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Immigration Statistics: A Story of Neglect (1985)

Chapter: Appendix A: Selected Forms

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Suggested Citation:"Appendix A: Selected Forms." National Research Council. 1985. Immigration Statistics: A Story of Neglect. Washington, DC: The National Academies Press. doi: 10.17226/593.
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Appendix SELECTED FORMS The forms that appear below include only those that are referred to in this report; they are used to collect a major portion of the available information about migration to the United States. Because of the very large number of forms used in connection with immigration, it was not possible to include a comprehensive array. The INS forms are listed in alphabetical and numeric order, followed by those used by other agencie 159

160 Sponsoring Fonn Agency Numbe r . . INS State Dept. Customs Customs NCHS ACVA SSA ORR G-23 G-325 C G-540 G-541 G-542 I-53 I-92 I-94 I-213 I-485 I-551 I-589 I-590 I-591 I-643 N-400 N-600 OF-155 A 5905 6059 B HRA-161 ACVAFS Form #1 SS-5 ORR-6 Form . Report of Field Operations: Selected pages Biographic Information--Applicant for Refugee Status Daily Record of Primary Inspections- CINSP-8 Semiannual Report of Primary Inspection Activity--CINSP-8 Semiannual Report of Hourly Workloads- CINSP-8 Alien Address Report Aircraft/Vessel Report (Passenger manifest) Nonimmigrant Arrival/Departure Form Report of Deportable Alien Application for Status as Permanent Resident Alien Registration Receipt Card Request for Asylum in the United States Registration for Classification as Refugee Assurance by a United States Sponsor in Behalf of an Applicant for Refugee Status Statistical Data for Refugees. Collected by the INS for the Department of Health and Human Services Application to File Petition for Naturalization Application for Certificate of Citizenship Immigrant Visa and Alien Registration Customs workload form Customs Declaration Card Standard Birth Certificate--1978 revision Refugee data form--American Council of Volunteer Agencies Application for a Social Security Number Card ORR Quarterly Performance Reports, Schedules B and C. Page . 161 169 170 171 172 173 174 175 176 177 180 181 185 187 188 189 192 195 196 197 198 199 200 201

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169 U.S. Department of Justice ~ FORM G-325C - ()!\~113 No. 111.~-()()~6 Immigration and Naturalization Service BIOGRAPHIC INFORMATION \~)~)roval expires t-:~()-X, tF ^ - ILV - ~ - C) DRIEST a) ( - IDD~C Nits) 0 - ~1 ~el~7HD^TE ( "O. - Do ~ - V,'.} N^TION^LITY O ~c _ ALL OTtlER N^MES USED FATFtER MOTl4ER {~ - e.. "A - C) CITY AND COUNTRY OF ElIRTH . . - F^MILY N^ME FIRST N^ME DATE, CITY AND COUNTRY OF BlRrH t' Kr4OWrd) CITY AND COUNTRY OF RESIDENCE 14USeAND on WIFE FAMILY NAME FIRST NAME 81RTl4DATE CITY & COUNTRY OF BIRTH DATE OF MARRIAGE PLACE OF MARRIAGE ( - Am. so ANTS) Arm genre. CIVIC "block P4^M~) 1 1 1 1 1 . . FOItMER HUSB^NDS on WIVES (elm ~ Ho COCKS BELOW. In "O~C, ST^~ '' - Offs''.} F^MILY NAME (boa ware, News - SINCE MAMA) ' 1 ' I FIRST N^ME | elRTHD^TE | D^TE At PL^CE OF MARRIAGE| DATE AND PLAN' OF TERMINATION OF MARRIAGE A~rLIC^NT'S RESIDENCE LAST FIVE YEARS. LIST PRESENT ADDRESS FIRST. FROM _ STREET AND NUME,ER CITY PROVINCE OR STATE COUNTRY MONTH YEAR . l ArPLICANT S EMPLOYMENT LAST rlVE YEARS. | - rdomc, so Amp) LIST PRESENT EMPLOYMENT FIRST. FROM . ~_ OCCUP^TION MONTH YE^R . t I I i I I . _ . . . . . IF YOUR NATIVE ALPHABET IS IN OT14ER THAN ROMAN LET' rERs, WRITE YOUR NA ME IN YOUR ~ I^TIVE Ai PHABET REL OW: . ~ MONTH Y E A R . PRESENT TIME FULL NAME AND ADDRESS OF EMPLOYER 1 TO MONTH Y E ~ R PRESENT TIME APPLICANT FOR REFUGEE STATUS | PENALTIES- SEVERE PENALTIES ARE PROVIDED BY LAW FOR KNOWINGLY AND WILLFUt LY FALSIFYING I OR CONCE^LINC A MATERIAL FACT D^'C (TIC - MARC OF ~PrLIC^~) ~ APPLICANT: BE SURE TO PUT YOUR NAME IN THE BOX OUTLINED BY HEAVY BORDER BELOW. | COMMUTE TI415 Box (FAMILY HA - at) (GIVEN NAME:) (MIDDLE NAMIC) FORM G-325C (Rev. 10-1-82)Y

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173 COMPLETE ALL ITEMS-PRINT IN BLOCK LETTERS WITH BALL-POI~ PA OR ALIEN ADDRESS REPORT USE TYPEWRITER- THIS CARD MUST BE MAILED. PLACE A TEN CENT U.S. ~~- AGE STAMP ON REVERSE AND DROP IN MAIL BOX. THIS CARD IS REVISED ANNUALLY. ONLY SUBMIT ~ CURRENT YEAR CARD. 1. (I^ST NAME) (FIRST) (MIDDLE) - 2. ADDRESS IN THE U.S. (EXCEPT COMMUTERS-SHOW ADDRESS IN MEXICO OR CANADA. SEE ITEM 15) CITY OR TOWN STATE ZIP CODE CHECK HERE IF l l I ADDRESS IS CURRENT 3. ALIEN NO. FROM ALIEN 4. PLACE ENTERED THE U.S. 5. WHEN ENTERED U.S. (MO/D LY/YR) 6. SEX At- O FEMALE _ 7. COUNTRY OF BIRTH 8. DATE OF BIRTH _ 9. Cl JUNTRY OF CITIZENSHIP 10. ARE YOt ~ NOW WORE ING IN THE U.S.? (MO/I lAY/YR) ~ YES O NO 11. SOCIAL SECURITY NO. (IF ANY) 112. FOR GOVERNMENT USE ONLY 13. PRESENT OR MOST RECENT OCCUPATION IN U.S. ( l(AIN JOB ) 14. TYPE OF FIRM OR BUSINESS OF PRESENT OR MOST RECENT EMPLOYMENT ( MAIN JOB) 15. STATUS (CHECK APPROPRIATE BOX) WHEN DID YOU RECEIVE YOUR PRESENT IMMIGRATION STATUE ( MO/DAY/YR) 1 O IMMIGRANT (PERMANENT RESIDENT) 2 0 1~IGRANT (COMMUTER WORKER-CHECK THIS BLOCK If YOU ENTER THE U.S. DAILY OR AT LEAST TWICE ~ WEEK) 3 0 VISITOR 4 0 CREWMAN 5 0 STUDENT 6 O EXCHANGE ALIEN 7 ~ REFUGEE-PAROLEE 8 ~ OTHER. (SPEC I FY) - 1~ ~ CERTIFY THAT THE STATEMENTS ON THIS ~RD ~RE TRUE TO THE BEST OF MY KNOWLE~E SIGNATU E (IF U DER 14 YE RS OLD SIGNATURE OF PARENT OR GUARDIAN) |DATZ U. - , DE - ^ , - ~ - T or ;U.T'C ~-I Form I.S3 ~ 1.l.8l7) M - IOR^T10 - ^ - D Fd^TUR^LIZ^T10" .~Rvl C. rot" PROVED O - . MO. ^~--RO~O.

174 AIRCRA"^ESSEL REPORT . O ARRIVAL Lest Formals J,ort Air1ine/V - eel (Name and Nationality) ! o DEPARTURE First For ion Port T Fonr' A.pp~d 0~6 No. 43~R0497 Flight Number Port of Arr/Dep __ TYPE OF TRANSI3ORT~CHECK ONE 1. 0 U.S. military_ncluding 3. 0 Commercial~hartered charters to military 4. 0 Foreign military 2. 0 Commercial scheduled Do Not Wrtb in Am Blocl~For INS U" Only _ . . Pasecn~ers Inspected Date of Arr/Dep Total Passan. re Passenger Deferred . _ Attach OF 7507, IC4O Declaration, or 1018, or List Crew Below. CREW: Nan" fOREIGN PORT AND COUNTRY | Deferred 1 Port . S"tus PASSENGERS TOTAL FORM I-92 (S" instructions on reverse of form) (liev. ~1-73)N ALI EN TOTAL United States Department of Justice Immigration and Natural'2ation Service

