! have resided continuously in the United States for at least five years and
continuously in the State in which this petition is made for at least six months, immediately preceding the date of this
petition and aftor my lawful admission for permanent residence, and I have been physically present in the United States
fur at least one-half of such five year period. (continued o«r>
AFFIDAVIT OF WITNESSES
The following -a knersrs. each being BCverslly. duly, and r;.ii>«ctivvly sworn, depose nnJ aay:
(1) My name it — •
I re»ld« at — »n(l
(A.mfcor <uirf .«•,«/) (City ar lawn) (Sim.)
(Z) My niuno li
a ~(N~umihfr~mi"i™,~t) (City ar low.) (A'I.I.)
I nm H cillwn of th« United StateB of America; I have personally known and have been acquainted in the Unlt*d Stutei with the petitioner named
In the petition for naturalisation of which thi» affidavit it a part, since at leait : to my personal knowledge, ba»d upon
(.ttoiuM (£>«r) O'»or)
frequent observation! and peraonal contacti with the petitioner within the StaU(») of residence of the petitioner ainee laid date, the petitioner hai
raided, immediately preceding the date of filing thli petition, In the United Slates eontlnuouily »inee the date lail mentioned; that the petitioner
1* been phynlcally present in the United Slat", for
which th« petition ii filed during at leaat the l/ut
(en a peraon of Stood moral character, attached t
id bapplneu of the United State*, and in my opin
I do »wear (affirm) that the atalemcnta of fac
the b*«t of my knowledue and buli.-f. So Help Me God.
''""(Sigiiaiwi'of'Wiiiuui
WHEN OATH ADMINISTERED BY CLERK OR DEPUTY WHEN OATH ADMINISTERED BY DESIGNATED EXAMINER
CLERK OF COURT
_ . .. . . . — ,. . , ».„ „!.„„-_... __)' -..I Subtcrlbed and rworn to (afflrmeOi before me by above-named pell-
Sub«rlb«l and worn to (affirmed) before me V »^»' ^"V" *&£' tloner and witneaM. in the reipeetive form, o( oath ahown In laid petition
Uon«r and wltncaMi In the rffpecUve forma of oath ahown In laid petition
and affidavit, and filed by aaid petitioner. In the office of the clerk of said ^ ^gjj^^ ft. U,!,
day of 18
• •- " ----- -- Dtritmattd Exnmmtr.
cay o . j HSK£1|y cuenrf That the foregoing petition for naturaliiatlon wa» by
.__._. ._ .._. - petitioner named herein filed in the office of the cJerk of aaid court
By _ - --'— at thlj day of
Deputy Clerk.
(HUg -£.-£_
Br . -
Form N-405 (Rev/. 11-27-78JN C*jm**r Cl4rrk'
Appendix I
(7) (If petition filed under Section .'i!9(a).) I have resided continuously in the United States in marital union with my
present spouse for at Ir-ast three years immediately preceding the date of this petition, and after my lawful admission for
pemianerit residence, during aJI of which period my said spouse has been a United States citizen, and have been physically
present in the United States at least one-half of such three-year period. I have resided continuously in the State in which
this petition is ma"ie at least six months immediately preceding the date of this petition.
(E) (If petition is ft!«t under Section 319fb).l My present spouse is a citizen of the United States, in the employment of the Government of the
United Stales, or of an American institution of research recognized aa such by the Attorney Generul, or an American firm or corporation engaged in
who!? or in part in the development of foreiRn trade and commerce of tho United States, or subsidiary thereof, or of u public international organiza-
tion in which the United States participates by treaty or statute, or ia authorized to perform the rninisU rial or priestly funrtions of a relipriom
denomination having a bona fldo prgcrizattor. within tbe Ur.itcd SlMca. or is enRr>fred solely M a missionary by a religions denomination or by an
inlcriienominalior.iU mission organitnvr.n hiving a bora flde organization with.r, ITU United States, and such spouse is reifii'aflv stationed abroad in
euch employment. J iotend tn goori fftith upor. naturalization to live abroad w.ih rny spouse and to return* my residence within the United State*
(?) (If petition in filej under Section 2iS ) 1 have served h-moruWy in the Armed Korcci of the United States for a period or perisdi HgjtrCRating
three yeius. 1 imve never been scr-rauid (j-nrr; the Armed r'oreva of the United Stales under other than honorable conjr.ion?. If nut still in service.
my service terminated within aix mcnt'is of the tiling of my petition.
( !P) (If petition ia ft I'd under Section .119.) While an alien or nonritizrn national of the United States. I served honornlily in an active-duty status
in the military, air. or n*val fnrers of the United S'Jites during either World War I 'or during a period beginning Septcr-ber 1. l(-3?. and ending
December 31, 1946, or aurini; a period beginning June 25, 1950. and ending July 1. 1956. or during a period beginning February 2S, 1961, and ending
Oetotx r If, 11-7-. or during n f.cri-.vd b< ginning - 1?. ... and ending 19 . or I was riisohnmcn after
n M' >.»:•!, of K.-IVU-.. ui.wr th.- Act of Juni'2'i. IvfO iJ'.L. f.!>:. cist Onts.-.'. .-I . If M-I. untied fn.ni MM h MTVU-I'. I v.»s ae]iHniliii -jr.'i.r 1-. n,ir.,l>le ivniliii.ms
At the linn- of i n'. ~tiii>-ii. r'-f-nliainieiit, or milurtinn 1 was in the Uniti-! Stale?, the i iituil '/»ne. Aim-runn Sninc'u. or Swains lsl:ir.\l. If not in nrv n( thvso
1.,-we-,. 1 »»» l:.*fi.i:y idmittvil tn tin- United SlMes fur t.vriiiimfiil n-si.l. v.-e ,-.,i.M'iiii.Mit in oiil^tnier.t i.r in.lvu-aon. 1 »:« m-ver •« i'aiw.i.1 fn m .-u K -• r. n «
OUil)' bi'ltl
ul duty v,huu
(11)
(12) I u» net and have not be«n, within the meaning of the ImmifrraUcm nnd Nationality Act, for a period of at lean 10 yeara Immediately preceding
the date of thit tittiiiun, a member of or affiliated with any organization proscribed by «uch Act, or any section. «uhaiJiary. branch, affiliate or aub-
divi«;on thereof, nor have I during tuch period believed in. advocated, engaged in. or1 performed any of the acu or activities prohibited by «uch Act.
( 13) I am. and hove b«n during all the period* required by law, a p«r*on of good moral character, attached to the prinelpiei of the Con>titution
of the United Slate* and well d imposed to the good order and happineai of the United Statea.
(14) It U my intention !n good faith to become a ciliicn of the United Stnti'a and take without auiilification the path of renunciation and allegiance
prescribed by the Immigration and Nationality Act. and to reside permanently in the United States. I am willing, when required by law, vo bear
arm< on behalf of the United State*, to perform noncombatant service in the Armed Forces of the United States, and to perform work of national im-
portance under civilian direction (unleu exempted therefrom).
(15) I urn able to read, write, and apeak the English language (unless exempted therefrom), and I have a knowledge and understanding of the funda-
mentals of the history, and of the principles and form of government of the United States.
(1$) Attached hereto and made pan of this, my petition for naturalitation. are the affidavits of at leut two verifying wltnnaea required by law,
and supplemental affidavit on Form N ..
(17) Wherefore I request that I may be admitted a citizen of the United States of America. I swear (affirm) thnt I know the contents of this potition
for naturalization subscribed by me, and that the same are true to the beat of my knowledge and belief, and that this petition ia signed by roe with
my full. tni£ name. So Help Me God.
(Full Name. Without Abbrttiotion)
•uoiiB3ijtJAai Xjauiui||ajd >q) )• spstu »iujuj^»)« tpi pJAOjdan qj»o japan rawaui!* puo
:p»jinbaj ||p» tiuxunoop jo uorisy
:p»»
««»UJ!M. ! MUOHIJSJ— -A(jns
~ »»oi|Ai :
"auu^ : js
»»niiA\. : «>
d|q»u»ti;i3 (2) OTWUIIM
HHproMrjio
p.iuoo
- uf
- uj
- uj
. . — . . _ — QJ _ — . . <sa<uj — -"
«l
:V»lO«>i :p»AiS331£ tpw.n&aj «uoi,
!«od»a
aszc-o " ••»« >O»H sss-o - ai
SZt-JJ
IAOQ ti.,,,0 *,!JA «p«»a «n«»dS :q
«ii»ua
Noixov j.anoo
NoiiVNiwvxa jto iansan
4/1/81
TM 709
ADMINISTRATIVE MANUAL
Appendix 1
H-407
Page 1
NrtftD BTATKO DBJPABTMXNT O3 JOGTICE
numunou .n» MmOAUunaa teamen
UNITED STATES or AMERICA
(To %• reialaait 67
FOB NATUKMJSATION
(la txi&air W a CWW. aader Ssatfaa ........... — .
lesmlsraSSWL MM! NaliMMiti? Ail)
rw> txaatna Iff ix»iaMMMMt»a,
(I) My fllU. Ww. Mrt ianain uumi I..
