Pein for Alien Fined) vases, V
Departanent of Homeland Security
US. Citizenship and immigration Services
‘APP i120 “ells Tt
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Your Malling Address ‘vier Names tue
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() wll apy for avn abroad at the Americ
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[Part3. Other Information
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Paes[Part4. Signature of Petitioner
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‘You may yl be inpsond for ot more hn year ot
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Your Certteaton
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Applicant: Pist your ame and Alea Reptraton Nur the box ould by bet border below.
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TERM BIT TEEN ee SR TE ETT
oEfix acion of Application/Petition Ace, «ance
Departmen of Homeland Security
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‘USCIS wit ho mi yaa rei ice (17970), which yu wil ocve within 10 day er your plication ws sn ace
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AUTHORITIES: Te infomation eqs on his for onthe asad evidence, collet wth nm
Nanay Ae, secon 101, e
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PURPOSE: the wimary pupa for prosiding te request informainon this nn te detent you han abled |
lig fo he iran beat or which vow ae lng, The nfrnaton you provide wil be ae granor dey th enti
oval
DISCLOSURE: Te informatie you provides voluntary. However rt rovde teristic, and any eg
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ROUTINE USES: The foro yu pode on his orm ay be shared with oer Federal, tt, ls, and rig goverment
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[DIIS-USCIS-007- Bones Infomation Sym and DIS-USCIS-CD|- Allen il, sy, snd Nato Fie Wai System oF
Records, wich ea be fund tamale govfnieasy.Thenfonallon sy alsa be nae seen proto lee