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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)
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
Y U.S. Immigration and Customs Enforcement REQUEST FOR CONTINUED PRESENCE 'POPfliffoYminifion'ronttO\Vatitt 1. Name: (Last) (First) 2. Date of Birth (mo., day, yr) 3. Country of Birth 5. Alias(es) 8. Passport Number 11. Social Security Number (Middle) 4. Country of Citizenship 6. Gender (check o
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
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
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 Birth (mo. and Form I-94
Parole and Law Enforcement Programs Unit
ORGANIZATION
Homeland Security
ORGANIZATIONAlbany
LOCATIONU.S. Citizenship and Immigration Services
ORGANIZATION
Department of Homeland Security
ORGANIZATIONthe Social Security Administration
ORGANIZATIONNew York Field Office
LOCATION
Michael C.Green
PERSONthe NYS Division of Criminal Justice Services
ORGANIZATIONHomeland Security Investigations
ORGANIZATIONU.S. Immigration and Customs Enforcement
ORGANIZATIONContact Information, Certification
ORGANIZATIONFederal, State
ORGANIZATIONPreparer
ORGANIZATIONNew York State Division of Criminal Justice Services
ORGANIZATIONMonitoring Case
ORGANIZATIONMonitoring Group
ORGANIZATIONRequesting Law Enforcement Agency
ORGANIZATION
Jeffrey Epstein
PERSONNational Crime Information Center
ORGANIZATION