tt.) U, IHW.I *lw.^mMa<M u ............................ "O
(tia) I w» IIUUB <( MM UauM 8lau»i AiBvtta <«<r U run ol wa.
l») TIM »U <UU n«r rakKn trtIO taaln) In rar «ur)
(•) Th. mid cMU ra kwn «
(>| TO* »ld cklld >u l>oluH»<l«>llU4 u t
M tb* UlllUd BHUJ
(•) t fW«) prai U«l ItMMMcMM'a IUUM >«
HL1BN BIOISTRiTtON NO ...... _
( IU UnllW Hulw •» A«Klrl«a: I fat*.
in mj MnontJ hi»»M»r. Wwd opo« Imwnl •fe
•ino ...d <l>u Ik. >«M b»i««t»ry !••!> rt<l*ri. k
p«il.ai»fi.i ..d. ir » >4oi>t«l .Mid. In UwkOT
* ---- ^...^... ...........
ill li. UoWUUry oilkln lk> Outell) tl aAtmtt •( tk<
lns Mu <lou •( Sll»j of Ihto pMIihu. <« l
lUmrOI ~.tln~~te dtw Ik. 4>u tart
»U« <f Dill wi>4: ••<) I »»•«
txn ph».r«llr omciM In Uw Uitlu4 3U.U. for m I«<|
b»nrfl,,.r» ,. no- nod 4gni<« .11 ratk MrM ku W>» > ixmno erf fni o>a .
SUU» (M »ll HopoMd to Uv> n«. *nbr gn4 kopoiMa «t tk. Ufclhnl Sum. >«4 m «r ••laic* U« <klM teMMUT U in mn •»
«4mitu<l a ntiwn of II* Unlud 3l«t«*.
I do ««.or (»«\rml ik»l |W lUUowou ^ txt I »»»• n>i> In tkl. »BU«h <T Ul« (Mllten fof »
of mr kiw»Mr> »"J Ullri.
iW» 1U ««H rtlM
lM •» (W U»IMI
»» ••^ItM K W
br « o» Irw U Iko Vol
WHBH OATH 'AogamurraaaD IT asian on osa-OTV CT.BHJC OP WHBN O*T»
CODttT
lobKntm) i»tf nran w ufflraart) Mm M b; »te><H<iM>d p
«Ukir>mti>itemp««m>m««Mlkih«mtouulp«uu.«Ba
KM fcj »M MUUosoW. to UH oflo d U.» chrt *llaUl>Mrt w
thl.
lhl«
IK«» 10-1-7*) T
FORM NO.
N-407
EDITION TITIX
REV ]Q i_7B PETITION FOR NATURALIZATION
SIZE
8 X 10 1/2
INSTRUCTION JUCFERENCE
8 CFR 322.1, 332a.2, 499.1; AH 2482 Ex. 1; Hat Hbk 1-50, -50.1, -51
USE
FILED BY THE PARENT OR PARENTS IN A NATURALIZATION COURT
PRIOR EDITION OF Rev. 8-31-71 HAf BE USED j 8CHKDOLB A
tasrsftwa^^sf
4UUIMI In artun Bin), u uoauM. liMn
. «. ««1 WIN to •>... MK! <klU «*f ue .««
i««< «M .Nalwa
t I tV». MitIM Md c
t»° •«-U>i.< «HunMi .xium
^
i-tMiMirt WHILf MF it t
OATH OF ALLEGIANCE
ocr tud fidelity u> oa;
wn Ihst I will tupport
d domestic, ihat I vUl
I HEREBY DECLARE, on oath, lh»t I absolutely «nd entirely renounce end abjure all
lor«i(n prince, potentate. lUIr, or tovfreigoty of »ht in or which I have heretofore be»n a subject or ci
and de/cnd the Constitution nnd tat lawn of U>e United Slaws of America ajiainst all eaeraiM. foreign i
bur true failb and allegiance to the wrae.
that 1 will bur aria* oo b«baU of U>« United StaUa when required by the !«» .
Uul I will perform »oneomb«un« tcrviee in the Armed Forces of tbe United Kuuo »b«u required by tne IAO .
that I will (xrform work of naUooal Imporunce under cmlito direction when required by the l*« .
and that I ukr Ou» obll«»lioo freely without any menUI re«rrv»tioii or |>urix»r of evuwa. HO HELP ME GOD In ac«no»l-
•dtnxnt whertof I have hareuoto affiied my tlcnature
SOT*. -I. nmMMlM «/ ml. «nr*« «I ««"i «« ««l«a»«lm»ite ««»«r««««!l»j«<>t »"«<««« Hhrt»eii«« *• '•»*• nxnoui
«kw I km taMMM ta*«." « II ftMto N«M>>. u» «rtw «J «.«ar »«« *« «*» -w i-»«»r • » •**» J to~ ton^uta. MratM.-
Petition ffrmoUd uid C«ru«t»t<r No
P*ution d*ai«d: Uti No. .
0»lb ol aUie«uuiM wkivwl: Utt No
V.R OUVKUNMKrT ffilNTINU OIF71CK 1»U O~ J1J-1M
4/1/81
10-123
TM
ADMINISTRATIVE MANUAL
Appendix I
N-407
Page 3
UNITED STATES OF AMERICA
CT?.SS??n'p£r Nn.'4h>" PETITION FOR NATURALIZATION **
(In behalf «C* Child, under Section •> «ratji<l«d.
Immigration and N.tlon»lllr A<l)
r...-.......!-..— .I.—.
"T-iti"^.0*',"- ^ «— , ,u, ^ «. ...— . — .. «<, k, — ... ,«-,
* If- »._.«« ..— .._,
,„, 1 a. . ,,,u.n * ,», 1-..M «.u. o, A™.*. — 1. ,-n =, „.
on U B!«l
(r.u ~ -~ .«»-. ^— .— ,
i«l Tl, "'drill wuboni on In
iu_» iiv.i IT.., *«,.-.. liw^p
IM«tW lUirl I «<l
tCOKTIHtXO~0
tii|
AFFIDAVIT OF WITNESSES
1"— — «—' .0..-—. «—•
ln>di.l
' "" ' ' «' - »-- «- " — ' « - — *" ' k'" ^- - - " - ""'"•' 8 "h - "»-
-'-
,~,. ,h>.T.II, ,.,,»nt in Ih, l'n,u.| SUM for ., I.MI n»nlhi of th.l p.rl«l. »d I h.., «,,»..! kr».M» Ih.l Ik
will child
k, I' mud
^^^T'l ^"nrThVVrn'lw's';.™.'!" *"" h"""nn" "' lh> l"1"1 Su" ' '" mv "1"">"n >h* 'k"'' 1""R""' " '» ""» "" ""
of m> >nn«M(i- .nH l»li«f
WHEN OATH ADMIHlSTEBUn BV CLBUE Oil DEPUTY CLEB* OP WHKH OATH ADMINUTEBED IV DUIGNATED
COUKT EXAMINE!!
mlntuM In lh< mi|<KtlT> lornu ol out, >howu In tut twlllloa ud UBdxil. uid wlluiM la tlM Mr>»nl» lofru ol otlb iliown In «ld pitllW, ud XII
Dl*d b7 »»ld tKtlt'.oi>«rU}, Ul lb« offln ol ItM obrk ot Mid court «t
ontrtll ud
dkvlt •(
... 10...
I BIIIBT CTtrrUT Ituu tn> knt>lB( pMltloo hr ulunUluUoo •
UoovU) >b*T» nuud Dtod 111 U» OO« ol IM otart it Mid court U
m br p«o-
" cur*.
»•
cwi.
»»rmN-«0-I -^
iltf». lft-S-78) V
•tff Ort.
4/1/81
TM
I'. S. fiOVKRNMENT PRINTING OPWCS
4/1/81
TM 800
N-4UB
Paoe 1
I'M I IP S1ATIS r>IP<.K1MFNTnF U'STJCt
tMMH.IMIUIN ASH \ATl'HALI7-ATICIN M.RVICE
Form ipprodd
audlfl Bunui Ko u-Ron.l
UNITED STATES or AMERICA
(To b« ,,,.,ned APPLICATION TO TAKE OATH OF
a. court ro,.,,d) ALLEGIANCE AND FORM OF SUCH OATH
(By > woman under Section 124 (c) of the Immigration and Nationality Act. or the Aet of Juivt 25, 1956. m amended)
(1) My full. mie. and correct name 11
(2) My pretent place of residence 13
()) Mr wxupmon i>
(5) My prlionil description u a* follow* Compleunn
lolm of hail . height tett . me
. color of eyei . .
puundi , vuiblc diltinctivc nurLi .. .
