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SECURITY U.S. Immigration and Customs Enforcement REQUEST FOR CONTINUED PRESENCE Part A.Informatlon on the; Vktlm;.` 1. Name: (Last) 2. Date of Birth (mo., day, yr) 5. Alias(es) 8. Passport Number 11. Social Security Number (First) 3. Country of Birth 6. Gender (check one) Male Female (Middle)

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OF HOMELAND SECURITY U.S. Immigration and Customs Enforcement REQUEST FOR CONTINUED PRESENCE Part A: Victkn 1. Name: (Last) (First) 2. Date of Birth (mo., day, yr.) 3. Country of Birth 02/21/1985 5. Alias(es) 8. Passport Number 11. Social Security Number (Middle) 4. Country of Citizenship 6. Ge

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ms Enforcement REQUEST FOR CONTINUED PRESENCE 1bartA: InforatatiOnon'theitiopm. N.3:7 -.72.44t''> ;a14cir iCPIAC:' 1. Name: (Last) 2. Date of Birth (mo., day, yr.) 6. Allas(es) 8. Passport Number 11. Social Security Number (First) 3. Country of Birth 6. Gender (check one) Male J Female (Midd