uscis - rded to us...u.s. department of justice immigration and naturalization service request that...
TRANSCRIPT
1
TO BE FORW f\RDED TO IMMIGRATION AND NATURALIZATION SERVICE
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(b)(6) No ..... I ____
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COLOR OF HAIR: BROWN
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CL Efll(. U ::: . D. 3TfHCT COLJp"iT CEN ihAL 01sn-:11._,; r OF CAUFOHf-H~.
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. , rlM N·SSO U S. DEP.ARTMENT OF JUS f 1 CE
IMMIGR4TION ANO NATURAl!ZATION Smrct !REV. 11·1·871Y
SIGNATURE OF HOLDER IS NOT REQUIRED ON THIS
DUPLICATE STUB
DUPLICATE DO NOT DETACH
(b)(6) No .
residing at ·._I _____ _.I• ENCINO t CA. ~ lJ H
Date of birth ·O ~t /?, 4 / 4 H . . . Date of order of admission . 0 J '/ 0 5 /9 p
Date certificate issued ....... ;TANUAPY · ·O S·TH i · · 119·0 · · · h,r J hr
. . . . . . . . .~: S_. p~s~r.i~~ ... Court at ..... ~o_s. ~g~l~s,. qa~if ornia_ . .
Petition No .. OOH0'04·52· .. INS Registration No. li,_ ___ _.
PERSONAL DESCRIPTION FORM (Type or print)
Date of hirth~_fJiqt : place of hirth~O~) CfWAM; sex M~lf: complexion ·-·-·-.... --·----···-··
color of eyes 6 (< e e N : color of halr ----·· _6R.Jyjf)_ ________ _
h · 1 f t / / · 1 · 1 j c1
Jt.... d · 'bl 1· 1· 1· k IW !Vt e1g 1t ____________ ee_ mrns; we1g 1t ___ JL _____ potm s: rn1 ms me we rnar s ·-·--, ·
---.. ·-·---·-··--··-···-"-·-----··--· .. ------·· ~-- : marital stains _}}Af (1_el country of nationality ___ l_H_/v__d __ h_ft _______ . __ . __ . ______ ..... _ ... __________ ....... -------.. -......... ---
(If change of name requested) change to: ---~-V~/J~f_...:...\ _:__• _________ _
ALWAYS GIVE YOUR ALIEN REGISTRATION NUMBER WHEN COMMUNICATING WITH THIS SERVICE 5
U.S. Department of Justice
Immigration and Naturalization Service
Request That Applicant For Naturalization Appear For Interview
Date
0MB NO. 1115-0064 Approval Expires 4·85
Alien Registration No.
Petition No.
6
c~ r
\ R \,: (b)(6)
This petition for naturalization , hereby made and filed under section ___ --~ __ . --• ___ _
lmmi,:ration and Nationality A ct, re.\pectfully shows: (IJ Mv full. true. and cmrcd name 1{'FLLIP EDW~Rfl HA_P'l'l',,JH·JN
(Full. frue namti. without abhfl'n'a(iom)
(2) Mv present place nf rc·;1dc:ncc ,.I ____________ _.L -• -----------IAPI. Oh.) (Sumher and Stret't)
-----ENC·*I...,.N""O----rr-;,.,. or Town)
- -LOS--ANGELES CALIFORNIA-/( ountn·J 1.\1a1,1
. 1n 1.1) 1 wa, horn nn --.,.J-F--.....-'!1-1---.-1r--•·······-··----··
(41 I rcljt1e,t th,it m\ name be chan!!cd to ~ONE ..
(5) ! ,va .... law!1illv ,H!mttled tn the I 1111tcd ">tati•<., tor ptrrnanen! n'.\tdenl'.t' and have not ahanJ1,1ncJ ·,uvh rcs,1denl't.:
( () \ I 11 !1kd undn ~tct1on I l 6( :11. j I ha\'(" H:<..:1ded con1 !ntWU'ih in! hl' l )n1ted Statn fo1 ::tl lc,t:--t I i\c :,L·,1r..., Lind crnit1mHHl'il\ :n I lH: \ta\(.''i ln 'Ah1ch lt11:) pc-tit tun I'> maJe l\ll ti ',! \ rnnnth:-:. 1rnmcd1all'h rrecerlm,c 11'1e· dale ol th 1, pt'titwn and after my law!ul c1d1Dh\1on f()r pcrrnancr11 r·L'1..,dl'.t1l'l'. ,u1d l ha\c hct:n rh\-.,1call\ pro:..·~cnt 111 the I n1tt:d
:,.;u11v-, 11ir ,d k:1..,1 nne-h,d! ,>1 !t'~'L' \·car period
(/) Ill rctIt1tin tiled umkr \e,twn ~ll.l(al \ I have resided l'.nntmuuu..,[y !hL· 1.:nitcd S1ale-., In rnarnal union V-1th mv rrc..,t·nt ... r(l\J\t.: !rir at lt:aq three the Li:11c ur thh pet1twn, and .tiler my lawful i.H.1m1ss1nn tor permanl'nt rc .. ,idenLc. dur111µ ,di 1)t \\ ht,:h pt:111.1d ·~,ud ... pnu-.;c h.1:-. heen a I StcHC"i crt11cn. rih\·\11._·al\v i11 the I irntcd Sta It:\ at lea..,t one-hall nt t.;tH:h th1cc ·)t'ar per1t1d I ha\:;,' re-,l(kd cnni1n11,,u-,i,, th(' ">ta!-:" ln which 1 hi-, r,c1itHJn 1:-. m;uk :it k·a-.,t
\!X rnonth ... 1111111e,t1a1cl\ prec,;d1n).'. tht' date 1il !h1-, r,tUlltHi
( X j [ l 1 p1.._·t lt i1 in ; ilcd l11Hk1 ·--;i.Tl ion 1. ! ()( b ), l \1 y -;pnu~e i~: a cn11u1 lit the ! i nited State-.., 1!i I hl' crnr \()~ me rtl o1 ( ;(·11, er nlli(tlt n/ ; hi.· l, 111kd St ate). or ,1j :rn :\ mcrican !Tl"il1t1.111()n ()J n:'>t'arch rc..:o~rn1ttl c11 -;uch h,, -\ttnrney (it'ncr~il, or c111 .. \111.cric.rn ll! ll! 1)r(11rror.iuon Pl v.,iwit• or 1n pan 111 \ he dc,,,c(opml.'171 n! tu1c1en traJc and cIinHn,:r1:c o! 1 he l 'nneU State½. nr '>uhsidiary then:ol. or ot a public rnternat1ona! (lr_!.!at111at1on 1n ·vh1d1 n1kd ')1.ite.., partIc1ratc~ bv treaty or '>tatute. or 1s ,..n1thor11cd !1) per1nr m thl' rrnni:-.tcri;!l 111 rn1c-.;t!v lunct1un" nt a re!1gwus denomination ha\110~ c1 hona 1iJc 1Jf)nrn11 .. 1tion w11 hin the l 'nJted "lLliL·, <1r ,, "'"'"''"" <.,olclv ,1:,., a m1:,.,)Ionarv h· a reliu1ou:-i d{.'JHHlllllalwn or lw Jn lntcrdennm1n,111onal 1111'>'!i011 organ1nif1Llfl have ;i hona lidt ur µan11;it1011w1th1111he Lnited S1a1c .... and \p11u-,c l"i ,c~u!ari\' stationed ~1hro;.1d 111 iuch t-'mp!nvmet1t I intend 111 gth1d f;wh upon naturnli1ation 10 li\c .1hriiad \\1th n1\ -,poU,l' and t11 rc,umc rn1,· 1•~·..,11.kni_:(' -..v1th1n 1hc l nitcd :)1lttc:s immcdlatcl\ upti!i trrm1nat:tln Ill ·,Heh L'mplll\mcnl Jhroad