. .« were married
.. ; he wai born
on . . . . ; and now mio«
i "• ) I lull, ur believe Ihat I lost, limled Stile* ciluenjhip uilrlv by reaion of mv mariiifte on
by . <W«»'M <D«t> 0"<1
(1) I have not acquired anv other nationally by an arTumanve aci tither thin bv marrii|ce
(V) I am noi and have not bern for a period r.f at lean lOyeiit immediately preceding the due of thil application i mrmber of or iDtlialni w.lh any
dunrig tuch period cngajted in or performed any «if thr atts or activtnn prohibited by that Act
( 10} I have retuird tuntinuuuily in the l.'nilej Males Irnill III. Jjlr of mi mittufe up In and mlluJing julv 2. 194U
(lit 1 hrreby apply to lake the oilh of allegiance is pmcribed in Section ))? of the Immic^tliun and Nationality Act and the regulation! there-
under and 10 become repatriated
lite jSovc n.lnu.1 applnau: m the .uli-t nf the ilrtlc til SJu! mutt >!
in . M
ORDER OF COURT
In the - .. . . Court
of
Ipon toniiildJimii ,il the fun-pimg applitatiuii »n.>. :he jprliunt haMiie u«'n ilv nail: m' allfKU"" m "P*n niujt tins
day of . 19 . it is lu-rcliy (iRlUKri. that tlir apr-lujimr he framed and thil the said
appluant he, and she hereby is repatriated as a uli;en nf the l*n>tfd Sult^ nf AnteriC'i
Bv the Loan
Mir""
NOTI TO fURK OF TOI'IIT -No In a lo b< fnllcal.il ,n (oont.i.on v,,h Ih. Mina «l Ihil ippnuiiiin II ipplilint J»m.ndi |I» l/.pl'OK Ion of IN ifflj
farm N-<08
,Hc> <.1-W|Y
FORM NO.
N-40R
EDITION
Rev. 4-5-79
TITLE
APPLICATION TO TAKE OATH OF ALLEGIANCE AND FORM OF SUCH OATH
SIZE
8 X
INSTRUCTION RJEyJERJENCE AM 2414 Ex.2, pg 3 8 CFR 324. 12, .13, .14, 332a.2, 332.13(g),
499.1; AM 2303.06; NAT HBK 1-51 1-53
use
FILED IN A NATURALIZATION COURT UNDER SEC. 324(c) OF THE I 4 N ACT OF JUNE 25, 1936,
AS AMENDED OR PURSUANT TO PRIVATE LAW
PRIOR ETITION OF 5-30-66 MAY BE USED
SCHEDULE
4/1/81
OATH OF ALLEGIANCE
/ HEKEBY DECLARE, on oath th«( 1 »btol
-- — — -."-
4/1/81
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
Budget Bunau No 4J-ROW e
UNITED STATES OF AMERICA
APPLICATION TO TAKE OATH OF
ALLEGIANCE AND FORM OF SUCH OATH
Alien Registration No
DUPLICATE
(To accompany
monthly report on
Form N-O
(Bf a. woman under Section 324 (c) of the Immigration and Nationality Ace. or «h* Act of June 25. 1936, ft amended)
To ibt HoHOraiit, iht Court of
Tbil *pflicaliott, hettby miult a*d /iltd. tupeelfuUy shows :
( 1) My full. true, and correct rume is ,- ...
(full, tnje nimt. without ibbrcviiiion. and sny oihet n«me which hit been uMd. muti ippcu hen)
(2) My present place of residence it'. '.
(Number «nd ureel) <Ci«ro«lo»nl (County) (St.lel l7ip (jxtel
(}) My occupation 11
(4) 1 wu born on in
IMomhl (D.yl (Ye«r) (City of town) (County. JiMriO, province, or Su«» (Country)
()) My personal desctipi.on is as follows. Complexion , color of eyes
color of hair , height feet inches, weight pound*; v.mblc distinctive marks
(6) lam. married, the name of my husband is ; we wcic married
on ., at ; he waj born
I Month I (Diy) lYrtrl (City or IO«T I I Si. 1C I U.ounlly!
•' on ; and now resides
(City or to~n> (Countv. dmnct. province, or St.te I I Country I (Month) (D.y) <Ye«t)
al
(Number »nd «reei I (City or io~ni (Suie'l (Country)
(7) 1 lost, or believe that I lost, United Sialei citizenship solely by reason of my mamaije on .
(Month) (D.y) IVni)
lo . ihen an alien, a citucn or subject of .... .
o' the race, and my mania! status wuh such person v»» Itrmiruicd on
^ <Mooih| (D.r) (V«i)
(Sim by vhn mom mintil uiiui icrmmitrdl
(8)1 have not acquired any other nationality by an affirmative act other than by marriage
(9) lam not and have not been for > period of at least 10 years immediately preceding the date of this application a member of or affiliated with any
organization proscribed by the Immigration and Nationality Act or any section, subsidiary, bram h. iftilulc. or subdivision thereof, nor have I
during such period engaged in or performed any of the acts or activities prohibited by thai Act
(10) I have resided continuously in the Uniled Stales from the date of my marriage up lo and including July 2, 1940.
(11 ) 1 hereby applv lo lake tht oath of allegiance as prescribed in Section 337 of the Immigration and Nationality Act and the regulations inefe-
under and to become repatriated.
(Full, Uu«, IIK) concH iifiulurr oi ippllc.nl. without nhoitvulion)
Subscribed and sworn to (affirmed) before me by the above-named applicant, in the office tif the cleik of said court al
this ...... day of . ... .... 19
CM.'"
B, f"AlJ
&j,*ij'a«i.'"
ORDER OF COURT
In lf« Court
of
• l "
O>)n consideration of the foregoing application and the applicant havmp taken the oath of allef;iani.c in open court this
diiy,°f u j L , L . ,' 19 •:.• !t '/hereby ORDERED that the application f* ^ramcd and thm the »»id
applicant be, and ihe hereby is repatriated as a citizen of the Lmted Stales of America.
By the Court
NOTE TO CLERK OF COURT -No In ii to bt coll«t«d in •connctnon with the Aim. of ihti .»nl.c.,^n I/ ...I., .. J j .L , /t
ntion. . 1« not «(»din( IS m>y be chiri.d ih.rrlor •( the prixred,nx, ire under Section )lf (e) of iK liiL^..ilo!. 2l iJ luiTTtT^I "t'"" °f lh*
the Ac. o/ June «. I»M. «. .nK.ded. i lot OOt nccedin* II may k« ch./aed iheretw. ' ' ' °' lh€ '«««'«'"»«> «~l N.lwo.lnr Aoj ,/ i
Form N-408
(Rev. 4-5-79) V
4/1/81
OATH OF AUEGIANCE
'^^ f "*»? "'
on Mptf 0< the Uni-ed s«« when re,Hired by lht law;
(FMli:iroc:"ind »;«« V,i'n,Vu« of Vppi kirn. w'iih0« '.bb^vu
Documentj or »ctiom required
Evidence of birth
Evid«n<« of mtttUge
Evidence of teri»in»rion of mirtugc
Any o.h«r nationality aequjled by ,ffirm|(iv? „
Attachment 10 Constitution
Applicant sworn by me un
Rf«o»nnriendalion ..
4/1/81
I'Nirrn STATES DKPARTMI'N'T OF JrsncE
lMMic.K.M'ius- ASH NAIL-JIALI.MIION SERVICE
TRIPLICATE
rffruauod by the repfttrJAKC and
Form approved
lludfjft Bureau No 4J-KOM8
UNITED STATES OF AMERICA
APPLICATION TO TAKE OATH OF
p!?«,r«d re,™' "'-£ ALLEGIANCE AND FORM OF SUCH OATH
Alien Registration No
-J
fi«d and
nccomprr
(By a woman uader Section J24 (c) of the Immigration, end Nationality An, or the Act of June 25. >93<S, •« trotoded)
To /Ae Honorablt. ihr ... Ci""/ of
TJHI appliealion, htteby mode and filed, reipeftfaliy ihou'l :
(1) My full, true, and correct name it ,-•
(Full, true name, without ibbrrvntion, *nd any other n«nvc which hn been ujed, mull >pp<» here)
(2 ) My present place of residence is .
(Number ind Krtet ) (City or toon) (Counr» ISule) tZip CoUri
(i) My occupation is
(4) I was bom on in
(Month! iU»vi iYc«rl (C.iry 01 town I (County, district, ptovinte. or Suic) (Country)
( 5 ) tyC personal description is as follows Complexion , color of eyes
color of hair height feet inches, weight . pounds; visible distinctive marks
(6) I am married, the name of my husband is we were married
on jt ; he was born
(Month) (Diy) (Yeir) 1C try or town I (Sum ((.ounlrri
at on ; and now resides
(Ciiyor town) (County, dimict. province, or Sine I (Country) (Month) (Diyl (Yrji)
at
(Number «nd >trtet ) i City or town I I Suit i (Country)
(7) 1 lost, or believjc that 1 lost, United States citizenship solely by reason of my marriage on
(Month) (Dir> (Yen)
to then an alien, a citizen or subject of
of the race, and my marital status with such person was terminated on
by (Month) <D.T) (Vc.rl
(Sow by wriii meitu mtniU uitui terminated)
(8) I have not acquired any other nationality by an affirmative act other than by marriage.
(9) I am not and have not been tor a period of at least 10 years immediately preceding the date of this application a member of or affiliated with any
organization proscribed by the Immigration and Nationality Act ot any section, subsidiary, branch, affiliate, ot subdivision (hereof, nut have I
" during such period engaged in or performed am of (he acts or activities prohibited by that Act.