175 1 94 ladle - ~oN AND NATURALIZATION SERVICE . ARRIVAUDEPAR7~1RE nECORD Form Ai~d ORB No. 111S.0n Ex'~W WELCOME TO THE UNITED STATES INSTRUCTIONS ALI. PERSONS EXCEPT U.S. ClTIZiENS MUST COMPI,E1E THIS FORM. A SiEPARATE FORM MUST BE CO~PLi=Ei~ FOR EACH PEON IN YOUR (;iROUP. TYPE OR PRINT LEGIBLY WITH PEN IN ALL CAPITAL LETTERS. USE ENGLISH. W NOT WRITE ON THE ElACK OF THIS FORM. This form is in two parts. an ARRIVAL RECORD (Hems I through 7). and ~ DEPAlt TURK RECORD Clams 8 through 10). You must complex both ports. Enter exactly the same information in spaces 8. 9. and 10 as you enter in spaces I. 2. and 3. · Item 7. I f you entered the United States by land. enter " LAND" in this space. WHEN YOU HAVE COMPLETED ALL REQUIRED ITEMS, PRESENT THIS FORM TO THE U.S. IMMIGRATION AND NATURALIZATION INSPECTOR. rim THIS SIDE FOR GOVERNi.EiNT USE ONLY (DO Ho! WanE BELOW THIS LINE) . _ NAME _ O u.' At 11 NU.IBER. DATEITIME REFERRED REASON REFERRED ADMISSION NUIdBER 995 - 015 7 2 4 7 8 I-94 ARRIVAL RECORD t. fAMILY N. - E (SURNAME) (tare one space "tween named <0 : OF . 11 NUMBER END TIME SECONDARY DISPOSITION 11. OCCUPATION FIRST (GIVEN} NAME (00 no; enter middle name; 2. DATE Of BIRTH DAY MO. YR. S. ADDRESS WHILE IN THE UNITED STATES (Sumter and StreeV 3. COUNTRY OF CITIZENSHIP 4. COUNTRY OF RESIDENCE (country where you they Clty 6. CITY WHERE VISA WAS ISSUED 7. AIRLINE ~ FLIGHT NO. OR SHIP NAME. 12. SCHOOL . . . 13. ITINERARY . . . . . . . . . . . . . . . . . . . 14. PETITION NUMBER 115 INS FILE NO. . I ........... 1C. WAIVERS THIS FORM IS RE- QIIIQED BY THE Ia~IORATION AND NATURALIZATION SERVICE, UNITED STATES DEPART DENT OF JUSTICE. SA Mall WAiRNING · ~ ao~mkanl Alto accepts un- aeti_ e~aioloynacnt k subject to "pompon, IIdPOiRTANT · i~etaia this permit in your posses- sion; you Mull screener it when foe icavo lee IJ,5. Allure to do so ably dcJa, your enlry into Ibe U.~. in Tic falare, 1 FISSION NUMBER 995-01572478 8. FAMILY NAIdE (SURNAME) (same as Gamily Name in llem 1 above} FIRST (GIVEN) NAME (same as first Name in lied 1 abodes 9. DATE OF BIRTH 10. COUNTRY OF CITIZENSHIP (same as loom 38boret (same ~ item 2J . . . . . . . . . . . . . . . DAY ~0. YR. . . . . . SEE lIEVElISE SIDE FOR OTHER IMPORTANT l~fOI~710N . · . U.S.I. l.~G "~ON AND I 1-94 DEPARTURE RECORD HATU - LeA~ONSERVICE| (Rev 1-~)u ........... ...... : j,,, '- 2 -4.-:--2, : :-':: .~ ~ :-: :-.: :-: .-:~dW: _ ::: :-,': . .~ : .2 . 2 ,.,-1 ~ :,:.:-,:,:: :2:','.:-,:2:2:~:-:2--,:,,.: . _ Vie ~ C _ . _ _ ~ ~b Vat _ _ ~ 00 ~ C), . _ 0 ' E :~ -m -_ j. ~E, ~- E O ' - _ 3 He .' c _ Z V, ,,,.- o O ~ c cL.° ~ ° _ c _ O . _ ~ ~ ._ ~ ~ ._ ~ ~ - . _ ~ ~ , 0 0 ~ be, ' 0 X ~ ' Loo . 1 1 -A . Or File by the 8uperinteudent of Documents. U.S. Government Panting O - he W~hlo~tor.. D.C. 30402 In At Cut IL o at: o C' o tc o UJ o E z cat ._ a . Z ~ _ . _ c · me it, ·-

176 Form T 213 (Rev. 41~79)Y UNITED.STATES DEPARTMENT OF JUSTICE Immigration and Naturatization Serv~ce He igh' Weight R E C O R D O F D E P O R T A B L E A L I E N {See A ~ -2790 31 34 for Instructions) fomily Non'. (Copitol letter') G;~-n Nome Middle Nome _ Countr`'of Citizenship Posspor' Number ond Country of issu. file Number n _ U S. Ad~r~ (Residence) (Number! (Street) (C j'Y) [Stole) I Z.p Codet c 2 Dot. Pla`e Time Monn-r of Lo~t Entry |Possenger Boorded At :o Number Str-~' City Province (Stole) ond Co~ ntry of Permonent Residence Z _ Z Birthdote Dot. of Action locotion Code O r, C;ty Province (Stole) ond CountrY of Bi th AR | Form (Type ~ No ) O ~ fted O O No'Lified ~ . _ visa l~d At-NIV No Sociol SecuritY Account Nome m rn .. _ Do'. ViSo Issuea Sociol Security No Send C O Rec Checir To _ _ Immigro'on Record C r m noI Record . Ncme Address ond No~ionolity of Spouso ~"oiden Nome if oppropriot6) . . Fqther s Nome ond Notionolity ond Address if Known Mothar s Presen' or~d Mo oen Nomes Not ono r ond Address if l(nown Monies Due/Property n U S. Not in Immediote Fingerp nted loci~ou' bool~ Checl~ed DeDo~ o'cn Chorgel, ;Code Worcs) Possession O None Cloimed O Se. Form 1-43 O Yes O No O Not listed C listed Code _ Nome ond Address of (los') (Cu'ren') U. S. Employer i TYpe of Emp;ovment _ Narrative (Outl~ne particulars under which alien located/apprehended 'nc~ude details not shown above re t~me place rnanr~e of last entr' and elements wh~ch establish ad min.3trative and/or cr~m~nal vioiat~on Indicate means anc, roule of travel to ~nter~or ~ Al~en has been adv~sed ot co n nun~cat~on pr~v'leges pursuant to 8 CFR 242.2(e). In~tial __ Date (If spoce insufficien' show continued. ond continue on reverse from bottom up) DISTRIBUTION Received ~sub jec' anc' documents (report of ~nterviewl from Officer 19 ot ! ) D ispos ition (Rece iv ing Off ice r) _ _ E y es C om plexion Sex Hoir OCCupOt;On Scors or "orks F. B. I No Mor tol Stotus C] W do~'v(e ~ o Slngle Q Morried O Soporoled O Divorced Metl~od of loco/ion/Apprehension AttNeor) IDore ~ Hour By Stotus at Entry | Slotus When found 1 L.ncgth of lime lilegollY in U S. Number IL Norionoli~v of Minor Children Salarv From To (Signoture ono Title) M.

177 U.S. Dep~eal of Jad~ Immigration and Naturalization Scrvicc APPLICATION FOR STATUS AS PERMANENT RESII)ENT ['P:E ~iTAblP OMB No. 1115~0053 Approval Expir" 8-85 Al'l'l I('AT10N b'()K Tl{~: Ill:!~:E'IT.~; ()E'XP:('TI(~N' O .~;e( ~l't,/hh 1&N A`t O S`` .'l44d) 1&.N' Aet O .~( 1:] Act of 9/1 1/.',` O .~( . '4.'), I&.N' .~( t O .se' . ,49. I&s .~( t tl)() N()T URITF: ARsO\E T111.~; LINE:.) (.810~: 1N'STRI'(~TI(l)~'X Bl~:FORE L'lLLIN'(i IN A}~l'l l('ATI(~!< 1E' \(~1 VEE:1) M()RE .~1'.~('E: T() AN'.~ ~:K ~'I'LL~ AN~ Ql'l]XTI()N ON TIll.`i b'I)RM 1'.~1: A .SICPARATE b;HF:ET ANI) II)ICNTII'i' ICA('}1 ANSUI£It ~ITH TI{lC ~'I MBEK ()E'TllE: ('ORRE:.~;I'()NI)I!\'(; ()I'IChiTI()!S ~'111 1!` ~AITI1 T\'l~lC~'RITER OR PRINT 1N BL'}; LETTERX IN INI{.) 1 I herein! appl! for the stat'~s of a la~ful permanent resident alien on the f`'llo~ing basis ((~heck on~ nf the IH)XP.K hch~v. ~ i\. O 11. 0 Asa perso'~ who entered the 1' S. `\itha visa issued tomeasthefianreenrfia'~`eofa 1'..~;. /i~izen nh/'n~ I m~lrri~d ~ithin 9~,da!s afr~r m! entr\ ',ras ~ /hild ·,f su/h fian/e. orfia~ee /.`ier.''14(d) 11N Act). As a persor, Rrd''t'~d asyl`~'n under Section ,/)~(al tn ~ho~n an im~nigrant visa is immediAt/ l! a`ailahle /.`i'.~ion '`)~/h, 1&N A/ t~ `~' fee r'q~'irod ) . _ . . . _ ., {'. O A~ a former gover',me''t <,fficial or as a memher of the immediat~ famil; of su/ h offi~ ial (Se~ ti<'n 1:] A/ t '~f .Seytemh' r I I I',.' n O As a person to ~`hom an immiRrant ~isa is immediately availahle. other than nne described ah/~' /.~ectio~ '4' 1&N' A`t) 13. 0 As a person who has resided in the I'nited Xtates continuous!! s~nce prior tn .1l,1! 1 19'4 (~;ection '49 1&N A<t' i'. O As a pers`,n who hAs re.sirled in the I'nited Ststes c<,ntin''ousl! sin(e ~ date on nr after .lul~ 1. 19~)4 i,ut hef<,rP .lune :~). 1',48 /X'/tion )4't 1&N' .~`t (' O As a motion to reope', nr tn reconsider m! t.ese in deportati/,n pro`et clings befor' an imneigrAti/~ judge (The fee for this r~lest is S.~n/\(, ~ ' M! liame is /famil! in capital letters\ (l'irst (liven) (Miadle) :3 .~` I'Il''l~' Ililmh~r . O .Uai/ O ~''mul'. . _ 4. I reside in th~ I'l~ited .~;tates at: /` /o) (Apt. ~'/~.) (~. dod Xtreet) (('it`) (State) (ZIP (~ode\ 5 Have ~ou ever applied hefore for pennanent resident ststus in the l'.~.7 ~ No O Vcs S. lIv f~le number i, · I dm ~ ~itiZ~I, '~f (('o`~ntr~l ~ Dat' ',1 hirth /If "~s': gi'' the da'~ an~l pkwe of filinV and ftnol d~po,2tion.' A- ~(}I`,,~lh\ ~ 1~! \ (\ ~ Hr, . ') I'!H`e of Birth ((~it! nr Towl~l (('o~!nt!. I'rn~i~l/~. or '.;t~t'~ (( ';U''tr! 1(, Na'''~'s!; app~ars nl~ no'~immigral~t d',<~'nent /l'`'rl'~ 1-~) I last,trri\~d i~ tl~' I'nited .`tates at tho port of (('it! and .~tatt') /~11 ~.~.,,,1h, (I)H!} {~8r} as a l~isitor st~del~t ~re\`lnall. `~ar`,,ee 4't~.) I I I \` n ~I I \\ ;~% 'le't ~I'sl.' / t' t1 11. M! nonimmigrant visa number _ vvas i~sued h'. the on (!61~th} (1);~V~ (\'~ar) O lrnited States (~onsul at ((~it!') (('nttntr! ) . 1:' 1 arn c~r'g!~, _ O d.ix ore' d _ . ~ 1.'l. I ha~e been married times inclr~ding m! present marriage if nov ~narried. (If y`~.' `,re ,,nld rn`~IT'cr/ qr'' '6e f''ll~'i'~v.) a 5'umber of times m! husband or wife has heen married | h. .Name `,f huch``n`] or v~if' (~\ife ~eixe maide'~ )'a~n`~) c. M! husband or ~ife resides O With me O apart from m' at .\ddrecc `Apt. ~'o.) V`~. .( .~tr`,et) ~T`>Wr1 or ('ItV) (I'r`,vin~, `\r .~;t~lt~i ((.n'~tr!: _ _ 14. a. I ha~e _ _ sons or daughters as follous: ((`omplete all (olumns as to each son or daughter: if living `` th !~ state "`vith rn' '' h~ I:,st ~ `,h~; `,ther~vis~ gi`~ ~ itV and state or c<,untr! of son's or daughter's residence). . ~ame Sex Plact of Hirth DHte of Hirth . _ . _ _ ~_ _ . . _ h. The follouing members of m! famil! are also applyi'~g for pern~anet~t residt~t status: il\ (\';lillt'tIt \I'S~t'l I'r l~lil''r llld`all~ flt tr:~\~'i} O ~l~arrl~d C] `\ ido`` ~ `t 4\\ F:K Fo~m I - 85 (Rev. 5-~83) N ~ti[.' ~:l~ ~ l, | Tt~ `~.- t ~I I<~-TI' rIl ~ `` '\l l I I ',`ll~l.kTI:l) l