(Q) ! I j ,net ll 1011 I ilL·d 11ndl'.r ')cctHtn I ha\'t' ,erved honorahlv in thl' :\1 med t·1Hcl'" lll 1 hl' l i ni1cd Statl'"- lni ,1 re nod rli pe1 t()d.., c1~,:rqiating thr, L· vear1 I have ne'/Ct hL'l'l1
-;cpd.rated !rom 1hr .,\rmcd hirci:.., \ :nited State, under other t!1an honur.ihlc r:ond1t1,.1n:-.. I! not ... u!l m ... cn1cc. 111\ ,en 1i...'l' tn1111na1cd 'i1·x month-. of thl~ lilinl! o! fn', :-'ll'llli·.•fl
( IO) flt pct 1non t i!c..J unJL·r '-,<.:c: inn \~9 j Wh1 h: an alien or noncil 11en nat 1ona! nf ! he \. n11cd State...,, ! \en·,:d honuL1bl\· : r1 Ml ;1c11\ •>d ut ·; ,t a1 Lh In 1 he mi I itu v, a1 r. nr naval ! on.T, d! 1 he ! : rntetl St ate•, dur: Ill! enhl'r \\, orid \~ ;u- l or durmg a period heµ,inninµ Sertem hn I. I Y IY. ,1nJ -:nd 1nt1, DtLTrn hl'r ~ I I 94f), 1 )!"dun n,u tt rniod heg1 nn ing .l u nc 25. l 950
I 111
( I 21
Ii .'I
( 14)
anc1 ('t1r!111L'. .Jul\' I !4)') :1 ncnnd ht::.!ltnninµ l-ehruarv 2~( !()fl I tllld endinv: Octoher i 5, lt)/X. or l ·.;,:a\ ll1'>chaq.re<1 ,t11,_·r five; \car-. o1 -,ervIct undt·r the ·\ct ol .Junl' ~()_ i q,;;o ! P I _.:;97 .. , I -..1 t It. "eparatcd l rmn \Lil h ... en 1cc, I 'NJ:-i '.\cr.ira1,~'d ttr~dcr honnr:thk cond 1uorh. •\t the r 11nc ut i·n i 11..t n11.:rn. rL•l'llli:-.1 mcnL or induct ton I -..v;,.l\ 111 the!: i1 11cd Statl''i. 1 he~ ·\tnencan Samoa. nr \wain" Island If not 111 Jll\ ut thl'\C I ''-'a:-. 1:iwtul], admitted to the I nit~d State, for permanent rc,1denn· -;ub ... cq11e11t tn l'fli1~~rnent OT ,ndnction ! ¼-a~. f1l'\'l..'.r scnaratcd from 1.,uch \t:r\,1ce tin accot1nt 111
n:1\,tl ,!1111, whatn1·r (Jt n~tust: 1 ! t,i \\t·Jr i11c uni!nrm. I have not nrev1011'il\ hl"en natural11cd un I wa~ 1111t d 1..·1111-,1..·1etltHJ\h nhicctnr who rcrfornh_:d no md11ar• Jtr. :;1
ha..;h (d the "~ttllt.' p(·t J()d 1)!
l .tm n(it ~llld llc11.c nut i)ct:n, 'within the me,lfllll,!l ofrhi2 lmmigrat1on and Nat!ondlit~ \ct. lot a period ut at ka~t 10 \Cdt's. 1111n1t.::d1atei\' r1eccd1nt'. the datl' 1JI thi, petIt1on, d
rncmhcr ,1111r atf:!lated with anv 0E.:;11111a!1un pro.;;u 1hcd hv such l\d. or any \LCt1on ~uh\idian. branch, al1tl1:111...· rn 1Uh(J1\ i-;i(1n th.:refll. 11or ha\c I Junng \Ut:h pcnud !1<:llt.::'.'L•d 1r1. Jdvu1.:,tlcd. 1..'.ng.a~L:d 111- ,)r pcrlllrmnl any df the ach Ill act1'✓ 1tlc'i p1oh1h11cJ hy ~uch \l't
I .mi, and have ht.:t'n dun nu a!! the ;1,·rind\ ;cquired h~ law. a pcr'>on ol gond ;noral ,:harackr attachL·d tu the p11nc1p!c, ,11 thl' 1 11n\l!tllt10111l1 till' I in1tcd \1:ite'i anti wcli di"!)O\l'd !11 the :..'.ll•)d 1)rdcr and happ1n,__ ... .., o1 th1: ! ,nJll'l1 \ialtc,
I! 1-, tn\' 1 nt cnt HJ n In µ011d ! ,1 ir !l ! 11 f)L'C\ itnt: a rtt lll't1 o( l h· l ,' nitcd State~ dlld !d ~t' \.Vit h{)ut q ual!! tt:at !on tht (lf\\ h of n:n ll!lC'.dl \()ll ,l nd a I lq.::1a nl'c hv ! he ! 1rn111!!.rat H )/l t1nd \J;tt1onal1tv At:L and 10 1t\1de rn::rmanen1lv in 1':iitcd States. l dill v.illin.u, when rcqunl'd hy la\\, to rw.ir <1r111-.. on heh.ti! 1it nited Stat~:s.,, to rer1orm no11i,,:nmhalant ...__:rv1cc in tl1c \rn~cd f-orn:<., of tht· i nitl'd State\. Jnd tn nerto,m work Ill n,itl(lll,tl ;mr1 ortancc undu l11,·1i1:w d11l'l'l(lf (unk-1.,, l'Xt-:rnr,tl'd thcrctruml
! am ahlc \\; 1ead. wnte. ,rnd -,peak the i·n1:J1-..h lar1guacc I unlc\~ cxcmp!ccl :twrcfr1rn1 ]. :ind l h;J\l' :1 ~n<H\-kdgt: and undtT,!:rndrng ol '. he !i1t1damcnt.1h of tht.' 111-.;h)r\'. dnd 111 thl' r1-:1k1pie" and i11rm in L:o\ernmcnt 111 :he I n1tcd ')late..,
( f 5) w hcrehH t' I l\'(J U(':,t that t irldV he t1drmttcd ;1 l..'.\ll/t'rl o1 the I! mtl'd "t.1tc, !!/ \ ltH'.rll a j 'Wl' dr rat 1 I r1n l l ha! l k llUY.. 1 he l."0\ll(:nL, ,d th ll pct 11 I I )fl tor nat 1l\ ;1 It; d{ \()11 ",11 h'inl hnJ
hv 111c d!Hl d1;Jt the "amr;:: arc 1111l' to 1hl' he:,! \)1 rny knowlcdµ.c an<.1 hc-ilct. and that 1!11" rct111n11 1..., s.,ignL·d h\ Inl' \;,'1th m:,- lull. trnc r1c111w ~o help me God. I !ti)
~j&/4-,t,~~-(Full Vame. Without ·1hhreviatinm)
---~~~~~~~::====~~~~~:==--When Oath -\dministered hy Clerk or Deputy Clerk of Court xaminer Suh,crihed and ,1,1,orn to 1atfirrned) before me bv abnve-narned lw ahovc-namc
petitioner in the respective forms of oath shown in said petition and said retnion and
affidavit. ,rnd I ilcd hv ,aid ret1t1oner. in the olficc of the clerk of ,aid th 1,
court at LOS Ab1Gi..£'t,ES, av ot 7
th,Q '2Nl) day ot J.ViGUST 1'8-9.-LEONARD~ BROSNA~
(·!erh
19
,d frum,ncr
or naturali1a11on the clerk of ,aid
dav of
r ·ter/,.
