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AND/OR REQUEST FOR VISA 1 APR 2013 3. APPLICANT'S LAST NAME - FIRST NAME - MIDDLE NAME 4. APPLICANT'S DATE OF BIRTH 5. APPLICANT'S PLACE OF BIRTH 6. SPONSOR'S LAST NAME - FIRST NAME - MIDDLE NAME 7. SPONSOR'S MILITARY RANK/CIVILIAN GRADE 8. SPONSOR'S SSN (If same as Item 3, X block) 9.a. APPLICANT'S CURRENT HOME ADDRESS (Include ZIP Code) b. HOME TELEPHONE NUMBER (Include area code) c. OFFICE TELEPHONE NUMBER (Include area code/DSN) 10.a. INTERIM ADDRESS WHERE APPLICANT MAY BE CONTACT.

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