178 15. 1 list below all organizations, societies, clubs, and associations, put or present, in which I have held membership in the United estates or h (foreign `~,untr`, and the periods and plHt't'~ elf such membership. (If you have never been a member of any organization, state ".Vor`~") 16. I O have not O have been treated for a mental disorder, drug addiction or alcoholism. (If you have been, explain.) 17. I O have not O have been arrested, convicted or confined in a prison. (If you have been, explain.) _ _ _ 18. I _ have not _ have been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency or similar action. (if you have been, explain.) . _ _ 19. APPLICANTS FOR STATUS AS PERMANENT RESIDENTS lIt!ST ESTABLISH THAT THE:`' ARE ADMISSIBLE TO THIS l SITED STATES. EXl'li:PT AS OTHERWISE PROVIDED BY LAW', ALIENS WITHIN ANY OF THE FOLLOWING CLAt;~;ES ARE NOT ADMISSIBLE TO THIS: 1'NITE1) STATICS AND ARE THEREFORE INELIGIBLE FOR STATI7S AS PERMANENT RESIDENTS: Aliens who have committed or who have been convicted of a crime involving moral turpitude (does not include minor traffic violations); aliens who have been engaged in or who intend to engage in an' commercialized sexual activity; aliens who are or at an' time have been, anarchists, or members of or affiliated with an; Communist or other totalitarian party. including any subdivision or affiliate thereof; aliens who have advocated or taught, either by person&l utterance, or by means of an; written or panted ~natter. or through affiliation with an organization, (i) opposition to organized government, (ii) the overthrow. of government by force or violence, (iii) the assaulting or killing of government officials because of their official character, (iv) the unlawful destruction of proper"`, (v) sabotage, or (Yi) the doctrines of world communism, or the establishment of a totalitarian dictatorship in the United States; aliens who intend to engage in prejudicial activities or unlawful activities of a subversive nature; aliens who have been convicted of violations `,f ant lam or regulation relating to narcotic drugs or manhuena, or who have been illicit traffickers in narcotic drugs or manhuana; aliens who have been involved in assisting anV oth~r aliens t`, enter the United States ill violation of 1~; aliens who have applied for exemption or discharge from training or service in the Armed Forces of the United States on the ground of alienage and who hare been relieved or discharged from such training or service; medical graduates (other than those for whom Relative petitions hare been approved coming pancipallv to perform services as members of the medical profession, unless they have passed Parts I and II of the National Board of Medical Examiners Examination (or an equivalent examination as determined bv the Xecretarv of the Department of Health and Human Services) and who are competent in oral and written English. Do my of the foregoing classes apply to you? O No O Ye' {If an,~Dcr ~ Yes, complain) 20. (COMPLETE THIS BLOCK ONLY IF YOU CHECKED BOX "A': "R: "(": or "D" OF Bl,OCK 1) APPLICANTS WHO (?HECKED BOX "A" "B" "(I" OR "D" OF BLOCK I 1!\' ADDITION' TO E:STABLIXllI),'(, THAT THI:\' ARE: NOT MEMBE:R.`i Oh' .~N'`i' OP'THE INADMISSIBLE (CLASSES DESCRIBED IN BLOCK to ABOVE MUST, EX('t~ AX OTHI:KU'It;~: I~ROVIDIOD PLY LA\\'. Albino Et;TAP5LJ,~! THAT THE:\' ARE N()T WITHIN ANY OF THE FOLLOWING INADlIISt;IBLF: (~I,ASSES: Aliens who are mentally retarded, insane, or have suffered one or more attacks of insanity; aliens afflicted with ps`<hopathi~ personality. sexual deviation, mental defect, nary drug addiction, chronic alcoholism or any dangerous contagious disease; aliens who have a physical defect, disease or disability affecting their ability to earn a lining: aliens uh`, are paupers, professional beggars or vagrants; aliens who are polygamists or advocate polygamy; aliens who intend to perform skilled or `~skilled labo; arid who hate nils been certified he the Secretary of Labor (see Instruction 101; aliens likely to become a public charge; aliens who have been excluded from the United States ui~hir, the past ~ear, or uh`, a' anv time have been deported from the United States, or who at any time have been removed from the United States at (government expenses; aliens who hate pressured or hate attempted ~' procure a visa by fraud or misrepresentation; aliens who have departed from or remained outside the ITnited tStates to avoid military service in tinge of mar or nnti`,nal emerRen(~; aliens who are former exchange visitors who are subject to but have not complied with the two year foreign residence requirement. Do any of the foregoing closes apply to you? O No [1 Yes (If anmocr is Ye&, complain) 21. I O do not U do intend to seer: gainful employment in the United 13t&tee. If you intend to seeL gainful employment in the United States. state the occupation you intend to follow.

179 22. O.'omplc`, 1/' is block only if you cAcelcd ~ D of bloclr 1) Oa I have a priority on the consular waiting list at the American Consulate at_ 0 . - .. A ~ b as of (Cit`) ~ `~" pun accuru~ng me i_ Immediate receive ~ ~ preference status wag approved by the district director at an (Date) (sit! and State) (Date) O c A visa petition has not been approved in my behalf but I claim eligibility for preference status because O my spouse 0 my parent is the beneficiuv of ~ vi" petition approved bv the d~stnct director at ^- (Citv and State) Cl d A visa petition in my behalf accomp Dies this application O e Other (Explain) 23 (Complete this boo only if you c/'celcd Boo E or I' of Block 1) A 1 first arrived in the United States at (Port) on lawn)_ (Dete) other means of travel) ~ by means of (Name of vessel or I O wee 0 was not inspected by an immigration officer B. I entered the U. S. under the name (Name al lime of unify) and I was destined to (sit, and State) I was coming to join (Nune and relationship) C 8inco my Fag entry I O beve not O beve boon Hong bom the United 8t~ (If you ~ bum ~n4 ~ ~ ~ ~ 1idirg ~ Fort Sac act Ryan o/ deparh~rc from and retun' to tar U. S.) 24 0 Completed Form 0-325A (Biographic Information) is attached as part of this application 26 IF YOUR NATIVE ALPHABET IS IN OTHER THAN RO]IAN LETTERS, WRITE YOUR NAlIE IN YOUR NATIVE ALPHABET BELOW 26 (8I(}NATURE OF PI B.8ON PItEP"INO FORM, IF OTHER THAN APPLICANT ) I declare that This dOCUm6Dt ~ prepaid by me ~ the request of the applicant and is bled OD B11 information on ~VhiCD I have aDy iDo~rl~e D.te _ Completed Form 0-325A (Biographic Information) is not stanched u ·wliceDt i' under 14 yeen of He Signature of Applicant Date of Sinecure Andrew of person prepping fond, if other th&D Splint: Occupation (Application not lo be signed beloved until applicant appears befog an officer of tic lmmigr~ion and 1~ ralizalion Satnec for c2aminati~m) ~ , do '~rear ( - irm) that I }ooze the contents of this _pplicetion sub cribed by me including the attached document', test the "me are true to the best of my iDo~vledge, end that correction. numbered ( ) to ( ) revere made by me or at my request, end that this application was signed by me With my full, true name (Complete and true ~i~twe of applicant) Subscribed and sworn to before me by the _bove-n_med _pplicent at on Olonth) Thy) (Year) l (-attire ~ title d deiced l GFO : 1984 0 - 432-105 (P - e ~

180 ;~1~ R~ISJRATION B;ECE~ ~ ~ :,,,4; - : : ' - L :77 ~ ..V.~:i : : .^V . :. ~ ~ I .... v Cat i. ... ... A: ~

181 U.S. Department of Justice Immigration and Naturalization Service REQUEST FOR ASYLUM IN THE UNITED STATES Form Approved OMB No. I 1 15-0086 INS Office Date: (Count ry 1. Family Name FirstMiddle Name 12 A number (if any or known) I All other names used at any time (include maiden name if married).1 Sex 1 4 Marital status G Male ~= Single o Divorced c, Female c Married ,~ Widowed I was born (Month) (Day) (Year) in (Town or City) (Scare `,r Pr`~`ince) Nationality-at birth At present Other nationalities 5. If stateless. how did you become stateless? 6. Ethnic group | 7. Religion 18 Languages spoken 9. Address in United States (In care of, C/O, if appropriate) 1~) Telephone number (Number and street) (Apt. No ) (City or town) (5tatel bier Slide) I (l',ciude are, Tildes l 11. Address abroad prior to coming to the United States (Number and street) (City) (Province) (Country) 1 12. My last arrival in the U.S occurred on: (Mo/Day/Yr) As a o Visitor o Student o Stowaway c Crewman 0 Other (Specify) . At the port of (City/State) I Means of arrival (Name elf vessel or airline and flight number. etc ) . I o was o was not inspected I Date authorized clay expires (Mo/Day/Yr) l 13. My nonimmigrant visa number is _ _ . it was issued by the U S Consul on (If none, state 'none'') (M<~/Da!/\ r at (City. County) 14. Name and location of schools attended Type of school Mo/Yr M<~/Yr Highest grade . ~ l 1 1 1 1 1 1 1 1 1 . 1 IS What specific skills do you have? lh S< Al Se~curitv N<, (if an! 17 Name of husband or wife (wife's maiden name) 18. My husband or wife resides o with me o apart from me (if apart. explain why) Address (Apt No.) (N`, and street) (Town or ~it`, (Province or stale)(C<~unlr' r Title of degree `,r cerl i ficat ion Form I-589 (Rev. 3-1-81) N (OVER) | RI.~1 1\ ~ 1) | I Rant 1 ~| Rl 1 I) I Rant | ( ()~1i'1 ~11 1 l leave I