7
English: Spaks
.I
G-325 Rec 81
G-32K ---------------ti (/J ll.1tqUUIH)
Ehgibiluy 101 (0: OK _________ _
Documents prl50llted:
Recommendation
G-3258 --------1,ll!!!l!!l!!!!!!!!!!~=---- II . ,,
N-426
Other
Prr/tminary Exam,n~r
COURi ACTION
DENIED
Grounds
l\d;;,,, or documents still required:
19 __ _
(DIii~)
8
NOTICE OF E. ,~y OF APPEARANCE AS ATTORNEY uR REPRESENTATIVE DATE ' 1PJ) In re: . ~l . ,,
✓ ~·· 1 )T/V!f?'~ I /J;Jc , . -·-
A . f A ') J-- .,, .... 7 Ak...1~ . '11/(! ,. v I ;; ;_...,,'' FILE P-1 tl
I hereby enter my appearance as attorney for (or representative of), and at the request of, the following named person(s):
NAME
'Phil/ Petitioner a Applicant
D
I .
(State) ( ZIP Code)
CA 713/(p
ADORES~ (Apt, No.) (Number & Street) (City)
Check Applicable ltem(s) below:
etitioner
0 Beneficiary
[J Applicant
t.=.J (State) (ZIP Code)
(; U,f I ,,.; /
I (b)(6)
[X] I am an attorney and a member in good standing of the bar of the Supreme Court of the United States or of the highest court of the following Stme, territory, insular possession, or Di strict of Columbia
Ca 1 if ornia _____ S_u_p_r_e_m_e_C_o_u_r_t ________ and om not under 0
(Name of Court)
court or administrative agency order suspending, enjoining, restraining, disbarring, or otherwise restricting me in practicing low.
2. I om on accredited representative of the following named religious, charitable, social service, or similar organization established in the United States and which is so recognized by the Boord:
[] 3. I am associated with _______________________________ ,
the attorney of record who previously filed a notice of appearance in this case and my appearance is at his request, (If yov cher,k this item, also check item 1 or 2 whichever is appropriate.)
[] 4. Others (Explain fully.)
SIGNATURE KAPLAN, KLEIN, STEINBERG & HADDAD
3600 Wilshire Blvd., #2230 S DNEY M. KAPLAN Los Angeles, Calif., 90010
ALAN R. KLEIN, SHERMAN I. KAPLAN I ELLIS s. STEINBERG' HENRY (;. HADDAD (213) 384-3308
PURSUANT TO THE PRIVACY ACT OF 1974, t HEREBY CONSENT TO THE DISCLOSURE TO THE FOLLOWING NAMED ATTORNEY OR
REPRESENTATIVE OF ANY RECORD PERTAINING TO ME WHICH APPEARS IN ANY IMM1GRA110N AND NATURALIZATION SERVICE
SYSTEM OF RECORDS: ----------,--------------------------(Name of Atlomey or Representative)
THE ABOVE CONSENT TO DISCLOSE IS IN CONNECTION WITH THE FOLLOWING MATTER:
NAME OF PERSON CONSENTING
Ph i/r' &, f!dtrf/11811f1 (NOTE: Execution of this box is required under the Privacy Act of 1974 where the person being represented Tsacitizen of the United States or an alien lawfully admitted for permanent residence.) ---------
Form G-28 (Rev,10-25-79)N (OVER) UNITED STATES DEPARTMENT OF JUSTICE
Immigration and Naturalization Service For sale by the Superintendent or Domments ,. 0 Government Printing Office, Washington. !J.C. 20402
9
u.3. 0epan:mem or .Justice Applicaw~n to Fiie Petition for Naturalizai1on i mm1gration and ~J2ruraiization Ser11ice
This block tor government use only.
Please read the instructions befpr~ filling out this form. I Section °1 Law t'.j1 ,/ .~~~ j
./~ ,// // / ,,.,... ./ •;., (. ( __ _,,·
1. Your name (Exactly as 11 appears on your Al1ewf(eg1stration Receipt C~rd) (b)(6j 4. Place you were admittea for permanent residenpy (City and State) I-IA--~T/Vl~N', Ff,.,hltt.1P e.0w,4,e._o BtJrrAL-O; M w '(_~JeK.
2. Yer •PAP Rrl~~a::mbdt 3 Yow Saoial Sn r'tl DI rho 15. Date your contin us reS'taency began in the U.S. (Month/Day;YearJ
A-. 3 - 2 2. - / 9' 5,. r 4 Your name (Full true and correct name. if different from above)
5. Any other names you have used (Including maiden) ) H A/27/VIA-I\/ PHIL. (sr,46lj; NAMG .... ,,.• I
6. Your date-0t'fiirth (MCJnth/Day/~). ·7. Your Sex
q - 2 4 - / t::/ 4fJ,_/ ~Male D Female
8. Your place of birth (City orfo:n)
(County. Province or State)
ON/ARI CJ 1 9. Was your father or mother ever a United States citizen?
('f Yes, explain fully) D Yes
/ 1 O. Can you read and write English?
0 No
11. Can you speak English?
• No
12. Can you sign your name in English? ,7
16. How long have you continuous' sided in the State wher!3 you now live?
(Number of Months) .3 v~s . 17. Do you intend to reside permanently in the..lJ · d States?
(If No, explain fully) Y~s
18. Have you served in the United States Armed Forces?
(If Yes, complete all of 1118) D Yes
Branch of Service (Indicate if Reserve or National Guard)
D Inducted
Location where you entered (City and State)
Service began (Month/Day /Year)
Service ended (Month/Day/Year)
Service number
Rank at discharge
Type of discharge (Honorable, Dishonorable, etc.)
D No
0 Enlisted
/ · . .,,., . ..efyes D No
13. Date you wen;r'admitteefior,perman;nt residency (Month/Day /Year) ~eason for discharge (Alienage, conscientious objector, other\
I
I
3-22-lq'S7 19. At what addresses in the United States have you lived dunng the last 5 years? List present address first.
Street Address City county and State Zip Code From (Month/Day/Year) To (Month/Day /Year)
1:/VC.I1\./01 CA ql'J/C,, 6-4-1"16?