( 10) t have resided continuously in the United State1, from the date cif my marriage up to and including July 2, WO.
(11 ) I hereby apply lo take (he oath of allegiance as prescribed in Section }}7 of the Immigration and Nationality Act and the regulations there-
undpr and to become repatriated.
(Full. (rue. ind correct u«n«lure of ipplicinl, without ibbrevuligni
Subscribed and sworn to (affirmed) before me hv (he above-named applicant, in iht- ufliie of tlic clerk of said u>urt at
. this day of ..... 10
CM""
By f"A°
Dtpul) Cirri.
ORDER OF COURT
In (he Court
o/ ;
at
Upon consideration of the foregoing application and the applicant having taken (he oath of allegiance in open court ihis
day of • • , 19 ... it is hereby OHDMRHD that the. application be granted and that the laid
applicant be, and she hereby is repatriated as a citizen of the L'mled States of America
By the Court
the him. of (hit ipplionon. If ipplie.nr demtndi ibe Iri
Form N— «OS
(Rev. 4-5--9JV
Page 5
Appendix 1
OATH Qf ALLEGIANCE
/ HEREBY DECLARE, on o»th. thai 1 absolutely and ennrely renounce and abjure all allegiance and fidelity to any foreign prince,
potentate, state, or sovereignty of whom or which I luvc heretofore been a subject »r citizen. i!ut I will support and defend the Consti-
tution and the laws of the United States of Amtncj against all enemies, foieign and domestic, that I will bear true faith and allegiance
to thcume,
that I will bear arms on behalf of the United Slates when required bs ihe law;
lhat I will perform noncumbatant service in the Armed Furies ol the United Mates when required by the law,
that I will perform work of national importance under civilian direction when required bs the bu. ;
and that I take this obligation freely without any menial reservation or purpose of ewsion SO HELP ME GOO In acknowledgment
whereof I have hereunto affixed my signature.
(Full. Hue. and cancel iignatufe of applicant, without abbirvialion )
The foregoing oath subscribed to by the applicant was administered to the applicant this . dtiy of , 19
By
Clt,k.
Drfmiy Oftk.
4/1/81
10-131
TM 784
ADMINISTRATIVE MANUAL
Append ix 1
(Please (ear off chii sheet ixr/orc submitting reques?)
REQUEST FOR
CERTIFICATION OF MILITARY OR NAVAL SERVICE
INSTRUCTIONS
Please use typewriter or print in block letters with ball -point pen. Be sure this
application and the complete return address are legible. Do not leave any questions unanswered.
When appropriate insert "none" or "noi applicable".
Authority for collection of the information requested on this form is contained in Sections
328 and }29 of the Immigration and Nationality Act of 1952 (8 U.S.C. 1439 and 1440). Sab-
mission of the information is voluntary. If your Social Security number requested on the form is
not provided, no right, benefit or privilege will be denied for such failure. However, as military
records are indexed by such numbers, verification of your military service may prove difficult.
The principal purpose fo< which the information is solicited is to secure a duly authenticated
certification of honorable active duty service from the executive department under which
petitioner served or is nerving to '.atiify statutoiy requirements fur naturalization. All or part
of the information solicited may, as a matter of routine use, be disclosed to courts ciercisin;
naturalization jurisdiction and to other federal, .slate, local and foreign law enforcement and
regulatory- Agencies, the Department of Defense, including any component thereof, the Selected
Service System, the Department of State, the Department of the Treasury, Central Intelligence
Agency, tmerpol and individuals and organizations in the processing of the application or
petition for naturalization or during the couses of investigation to elicit further information
required by the Immigration and Naturalization Service to carry out its functions. Information
solicited which indicates a violation or potential violation of law, whether civil, criminal or
regulatory in nature, may be referred as a routine use, to the appropriate agency, whether
federaf, state, local or foreign, charged with the responsibility of investigating, enforcing or
prosecuting such violations. Failure to provide any or all of the solicited information may
delay the naturalization process or result in a failure to locate miltary records or prove
qualifying railrtary service.
N-426
Page
FORM HO.
N-426
EDITION TITLB
REQUEST FOR CERTIFICATION OF
REV. 5-12-77 MILITARY OR NAVAL SERVICE
SIZE
8 X 10 1/2
XWSlRuCT T.Ofi jRE.rEK.HNCE o PPP ^9R '? ^9Q 9
.2, 335c.3; AM 2482 Ex. 2; Nat. Hbk 8-11,
499.1; 01 328.1,
GIB A- 10
USE
USED BY APPLICANT FOR NATURALIZATION TO ESTABLISH AN AUTHENTICATED
RECORD OF SERVICE
PRIOR EDITIONS MAY NOT BE USED |s
CHEDULE „
D
4/1/81
UMIT£0 STATES DEPARTMENT OF JUSTICE ALIEM HEGISTBA MOM
MO
I a~A~re of REOoEiv ~j
REOUfcST FOR I ^-^ • ' '
CERTIFJCAT10N OF MILITARY OR NAVAL SERVICE
con*^. *.«,.,!««,«. of m,',ur,
«rv,cr on *e ,ev«.se »r,,!
,. (mrn.hrd to help Igute and iden.ify my military record.. APPLICANT: FURNISH AS MUCH INFORMATION AS POSSIBLE IK
YOU «E#E ISSUED A REPORT OF SEPARATION.. CO FORM 2M, ATTACH A COPY FILL IN THE BLANKS ON THIS PAI'.E
ONLY. PLEASE TYPE OR PRINT CLEARJLY. PRESS FIRMLY-ALL COPIES MUST SE LEGIBLE. 4DO NOT USE PENCIL)
Fat an effective record* searcn, if i* important that ALL periods ol service he show below ft's
space is needed. i
e blan* sfterf i/ mon-
ACT
IVE SERVICE
1
— se-Bwce 'iTuMBf n
RESERVE OR NATIONAL f
UARD SERVIC
;: — ~~*~ If none, ch
clr CD None
, I
ARE YOU A MILITARY RE
TIREE OR FLEET RESERVIST' Q No Q Yea
sic
«ATUBE f*>«»««nl K«r.«>
INSTRUCTIONS TO CERTIFYING OFFICER
c» of the
itabliihed by
I service.
The reverie of Uus form ihould be completed, or tti< mfon-ulion coll«d for fvxtii*h«d by nepan
t.S« fnrm *nd I«ll«i" returned io (tie office of the !m mi staler, 4n<( N"<!ar<Umt!>jn Scrvk'e at din addfei
dered by the
te leller^.anjt.
o Ln -h« bo i
Inwlgr.it Son and Mfltura) Izat Ion Service
RETURN TO
4/1/81
10-133
TM 784
ADMINISTRATIVE MANUAL N-426
Appendix I Page 3
APHLICAN f DO NOT FILL OUT THIS PAGE
CERTIFICATION
N>irru' correct'.v shown on front ol lorn.
Nuri.c af, s tin AT. in records
OF MILITARY OR NAVAL SERVICE
ACTIVE SERVICE
i i
PLETE ITEM it.
!
!
RESERVE OR NATIONAL GUARD SERVICE
! i e. •
• CHECK *HICM
URA-... «0» e
«,.lfc., ,.,U..O
PLETE ITEM \\.
n STATEMENT REGARDING ALIENAGE, fComplrif fax item on .-)/./, fose*.;
Record shows this person WAS NOT discharged on accountant alienage.
Record shows this person WAS discharged on account of alienage. Details
•.-. REMARKS. Use for continuation of any of atxive items. You should also show in the space below any DEROGATORY
INFORMATION in your records relating to th^jie^viceman's character, loyalty to the United States, disciplinary
Actions, convictions or other matters touching ort his fitness for citizenship.
1 Complete Ihis block il subject is a "Lodge Act enlistee" - 64 Slat. 316 (Army). Subsequent to enlistment under the
: Lodee Acton , subject entered - - — —
••-— - (lhe Unlted suits, Am»ric«n S.moa, Sw.ins Island, or
j the C.nsl Zone) P
! pursuant to Military orders on
viu
1
I CERTIFY that the information bete'givcn "•"ncerning the service of the person named on the face of this form is correct
(Nu
[SEAL] fO/j
Date . 19
mt of d«p«rtrflent or organizalion)
ricial signature! ,
By
A n
TM 800
ADMINISTRATIVE MANUAL
Apnendix 1
"(-430
Pane 1
10-135
OMB No 43-RM33
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION AND NATURALIZATION SERVICE
' Ali.n R«'gi«r>tlon No
riling u it!
II vnvi an' appKini; [or citizenship (or yc
in lusicirv Vim will also ht tested on reading
Ill ill** United Stales for a total of at least
phyiicallv unable to read, write, or sptaU
YOU MUST BRING WITH YOU:
it! sprakinc Knglish unless on the davuf wur jp|M)imnifnt, vnu havr hfrn living
as a lawful permanent resident and are. over SO years old. or unle« you arc
ulr payable to "Clerk nl Court";
1 Trm Intrr
_• J25 filin« Ice (cash or > numrt ordr
3 Alien Registration Rei-eipt Card
4. Anv drafi cardi
5 Your passports and/'or anv other dwurnenf* vou ha\r which \ou usfd I
G Thr I'rrwnal Description Form on thr back, ccmflflrtf filtrd in
7 The third page of this leite-r with the rumri and addrcurs of your two wi
B. Thine items ctuckrd on the back >ide of this letter
irction with am* entries in thr United State
i Ailed in on the lines provided
Pl.F.ASF. KEEP THIS APPOINTMENT EVEN IF YOU DO NOT HAVE AM. THE ITEMS NUMBERED ABOVE OR THOSE
CHECKED ON THE BACK. HOWEVER, YOU MUST BRING THE S'25 FILING FEE AND TWO UNITED STATES CITIZEN
WITNESSES.
