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ant's Contact Information 4. Applicant's Daytime Telephone Number 5. Applicant's Mobile Telephone Number 6. Applicant's E-mail Address Part 5. Contact Information, Certification, and Signature of the Interpreter Interpreter's Full Name Provide the following information concerning the interpreter: l.a. Interpreter's Family
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
ntact Information 4. 5. 6. A licant's Da time Tel hone Number A licant's Mobile Tele hone Number E-mail A licant's Address --/N/24o Part 5. Contact Information, Certification, and Signature of the Interpreter Interpreter's Full Name Provide the following information concerning the interpreter: 1.a. Interpreter's Family
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
tforingthit 4. Interpreter's Daytime Telephone Number 5. Interpreter's E-mail Address Fox= I-102 10/19/17 N Page 3 of 4 EFTA01699765 Part 5. Contact Information, Certification, and Signature of the Interpreter(continued) Interpreter Certification I certify that: I am fluent in English and ,which is the same language
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.
Entities connected to both Contact Information, Certification and Form I-94
National Crime Information Center
ORGANIZATIONRequesting Law Enforcement Agency
ORGANIZATION
Department of Homeland Security
ORGANIZATIONMonitoring Group
ORGANIZATIONMonitoring Case
ORGANIZATIONthe Social Security Administration
ORGANIZATIONNew York Field Office
LOCATION
Michael C.Green
PERSONthe NYS Division of Criminal Justice Services
ORGANIZATIONAlbany
LOCATION
Jeffrey Epstein
PERSONParole and Law Enforcement Programs Unit
ORGANIZATIONU.S. Immigration and Customs Enforcement
ORGANIZATIONFederal, State
ORGANIZATIONPreparer
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATION
Homeland Security
ORGANIZATIONHomeland Security Investigations
ORGANIZATIONU.S. Citizenship and Immigration Services
ORGANIZATIONBirth (mo.
LOCATION