Present
• Sfl&,:E'Mitt-A/ t:J,4,k:':51 . 3-15"-1'976 0-4 -1e-;B7 CA 'fl4tJ3 N&tv Yt:J;f!::..KI
NV ltJtJ/4 t) C TtJ/5~;1!!?, I 1"?87 p,eese/Vr
. .......... /"1,'f / .t:t:7,/// .. /.·/~ .. ' .. -
/ /"·,_/' i,.,· ~· j • ✓ ,, ;
-· ~l,. .... // 20. What employment have you held during the last 5 years? List present or most recent employment first. (It none, write 'None·.)
Occupation or Type of Business
A~r"te, Tf!ft-ev,-s," 11SATV~OII-Y /<l/6Ht LIV61
At:.7'"/N6" w~Ir1..v~ l/AJe/tJVS !fMPU}y€,eS
From (Month/Day/Year)
I
To (Month/Day/Year)
_-,.-. I ,.
I
21 Whal 1s your present marital status?
.,M.Mamed D ,Widowed
22 Complete the t
r1rst (given) e
VtC/<I ..:TO Place he or she entered the U S '.Jate entered the US (Month/Day/Year)
Date naturalized (Month/Day/Yean Place natc1ralized (b)(6)
23. Complete the following 1! you were prevIousIy married
Name of prior husband or wite
'GtzercHr?N LBWIS
Name ot prior husban'ifor w,te
ptir
Date ot ::i· , (Mo:r,rtlav/Year,
4 -/ 1-lt:fSB His or her Alien Registration Number
C::iJmry of t1\rtr ll,S,A-~
resent immigration s1a1Js
i City and State '.l' col'.lntry
JiiNCtN01 5P"t.,/F. q J'3 / b
How marriage en
1 INS sta1Us
D Alier
D Cit1zer,
INS status
D Alien
D Ci11zer
D Alien
. .-,,- 0 Cltize~
25. Complete all columns tor each of your children. (If child lives with you. state '•witn me' in Location column, otherwise, give the City and $18Mol tha1 child s residence.!
· Indicate your total number ot children .t:JN C Given name
ScAN e:-OWA/f:P
I J
I I
/ J
i
,/
Date of birth
I /
/
Country ot birth Date of entry Port 01 entr LocaMn Alier, Re istrat:on No Se,
✓-··'O Male
D Female
D Male
D Female
D Male
D Female
D Male
D Fema1;:.
0 Mal0
D Female
26 Complete the following with regard to each absence you have had trom the United States for a period of six months or less since you entered for permanem
residence. (If none, write "None".)
Ship, airline, railroad or bus company', or otrer means used to return lo the United States Returned at (Place or por1 ol entry) Date departed Date returned
Snip, a1rl1ns. railroad or bus conwimy, or other rreans Returned at !Piace ar port of en1ryi Date deoarted
-, ----------:------:,-------,----,,.--------+------------+-------,--------/
11
28 The law provides tha1 you may not be regarded as qualified tor naturalIzat1on.
i! vou Knowingly committed certain ottenses or crimes. even though you may
not have been arrested Have you ever. In or outside the United States ·
" I
r If you answer "Yes" to a) or b), give the following information as to each
1nc1dent.)
Where (City, State and Country)
in any other place, and your foreign military service (If no~write "None· )
Name of organization ,,.
✓
(/'.,/ 121 r EJ£ s 6tllt-D Cir AM&;e/CA/ ~57
SU!t?&N A CTCJ ~ 5 WILD
ACTti£5 GQ vi ry
~Me,e/CA/IJ FE1J&R"1T/tJN OF rt:l 'E3VISION /'tAIO RA-PIO ,A,e-,-;575 ASS0?1Ar1tJ1v tJF C..14N~J)JJ4A.i
-rGU!3VIS!O/v /9-AJO !:A-0/0 rlRr/STS
7f/l!? ae1sre?Av socu::ry c1+t,1 PO!f2tv1 ~ t-c?AGue ()r-
O?A/56/2.VATtON vcrre12s 30. Are ou now, or have you ever, 1n the United States or in any other lace1ieen y p
a member of, or In any other way connected or associated with,.Jhe
Communist Party? (If "Yes", attach tull explanation) ,,/
D Yes JB!No 31 Have you ever knowingly aided or supported the Communist Party directly, or
indirectly through another organization, group or person? (If "Yes", at\a(h full _.,,,/-✓
explanation)
D Yes .3'...No
32. Do you now or have you ever advocated, taught, believed in or knowingly
supported or furthered the interests of Communism? (If "Yes", attach full ,/
explanation) /
D Yes ~No 33. During the period March 23, 1933 to May 8, 1945, did you serve in, or were you
in any way affiliated with, either directly or indirectly, any military unit.
paramilitary unit, police unit. self-defense unit, vigilante unit, citizen unit, unit
ot the Nazi Party or SS, government agency or office, extermination camp,
concentration camp, prisoner of war camp, prison labor camp, detention
camp or transit camp, under the control or affiliated with
a1 the Nazi Government of Germany?
D Yes Ja"' No
~,
a; Know1noly committed anv crime ror whIcr you have not been arrested 0
- · D Yes ~c
b) been arrested, cited, charged, indicted, convIc~ec 1ined or Imprisonec to,
breaking or vIolat1ng any law or ordinance, inc'lud1ng traftic regulations?
JS Yes D No
' Date of Offense Nature oi Offense
[ vA,e1tJ115
- ,,,,,,,/"'
Location of organi~
tt;sA~1~./e<;
Outcome ot case, it any
/Nt-.A$11H E Yt?A.12.'5.
_ NP: ft-,:Z!f?.t?S-7.S, /J' /'. ,._.:;:,.,-.,,;"; .' ,;~ ... ,- - '
_..-,""'~;,,
Membership lro_!JV" Memberoh1_p tc
11'&1 PR€5t3-IT
los A-1'7161.es JCjgo !1.e~6Urj Los 4'nj.G-l~s !'184 P~ev~
I
Lo-s A119€l.es IC/7'7 p,et5&J?f I
I I
rt>/((),Vrt) I Ct/NADA 1186 Pl?e58v7'
AltJrfolK, Virq,111Q 1'17'1 PRe5€M
.. S~f0. Mvt1ic;,a·::- l'lt31 f'R£S&"A...1 ; .,, ,-i ., ,f / ... cs..-"'
'<J21</Jurin the enod 'OHvlaroo 2~, 1~83 !o'Ma 8, 1945, did you ever order. IncIte. g p y
assist, or otherwise participate In the persecution of any person because ot
race, religion, national origin, or pollt1cal opinion?
D Yes
35. Were you born with. or have you acquired in some way any title or order oi
nobility in any foreign state?
D Yes
I-
... I
36. Have you ever been declared legally incompetent or have you ever been
confined as a patient in a mentai institution?
D Yes
37 Are deportation proceedings pending against you. or have you ever be:n
deported or ordered deported, or have you ever applied for suspension of
deportation?