IMPORTANT: The two Uniled State
i rnusi be pcnons
lifv fri
al U
id oh,
i Ah, •.:! tin.r i|iulltn:i!iulH l'-r n:itur.ili7al.(.n durmc the (last . ...
< These vvitneises mutt lite or h.it,' l.v.il in -li-- irenri.il Jrc.i in whuh u.ii liu- or lived duiinti lh.it peni.d, and rnuM
seen you very often in the are.i in which vou live ,,r lived If t'le wnn.-wi » >ou brins with vi>u cjn COUT only a p»rt of
tumilxr nf M'.iil shuwn above, lli.it will he sju<[.u u.rv provided ili.il the. ..HI enter no ln< than she ',IU nv monllii 'I hr
of the perkid can be uvered al J later dalv. In ailid.mli of oiher witnesses. This will lie e.\pl.iin. d tu vim whin Mm a|i|iv.ir
re the-xamiiKT. ('Jlli, 319 • .1 '
lifv fri
chiKl
.ili-.HK
the pe
tcjufy from personal knowledge and i.b»cr-.jiinn about »our .lualificaiions for naturaliution. (319 ib (c1, (d). 329i
FORM NO.
N-430
EDITION
Rev. 2-12-80
TITLE
REOUFST
THAT APPLICANT APPEAR WITH WITNESSES
SIZE
8H x 11
INSTRUCTION
REFERENCE
01 335.
.Sli AiO
2(c), 341. 5{b); AM 2414 Ex. 1; Nat Hbk 1-1, -6, -10;
nsz
USED TO NOTIFY
EXAMINATION AND
APPLICANTS FOR NATURALIZATION TO APPEAR WITH WITNESSES FOR PRELIMINARY
TO OBTAIN PERSONAL DESCRIPTION FOR PREPARATION OF CERTIFICATE
PRIOR EDITIONS
MAY NOT
BE USED
| SCHEDULE A
VOU MUST ALSO MM w,TH YOU WHAT ,S CHECKED B BEUW:
D ^k««l fon»(.)
Q Your marriage certificate.
D
Q Your birth certificate.
D Vo», Spo.K, bi
D Th,chM(chi,dren)
forth,child (chil
D
Yourdi^argccertificate(S).
PERSONAL DESCRIPTION FORM
-Date of birth
color tif 'eyas
height
; place of birth
; color of hair
inches; weight
pounds; visible distinctive marks
; marital status _
country of ^nationality
(Change Of name requested] change to:
^S^ATION wl^i^Z
4/1/81
i o i r\M i i vc.
Appendix 1
N-4JO
Page 3
Authority for collection of the personal data information requested on the Description form is
contained in Sections 332 and 338 of the Immigration and Nationality Act (8 U.S.C. 1442 and 1449).
Submission of this information is voluntary. The principaj purpose for requesting this information is to
comply with the statutory requirements as to the contents of a certificate of naturalization. The in-
formation requested, as a matter of routine use, will be furnished to the clerk of the naturalization
court where your petition for naturalization will be filed in order to place the information on a certif-
icate of naturalization in the event you are admitted to United States citizenship. As a routine use
all or any part of the information may be disclosed to a court, and to other federal, state, local or
foreign law enforcement or regulatory agencies, Department of Defense, including any component
thereof, the Selective Service System, the Department of State, the Department of the Treasury, the
Department of Transportation, Centra! Intelligence Agency, Imerpol and individuals and organiza-
tions in the processing of your application or petition for naturalization or during the course of
investigation to elicit further information required by the Immigration and Naturalization Service to
carry out its function. Information requested which indicates a violation or potential violation of law,
whether civil, criminal or regulatory in naturej may be referred, as a routine use, to the appropriate
agency, whether federal, state, local or foreign, charged with the responsibility of investigating, enforc-
ing or prosecuting such violations. Failure to provide any or all of the requested information will
prevent the issuance of a certificate of naturalization.
FILL IN NAMES AND ADDRESSES OF YOUR TWO WITNESSES
(Type or print)
(1st witness)
Residing at
(Street address, city or town, and State)
(2nd witness)
Residing at _
(Street address, city or town, and State)
DO NOT WRITE BELOW THIS LINE
U.S.
State
Physical presence
Mos.
(Naturalization examiner]
us. OOWERNWXT nuHUNG omoc •,
4/1 /81
UNITED STATES DEPARTMENT OF
MW.OIUT.flN AND NATU.ALIZAT.ON
NOTICE TO PRODUCE WITNESSES
Data:
No.:
•P-
To PetitioBer
TITLE
KOTICE TO PRODUCE WITNESS
^SI-RUCTION
01 335b.3; Nat Hbk 1-35
INSTHUCTIO.S TO PETITIONER FOR NATURALIZATION R,
PRIOR EDITIONS MAY NOT BE USED
REGARDING DEPOSITIONS
10-139
TM 786
ADMINISTRATIVE MANUAL
Appendix I
N-462A
Page 1
UNITKO STATES DEPARTMENT OF JUSTICE
immigration and Naturalization Service
INTERROGATORIES IN DEPOSITIONS OF WITNESSES
INSTRUCTIONS
(Tejr all This Sheet Before Completing Form}
This furrr must be filled out jnd sworn to r..> the witness either at the office of the Immigration and
Naturalization Semcc or before a postmaster, without charge, or befoie a notary public or other person
authorized to administer oaths for genera! purposes. UNLESS EVERY QUESTION IN THE FORM IS
ANSWERED IN FULL BY THE WITNESS, IT WILL BF. OF NO ASSISTANCE TO THE PETITIONER AND
WILL BE RETURNED AS UNSATISFACTORY THE WITNESS MUST BE A UNITED STATES CITIZEN.
AND IF NATURALIZED OR BORN ABROAD. MUST PRESENT HIS ORIGINAL NATURALIZATION
CERTIFICATE OR CERTIFICATE OF CITIZENSHIP TO THE PERSON BEFORE WHOM THIS FORM IS
SWORN TO. The person before whom the form is sworn to must sign his name and title on the bottom of
page 2, and affix his seal if one is required. After the form has been sworn to, it should be returned imme-
diately by the witness to the Immigration and Naturalization Service at the address on the lop of the form.
Authority for collection of the information requested on this form is contained in Sections 332 and 335
of the Immigration and Nationality Act (8 U.S.C. 1443 and 1446). Submission of the information is voluntary.
The principal purposes for requesting the information are to determine the qualifications of additional wit-
nesses, other than the verifying witnesses to a petition for naturalization, to act as witnesses and give
depositions covering the petitioner's periods of residence and physical presence within the United States
and the other statutory requirements for naturalization. The deposition taken will be forwarded to the clerk
of the naturalization court wherein the petition for naturalization is pending and filed. The information re-
quested mav, us a matter of routine use, be disclosed to naturalization courts and to other federal, state,
local or foreiRti law enforcement and regulatory agencies, the Department of Defense, including any compo-
nent thereof, the Selective Service S\sterr,, the Department of State, the Department of the Treasury, the
Department of Transportation, Central Intelligence Agency, Interpol and individuals and organizations in
the processing of any application or petition for naturalization, or during the course of investigation to elicit
further information required by the Immigration and Naturalization Service to carry out its (unctions. Informa-
tion solicited which indicates a violation or potential violation of law, whether civil, criminal or regulatory
in nature, may be referred, as a routine use, to the appropriate agency, whether federal, state, local or
foreign, charged with the responsibility of investigating, enforcing or prosecuting such violations. Failure to
provide all or any of the requested information may result in the petitioner having to furnish additional wit-
nesses.
Form N-462A (Rev. 6-«-78) N
FORM NO.
N-462A
EDITION TITJUE
REV. 6-6-78
INTERROGATORIES IN DEPOSITIONS OF WITNESSES
SIZE
8 X 10 1/2
INSTRUCTION JUCFEJRJENCi:
8 CFR 335b.3(a), 499.1;
01 335b.3, .4; AM 2482 Ex. 1; Nat Hbk 1-35, -46, -47, -48
use
USED BY THE SERVICE OR OTHER PERSON AUTHORIZED TO TAKE DEPOSITION OF WITNESSES
IN A NATURALIZATION CASE. FORWARDED TO CLERKS OF COURT PRIOR TO FINAL HEARING
PRIOR EDITIONS MAY NOT BE USED
I SCHEDULE A
.