182 19 If in the U S. is your spouse included in your request for asylum? c Yes c No (If trot. explain why) 20 If in the U. S. is spouse making separate application for asylum? o Yes ~ No (If not explain why) 21 If in the U. S. are children included in your request for asylum? o Yes o N<, (If not. explain why) 22 I have---urns <,r daughters as follow!) (Complete all columns as to each son <,r daughter If lining with ><)u state 'with me in last column otherwise give cit) and state or f<,rcign country <of son s or daughter s residence) Name ~ Sex | Place. of birth t I . 23 Rclati~es in U S. other than immediate family Name Address 1 .. '4 ()ther relatives who are refugees hut outside the U. S. Name D<~ument type (~ _1 ~ 1 1 2' Lisl all travel <,r identity d<~umcnts such as national passport. refugee c`,n~enti`,n travel document or national identit! card . . D`,Lument number Issuing counts\ `,r Datc of Date of C t authority Issue exrt~rat~on `,s . _ . __ . 26 Ash) did )ou (obtain a U S. visa' 27 If you did not apply fair a U S. visa. explain why ninth 2X Date elf departure from your ~,Untr! elf nat'0nali'! ( M`~/DayA'r) Date <lf thirty N<)w lie ing at _ . Rc lati~'nship Immigration status Countr! There presently located ()t)talned b! ~ ham 2q Cat exit permission required to lease your country' ~ ~ es ~ N(, (If so. did !(,U obtain ceil ''ermissi`,n ~ ies ~ N(, (If not. explain win`) ( _ )

183 . 30 Are you entitled to return to country of issuance of your passport O Yes O No Travel document O Yes O No (fir other document O Yes O N<, (If n<,t. explain why) 31 What do you think would happen to you if you returned? (Explain) 32 When you left your home country, to what country did you intend to go? 33 Would you return to your home country? O Yes O No (Explain) 34 Have you or any member of your immediate family ever belonged to any organization in your home curry'' O Yes O No (If s es. preside the f~ll<~^h~g inf~rmati~n relating to each organization: Name of organization, dates of membership or affiliation. purpose of the organization what, if any. were your official duties <>r resp`'nsibilities and are you still an active member (If not, explain) 35. Have you taken any action that you believe will result in persecution in your home country O Yes O No (If yes. explain) 36 Have you ever been O detained O interrogated O convicted and sentenced O imprisoned in any country'' O Yes O No (If yes. specify fair each instance what occurred and the circumstances, dates, location, duration of the detention or imprisonment, reason for the detention fir c`'nvicti`~n. ~ hat thermal charges were placed against yo`', reason for the release, names and addresses of persons who could verify these statements Attach documents referring tot there incidents. if an! ) 37 If you base your claim for asylum on current conditions in your country, do these conditions affect your freedom more than the rest <,f that country' p<,pulati<,n' O Yes O No (If yes, explain) 38 Have you. or any member of your immediate family, ever been mistreated be the authorities of your home countr`/c`>untry of nationality O Yes O I've If yes clue '' mistreatment because of O Race O Religion O Nationality O Political opinion or O Membership elf a particular social group' Specify f`>r each instance `` hat `~.c urr.d and the circumstances, date. exact location. who took such action against you and what was his/her position in the government reason why the Incident occurred namer and addresses of people who witnessed these actions and who could verify these statements Attach documents referring tot there incidents . . 39 After leaving your home country, have you traveled through (other than in transit) or resided in any other country before entering the L' S. ' 3 Yes O No ( If ~ en identify each country, length of stay, purpose of stay, address, and reason for leaving. and whether you are entitled tot return tat that country f or residence pure 40 Why did you continue traveling to the Li S. ? 41 Did you apply for asylum in any other country O Yes-Give details O No-Explain ``hs not (a) ((N\ er )

45. Under penalties of perjury, I declare that the above and all accompanying documents are true and correct to the best elf my knowledge and belief. (Signature of Applicant) (Date) 184 - 42. Have you been recognized as a refugee by another country or by the United Nations High Commissioner for Refugees? O Yes O No (If yes. where and when) 43. Are you registered with a consulate or any other authority of your home country abroad? O Yes-Give details O No-Explain why not 44 Is there any additional information not covered by the above questions? (If yes, explain) (Interviewing Officer) ACTION BY ADJUDICATING OFFICER Advisory opinion requested O (Adjudicating Officer) (Date of Interview) O GRANTED O DENIED (Date) (Date) GPO: 1981 0 - jSO-419

185 REGISTRATION FOR CLASSIFICATION AS REFUGE E Section 207 Immigrotion ond Notionolity Act loom Ap',roved Budget Bt.~au No 43-R0408 UNITED STATES DEPARTMENT OF JUSTICE IMMIGRATION AND NATURALIZATION SERVICE File No A REGISTRANT TO FURNISH THE FOLLOWING INFORMATION (READ INSTRUCTIONS ON REVERSE) TY PE OR PR INT 1 lay name le 2 By present ·ddresa le Flrat leliddle 3 I we. born on (month)(day)(yo-r) I Place of birth (city or town) I (Province) I (Country) ~, _ 4. Hel~ht I ~el~ht ~ Eye. I Hair I Complexion I Marks or Scar a Last My present n-tlon-llty le 5 1 fled or was dleplaced from (Name or co~) On or about (month) _;~ 6 Iteeson. (St-se in det-ll) 7 By preacnt lmmtgratlon statue in (Country in which residing) The evidence of my immleration status in the country in which I am residing is (De scribe) J Iffy apouse's name is , is: 9 (His)(Her) present address is | 10 Spouse's nationality is 12 Name of child(ren) My spouse [I All O will not accompany me to the United States Date of birth Place of birth . . ._ . . . 1 1 1 1 Plee. · mark (X) in front of name of each child who will accompany you to the United States _ . 13 Schoollne or Education __ Type Dates attended Title of Decree _ _ . Pre sent addre as Name and location of school _ _ ~1 1 1 ._ _ _. 14 11liltery ~tarvico ~h1 1 1~1 Country | Organizationl Datee | S-rl-l No |Punk Att-ln d 1 1 1 1 1~ ___ ~1 ~__ I I_ Form I-590 (Rev. 5-1 - 80) N ~ A.... -

186 IS. ~ flat below all or.anlsetione, aocleties, clubs, and aesoclatlons, peat or present, In which I have held membership, and the perlode and places at such momberehip. (if you have never boon a member of any organization, state "None") 16. l n have O have not been charged with a violation of law. (If you have over been charged with ~ violation of law, Solve date arid place and nature of each chergo and the final result) 17. I O have O have not been In the United States. (If you have ever been in the United States, show the dates of entry and departure and the p~poso of your entry. Flexor, pennaner~t realdont, student, acumen, etc.) File or Alien Registration number 18. I :~eve the following close relative. in the United States: Names Relationahip Preeent address - 19. I am being aponeorod by (Givo name and addresa of United Statoa Sponsor) Date | Sl~nature of re~latrant DO NOT WRITE BELOW THIS LINE 1 I, , do swear (affirm) that I know the contents of this registration sub. scribed by me including the attached documents, that the same are true to the best of my knowledge, and that cor- rections, numbered ( ) to ( ), were made by me or at my request, and that this registration was signed by me with my full, true name: ( C amp le t e and t rue s is net ur e of red l a t rant) Subscribed and sworn to before me by the above-named registrant at on (Signature and tItI. Of officer) . _ 1 '-- 1 1 1 INTERVIEW APPROVED DATE DATE _ . Immi~ratlon officer Officer In Charge . . INSTRUCTIONS (rnont h)(d. y)( ye -r) This form should be executed, signed and submitted to the Officer-in-Charge of the nearest overseas office of the United States Immigration ant Naturalization Service. When your name has been reached as a registrant you will be furnished additional instructions. 1. REGISTRATION - A separate Registration Form must be executed by each registrant and submitted in one copy. A Registration Form in behalf of a child under 14 years of age shall be executed by the parent or guardian. 2. ASSURANCES- Assurance Form I-591 executed by a United States sponsor will be required before your refugee status may be authorized but need not be submitted at this time. GPO 870 024

187 UNITED BYA"S DEPA-~!ENT OF')UBTICE 1041~TION ANO NATURALILATO~ ACE ASSURANCE BY A UNITED STATES SPONSOR IN BEHALF OF AN APPLICANT FOR REFUGEE STATUS (Section 207 Immigration and Nationality Act) (See Instructions on Reverse) Name of Sponsor Prea~nt Address (Number) (Street) Date of Birth (Month) (Day) (Year) Place of Birth - _ . I am a citizen of the United States by O birth n naturalization (If naturalized, show date, place naturalized slid certificate number) (City) F arm Appro ved OMB No. 43-R0407 (State) (ZIP Code) The refugee status into the United States of the applicant, his spouse and children, as described below, is herewith sponsored, and transportation from a port of entry in the United Sea tes to final destination in the United States is assured. Prlnclp-1 ·ppIicent's name (First) Place of birth Name of pelnclp-1 ·pplicnat's spouse 1e (Flret) (Middle) P resent ·ddre as (Ml dell e ) ~ ~~ Dat- of blrt1` | Place of birth _ 1 Chlld(r Name _ Date of birth _ 1 ( L ~ at) Date of bit (L-at) Place and Country of birth , . Assurances are herewith given that for one year, and without displacing any other person, the principal applicant will be employed and that he and all members of his family will be housed. t _ _ TO BE EXECUTED BY INDIVIDUAL SPONSOR I O am ~ am not relates to the applicant. (If relates show exact relationship) I have within the past five years sponsored the immigration of persons into the United States (~e number) I understand that the assurances given by me as stated above are my personal obligations. ~ certify that I am financially responsible ~ -~ O ate: _ Place Sl~neture of Furor Name of Agency Dot. TO BE EXECUTED BY VOLUNTARY iGFx(;Y _ . Place . Signature of ·uthorlzed offlci-1 of agency - Loc-l RePresentative of A~ency n United Statea in area where condition-l entrant will be located Name _ Address (Number) (Streets 1 1 Form I-S91 (Rev. 5 - 1 - 80) N (~It) ) (State) (ZIP Code) GPO 87 1 421