0 Yes, ,
38. When was your last federal income tax returrrl11ee<r·
,,,e! No
<vearJ 1'901!,
39. Since becoming a permanent resident ot the United States. have vou i1leo an
income tax return as a nonres1denP /If 'Yes . explain fully;
D Yes )J.'.'No
40. Since becom1';g & permanent res1den: o: the United States. have vou ta1ieC: 1,
41 Have you ever claimed 1n writing. or 1n any other way. to b' 'Jnited States
c1t1zen? .,,,./
D Yes )(No
42 Have you ever deserted from the military, air or naval forces of the Unit;d
States? ,/
D Yes .2!.ti(t _,,f
43. Have you ever 1ett the United States to avoid being dratted into the Ar,wred /
Forces of the United States?
D Yes
44. Do you believe in the Const1tut1on and form of government of the United / States? ,/
.l!J Y"':s'~ • No
45. Are you willing to take the full oath of allegiance to the United States? (See
instruction #5 J
• No
46 It the law requires 1t. are you willing to bear arms on behalf of the United
States? (If "No', attach a full explanation) ,
Mes D No
47. If the law requires it, are you willing to perform noncombatant services in the
Armed Forces of the United States? (If "No"/4tach a full explanation)
}(Yes D No
48. If the law requires it, are you willing to perform work of national importance
under civilian direction? (If "No", attach ~11y61anation)
~es D No
This.block is to be completed by the person preparing form, if other than
the applicant.
I declare that this document was prepared by me at the request of the
applicant and is based on all information of which I have any knowledge. , ~
Signature /j/ X ,, f ,
Address
Telephone.,Number i-,,."!l. ;".l.f'V-. ' '-· : J ··,;" I
49. Did you ever apply for exempt1r ·•om military service because of al1e11age,
conscientious ob1ect1ons or r ,easons') (It "Yes·. attach a tull explana-
tion)
D Yes
50. Did you ever register under United States Selective §erv1ce laws or drafl ·-laws? (If "Yes", complete the following) //
ft'i~s D No
Selective Service Number
Present classit1cation
4F,. ·+-..,.~ ! ;
.LA.) Aci 11v ~'i_.,ti;t.-wi•~:: 51 The law provides that you may not be regarded as qual1tied for naturalization,
it, at any time during the period for which you are required to prove good moral
character, you have been a habitual drunkard; advocated or practiced
polygamy: have been a prostitute or procured anyone for prost1tut1on: have
knowingly and for gain helped any alien to enter the United States illegally;
have been an illicit trafficker in narcotic drugs or mariJuana: have received
your income mostly from illegal gambling, or have given false testimony tor
the purpose ot obtaining any benefits under this Act. Have you ever,
anywhere, been such a person or committed any of these acts? (If you
answer yes to any of these, attach lull explanation.)
D Yes ';i!.No
You may, by law, change your name at the time you are naturalized._lf you wish
to do so, please print or type that name below, or the name you want your
cerlmcat~
Signature of Applicant
X I (b)(6)
Mailing Address Number
:C/M I 913/~
State Zip Code
7 (27 /,e9 Telephone Number
J J Date
Do not fill in blanks below these lines: This application must be sworn to before an offf1cer of the Immigration and Naturalization Service.
AFFIDAVIT
I do swear that I know the contems of this application, comprising pages 1 to 4,
inclusive, and.the supplemental forms thereto,
_----.,/1 4-v f2 -- . (Form Numbers ~7· \...- -,.... ·
subscribed to by me; that the same are true to the best of my knowledge and
belief. that correctionf numbered:
l
'\
/
Subscribed and sworn to before me by applicant at the preliminary invest1gat,on
"U' '\ o ;% .., This Ii t; r.? 1,!~ot · , 19 __ _
I certify that before verification of the above applicant stated m my presence he or she had (heard) read the foregoing application, corrections therein and supplemental form(s) and understood the contents thereof.
.. },,..1 _.,1..,-,r- . ..' l . .,, ~, .: .r 1/,-({,:vt?kfl • ./ :lkC;_z/4,-.,.,,.,-,,4 .L·~ omplete and true signature of applican~11 ,;; ,c,., ,,
7 ;.,;, ' z;;". (Naturaliza~~o . . E. xaminer) (__
\'Demonstrate applicant's ability· to write Engl1sh1· / _,,,[' t'\ .. ,; 1 _ C .. A'~ 1 <I d'J .,- , f 1-r'-; 4r· - t. /,r(;,/ •// f(, (,.. /
t~or Filed f
,'D3!e. reas:::ns:
~'.)rTT, N-400 (51; 2/88\" ,.,· .....
13
FINAL REA.ING
14
UNITED ST ATES DEPARTMENT OF JUSTJCE
IMMIGRATION AND NATURALIZATION SERVICE
COVER SHEEJ
·"f,hisis apermanentr:ec~rd ofaheJmmigtation and Naturalizatioli'Service. Any part of this ;"' ,record.that is remov_~dMusr BE RETURNED after it has served its purpose.
INSTfiUCTIONS
1. > flace .a separat{,cover sheet on the top of each Record of Pr<:>ceeding.
2. Each Reco;d ofi~roceeding is tO be fastened on the inner left side of the file jacket in chronological order. · · ·
3. Any person temporarily removing a.ny part of this record must make, date, and sign a notation to this effect which is to be retained in this record, below the cover sheet. The signer is resp,onsible for replacing the removed material as soon as it has servedits purpose.
4. See AM 2710 for detailed instructions.
M•l 75 (Rev. 10•20-69) GPO : 2002 193-68 J Q.L. 3
15
Date , , ROUTING AND TRANSMITTAL SLI ;-·!,,-.I
•, I 1,./ ,._/ / /
TO: (Name, office symbol, room number, Initials Date building, Agency/Post)
1. //i/fJf 11
2. ,1fft.1v, \ -,-· P11 'f('I t, / ( ( J p (Z JI ..., V. ! , ' • ) ,,I • I '-
l .r "
3.
4.
5. Action FIie Note and Return
Approval For Clearance Per Conversation
As Requested For Correction Prepare Reply
Circulate For Your Information See Me
Comment Investigate
Coordination Justify
FROM: (Name, org. symbol, Agency/Post)
' l•11r' Jf'k> ,·1 u 5041-102 * U.S. GPO, 1986-181•246/40021
Signature
Room No.-Bldg.
Phone No.
OPTIONAL FORM 41 (Rev. 7-76) Prncrlbtd by CISA FPMRC41 CFR)101•11.206
16
.... Wl,ilt~~ . . ~~t!l#t!f t1,1),· · n111(<
',,, ,,.-, ';,
17
U.S. Department of Justice Imm1gratior, and NPturahzat10n Service (ll\i}1
M!--r--llt.;auuri uy Law1u1 r-t:rm,mern ne::i1uer1t '.>rv1s. ,,,., cow
for New Alien Registra 1 ·"n Receipt Gard
00 NOT WRITE IN THIS BLOCK ,------·---.._..,... --... --.--•t"'••
1------------1i tAPPR. 'Q\)E-cl l. A# r or r :es• 1
1-------------10 I G-28 or Volag# , I l
f I V ~ Q 1QRA I t-------------1:, ! I \,; lvlJ'-'' .f
ii Ny£ I ~ 11 F/P to FBlm~--~--
IAY 1 t (-r-ss:- to TCF ___ ~~---
(Date)
1. Name (Family name in CAPS)
HltRTMAtvN r MSCfl§§ INqmper and §)(MP
(First)
pH IL-IP (Middle)
eDWAR.D
(Town or City) (State/Country)
NE:; W YO 12-J<. 1
(ZIP/Postal Code) NY ,oo,q
3. Place of Birth (Town or Ci1y) (State/Country)
B/2/+AlrFO/€.P I otvTA-R..10 CANAl>A 4. Dale of Birth (Mo/Day/Yr) 5. Sex
9 ... 24 -40 .M Male D Female 6. Name used when admitted as permanent resident (if diHerent from 1 .)