Appendix I
TM 736;
OF
CLERK OF COURT: PJeasefHewuh pennon
' n'""" D.«c,o, o, Off.ce, ,„ <.„.,«
: Filed
WT«^TOR,ES,NDEPOS,T.ONS OF WITNESSES
IN THE MATTER OF ' ( ° ^ a"SWered b>' *'«ness, not by petitioner)
follows
l.Q. State your fuli name, age, and address.
A. Name
b>' me' dep°Sed- fe^ified and said a
2. Q. Where were you born? A.
Q. Are you a. citizen of the United States? A.
•6-«- 'State when and where .you first met
and how^you came to meet him or her. A.
in the United States
r No)
FORM N-462A (Rev. 6*6.78) N
(Pog«
4/1/81
Tfi 786 ADMINISTRATIVE MANUAL N-462A
Appendix I Page 3
ore impoMoni, each block should be filled in as completely 01 po»$ib-le.
8. Q. To vour personal knowledge, where and between what dates has he or she resided in the United States?
From- To-
Cm or To*n Male M>in|h
1
9. Q. Where did you live during the time he or she resided in th
e plares mentioned in Oi.iec;fjon fi3 A
'Slre<M and numh«-r) iCilyl
11). Q. How often did you see him or her while he or she resided
(Sidle) Country)
in the places mentioned in Question 8? A.
11. Q. Since vou first met him or her in the United States lir.s he
States? (Yes or No) (.If yes state when, how long and purpose of euc
or she ever been absent from the United
:h absence) A.
12 Q. Has he or she been arrested or charged with, or convictec
or No') (If "yes", include date, place, and description of offense.)
'. of, a crime or a violation of law? (Yes
A.
13. Q. Has he or she to your knowledge, been a person of good moral character during all the time you
havp Vtnov-'n hi;Ti >ir her' A. , .,
(Yes ur No)
14. Q. Has he or she ever been an anarchist, a believer in anarchy, or a member of the Communist Party or
affiliated with any other subversive organization, or with any group of persons teaching disbelief in or opposi-
tion to organized covernment? A.
CYes or No) Uf "yet" include explanat
15. Q. During all the time you have known him or her, has he or
stitution of the United States and when naturalized will he or she b
16. Q. Do you know of any reason why he or she should not beco
or No) (If "yes" include full details in regard to each reason.) A-
on)
she believed in the principles of the Con-
e loyal to the United States? A.
(Ves or No)
me a citizen of the United States? (Yes
17, O, Do V°1J rornrnmend pirn or Tier for citizenship? A
,
(Yet o
No)
Subscribed and sworn to before me at
(Signature of witnett)
this day of
.19 . Certificate of naturalization
or citizenship exhibited by witness.
(Was or Wj» not) (Signature of «U*«tor) •
iPO UJU-6J^ (Tille of »H«ltor) (PoQ«2)
4/1/81
10-143
TM 696
ADMINISTRATIVE MANUAL
Appendix 1
roHH N.ieo
Typewrite liata on this certificate and stub.
Type uti stub surname first (ALL CAPITALS*
ftillou-tul by Christian and tniddlr mimes in full
without abbreviations . lower cmei.
ORIGINAL STUB TO BE
RETAINED AS COURT RECORD
If a clerk of court denirou to file stub aa « card
index record, this stub may be trimmed »o as
:o make a 3 x 5 card.
Nume
residing in
Hate of birth .
Date certificate i«»ued
N-b50
Page I
9779001
Dale (if oriler of Hilmiision
Alien lU'KiMratioil Si
.Xo. 9779001
.SECURELY AND PER-
MANENTLY AFFIX
PHOTOGRAPH HERE)
UHE S£J. CF THE COL'RT vVtiL
8!: IWI-SE5SED SO AS TO COV-
ER ~ ^C=TlON CT THE Lu*ER
EDGE OF THE PHOTOGRAPH!
ii/^
'
IT IS P-NISHfBLE BY 'J. S. LAW TO COPY,
PRINT OR PriCVTOGS^PH THIS CERTIFICATE.
FORM NO.
N-550
EDITION TITLE
REV. 12-1-69 CERTIFICATE OF NATURALIZATION
SIZE
8 X 10
LNSTRUCT1ON REFERENCE
8 CFR 332a.2, 338.11, 499.1; AM 2482.02, ,05
USE
ISSUED BY THE CLERK OF COURT WHEN A PETITIONER FOR NATURALIZATION HAS DULY TAKEN AND SUBSCRIBED !
TO THE OATH CF ALLEGIANCE AND A FINAL ORDER ADMITTING PETITIONER TO CITIZENSHIP HAS BEEN DULY
SIGNED BY THE COURT.
PRIOR EDITION MAY NOT BE USED SCHEDULE B
Page 2
Appendix 1
N«- 9779001
SIGNATURE OF HOLDER
IS NOT REQUIRED ON THIS
DUPLICATE STUB
DUPLICATE
DO NOT DETACH
residing at
I),,n- (if lurth
Unlf ceitificute,
>"ii' »' order <>( odrm
Alien Rc«i»lr»tion No.
TY^juT^^^ ^b\ ~^^?J
"""'""'l"'"'»'"">"'" """"" "" '' '" B^»MIII»'«I ami^rr.;-^.^^^*!**^^ •;_T^_ UsJJ/i"1^- 1-'*:>*3
Xo. 9779001
TO BE FORW/.RPEO TO
MMiGp£.:iON "'•ID NATuRALItftTION1 SERVICE
/'fttt/tSt.Wn
•DUPLICATE
^*V/''''>1'' 'M'lA'f
«-6 ft>/ farts
.i ...... ..... ..... _.....,-... ._ /<
/Ati/ Mr t&U'M/t/ft'/t st/ftr yfti-M '.> fa". 'r/rt///ttt///tty>/H>/wf/frfi/t st//t.tn/ Stwfr /.'" Mv/tt:u "/
'
(SECURELY AND PER-
MANENTLY AFFIX
PHOTOGRAPH HERE)
(THE SEAL OF THE COURT WHX
«E IMPRESSED SO AS TO COV.
£B A PORTION OF THE LOWER
EDGE OF THE PHOTOGRAPH)
IT 15 PuNlEHABuE Uf U. 5. LAA TO COPV,
PRINT OR PhCTCSRAPH THIS CERTIFICATE.
S.-U.S. GOVERMMENT PRINTING OFFICE.
4/1/81
10-145
TM 680
ADMINISTRATIVE MANUAL
Appendix 1
N-5oOA & AA
Page 1
FORM NO.
EDITION TITLE
REV. 12-1-69 CERTIFICATE OF CITIZEHSHIP
SIZE
8 X
10
INSTRUCTION REFERENCE
01 3»H.9j AM 2303.07; 2^82.O21.Ol|
USE
ORIGINAL AND DUPLICATE WT2H "A" NUMBER IS CERTIFICATE OF CITIZENSHIP ISSUED WHEN CITIZENSHIP
WAS DERIVED AFTER BIRTH. OATH OF ALLEGIANCE APPEARS OS REVERSE OF DUPLICATE. ORIGINAL AND
DUPLICATE WTTH "AA" NUMBER is CERTIFICATE OF CITIZENSHIP ISSUED WHEW CITIZENSHIP MAS ACQUIRED
AT BIRTH. OATH OF ALLEGIANCE APPEARS ON REVERSE OF DUPLICATE,
PRIOR
EDITION OF 3-1-61 MAY BS USED j SCHEDULE B
4/1 781
WE 680
4/1/81
10-147
680
MANUAL
Appendix 1
N-56QA & AA
Page 3
of glttegtance
I hereby declare, on oath, (affirm) that I absolutely and entirely renounce and abjure all allegiance and
fidelity to any foreign prince, potentate, state, or sovereignty of whom or which 1 have heretofore been a sub-
ject or citizen; that 1 will support and defend the Constitution and the laws of the United States of America
against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same;
that I will bear arms on behalf of the United States when required by the law;
that I will perform noncombatant service in the Armed Forces of the United States when required by the law;
that 1 will perform work of national importance under civilian direction when required by the law;
and that I take this obligation freely without any mental reservation or purpose of evasion: SO HELP ME GOD.
In acknowledgment whereof I have hereunto affixed my signature.
Subscribed and sworn (affirmed) to before me, a designated representative of the Immigration and
Naturalization Service, this day of , 19 ,
at -
(Title).
.., 19..
I hereby certify that I have this day received original certificate of citizenship of which this is a duplicate.
TM 417
ADMINISTRATIVE MANUAL
Appendix 1
MO .
N.561
10
Rev. 5-1-57
CERTIFICATE OF CITIZENSHIP
i (HSTK.CTICN H
01 343a.5(bjj AM 2482.02
US£ USFD TU REPl ACE A LOST, MUTILATED OR PSSTROYPD CFRTSFICATF OF CITIZENSHIP SSSUFO BY THF SERVICF, OR
TO Ofef7,lN A CnRTi.'-'ICATr W A CHAHG^D NAME
SCHED'JLEB
4/1/81
TM 660
ADMINISTRATIVE MANUAL
Appendix 1
N-570
FORM NO.