188 U.S.DepartmentofJustice Health and Human Services OMBNo.1115~0104 Immigration and Naturalization Service Statistical Data Approval Expires 10/83 Name lost (Family) First (Given) Middle Date Alien Registration Number I Country of Birth Co`'ntry of Citizenship Native Language Current Address Number and Street Apartment No. City State ZIP . _ _ _ 3 e Date of Birth Social Security Number Month/Day/Year ( ) Telephone Number My three (3) most recent cities of residence in the United States have been (list most recent first): CITY OR TOWN There are members of my household. Number STATE FROM month/year TO month/year PRESENT of whom are employed. They are (please use another sheet if needed): Number NAME RE ATIONSHIP SEX ;SELF) ~ (SELF) ~ _ , , My employment since entering the United States has been (list r lost reck ant first): 1 ~, COMPANY NAME CITY STATE DATES mo/yr mo/yr l My major occupation or profession before coming to the U.S. was: COUNTRY OF BIRTH \\\\ IOB TITLE ALIEN NUMBER \\\\\\ CURRENTLY EMPLOYED? yes no O O 0 ~1 O O C: l WAGE PER HOUR ATTENDING | SCHOOLS | yes no lo _ lo O C: C: . CHECK ONE: PART FULL TIME TIME o lo lo My education bet~ore coming to the United States was (check all that apply): 1 41 ~ - 1L~' My knowledge of English was acquired by (check all that apply): Training in the U.S. ~ Training in another country I I Use in the U.S. | | Use in another country Grades 1-8 Some high school High school diploma LO Technical school ~ Technical school certificate 4| Some university University diploma Training in refugee camp Other (Please explain): ~ nave had the following training or education in the U.S. (check all that apply): | TYPE OF SCHOOL | COURSE OF STUDY 1 1 ~ O High school | 1 1 O College j 1 O Technical/Vocational l , .. 1 | OOther(specify): l - Since in the United States, I have received the following public assistance in my own name: ~. ... _ , | 3 Cash assistance (welfare) J Food stamps SSI (gold check) O Medical assistance O Other(specify): Fonn 1643 (1~31-81) CHECK IF STILL ATTENDING lo o O lo CHECK IF COMPLETED lo lo lo lo FROM month/year : Graduate studies [I Professional training U Graduate degree My English ability is (check one): | ~1 None | O A few words | O Fair | O Good I TO I I month/year l 1 1 1

189 UNITED STATES DEPARTMENT OF JUSTICE IMMIG"TION AND NATURALIZATION SERVICE OMB NO. lIIS 0009 Approval Expires l/31/84 FEE STAMP I+ICATtON TO FILE PETHION FOR NATU~lUTtON Mail or cake to: IMMIGRATION AND NATURALIZATION SERVICE (See INSTRUCIlONS. BE SURE YOU UNDERSTAND EACH QUESTION BEFORE YOU ANSWER IT. PLEASE PRINT OR hP8) Section of IN Date: ( Live Blank ) ( 1 ) My full true "d correct name is........ (2) I now live at...................... ALIEN RE61STIUTION ( Show the exact spelling of your name as it appears on your alien registration receipt card, and the number of your card. If you did not register, so state.) Nellie............ Bin ( Full tree name without abbreviation) j ( Number and street, ) (City. county, state, zip code) ( 3 ) I was born on.................................................... ( MOD[h ) ( Day ) ( Year ) (4) I request that my name be changed to... (S) Other names I have used are:.......... ( Include maiden name ) (6) Was your hither or mother ever a United States citizen?. (7) Can you read and write English?........................ (8) Can you speak English?.................................. (9) Can you sign your name in English?.................... (10) My lawful admission for permanent residence was on........ (ll) (a) I have resided continuously in the United States since ............. (b) I have resided continuously in the State of ............................ ( City or town ) ( County, province, or stare ) ( Country ) ............................ Sex: O Male O Female ( Month ) ( Day ) ( Year ) .. at........................................................... ................................................................................ ( City) ( State) ................... .............. ( Month ) ( Da, ) ( Year ..................................... since . O Yes O No ( If "Yes", explain fully ) ....... ...... O Yes O No .... .... O Yes O No .... ....O Yes O No . under the name of ..................................................................... ( M`,n~h ) ( Day ) ( Year) (c) During the last five years I have been physically in the United States for a total of .... months. Flow _ TO - STREET ADDRESS _ _ . (id) , 19 ......... PRESENT TIME ............. ....... ... ......................... .. ....... ............................................................ (0-- ,19 ........................ ,19 ............................ ........ ................... ........................................................... (C) ,19 ............................ ,19 ............................................................... ........................................................ (d) , 19 ........................... ,19 ...................... ... .................... ........ .. ................................................ CITY AND STATE (14) (a) Have you been out of the Un ted States since your lawful admission as a permanent resident? .. . O Yes O No If "Yes" fill in the following information for every absence of less than 6 months, no matter how short it was. DATE DEPARTED _ NAME OF SHIP, OR OF AIRLINE. RAILROAD COMPANY, BUS DATE RETURNED COMPANY. OR OTHER MEANS USED TO RETURN TO THE UNITED STATES . . ~- PLACE OR PORT OF ENTRY THROUTGH WHICH YOU RETURNED TO THE UNITED STATES (b) Since your lawful admission, have you been out of the United States for a period of 6 months or longer? O Yes O No If "No", suite "None"; If "Yes", fill in following information for every absence of more than 6 months. DATE DEPARTED _ NAME OF SHIP OR OF AIRLINE, RAILROAD COMPANY, BUS . DATE RETURNEDCOMPANY, OR OTHER MEANS USED TO RETURN TO THE UNITED STATES ............................. ............................. .......................................................................................... ..................................................................................... ............................. ............................. .......................................................................................... ..................................................................................... ............................. , , ..................................................................................... Form N-400 ( Rev. 4-14-81 )Y (1) PLACE OR PORT OF ENTRY THROUGH WHICH YOU RETURNED TO THE UNITED STATES (OVER)

190 (2) (IS) The low provides that you may not be regarded as qualified for naturalization, if you knowingly committed certain offenses or crimes, eaten though you may not have been arrested. Have you ever, in or outside the United States: (a) knowingly committed any crime for which you have not been arrested?..... (b) been arrested, cited, charged, indicted, convicted, fined or imprisoned for breaking or violating any law or ordinance. . . _ ................. Al Yes n No ~nc~uu~ng traffic regulations? O Yes O No If you answer "Yes" to (a) or (6),.give the following infn~marimn tic rm ^~ ;~;'I~_. OUTCOME OF CASE, IF ANY 1 .......... ( to ) List your present and past membership in or affiliation with every organization, association, fund, foundation, party, club, sc~ciety or similar group In the United States or In any other country or place, and Your foreign milir~rv cPrvir~ ~ i' none -'r;~^ "I " ~ (17 ........ to 19 ........ to 19 ........ to 19 ........ to 19 .......... to 19 ......... to 19 ......... to 19 ) (a) Are you now, or have you ever, in the United States or in any other place, been a member of, or in any other way con nected or associated with the Communist Park? (If "Yes", attach full explanation) . O Yes O No (a) Have you ever knowingly aided or supported the Communist Party directly, or indirectly through another organization group or person? (If "Yes", attach full explanation) Lo (c) Do you now or have you ever advocated, taught, believed in, or knowingly supported or furthered the interests of Communism? (If "Yes", attach full explanation) O Yes O No ( 18) During the period March 23, 1933 to May 8, 1945, did you serve in, or were you in any affiliated with, either directly or indirectly, any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, citizen unit, unit of the Nazi Parry or SS, government agency or office, extermination camp, concentration camp, prisoner of war camp, prison, labor camp, detention camp or transit camp under the control of or affiliated with: (a) the Nazi Government of Germany O Yes (b) any Government in any area occupied by, allied with, or established with the assistance or cooperation of, the Nazi Government of Germany? O Yes ( 19) During the period March 23, 1933 to May 8, 1945, did you ever order, incite, assist, or otherwise participate in the persecution of any person because of race, religion, national origin, or political opinion? O Yes (20) Have you borne any hereditary title or have you been of any order of nobility in any foreign state? .... ........... ( 21 ) Have you era been declared legally incompetent or here you ever been confined as ~ patient in a mental institution ? (22) Are deportation proceedings pending against you, or have you ever been deported or ordered deported or have vain aver Nip for suspension of deportation? ( 23 ) (a) My last Federal income tax return was filed ~ year' Do You owe anv Federal raxes~ (a) Since becoming a permanent resident of the United States, have you: -filed an income tax return as a nonresident? -failed to file an income tax return because you reboarded yourself as a nonresident? (If you answer "Yes" to (a) or (a) explain fully.) ( 24 ) Have you ever claimed in writing, or in any other way, to be a United States citizen? O Yes (2S) (a) Have you ever deserted from the military, air, or naval forces of rheUniredStates? n Yes (b) If male, have you ever left the United States to avoid being drafted into the Armed Forces of the United States? . O Yes (26 ) The law provides that you may not be regarded as qualified for naturalization if, at any rime during the period for which you are required to prove good moral character, you have been a habitual drunkard; committed adultery; advocated or practiced polygamy; have been a prostitute or prc~cured anyone for prostitution; have knowingly and for gain helped any alien to enter the United States illegally; have been an illicit trafficker in narcotic drugs or marl juana; have received your income mostly from illegal gambling, or have given false testimony for the purpose of obtaining any benefits under this Act. Have You ever. anvwhe~e. O Yes n Yes Yes O No O No O No O No Lo No O No Yes O No _ Yes O No O Yes O No · O Yes O No Lo No Lo No Lo No been such a person or committed any of these acts? (If you answer yes to any of these, attach full explanation ) . . ; O Yes O No (27 ) Do you believe in the Constitution and form of government of the United States? .. ....................... O Yes O No 28 ) Are you willing to take the full oath of allegiance to the United Stares? (See Instructions) . O Yes O No (29) If the law requires it, are you willing: (a) to bear arms on behalf of the United States? (If "No", attach full explanation) O Yes O No (a) to perform noncombatant services in the Armed Forces of the tJnited States? (If 'No', attach full explanation) ..O Yes O No (c) to perform work of national importance under civilian direction? (If ''No"', attach full explanation) O Yes O No (30) (a) If male, did you ever register under United States Selective Service laws or draft laws? O Yes O No If "Yes" give date ; Selective Service No ; Local Board No ; Present classification (a) Did you ever apply for exemption from military service because of alienage, conscientious objections, or other reasons? O Yes O No If "Yes," explain fully ................................................................................. ............