-6- Sl/14/C (b)(6) r C I I C It ti b 8 Cl'?? Rn isl t' ti b If I I
'
Status V~rif1ed CJ CIS 1t:,il\~~ tlfd' ) \ L l-151 /i-55111m'.;Jiil!.CltM!li..:Se""r._.y_..Jc ... tt~• ~---·-
By /. r,
\~-' (nitials
i h,C'r\'. Y.ork; N.Y,· Specify
oo ! 1qhf Oau ~C~-~I __ _ Date P., ;· - f, ?·l 1--t;'J
12. The city you lived in when you applied for your immigrant visa or for adjustment to permanent resident status
BRAI\ITFC)lf!.DI _q_"!'_~fi!Z I°' Cl'J ~:'A-_ 13. Your destination (city and state) in the U.S. at the lime of your original
admission.
14. The consulate where your immigrant visa was issued or the INS office where your status was adjusted to permanent resident.
NtA6"2A FAUS1 Ncvv YORK: 15. Your port of admission to the U.S. if you entered with an immigrant
visa.
BUPFALcJ I
A.Jt:PV yoRt<-16. The date you were admitted or adjusted to permanent resident status.
3-22-57 9. Country of Citizenship
Cl"r'NAPA 17. List the dates of all your absences from the U.S. lasting one year or
longer since you became a permanent resident.. ,..... 1C' / I , • 1 .~f J_~ f t~ 10 I , '--· . ' . , ::;: I : t. , : ,,
. 10. Your Mother's First Name
PC>RJS 11. Your Father's First Name
,l?.l/~R., 4-:? / : --;: ',, (\ -" 11 -• {)
/..I 1., I ~·
, ~8. Reason for new card (If you check a or b, you must pay $15.00 to file this form)
a D My alien registration receipt card was lost, stolen, destroyed, or mutilated. Explain how the card was lost. stolen, de3troyed, or~tilated (Attach the rem:,-indeI
of the card, if it exists.) / .) .- ~-:fr' ll ~ , My name .has been changed (Attach. the de. cree of the court or the marriage certificate and your old card) . f /; /w};, 1 )k_; .{J,{A\.,,t,,,,_.
/~ ~ I~ ~ I am required to be registered and fingerprinted after my 14th birthday. (Attach your old card. You MUST use the frngerprifit card Form F
1 258. which you can
get from any U.S. Consular or INS office) ' ... /JI ff tr J ~. F~ j ' d !J I am an alien commuter taking up permanent residence in the U.S. (Attach your old card)~- 0 t fT , f~ f .J ( ~
1 I received an incorrect card. (Attach your old card and explain what is wrong with 11) ) / .,.. / 1/, - . L . ;l }/ L '. ! .. · _ J I never received my card. F;u F - 61 .... 11--s·1- 6- / j" 11 r fJ-rr)l V,{,t.4t::C, r~[ZL()>( u
g Other (Explain) _______ 1 ------------------------------------
Penalties: You may, by law, be fined up to $10,000 or imprisoned up to five years, orF\oi\,9o'fJn&~~gfy and willfully falsifying or concealing a material fact or using any false document in submittil}9 lhis )P~.ki{ltion.
r!A~ 1 0 -. .. 00 Your Certification I certify, under penalty of perjury under the laws of the United States of America, that the above information is true ai~tfi:lir1IGQWJ li(,Qbe the release of any information from my records which the Immigration and Naturalization Service needs to determine if I am eligible for the benefit that I am
'"""' $~tr// 2 (b)(6) Signature -~~~~~~--..----~~~ ... '/LlL~_,..1/ __________ Date '5'- / / - 88 Phone Numb•dl'--!!!!!!!!11--------
/7 Signature of Person Preparing Form if Other than Above // ~)
I declare that I prepared this. document at the re.quest ot the person above and that it is based on all informat.io1f which~e y~ kno.wledge ..
,r- 1/ . .,.. '"' µ "~ ·. /L)· • l{y'r~' , ,,, '7 2-C ,x IA ., ·; I O c I,( fi v1~ ,. / vkcr/ln-., 1 r'- /l, . .__ l[,1 c r / q, ,, .. / , , . . ·-.:.,:.y----: _____ ,...-s_
/ //
/~'
1Pr:~·. NameI (Address) (Signature) 1DaieI
G-28 ID Number __ _
'
INITIAl. RECEIPT RESUBMITTED RELOCATED COMPL.ETEC'•
Rec- 0 ,Si:'nt Ar,;::1rcved r)en1ed ! R':'1' .,,,,,:1 I i l !
18
U.S. Department of Justice Immigration and Naturalization Service (INSj
Application by Lawful Permanent Resident for New Alien Registration Receipt Card
Instructions
Read the instructions carefully. If you do not follow the instructions, we may have to return your application, which may delay final action.
1. Who can file?
You may file this form only if
• you are a lawful permanent resident of the United States and
• you need a new card.
2. What documents do you need?
A. If you have your old card, you must give it to INS with this application.
B. Give the INS two color photographs of yourself taken within 30 days of the date of this application. These photos must have a white background. They must be glossy, un•retouched, and not mounted. The dimension of the facial image must be about 1 inch from the chin to the top of hair: your face should be in 3/4 frontal view, showing the right side of the face with the right ear visible.
Using pencil or felt pen, lightly print your name (and Alien Registration Number, if you know it) on the back of each photograph.
3. How should you prepare this form?
A Type or print legibly in ink.
B If you need extra space to complete any item, attach a continuation sheet, indicate the item number, and date and sign each sheet.
C Answer all questions fully and accurately. If any item does not apply, please write "NIA"
4. Where should you me this form?
A. If you are in the United States, take this application form in person to the INS office having jurisdiction over your place of residence.
B. Ii you are outside the United States, take this application form in person to the United States consulate or INS , office that has jurisdiction over the, place where you a,(.13 now living. '· .. , ' ''
~ .;. '>fU·
5. What is the fee?
If you check (a) or (b) of item 18 "Reason for New Card," you must pay $15.00 to file this form. The fee will not be refunded, whether the application is approved or not. DO NOT MAIL CASH. All checks or money orders, whether U.S. or foreign, must be payable in U .S currency at a finan· cial institution in the United States. When a check is drawn on the account of a person other than yourself, write your name on the face of the check. If the check is not honored, INS will charge you $5.00.
Pay by check or money order in the exact amount. Make the check or money order payable to "Immigration and Naturalization Service." However.
A if you live in Guam: Make the check or money order payable to "Treasurer, Guam", or
B. if you live in the U.S. Virgin Islands: Make tile check or money order payable to "Commission of Finance of the Virgin Islands".
