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Y TO: Unit Chief Parole and Law Enforcement Programs Unit Homeland Security Investigations U.S. Immigration and Customs Enforcement FROM: FBI, New York Field Office RE: Request for Continued Presence for: SAC , of the FBI New York Field Office concur in this request and certify, in accordance with the Depart
y/town/village, state/province, and country where you were born. 19.a. Citv/TownNilla e of Birth 19.b. State/Province of Birth 19.c. Country of Birth =IS 20. Datc of Birth (mm/dd/yyyy) I Information About Your Last Arrival in the United States 21.a. Form 1-94 Arrival-Departure Record Number (if
ations 2. Namc of Certifying Official 'Amanda Young 3. Title of Certifying Official Special Agent 4. Division/Office of Certifying Official 'New York Field Office 5. Agency Mailing Address Street Number and Name For USCIS Use Only Returned Date Date Resubmitted Date Date Reloc Sent Date Date Reloc
e the space provided in Part 9. Additional Information. Family Name (Last Name) Given Namc (First Name) Middle Name (if any) 3. 5. 6. Date of Birth (dd/mm/yyyy) 4. Gender or Sex K Male ❑X Female K Other Alien Registration Number (A-Number) (if any) ► A- U.S. Social Security Number (SSN) (if
: Unit Chief Parole and Law Enforcement Programs Unit Homeland Security Investigations U.S. Immigration and Customs Enforcement FROM: SAC FBI, New York Field Office RE: Request for Continued Presence for: SAC of the FBI New York Field Office concur in this request and certify, in accordance with the Departme
tate/province, and country where you were born. 19.a. CityfrownNillage of Birth 19.b. State/Province of Birth 19.c. Country of Birth 20. Date of Birth (mm/dcVyyyy) Information About Your Last Arrival in the United States 21.a. 21.b. 21.e. 21.d. Form I-94 Arrival Ito Passport Number Departu
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