191 (3) ( 31 ) If serving or ever served in the Armed Forces of the United States, give branch O inducted or O enlisted at................. type of discharge............................................................................... ( Honorable. Dishonorable erc. ) reason for discharge........................................................................ .......... , 19 , and from , 19 to , 19 ....... ; ; rank at discharge ~ "i~ena`ze `~;nscien''<>us objector orher ~ O Reserve or O National Guard from 19 to ( 32) My occupation is............................................................................................................................................ List the names, addresses, and occupations (or types of business) of your employers during the last 5 years. (If none, write "None.") List present employment FIRST. I From (~)- , 1') (6) , 19 . ~ To ......... PRESENT TIME ........................... , 19 ....................... , 19 ....................... 19 EMPLOYER S NAME I ADDRESS I .......................................... ...... .......................................................... .......................................... ...... ...... . ... .......................................... ...... OCCUPATION OR TYPE OF BUSINESS ( 33 ) Complete this block if you are or have been married. _ `~;`r;u~J, marr'cJ, J'v`>rc.cJ, w'`l`,wcJ) We were married on at O apart from me at ................ He or she was naturalized on....... Or became a citizen by ....................................... . The first name of my husband or wife is (was)....................................... ..... He or she was born at ........... on He or she entered the United States at (place) ............... on (date) for permanent residence and now resides O with me ....................................................................................................................................................................................... ( Show full address if nor living with you. ) .............................................. at ; Certificate No .............. His or her Alien Registration No. is ( 34 ) How many times have you been married? How many times has your husband or wife been married?. If either of you has been married more than once, fill in the following information for each previous marriage. DATE MARRIAGE ENDED NAME OF PERSON Tr, WHOM MARRIED . Scheme One) PERSON MARRIED WAS C] IZEN ALIEN O O ,, 0 - 0 - --0 0 ........... :0 - O _ Hole MARRIAGE ENDED (3S) I ha~re children: (Complete columns (a) to (h) as to each child. If child lives with you, stare "with me" in column (h), orher (Number) wise give city and State of child's residence.) (a) Given Nam" | ( b) Sex | _ =_ _ = =_ ( c ~ Place Born ( Country ) (36) READ INSTRUCTION NO. 6 BEFORE ANSWERING QUESTION (36) I.................... (Do) (Do Not) ( f ~ Por'of Entry ( R) Alien Registration No. ( h ) Now Living a' ..... want certificates of citizenship for those of my children v~h`> are in the U.S. and are under ace IX years that are named below (Enclose I1S Or each child for whom you want certificates, otherwise, send no money with this application.) .................................................................................................................................................................................................... (Write names <if children under ;~e 18 yeJr~ and who are in the tlS f<>r whom you went certlh~Jtes~ If present spouse is not the parent of the children named above, give parents name, date and place of naturalization, and number of marrla~es

192 U.S. DEPARTMENT OF JUSTICE I~Y16"SIO?' AND NATURALIZATION SERVICE ORB No. 1115 0018 Approval Expires 7/31/85 Tako or mall this application to: IlIMIGIlATION AND NATURALIZATION SERVICE ( ~ ) . ~ APPLICATION FOR CERTIFICATE OF CITIZElSNIP l Fa: Scour 1 1 Date (FulL True Name, without Al>breviatione) . . . .. ... ......... ....... . .. (Apartment nil - her, Street addre - , end, if swropriate, ..in care ot-') ..... .. .... ......... . . . . .. . . ....... ......... (City) (County) (State) nee . . (ZIP Code) ALIEN REGISTRATION | (Telephone Number) (SEE INSTRUCTIONS. BE SURE YOU UNDERSTAND EACH QUESTION BEFORE YOU ANSWER IT.) I hereby apply ~ the Commissioner of Immigration and Naturalization for a ce~iffca~ showing that I am a citizen of He United States of America. (1) I ~ bont in .............. .... . . . . on (Cite) (I) ply personal d;eacription is: Sex ...... ; complexion . . . . . (8~" or o~untrr) , . .. ...... ( Yontl' ~( Dear ) ( Y - r ~ ........ .... ; color of eyes ; color OI nalr Nelsen' . bees Inches; Vegan pounds; risible distinctive marks .. . ........... Ilarital Stun: O Single; O Varied; O Divorced; O Widow(er). (3) I arrived in the United States at .... .. ... ...... ... . on under the name ... .... .. . (City and State) he moo n ~ ^, (Mono\ (Dar) (Year} (Name Or ably or over means of arrival) O on U.S. Passport No issued to me at . ...... on ... .............. .. O on an Immigrant Visa. O Other (specify) . .. ~ ---- (Der) (Year) (I) FILL IN THIS BLOCK ONLY IF YOU ARRIVED IN THE UNITED STATES BEFORE JULY 1, 1924. (a) lay lot permanent foreign ~idenee are ... (c - ) (a) I tools the ship or other conveyance to the United States at .......... ~ Country ~ ...... . . .. ............... . .. . .. ~ Colmtrr) (CItr) (c) I w~ coming to .. .... . . ... . at ... . . .. (Now of person in the United Stow (City and State where Ill person w~ lions) (d) I traded to the United States With . ............................................ .... ............... - -------- (N~_ of I_-n or rustic with whom ~ Clod, Id t-ir rchtiooship to you. it any) [S) Ileve you been out of the United States since you Brat arrived ~ O Yes O No. If 4'Yes" kill in the following infonnstion for mere Seance. =~: DA" D - ~ (6) I _ _ _ _ filed a petition for naturalization. (have) ( have not) PORT OF RETC'RN TO SHE UN'!rED STATES ~ ~Dam Recount NAME OF AIRLINE, OR OTHtR ~IEA}SS USED TO RETURN TO . . . . . . . . . ... ....... . .......... . ..... .... ........ ............. ... . ........... . .......... . . . . ... .... ....... .. ... ... ............ . .. , ................. ............ . .... .. ... . . . . . . . .... .............................. .. ................ ................... .. .. ....... . . ........ .. . . . .. . . . . . . . . .. ......................... , . .. ................. ...... .. . . . .. ...... . . . . . . .. . . ....... ........ .. . .. ..... ..... ..... ..... ..... ..... .... .......... (If "have", attach full explanation.) TO T.E AmlCA - .- De cat write ~a the Mob 11~ IBM. Continue ~ mat - Be. ARRIVAL R1 :CORDS EXAMINED Card Index . .... ........... - -- I"ex boom asp. ARRIVAL RECORD FOUND All.., ales . ... ... ......... .. .. ..... .... .. Form N~600 (Rev. 5~5~83)N planner . .. . llantal Stun........... .. .. ... . . Age.. (Signature of "reDn males Greta (1)

193 ICONTItIUE HERE) (7) I cell- United States eiti#nship through-~ (check whichever applicable) O Other; O mother; 3 both parenb; O "opff~ep.~t(~) O husband (8) 11, f~er's - - e ~ . ... ........... . ; he was born on (City) (state or country) am1 ~ of ~th.) .. . .. .. . ... _ .. .... .. . . . . _ (Honth) (Day) (Year) (Street uldr~. city, and State or country. It de d, ferrite. U. helms ~ d~itie.~ ^~. TIn;~ - -I by O birth; ~ naturalization on . (llonth) (Day) (Year) ............ . . Certificate of Naturalization No (Near of court, city. and State) O through his parent(~), and . ~ ) ~ ~ .. issued Certificate of Citizenship No. A or AA ... .. (If known) His former Alien Registration No. was ... He ~ )lost United States citizenship. (If citizenship lost, attach full explanation.) He resided in the United States from to , from to ; from to (Y-r) (Year) (Year) (Year) (Year) (Year) from . . . to ., from . to , I am the child of his marriage. (Yam) (Y - r) (Year) (Year) (~et, Id, ad, etc.) (9) lily mother's present name is . . .; her maiden name was she was born on . . . .. , at (Month) (Day) (Year) (Street addreca, city, and State or country. If dead, write "dead" and date of death.) by O birth; O naturalization under the name of . . on . ... ... in the . ( Month) (D - ) (Year) ; she resides .... ... . .. . .. .... .. ... .... . . . . ...... (City) (State or country) She became a citizen of the United States (Name of court, city, and State j Certificate of Naturalization No . ; O through herparent(~),and issued Certificate ~ wee) ( was not of Citizenship No. A or AA . . ( If known ) Her former Alien Registration No. was She lost United States citizenship. (If citizenship lost, attach full explanation.) (me) (tan not) She resided in the United States from to , from (Year) (Year) to _______, from ______ _ to __ ; I am the child of her (Year) (Year) (Year} (10) Sty mother and my father were married to each other on at (Month) (Dar) (Year) (City) (State or country) (11) If clam is through adoptive parent(s): I was adopted on (Month) (Day) (Year) at . . _ _ ( City or town 3 ( State ) ( Country ) who were not United States citizens at that time. (12) My . served in the Armed Forces of the United States from ~ Others (mother) to ; from to ; from (Year) (Year) marriage. _ (lat. Id, Id, etc.) by my to and .. . ... . honorably discharged. (Date) ~ was) ( was not) (13) I _ lost my United States citizenship. (If citizenship lost, attach full explanation.) ( have) (1 - ve not) (14) I submit the following documents with this application: Nature of Document (2) (Year) (Year) (Year) .. ... . . .. (Name of Court) . (mother, father, Darente) . . (Date) Names of Persons Concerned

