APPLICATION NOT TO BE SIGNED BELOW UNTIL APPLICANT APPEARS BEFORE
AN IMMIGRATION JUDGE
I do swear or affirm that the contents ofthe above application, including the documents attached hereto, are true to the best ofmy knowledge
and that this application is now signed by me with my full, true name.
(Complete and tnte signature of applicant or parent or guardian)
Subscribed and..sworn to before me by the above-named applicant at
Date: (Month. Day. Year)
CERTIFICATE OF SERVICE
I hereby certify that a copy of the foregoing was: 0 - delivered in person, 0 - mailed first class, postage prepaid
(Month, Day, Year) to
(INS Disfricr Corrnsel and Address)
Signature of Applicant (or attorney or representative)
Please use a separate sheet for additional entries.