6. What are the penalties for submitting false information?
Title 18, United States Code, Section 1001 states that whoever willfully and knowingly falsifies a material fact, makes a false statement, or makes use of a false document will be fined up to $10,000 or imprisoned up to five years, or both.
7. What is our authority for collecting this information?
We request the information on this form to carry out the immigration laws contained in Title 8, United States Code 1304(c). We need this information to determine whether a person is eligible for immigration benefits. The information you provide may also be disclosed to other federal, state, local, and foreign law enforcement and regulatory agencies during the course of the investigation required by this Service. You do not have to give this information. However, if you refuse to give some or all of it, your application may be denied.
II is not possible to cover all ,the conditions for eligibility or to give instructions for every situation, If you have carefully read all the instructions and s~h-,:auestio,g~, 5iease·contact your nearest INS office ..
GPO: 1987 0 - 177-626
r'o,· "le by th,, Superintendent of Documents, U.S. Government Printir nmce Washington, DC 20402
19
20
~32 L9!3S8@ tl070:)\17Qd l (_\j
; .... 1 __ .... (b)(6)
21
NOTICE OF ENT1..-,,-0F APPEARANCE AS ATTORNEY Ok r-.EPRESENTATIVE
In re: I-90 Application by Lawful Permanent Resident DATE
for New Alien Registration Receipt Card for Mav 12 lOQQ
Philip Edward Hartmann FILE No,
I hereby enter my oppeoronce as attorney for (or representative of), and at the reouest of, the following named person(s):
NAM£
1
O l'e!ltlontr (];; Appl ie.,t
Philip Edward Hartmann (b)(6) O s ..... ,nc11ry 0 AODRltSS '"~t. N<,.l l"lu.,_ ........... "" (City) (Stat•) ( ZIP Cod•)
LJ I New York NY 10019 N O Potltictner 0 Applicant I O e,,,.ne1 ory 0 AOOR£SS (Apt, No,) (N\.ll'Tlb•r & Strut) (City) (State) (ZO' Code)
Check Applicable ltem(s) below:
[~ I om an attorney and a member in good standing of the bcr of the Supreme Court of the United States or of the highest court of the following State, territory, insular possession, or Di strict of Columbia
NEW YORK COURT OF APPEALS ____________________ and om not under a (N-• ol Court)
court or administrative ogenc:y order suspending, enjoining, restraining, disbarring, or otherwise restricting me in practicing low,
CJ 2. I en on accredited representative of the following named religious, chaitoble, social service, or similcr orgcnizotio:i es.toblished in the United States and which is so recognized by the Bocrd:
I om associated with [] 3. -------------------------------, the attorney of record who previously filed a notice of appearance in this case and my oppeoronce is ot his request. (If pov check this item, also check item 1 or 2 u:hicheve r is a1Jvropriate.)
[] 4. Others (Expl oin fully.) PT.EASE NOTE: IT IS RESPECTFULLY REQUESTED THAT, IN CONFORMITY WITH THE PUBLIC LAW 90-83, 5 U .C .500 (F), STAT. 195, !HE UNDERSIGNED BE GIVEN NOTICE OF ALL
NICATIONS ITTEN OR OTHERWISE, IN THIS MATTER )
COMPLETE ADDRESS
LAW OFFICES OF ALLENE. KAYE, P.C. 233 BROADWAY, SUITE 760
NAME (Type or Print) LAW OFFICES OF ALLENE. KAYE, P.C. TELEPHONE f2"f2'f 964-5853
PUR!WANT TO THE PRIVACY ACT OF !97J, I HEREBY CONSeNT TO THe 0/SCLOSURe TO THE FOU,OWTNO NAMED ATTORNEY OR
REPRESENTATIVE OF ANY RECORD PERTAJ.MINO TO ME WHICH APPEARS IN ANY IMMIORAT10N AND NAT'URALIZAT10N SER\l!CE
SYSTE.'>f OF RECORDS:
(N-• ol Atlomoy or R•preu,11atl.,•)
THE ,\BOVE CONSENT TO DISCLOSE IS IN CONNECTION WTTH THE FOl.l.Ol+tNC ~UTTER:
NAME. OF PERSON CONSENT/NC I SIONA TURE OF p ER SON CONSENTINO
l DATE
(NOT£: Execution of this box is required under the Privacy Act of 1974 where the person bein.9 represented i's'a"citizen of the Vriited States or an alien lawfully admitted for permanent residence.)
Fam G-28 (Rev, l0-25-79)N (OVER) UNITED STATES DEPARD!E:--IT OF JUSTICE
Immigration and Naturalization Service
22
UNITED STATES DEPARTMENT OF .JUSTICE
IMMIGRATION AND·NATURALIZATION SERVICE
INSTRUCTIONS ) ,-· . . '. '
J. 'Place ,a separit¢'1cover sheet on the top of each Record of Proceeding.
2. , Each Record;9f.~1tic~eding is to be fastened on the inner left si~; of the ftle jacket in chroncilogi9al fa~~er. · , · · .·.
3. Any persontell})pqr.u-ily removing llny par.t of this record must make,date, and sign a notation to thisieffoctwhich is to be.retained in thisrecord,.below the cover sheet. The signer is respm1.siblefoneplacing the removed material as SOQJl, as it has served its purpose. :::,,c, ; . ·
4. See AM 2110 ri/aetailed instructions,
M•l 75 (Rev, 10•20·69) GPO: 2002 193-681 Q.L 3
23
U.S. Department of Justice
Immigration and Naturalization Service
Notice of Final Natunilimtion Hearing
i ·' I ' / . ,...,.. 1,v Petition No .
0MB No. l I t>-0052 Approval Expireo 9-30-84
PHILIP EDWARD HARTMANN (,,~. ._,,, ,
0 I,_
\Vi AR# .AJ._ ___ _.L
'd' Date
(b)(6)
You are hereby notified to appear for a hearing on your petition for naturalization before a judge of the naturalization court on JANUARY O 5TH, 19 9 0 - U.S. DISTRICT COURT
ROOM 329 312 N. SPRING ST. LOS ANGELES, CA. 90012
Please report promptly at ~2~:~3~0~~P~M.
If the judge finds you qualified for naturalization, you will be sworn in as a citizen.
YOU MUST BRING WITH YOU THE ITEMS MARKED [!j BELOW:
[!j This letter, WITH ALL OF THE QUESTIONS ON THE OTHER SIDE ANSWERED IN INK OR ON A TYPEWRITER.
[!] Alien Registration Receipt Card.
[!] Reentry Permit, or Refugee Travel Document.
[!] Any Immigration documents you may have.
D Your child (children): __________ _
Ii] Other Please bring 2 (2x2) front view photos with you to the court house and sign your certificate there.
Proper attire should be worn in court.
If you cannot come to this hearing, return this notice immediately and state why you cannot appear. In such case, you will be sent another notice of hearing at a later date.
Form N-445 C r,...,.,rry L \J j J tL !\
24
U.S. Department of Justice
Immigration and Naturalization Service
To Petitioner:
In connection with the hearing to be held on your petition for naturalization, answer each of the questions below "Yes" or "No" without giving any further explanation.
The questions refer only to what has happened after the date you appeared and filed your petition for naturalization. They do not refer to anything that happened before that date.