194 - (16) Fill in this block if your brother, sister, mother or father e~rer applied to the Immigration Service for a certi~cak of citizenship. . . _ Name OF IteLAS'" Rc~r~oNalilp I Mate of Birth . . WHEN APPLICATION| C - Fact NO. A~ F1 - NO.. 1, 1CWOwH. SUDMIrT~D , AND LocA7102. or Oral" -- _ . (16) Fill in this block only if you are now or ever have been a married woman. I hare been married . ..... time(s), a. follows: (I. 2, S. etc.} DATE MARRIED | MARC or H UB8AND In Mince H" B"N nea~r.~"D C's~ztNaH', or HUSBAND Date Marriase How Marriage Ended Ended ( Dacth or dlivorce ) _ _ (17)Fill in this block only if you claim citizenship through a husband. (Marriage must have occurred pmor to September t, at 1 9~.) Name of citizen husband . .......... . ...... . , he was born on . ... ...... ............. (Give full and complete name) (Month) (Da,) (Year) .; and resides at .. ,_ _ _,,,,,,,,,,,,,, ,.,_ _ _. _._ ~ - ~" ID "L ._ _ - --.- - -.--------------------------------~----- - ~ --a----' (City) (Sate or country) (Street addle, city, and St te or country. If deed, write . _ ... He became a citizen of the United States by O birth; O naturalization on . .. "dead" and date of death.) (month) (De,) (Yeer) in the . ... . .... . . Certificate of Naturalization No. . (N. - ne of court, city, and State) G through his parent(~), and .......... issued Certificate of Citizenship No. ~ or AA ( treat ( wry not) He .. ..... since lost United States citizenship. (If citizenship lost,attack fun cxphnation.) ( h - ) (has not) I am of the . . . . . - - - . . race. Before my marriage to him, he was married ... . . .. time(~), as follows: it. 2. I. etc., I, l(~ - HA. B - N TeRuIr.AseD: Date Marriage Ended How Ferrite Ended (Dam or di~orec) (18) Fill in this block only if you claim citizenship through your stepfather. (Applicable only if mother married U.S. Citizen pmor to September *2, 1920.) The full name of my stepfather is at ........ ... ...... . . ; and resides at . .. .... . (City) (State or country) . ; he was born on ( Honth ~ ~ De, ) ( Year ~ (Street address city; ·ni Si - the or country li dead; write ...... . He became a citizen of the United States by O birth O naturalization on "deed" and date of dentin ) ' in the . (Month) ( Day) (Year} .... .... . ... Certificate of Naturalization No .............. (N - ne of court city and State) O through his parent(s), and issued Certificate of Citizenship No. ~ or AA (amp) (wee not) He .... . since lost United States citizenship. (If atisc~uAiplost,etteeh fuU cxploatu~n.) ( h - ) ~ h" not ~ He and my mother were married to each other on . .. . at . . (Month) (Day) (Year\ {City and Ste e or country} My mother is of the . . . race. She issued Certificate of Citizenship No. ~ .... ... Amp) (arm not) Before marrying my mother, my stepfather was married . .. . time(~), as follows: (t, 2 ~ ete ) . _ D^se h(AanIED Near or W.'" -_ It HAa - A" H." B"N TERMINATED: Date liarriace Ended How lI-rri~e Ended ( D - tl' or titeorec ) _ (19) I _ __ _ _____ previously applied for a certificate of citizenship on , at _ _ - (beve) (babe not) (20)- of Deraon predefine torm it other than apDIieent I deehre that thin document was prepared by me at the request of the applieent and h t - - on ·11 in formation of which I he ve an, knowledge . _ SI6NATU - : I Dam: (3) (Date) ( OlBee) ( 8tC N ~ ) (8~ of ·pplie~t or p~t or Words)

195 Appendix D Part IV _~ Fo rm OF- 1 55A Q.PIlO~~t fORM ~ 55A ~O 821 (tornterly OF 15$ DtPT Of STATE 'JS~ /54r) ·~1 '26 770: IMMIGRANT VISA AND ALIEN REGISTRATION l ('Jr\! Y~InC) (.~!iddl~ .\a,>~) ~ THE IMMIC RANT NAMED ABOVE ARRIVED IN THE UNITED Y STATES VIA (.~, t~f y`~,i `'r J1i'~f't l'`~. `~/ ~rrr/`a/} ~ Of: (~mi/y Name) ACTION SY IMMIGRATION INSPECTOR =~EET ADDRESS. I~CLUDE. IN C4RE OF & APT# ~F AP IN Ti1E UNITED STATES I _ 1 SEC 21 2(0H 14) 1 IABOR CERTIFICATION O NOT APPLICABlE O NOT REQUIRED O~D IV- r ~ CITY AND COUNTRY Of BIRTH ~ ~ __ ~ _W CITY AND COUNTRY OF lAST RESIDEN\E 1 \ -_~ , . . _ _ MARIrAl STATUS MOTHER S F1 --NAM FAT S flRST NAME []M lis LI~ [)~Lls~P ~( . CITr STAr~ZIP CODE IF AVAICABlE so I ss . , :i MO DAY YR OF BIRTH O rHE t"MIGRANr HAb BEEN PREVIOUSIY Ir~ THE UNITED STATES ,r __ _ . . _ _ _ _ . {~S FILE ~ IF KNOWN _ . + _ INE/;i8lIITY F()g VISA w^~ED UN0,F. 5EctlOt. \5Z~ 21 21e) 0 21 21h 0 212lg) 0 2'i' _. _ _ _ _ _ _ _ _ NAllONAI ITY - ~CUPATION This visa is issuod under Sccti<,n 221 of thc Immig~ti`,n and Nali<>r';'lity A~ t, ;~nLI up<,n the hasi~ `,f thc f;~ct~ staled in the application. P`~sscssi`,n c~f a ~isa does '~'title thc hcarcr t<, cr~:e~r the Unitc~l St;~tc~ ~f al th~ ti','~ hc seeks to enter he is found t`, hc inadmissible. IJ~,n~rival ''~ the Ur~ited States. ~t must l'` ~urrcr~dere`! tt~ .' United Statcs Immigrati`,n ()fE'ccr \ AME RICAN ~_ . . ~ / Consulor Otficor of 1he United Stotes o\~eriCa =t Torift No 21 Fee Poid S7S locol Cy, Equiv. ACTION Of I.J. VISA TU ~ O ~ 2 . ~cr,o~ o~ APPE^l ~ IMMIGRANT CLASSIFICATION CtASSIFICATION SYMBOt fOREIGN STATE OTHER AREA lI"lTATION IMMIGRANT VISA NO ISSUED ON (soy) ("onthI IYeo THE VAllDITY Of THIS VISA EXPIRES MIDNIGHT AT THE ENr) OF [soy) I"on~h) !Yearl PASSPOR! .. _ NO. ._ OR OTHER TRAVEL DOCUMENTS (Describe, ISSUED ro BY ON EXPIRES IV- ~I FOREIGN ~ FFAIRS ~NUAL JU N t 4 1q Q~

196 . 131 m . ~ . _ J ~ l 1 1 1 . 1 ~ .. _~ LIT T hi - "i. ''a 1' eia Ial ~ 1 . 1 ~ 1 _ `3 1 Cat 1 -1 1 . rim I I r I I 1 1 1 -- - ~ ~ ~ ~ ~ I ~ I T ~ ~ _ ~ Jo 1 - ._ :- 1 1 1 1 _ ~ 1 1 1 1 111 1 1 1 to 1 -.1 i, ~] S ~N U r F~- 11 ; ; O U C V.

197 .,~. WELCOME TO THE i.' U N ITED STATES DEPARTMENT OF THE TREASURY UNITED STATES CUSTOMS SERVICE CUSTOMS DECLARATION ins n 0~. Al -. . Each arriving traveler or head ot family must provide the following intormat,on (only ONE written declaration per family is required): 1. Name: ~ Lest . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ fits, _ _ _ _ _ _ _ _ _ _ M,aal. It'll,./ 2. Number of family members traveling with you -------------------- 3. Date of Birth: --A-~-,b /~ Cry -it- r-' ~~ 4. AirlinelFlight: ------------- 5. U.S. Address: ----------------------------------------------- 6. lam a U.S. Citizen If No, Country: --__________________________ 7. I reside permanently in the U.S. tf No, Expected Length of Stay: -------------- 8. The purpose of my trip is or was O BUSINESS a PLEASURE 9. 1 am/we are bringing fruits, plants, meats, food, soil, birds, snails, other live animals, farm products, or l/we have been on a farm or ranch outside the U.S. 10. 1 amlwe are carrying currency or monetary instruments over $10,000 U.S. or foreign equivalent. 1. The total value of all goods llwe purchased or acquired abroad and am/are bringing to the U.S. is (see instructions under Merchandise on reverse side; visitors should report value of gifts only): YES NO O O YES NO O O YES lo YES lo _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ., c twos NO lo NO lo ~- SIGN ON REVERSE SIDE AFTER YOU READ WARNING. (Do not write brow to is line.) INSPECTOR'S NAME BADGE NO. STAMP AREA Paps Deduction Act Notice: The P4~ P auction Act d 1980 ~ we muet 1~1 you Baby we ar cotbct~ng tt~le infomeation. how _ w111 Has it and ~thcr Mu ~vc to gee It to us. Verb ask for the information to cany out the Custome. Agacultu~. and Cut 1~ d the Unild Stat-. Verb need It to ~ that try_ are complying with them lam and to albeit us to tigue and coUcct the rot amount d Outlec arm taxca. Your depone. is mandatory Customs Form 6059B (102584) WARNING AGRICULTURAL PRODUCTS To prevent the entry of dangerous agricultural pests the following are restricted: Fruits. vegetables plants plant products soil meats. meat products birds snails. and other live animals or animal products. Failure to declare all such items to a Customs/Agriculture Officer can result in fines or other penalties. CURRENCY AND MONETARY INSTRUMENTS The transportation of currency or monetary Instruments regardless of the amount. Is legal however if you take out of or bring into (or attempt to take out of or bring Into) the United States more than $10 000 (U.S or foreign equivalent. or a combination of the two) In coin. currency. travelers checks or bearer Instruments such as money orders checks. stocks or bonds you are required by law to file a report on a Form 4790 with the U S Customs Service If you have someone else carry the currency or Instruments for you you must also file the report FAILURE TO FILE THE REOLIIRED REPORT OR FALSE STATEMENTS ON THE REPORT MAY LEAD TO SEIZURE OF THE CURRENCY OR INSTRUMENTS AND TO CIVIL PENALTIES AND/OR CRIMINAL PROSECUTION MERCHANDISE In Item 11 U.S. residents must declare the total value of ALL articles acquired abroad (whether new or used. whether dutiable or not and whether obtained by purchase. as a gift. or otherwise) which are In their or their family s possession at the time of arrival. Visitors must declare in Item 11 only the total value of all gifts they are bringing with them. The amount of duty to be paid will be determined by a Customs officer U.S. residents are normally entitled to a duty free exemption of $400; non~res~dents are normally entitled to an exemption of $100. Both residents and non-res~dents will normally be required to pay a flat 10°/0 rate of duty on the first $1000 above their exemptions It the value of goods declared In Item 11 EXCEEDS $~.400 PER PERSON. then list the articles below and show price paid or. for gifts. taker retail value DESCRIPTION OF ARTICLES I PRICE | CUSTOMS USE TOTAL PRICE _ _ _ _ .~ IF YOU HAVE ANY QUESTED_ A_ w~r - ~ · REPORTED OR DECLARED ASK A CUSTOMS OFFICER. I have read the above statements and have made a truthful declaration. S/G`VA [URE DA rE {MO"~/O.YIY - ,, Customs FORn 6059B (102584) (BaCk) GPO: 1984 0 - 458-903

198 l 12~1~1 ~- e z ~ z =",,,o ~ ~ J. ~ it ~ ~ ~ ~ ~ <~ N0151~3H 8L6t SOIlSll~lS 141~3~ ~0d H31N30 ~NOI1~N-301~35 H1~3~ ol~8nd-3~3M ant N011~0~03 U11~3~ do lN3Wl~VdBa ?