N-570
EDITIOM TITLE
REV. 12-1-69 CERTIFICATE OF NATURALIZATION
SIZE
a x 10
INSTRUCTION HEfBHMCE
01 343&-5; AM 2U82.02
USE
USED TO REPLACE A CERT IPIC ATE OF NATURALIZATION OR REPATRIATION ISSUED BY THE COURT, OR TO OBTAIN A
CERTIFICATE OF NATURALIZATION IN A GHJUKJED NAME
PRIOR EDTTIOU OF REV. 8-1-60 MAY BE USED \ SCHEDULE B
4/1/81
TM 800
ADMINISTRATIVE MANUAL
Appendix 1
N-577
Paoe 1
10-151
UNITED STATES DEPARTMENT OF JUSTICE
Immigration one! Naturalization Service
APPLICATION FOR'A SPECIAL CERTIFICATE OF NATURALIZATION TO OBTAIN
RECOGNITION AS A CITIZEN OF THE UNITED STATES BY A FOREIGN STATE
INSTRUCTIONS 'I O THF. APPLICANT
outside :he United Siute
nRli>r.. t'.C. 20536
it this application ID the Cnnimis.sioncr. Immigration and Naturalizai ion
PHOTOGRAPHS
You arv required !•-' send *ith this, upplicdliun thn.-c tdcntic.i! photocr.iph>. "I touiself t.tkea within 30 davs of
the date ol this application They may be in natural color tn ;r. Mack «nd white, bul block and while photographs
whit.li have hi en tinted nr otherwise colored art- noi .,n-<-[,tub'.e. These photo|:r..phs must be 2 b\ 2 inches in size,
must not 'H- pasted on u card or mounted in anv other WcH, must be on thin paper. h*\ e d light bac kjjrojnd. and
cle.irl'. r.hn-A .1 Inmi •. lew ui" vrmr fwcr wuhoul hat. Snapshots, group. full-length portraits Or vending rrachine
photograph;; will not bi .ict rpled. F.ac;h ol these phxti^.-nphs "nusi he sinned K vnu on the r.j-i;in and not on the
I'tifr <» the clultiinp.
FEE
FhE— A leu- of ten doll. its (S10) must be paid lor hling this application. It cannot be refunded regardless of the
action taker, nn tlie applic.Uor.. DO NOT MAIL CASH. ALL FECS MUST BE SUBMITTED IN THE EXACT AMOUNT.
Payment b\ thecu or roney oidet must be drawn on ;i b;,nk or other institution locjted in the United Stales and be
payable in United St.itt-s currency. It applicant resides in Guam, check or money order roust be puy.ible to the
"Treasurer, Guam." If ..pphc.int reside-, in the Virgin Islitnc.-.. check or mimes order must be p.iuible to the "Com-
missioner of Finance ot the Virgin (islands." All other applicants must rnak-e the check or money order payable to
"Immigration and Naturalization Scrvicv." When check us drawn on account ot ,, person other than the applicant,
the name of the applicant must be entered on the fact- of the check. II application is submi'ted from outside the
United States, remittance mav be made by bank international money order or foreign draft drawn on a financial in-
stitution in the United States and payable to the "Immigration and Naturalization Service" in United States cur-
rency. Persona) checks are accepted subject to coHcctibility. An uncollectible check will render the application
and any document issued pursuant thereto invalid. A charge of 55.00 will be imposed if a check in payment of a
fee is not honored by the bunk on which it is drawn.
AL'THOKITY
Authority for collection of the information request! d on this form is contained in sections 332 and 3-13 of the
lnirr.i^r..tion and Nationality Act 18 L'.S.C. 1443 and 14:.-) i Submission of the information is voluntary. The principal
purpose lor reciuc'S'in^; the iniormatum is lor use by an assigned oflici-r of the Immigration and N.ituroli/ation Serv-
ice Ui dn ermine Hj^iicnnt''; eligibility tor ;< special certificate ot naturalization to obtain recognition as a citizen
t»l the United States bv h lureipn Mate. The informal inn leque.sled may. as a nailer of routine use. be disclosed to
naturalization courts .,nd i-- other federal, state, local oc foreign l.m enforcement and regulatory agencies, the
DepHrlri-nt oi Dctensc. including anv coinponenl thereof. !he Selective Service System, the Department of State,
thf Di'parimeni of the Treasurv. the [Irpiirlmcnt ol TrunsuurlhtK-n, Central lnn.-1'igence Agenr>. ln!er(,ol and indi-
iidiiul;. und (irt'dnij«iu':ih in the process ill); ol ,.n a|,|,licnluin. Or during thi- course t»f investigation to elicit lurther
inlVirrridtmn required b\ the In.mpr.-ilitin ,mrl N.itur.ilua: mn SerMce to carry rut us functions. Inundation solicited
whu-ii indicates .1 violation nr potenti.,! •. iul.itic<n nf l.iiw. whether civil, criminal nr regulaion ir. nature, may be
referred, as .1 uuitme u>e. U' the appropriate agtncy. whethci fcder.,1. :.t<.ti-. loc-i.! or foreign, chirgecl with the
responsibility ol inves: if.,i;in^. enforcing ur prosvcuting such vioK.tuin^. Failure to provide all or any ot the
requested mlorni»tion m.is result in disapproval of the application.
(R«v.ll-J7-79)N
FORM NO.
N-577
EDITION
Rev. 11-27-79
TIT1X
APPLICATION FOR A SPECIAL CERTIFICATE OF NATURALIZATION
OBTAIN RECOGNITION AS A CITIZEN OF THE UNITED STATES BY
FOREIGN STATf
TO
A
SIZE
8 X 10'j
INSTRUCTION
.30.01, 2984
REFERENCE
Ex. 2; Nat Hbk
8 CFR 343b.l, .3,
7-1, -6, -7 GIB A-9
499.1; ol
AM 2414
103. 8(e) (7),
Ex. 1
343b
1, .4; AM
2301.30,
SUBMITTED TO THE SERVICE BY A NATURALIZED CITIZEN WHO DESIRES TO OBTAIN RECOGNITION AS A
U.S. CITIZEN BY A FOREIGN STATE
PR.IOR EDITION HAY NOT BE. USES
SCHEDULE
APPLICATION FOR A SPECIAL C
RECOGNITION AS A CITIZE.. ."
i»l OP Uk« to- (See Instructions on reverse)
'""'^'ON AND NATURALIZATION SERVICE
1- My name is
2- I now rsaide at
(Apt. N~
3- 1 was naturaijaed on
a t-~— -___„__
4- My personal description is: sex
color of eyes _
BY A FOREIGN STATE
Cation as a citi2en onhe - njted s— -^~;
(F^ST™
(G've tn-TS^U^r
( .
!eet inches; weight
Pounds; mible distinctive marks
-. Former nationality
on
i have not retained
"P-mutiv, .broad. His name and add^T °' """^
Marlta] status
S. I was born in , __
( City o7~to^
- °- I arrived in the United St,tes at
4/1/81
11. (If certificate required in connection with property abroad.) The property consists of _.
and is located at
Signature of
person preparing form, if other than applicant
Signafur
e o
t
Applicant
1 declare
request of thi
which 1 have
Signature:
that this document was prepared by me at the
I applicant and is based on all information of
any knowledge.
.
.
, , ,
1 d
best of my knowledge and belief.
Complete signature of applicant:
Addmi Dux-
Mailing
\, Ci
ty
, S<
• U, «ntl ZIP Code)
EXAMINER'S REPORT
Date
I have investigated this application and I am
.satisfied that the applicant is the individual who was
naturalized as alleged in the application; that he has not, since his naturalization, become expatriated; that he
requires the certificate to obtain recognition as a citizen of the United States by a foreign state; and that the
certificate, if issued, will be used only for such purpose. The naturalization has been verified.
I recommend that this application be granted.
(Slgnolurn)
Approved:
- 19.
(Tulr of officer melting
(Diitrlct Director)
4/1/1
Til 770
K-578
ADMINISTRATIVE MANUAL
Appendix I
(To to forwarded lo Secretary of Slate)
UNITED STATES DEPARTMENT OF JUSTICE
IMMIGRATION* AMD NATURALIZATION MMVIca1
WASHINGTON. O.C.
SPECIAL CERTIFICATE OF NATURALIZATION
laaued by the Commissioner of Immigration and Naturalization and furnithed to the Secretary of State for tr*nami«ai«n to
the proper »uthority of the foreign itate named herein for utt by the applicant for the aole purpoae of obtaining rttog-
nition by cuch foreign «UU aa a dtittn of the United States if America. Thii eerti&eaU la invalid for aJI other
purposes.
Personal description of applicant named Herein as of date of issuance of this certificate:
Age years; sex .; complexion •••• ;
color of eyes ; color of hair ; height feet inches;
wtight pounds ; visible distinctive marks
Marital status former country of which a citizen, subject,
ornatiom"
This is to certify that
who now resides at
has applied to the Commissioner of Immigration and Naturalization for a SPECIAL Certificate of Nat-
uralization for use by such applicant for the sole purpose of obtaining; recognition as a citizen of the
United States of America by _ ; and the Commissioner of
Immigration and Naturalization has found from satisfactory evidence submitted to him that said appli-
cant is now a citizen of the United States of America
as shown by the records of the Immigration and Naturalization Ser\ ice,
United States Department of Justice, Washington, D.C.
