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or print in black ink Part 1. Information About You U.S. Physical Address To Be Completed by an Attorney or Accredited Representative, if any. K Select this box if Form O-28 is attached to represent the applicant. Attorney State License Number I. Alien Registration Number (A-Number) 6.a. In Ca
hed my original Form I-94 or I-94W. 1.d. 0 I am applying to replace my Form 1-95 because it was If you are unable to provide the original of your Form I-94. mutilated. I have attached my original Form 1-95. 1-94W, or 1-95, provide the following information: Le. g I was not issued Form 1-94 when I was
2 mentions1 same-page
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amp Action Block Valid From K Authorization/Extension Valid Through Alien Registration Number A- , Remarks To be completed by an attorney or K Select this box if Form G-28 Attorney or Accredited Representative Board of Immigration Appeals (BIA)- accredited representative (if any). is attached.
st describes your reason for requesting an initial or replacement document. (Select only one box) l.a. O 1 am applying to replace my lost or stolen Form I-94 or I-94W. 1.b. O I am applying to replace my lost or stolen Form 1-95. 1.c. O I am applying to replace my Form 1-94 or I-94W because it was mutil
2 mentions1 same-page
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U.S. physical address in Item Numbers 6.a. - 6.1. 1 1 La. In Care Of Name To Be Completed by an Attorney or Aerredited Representative, if any. K Select this box if Form G-28 is attached to represent the applicant. Attorney State License Number Lb. Street Nut and Name 6.c. Apt. 0 Ste. 0 FIr.
cribes your reason for requesting an initial or replacement document. (Select only one box) La. 1.b. O I am applying to replace my lost or stolen Form I-94 or I.94W. K I am applying to replace my lost or stolen Form I-95. Lc. K I am applying to replace my Form I-94 or I-94W because it was mutilated.
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Mutual Connections (37)
Entities connected to both K Select and Form I-94
Jeffrey Epstein
PERSON3 w/ K·3 w/ Form
Homeland Security
ORGANIZATION3 w/ K·3 w/ Form
Albany
LOCATION3 w/ K·3 w/ Form
U.S. Citizenship and Immigration Services
ORGANIZATION3 w/ K·3 w/ Form
Department of Homeland Security
ORGANIZATION3 w/ K·3 w/ Form
the Social Security Administration
ORGANIZATION3 w/ K·3 w/ Form
New York Field Office
LOCATION3 w/ K·3 w/ Form
Michael C.Green
PERSON3 w/ K·3 w/ Form
the NYS Division of Criminal Justice Services
ORGANIZATION3 w/ K·3 w/ Form
Homeland Security Investigations
ORGANIZATION3 w/ K·3 w/ Form
U.S. Immigration and Customs Enforcement
ORGANIZATION3 w/ K·3 w/ Form
Federal, State
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Preparer
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New York State Division of Criminal Justice Services
ORGANIZATION3 w/ K·3 w/ Form
U.S. Social Security
ORGANIZATION3 w/ K·3 w/ Form
National Crime Information Center
ORGANIZATION3 w/ K·3 w/ Form
Parole and Law Enforcement Programs Unit
ORGANIZATION3 w/ K·3 w/ Form
Requesting Law Enforcement Agency
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Monitoring Group
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Monitoring Case
ORGANIZATION3 w/ K·3 w/ Form