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EFTA00313939
Month O 1 Day 2.O Year 5 3 Number of Family members traveling with you (:::3 (a) U.S. Street Address (hotel name/destination Cj C- fist -1 1st Sircer (b) City Ni GvJ yoRK IC) State Passport issued by (country) Passport number Country of Residence \ *1 IR O f gfr Countries visited on this
EFTA01688646
DO.B. /-2O-O ef ASTEI11 ?tele -44i ,./r., ADDRESS Street City MP Det-n-e. as c.,.6trite- PHONE NUMBER ADOTNL SUSPECT / D.O.B. I ADDRESS Sircer Cory ZOG PHONE NUMBER SPECIAL INSTRUCTIONS FOUND PROPERTY CLAIM 0 GO DAYS NOT CLAIM 0 REMO QUANTITY VALUE DESCRIPTION SA aavtit .. Li
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