In testimony whereof this SPECIAL Certificate of Naturalization
authorized by section 348 (c) of the Immigration and Nationality Act is
issued this day of
in the year of our Lord nineteen hundred and
Ph0u>cr»[>li and licn»lurr of •pplkial
[SEAL]
FORM NO.
N-578
EDITION
Rev. 10-3-62
TITLE
SPECIAL CERTIFICATE OF NATURALIZATION
SIZE
8 X lOJj
INSTRUCTION REFERENCE
&CFR 343b.ll: AM 2482.03
USE
ISSUED BY DISTRICT IN DUPLICATE - ORIGINAL FORWARDED TO SECRETARY OF STATE FOR TRANSMISSION
TO A FOREIGN GOVERNMENT
SCHEDULE B
4/1/81
10-155
ADMINISTRATIVE MANUAL
Appendix 1
r-o,» Approved
ouu NO. «:i- ROIO:
N'u ----- ...... _______ .....
APPLICATION FOR A CERTIFICATE OF NATURALIZATION OR REPATRIATION
fUmier Section 343 («) ol the Immigration and Nationality *" « I 2th • ubdJviBion Section -t. <i( A<:t of )un«. jq ,90ft,
(See instructi
« I 2th • ubdJv
on rev«is«)
K«e Stamp
Take1 or mni! to-
IMMIGRATION AND NATUKALIZ ATION SERVICE,
1 hereby apply for \ cerlificfttc of rmUKRlizaiion or repatriation an a citizen <>f the U n i ted S t'n tes of
America.
1. My rmrne is __..._- -^^ -,—,;,-. „.„., -„„•„„-„, -,hr.vl.1,0,1, - -
2. I now reside at -•- • -
3. I was born in
4. My personal description is- Sox ; complexion ; color of ese-i ; color of hair ;
height feet inches; weight riciun-ls; vf-ihl*' djH(,in«.-ns.« nrirks _ .
Marital status Korn.rr •illi',!i:iiii'i-
5. I irnved in the O'nilC'l States at
on tKe vossal
j^.-..-^—^ h>- vtel(1 >hllw „„„,,„ .,,
6. I originnlly acnuireH l.,'uiu>d State.s citizonsnip (rl.ci'l. .ipiiroprnU.- t>loch)~
| ; By birtli.
2 !i\ mturaiisntmn in Hie ' " ------ ...... --------- '. 'ourl tvt
rnlt! So.
__ __ _ _____ _ _ ........
""2 Tlirouph t^o nauiraliz.iuon or citi7.onshi|i of in\ |i.iri'n(<s) or l.u:-ilinn'l.
(Clvo (ten r«l>
whereby I last my Uniu.vl Suto.s c-i(iz(.'fis^ij>.
fmiliuxry ^j
S. 1 i'ntcTi-1 the < f service of on
1 . f irounlrv)
(^ naval j
in ronncclifin »it|i wt.tch 1 -Ij-l Ul.o an oath of alloj.'irxnfo Ui Onl cotinlry. whuroliy 1 ln«.| c y
',. niti--! .-['Hi'- fitiicn-i1'i|i. \t the tiri(> of onu'rinj1. *ui'h «<>rucc. in Jid'liiion t'> i'i> \.!nil("l Sl/ito*- citizen-
~hi|i. 1 then h:ul or (lion arnuirC'l the nation:ilicv of ._ . . , ... . .
(N«m« (•/ fttr«l«n i-,»inHry. if none »li»tu "Son*")
11. \ftcc lo«!inj: cuizcn'iKip, I >vr\« nftturn!t/.i"l n citi/.on of tho t'nil.o'1 .Sti\U-« hx i.il.mi1 I do onih of ronuiicin-
tion find alk-^i.-xncc to tht1 United Stato- before tl.i- . - . rourl
IMonlll) (ll«v ) IY««'«
10. Since the -lute 1 tool: such onth of nllffiuniv. I h:»v«> Uv-il ins '• t\iU"l M,iU<*. fiti7.«ns^i|> in
•\ny r.i.xnnor.
1 fortify Uirvi the nhovo sUvUMncnts <wv true 10 ilie ho^t tif nn I'.nnsv lodpu ivinl lii-lmf.
Page 1
FORM NO.
M-580
EDITION
REV. 9-27-75
TITLJE
APPLICATION
FOR A
CERTIFICATE
OF NATURALIZATION
OR REPATRIATION
SIZK
8 X 10 1/2
INSTRUCTIOH 3L&FS&ENC&
.30.01, 2713.11, 2984 Ex. 2;
8 CFR 332a.2
Nat Hbk 7-1
thru -7
, *»99. 1; 01
103.
3<e)(7), 3*3.1
; AH 2301.30
-
SUBMITTED TO THE SERVICE BY A
ALLIED ARMIES DURING WORLD WAR
THE U.S.
PERSON WHO LOST
1 OR U OR BY
CITIZENSHIP OF THE U.S. INCIDENTAL
VOTING IN A POLITICAL ELECTION IN A
TO SERVICE IN ONE OF THE
COUNTRY NOT AT WAR WITH
Appendix I
EXAMINER'S REPORT
1 Kavo investigate'! I'M* implication ami fin'! that the- applicant has.
the nl lega-
tions in t>'u ipplica't.ion re»iHin^ the nnnner fn which ho oru'inally acduirH UrritH Suites citizenship .in'!
lost it; t'-nt such loss was the first act of expatriation: that (s) ho is the same
person who wis nrUurn lizfl or rpp-urntp'1 un ior _.__, — ___ — ......-..___ ; rui'l that
(<) v,e his
(Section 323, or A0( of 1906)
heconio oxpatriate-1 since such naturalization or repatriation.
report is attache"! hereto.
_ Keen verified.
The naturalization or repatriation has
1 recommend that the application he_
>:r\nte I. 'in'! that a certificate of
Approve
,10.
(Sig
INSTRUCTIONS TO THE APPLICANT
This loim must be completely filled out in ink or on a typewriter
PHOTOGRAPHS.-- You are required to send with this application three identical photographs ol yourself taken
•o.ithin JO days at the date of this application. They may be in natural color or in black and white, but black and white
[.holographs which have hcen tinted or otherwise colored are not acceptable. These photographs must be 2 by 2 inches
in size with the distance from the top of head to point of chin approximately 1 1/4 inches; must not be pasted on a i.'ard
01 counted in any other way; must be on thin paper, have a light background, and clearly shoo, a front view of your face
without hat. Snapshots, group, or full-length portraits will not be accepted. YOUR PHOTOGRAPHS SHOULD NOT BE
SIGNED UNTIL AFTEH THK NEtt CERTIFICATE IS MADE OL'T, but on the back of each photograph your name MUST
NOM be printed lightly and Carefully, using a soft pencil to avoid mutilation of the face of the photograph.
FEE.-- A fee of five dollars (Si) mus>t he paid for filing this application. U cannot be refunded regardless of the
action taken on the application. DO NOT MAIL CASH. ALL FEES MUST UE SUBMITTED IN THE EXACT AMOUNT
Payment by check or money order must be drawn on a bank or other institution locace.i in the United Scales and be pay-
able in United States currency. If applicant resides in the Virgin Islands, check ot money order must be payable to the
''Commissioner of Finance of the Virgin Islands." If applicant resides in Guam, check or m/iney order must be payable
Ki the "Treasurer, Guam." All orher applicants must make the check or money order payable to the "Immigration and
Naturalization Service," ^hen check is drawn on an account of a person other than the applicant, the name ot the appli-
cant must be entered on the fare ol the check. Personal checks are accepted sub|ect to collectibility. An uncollectible
check will tender the application and any documents issued pursuant thereto invalid. If payment is made Viy the type of
international money o der that cannot be ma iled, the money order must be drawn on che postmaster of the city in the
United States to which the application w'.ll be mailed, and th»r city, the money ordet number, and the date must be shown
clearly on the top margin of the application form,
AUTHORITY.— Authority lor collection of the information requested on this form is contained in section 3J3 and
i.f \ at th<! Immigration and Nationality Act (3 U.S.C. li-o and \^")4}. Submission of the information is voluntary. The
principal purpose lor requesting the information is for use by an assigned officer of the Immigration and Naturalization
Service to determine applicant's eligibility for a certificate of naturalization or repatriation. The information requested
may, as a matter of routine use, be disclosed to naturalization courts and to other federal, state, local. or foreign law
enforcement and regulatory agencies, the Department of Defense, including any component thereof, the Self c-tivc Service
System, the Department of Staic, the Department of the Treasury, the Department of Transportation, Central Intelligence
Agency, Imerpol and individuals and organizations in the processing of an application, or during the coursr of investi-
gation to elicit further information required by the Immigration ind Naturalization Service to carry out its functions.
Information solicited which indicates a violation or potential violation of law, whether civil, criminal or regulatory in
nature, may be referred, as a routine use, to the appropriate agency, whether federal, state, local or foreign, charged
with the responsibility of investigating, enforcing or prosecuting such violations. Failure to provide all or any of the
requested information may result in disapproval ot the application. .
4/1/81
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