199 AMERICAN COUNCIL OF tIOLUNTAR~Y AGENCIES FOR FOREI(;N S ERVICE, 1 ~.c 200 Park Avenue South - New York, N.Y. 10003 Date: File ID ~Present Location: The fit flowing persons: 1. 2. 3. 4. 5. 6. r ~ 8. 9. 10. 11. 12. Name . A Number Date of Birth Sex Place of Birt h ~ . ~ have been accepted for resettlement under the auspices of: Voluntary Agency (Principal Sponsor) Tel : Airport of Final Destination: Special Instructions: Loc al Sponsors Tel: This agency agrees to assign the principal refugee named above to obtain `:~;lpl `~ ~ ~ ~I)' and housing for him/hersel f and family, i f any . Signa tu re Authorized volag Representation ACVAFS Form $1

200 DEPARTMENT OF HEALTH AND HUMAN SERVICES SOCIAl SECURITY ADMINISTRATION form Approved OMB No. O9000S6 FORD SS-5 - APPLICATION FOR A SOCIAL SECURITY NUIIIBER CARD (Original, Replacement or Correctlon) MICROFILM REF. NO. (SSA USE ONLY) . . . Un-~ the required In1Ormatlon le pro~lded, we nay not be able to laud ~ Soclal Security Number (20 CFR 422-103(b)) . _ , INSTRUCTIONS ~ Before completing this form, please read the instructions on the opposite page. You can type or print, using TO APPLICANT ~ pen with dark blue or black ink. Do not use pencil. ~1 ~1 1 0 - m 2 esP 3 ~8 6 9 FN, PNO 101 L NLC 0h 11 ASO _ _ NAME TO first : Middle ; ' ~~' BE SHOWN ' ~ ON CARD I _. . 1 FULL NAME AT First ElIRTId (IF OTHER THAN ABOVE) OTHER NAME(S) USED MAILING ADDRESS CITY CITIZENSHIP (Check one only) O a. U.S. citizen O b. Legal alien allowed to work c. Legal alien not allowed to work O d. Other (See instructions on Page 2) SEX 4 ~SEX O MALE FEMALE . . ' Middle ' I 1 1 _ sstreet/Apt. No., P.O. Box, Rural Route No.) STE ETB DATE MONTH ~ DAY , YEAR | AGE | PREA5GEE| 8 | OF ~C MOTHER'S First' Odd e NAME AT I HER BIRTH ~ ' FirstI Mld(lle I Last FATHER'S NAME ~ a. Has asocial Security number card ever I_ | =1 ~MONTH , YEAR beenrequested for the person listedin item IJ YES(2) LJ NO(~) LJ Don't know(~) It y s, ~j _ . _ ~ b. Was a card received for the person listed in ~ YES(3) t1 NO(1 ) ~ Don't know(, ) If you cocked yes to · or b, comports item 1 ? Items c through e; otherwise 90 to Item 11. STATE ZIP RACE/ETHNIC DESCRIPTION (Check one only) (Voluntary) O a. O b :;1 c d. Northern American Indian or Alaskan Native 21 e. White (not Hispanic) ZIP CODE it. Asian, Asian-American or Pacific Islander (Includes persons of Chinese. Filipino, Japanese. Korean, Samoan. etc.. ancestry or descent) Hispanic (Includes persons of Chicano, Cuban, Mexican or Mexican- American. Pueno Rican, South or Central American, or other Spanish ancestry or descent) ,. Negro or Black (riot Hispanic) STATE OR FOREIGN COUNTRY ~ FC, ~ O Last (Her maiden name) c. Enter the Social Security number assigned to the ~ ~I l person listed in item 1. L_ LJ L J LJ LJ I LO LJ LJ , d. Enter the name shown on the most recent Social Security c' Err e. Date of ~ MONTH , DAY , YEAR issued for the person listed in item 1. P birth correction _ Do (See Instruction 10 on page 2) ~ ~MONTh1 ~DAY ~YEAR I Telep hone ~ umber where we ~HOME ~OTHER TODAYS ~1 ~ Ican reach you during the _ DATE ~, 1 ~ | day. Please include the area code. ~ WARNING: Dell~tely tuml~lng (or causing to be hmbhed) blue Intom'stlon on this apDlicatlon is ~ crime punlehable by tine or Imprisonment, or beflh. . IMPORTANT REJOICER: SEE PAGE 1 FOR REQUIRED ~IDENTIARY DOCUMENTS. YOUR SIGNATURE WITNESS (Needed only it signed by mark "X") t)O NOT WRITE BELOW THIS LINE (FOR SSA USE ONLY) r . . . I ASSIGNED Cl [A ~ ~ ~ O O O O O pQC INTC |CAN TYPE(S) OF EVIDENCE SUBMITTED Form SS-S (5-84) Destroy prior editions YOUR RELATIONSHIP TO PERSON IN ITEM 1 O Self ~ Other (Specify) WITNESS (Needed only if signed by mark "X") ale lo, - MANDATORY ~ IN PERSON Am I NTERV I EW CONDUCTED _ IDN IT\/ 3 DTC |SSA RECEIPT DATE l NPN l SIGNATURE AND TITLE OF EMPLOYEE(S) REVIEWING EVIDENCE AND/OR CONDUCTING INTERVIEW DATE DATE DCL

201 So r - ~ - r- c^ ~ ~ _ 2 _ Cal ' ~CO _, ~ Car C: 1 -:11 1 1 1 =11 1 1 `0 11 1 1 ~ 1 ~ 1 ~11 1 11 1 1 11 1 1 1 1 1 ~ 1= 1 ~ As: 1 C1 1 . 1 1 Cur1 1 1 1 ~1 1 1 I ~1 1 1 I- ~1 1 1'<11 1 1 1 1 1 11 1) 1 ~.1 1 1 1 1 X 1 1 1 1 1 1 1 1 1 1 X 1 1 1 oh 1 1 1 1 1 X 1 1 1 1 1 1 1 1 1 1 X 1 1 1 1 1 1 1 1 1 1 ~1 1 1 1 1 1 1 1 1 1 1~:1 1 1 1 1 1 1 ~I 1 1 1 1 1 1 1 1 ~ 1 1 X 1 =1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 can 1 1 1 1 c 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 C 1 ~1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ~,=1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 ~ 1 1 1 ~1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ~1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 no, 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1-. ~1 e: 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 An' 1 - 1 - CO o~ 1 ^ ~ E A ~ - C,` O ~ ~As, ~· - a) ran 1 ~cry Q~ O Cry ~Car o ~- ~O c: a) ~u: ~e~ C) a:: ~ ~ >, ~be' A, ~a) ~c' c tO ~ ~S ~Q' =: ~:, ~Em O ~Em O ~O t ~=5 ~ a) c ~· - 0 : ~ a, ~s ~ tD C: ~4¢ ~ ·- ~U] OC :~ S 3 c: O a ~ cd C~ ct k4- ~0 C ~=~- :> 0) ~ ~c~ ~ ~ Cd ~C: cf: ~a Q) ~ O ~ .= t) ~O ~ ~c: c~ ~o ~ a' · - a, ~ Q) ~ · - ~- ·~- 0 ~L3 0 m ~ ~(3 cd ~ ~Q c~ ~o ~a) ~z ~ ~ co . - ~. - ., ~ ~=~ , u ~ ~oo C.) a) ~ a) ~:> ~1 ~ ~S ~ ~E - ~o) ~ c~ ~=) ~ 1 ·- O Ct: S ~a) 0 a I E bO C) G' ~ ~ ~ E ~· - ~ ~ O :~ O) hD ~ ~ ~ S ~O O S 43 ~C~ 3 Q cd Q ~I E Z m ~ ~ 0 ~ ~ I `: ~ c) ~O ~. - . - I U) C~ ~ C) ~ ~ S COE ~ O cd c: ~c' ~ c-, Q) c a~ ~ a~ ~ ~ ~cc·- ~ C) ~ cn ~ a ~a~ c: c a, s ~ 0 U) 0 ~ 0 ~ (5 ~ Lb ~ O Q' ~=: 0 ~I 03 = - ~) E C~ =; · · · · · ~· · · · · · ~ C~·· ~ ~ ~ ~ ~ ~Z O ~E O ~ · · · · O c m c ~a

202 3 - C: U: 3 en g Cat ED A A: o A: or ~a) . TIC ~. o E C' et; ~CO AD AD ~C) O `:: ~ - .C C/3 CE ~ =: as .Cd~ O So · - EDQ ~Cal:5 D a) ~ED O · - _ Do: SO =: ~ ~ ~Q So 1 ~ ~.= a) ~ , ° ~1 ~' 1~0 1, cobee ~ I .,1. l 0 ~Al .. E ~ ~ 1 . I ~ o 1 c' o a) ED ~ to E 1 1 ;5 Al ~ ~ I O ~ mt ~ ~cd I ~ ~ mom ~a) or, a) =: ~ cat 1 1 ~ ° ° ~ ~ ~=> o 1~e c~ ~a 1- ~o ·~ ¢1 1 0 cn 1 - ~bD 0 · ~c: C: S ~ · - C) s0)~1 1 -= 0 C) ~ E ~O O §341,° ~C~ ~0 ~L t3 CO ~ U) C) ~ C) `: tD ~ ~·- ~0 ~| ° h~l 1 8| ' | ~ ~ ~ E ~ g~ 5~=l lo0 =1 ~C E ~ oC ~ ~ ~0~0~ ~ ~ ~0 ~ '- ~ 3 ~ Z · ~ U] U' ~: ~ Q) C: E C) Cd a a) ~ tD ct , · - a) E O C~ o U] Q a) cs .~1 1 Q 3 ~ O C) 0 ~ O Q) S b0 - :5 a) a S" S C~ C~ O O C~ o ~; z ~: z ~0 H H H u, to c: C) a) · - Q ~ O U] a) ~D a) · - a b: a :, a~ c~ ~ U] C~ J: O C~ a) Q) D S ~: o . - Ct C) ~ ~r o

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Immigration Statistics: A Story of Neglect Get This Book
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This book examines the needs for and availability of statistics concerning immigrants and immigration. It concentrates on the needs for statistics on immigrants, refugees, and illegal aliens for policy and program purposes, on the adequacy of the statistics that are produced and of the statistical systems that generate them, and on recommendations for improving these systems. Also, the history of immigration legislation and the estimates of the size of the illegal alien population are briefly reviewed.

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