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Izenship I am in the United States as a: Permanent Resident Visitor (Specify) Other Student (Middle Name) *Date of Birth (mm/dd/yyyy) A-Number (Copy Number From Alien Card) A- *Present Address Years (If the above address is temporary) I expect to remain there Last Address *(State) *(Zip Code) *(City or Post Office) (Street or Rural Route) (City or Post Office) (Street or Rural Route) Months (State) (Zip Code) (State) (Zip Code) I work for or attend school at: (Employer's Name or.

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