After you have answered every question, sign your name, give your address, and fill in the date and place of signing.
You must BRING THIS COMPLETED LEITER WITH YOU to the hearing and give it to the naturalization examiner, who will question you further on your answers. '
After the date you filed your petition:
1. Have you married, or been widowed, separated, or divorced? (If "yes" please bring the proper document, i.e.: marriage certificate, death certificate, divorce decree, separation agreement, etc.)
2. Have you been absent from the United States?
3. Have you knowingly committed any crime or offense, for which you have not been arrested; or have you been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law or ordinance, including traffic violations?
4. Have you joined any organization, including the Communist Party, or become associated or connected therewith in any way?
5. Have you claimed exemption from military service?
6. Has there been any change in your willingness to bear arms on behalf of the United States; to perform non-combatant service in the armed forces of the United States; to perform work of national importance under civilian direction, if the law requires
(I) Answe, -/4.. (2) Answer
(3) Answer
(4) Answer
(5) Answer
it? (6) Answer
1 7. The law provides that a petitioner for naturalization shall not be regarded as a person of good moral character who, at any time after the filing of the petition for
1
/
naturalization, has advocated in polygamy or been a polygamist; received income mostly from illegal gambling; been a prostitute or procured anyone for prostitution;
1,
knowingly and for gain encouraged or helped an alien to enter the United States illegally; been an illicit trafficker in drugs or marihuana: or has been a habitual J_&__ drunkard. Have you been such a person or committed any of these act,? (7) Answer
1 .
I certify that each of the answers shown above were made by me or at my direction, and that they/ are true and
(b)(6)
L INSTRUCTIONS: USE TYPEWRITER. BE SURE ALL COPIES ARE LEGIBLE. Failure to answer fully al! questions delavs. ac:tic:.. ·
Do Not Remove Carbons: If t- 'writer is not available, print heavily in bto,·1- letters with ball-point pen.
0MB No. 1115-0066 U.S. Depanment of Justice
Immigration and Natural~zation Service ' BIOGRAPHIC INFORMATION ' (b)(6)
(Family name) (First name) (Middle name) ~ALE :I BIRTHDATE (Mo.-Day-Yr.l ii NATIONALITY fllC ,uum·n
H#-1MMIN, Pffll/P ~l'f-,et:) r.J FEMALE 9',,.. 2-4--/9'4'8 CA1\11'j-!)/,4/v A I ALL OTHER NAMES USED (Including names by previous marriages) CITY AND COUNTRY OF BIRTH SOCIAL c:i:r1 IAITY w, Plf IL-- /-1-A-!!!:TMAN ('>TR65 N~) 9£.41\/'TA:);R.l) t)IJT/f.A?./0 ,,.. ..... ~,,,, (If any)I
/ / FAMILY NAME FIRST NAME DATE, CITY AND COUNTRY OF BIRTH (If known! CITY AND COUNTRY OF RESIDENCE.
FATHER r/"f,€TmA-NN, Rvl'eter MOTHER (Maiden name) /IV/tA:!0(!!:-/ •. ,l. 1 /;>t,le/ '5 HUSBAND (II none. so state) FAMILY NAME FIRSTNAME BIRTH0ATE CITY & COUNTRY OF BIRTH DATE OF MARRIAGE PLACE OF MARRIAGE
OR (For wne. give maiden name1
I ~ 4- l/-171716-P~I~ I 91 A/6/,1/ YO.A< C WIFE C)M()Af./L VICJ:::/ t7i i,ss ,:::'A-Us, i~~N, I 11-2~- .e::.-1ry
FORMER HUSBANDS OR WIVES itt nooe, so state)
I nATF ~ P1 "-; I FAMILY NAME (For wife, give maiden name) FIRST NAME RIRT..!f\/iTJ: f\/iTIC AW'\ Pl u ; ,.
. Sr,,e+; A- L.-ISA t...6Wl5 &£/5'/Z/lt!f;,
APPLICANT'S RESIDENCE LAST FIVE YEARS LIST PRESENT ADDRESS FIRST. FROM TO
STREET AND NUMBER CITY PROVINCE OR STATE COUNTRY MONTH YEAR MONTH YEAR
/!E~CINtJ CAt,.1,= v.s;if l'tLl t-- 8"'! PRESENTTIME
Sll!f/li!MW ?A-K$ - cAt.,./F V.S'4 /\1,.iif-,E 7~ A,//6 B"f NYC. NY vs-4 ()t:,, 'S7 F'te.lE ;SEFN: -
APPLICANT'S LAST ADDRESS OUTSIDE THE UNITED STATES OF MORE THAN ONE YEAR FROM TO
STREET AND NUMBER CITY PROVINCE OR STATE COUNTRY MONTH YEAR MONTH YEAR
$11?.,1t-A/"T'Ft11!!(.) - d JVrA RI o cA-wA-04- /'!/St M,+c1 /t!f ~i .. ;:, I LJ\C, v1..- 1,...r,,11v . NONE, SO STATE) LIST PRESENT EMPLOYMENT FIRST FROM TO FULL NAME AND ADDRESS OF EMPLOYER OCCUPATION (SPECIFY) MONTH YEAR MONTH YEAR
NBC. - 3 0 l<.()~P:6/.-t.Ele ~.t.4--24; NY, Ar/ IO I/ Z. A-t:../Tl}te::_ 91!--PI /'/IJ• PRESENTTIME
~ 'SGt.-F r llAR.t o vs Gr/VJL}t..,tJ YE:le.<. \ A-t"'.:n;:) I<!. 147"1 /I', - -JT,.. .,, ).A I ,If!!!./ ./ ~L~
Show below last occupation abroad !f not shown above. (Include all information requested above.)
THIS FORM IS SUBMITTED IN CONNECTION WITH APPLICATION FOR DATE
s~/ 3',ATURALIZATION • OTHER (SPECIFY): 7-:Z.1-6''1 • STATUS AS PERMANENT RESIDENT
If YOlJA NA1Nf AlPHA6ET 15 !N OTHEH IHAN HOMAN Lf'T!ERS WRITE YOUA NAM!: !N YOllR NATIVE: ALPf1ABET IN THIS SPACf
Are all copies legible? ~ Yes PENALTIES: SEVERE PENALTIES ARE PROVIDED BY LAW FOR KNOWINGLY ANO WILLFULLY FALSIFYING OR CONCEALING A MATERIAL FACT.
APPLICANT: COMPLETE THIS BOX (Family name)
BE SURE TO PUT YOUR NAME AND ALIEN REGISTRATION NUMBER IN THE BOX OUTLINED BY HEAVY BORDER BELOW.
(Given name) (Middle name) (Allen registration number)
- (b)(6)
·r /J/--'f'.-CJ(J
26
I
,<
U.S. Depwt,meril of Justice 0MB No. 1115-0066
immigration and Naturd~zation Service ., BIOGRAPHIC INFORMATION (b)(6)
(Family name) (First name) (Middle name) g.MALE ;j·BIRTHDATE (Mo.•Day-Yr.)·· I NATIONALITY FIi i: .111unr-n I
HA/2'.i/Vi.A /V'li / "'.:..t-1 I l! µ ;:: 01,v.,;!Z/ A:..µ :7 FEMALE 0·-2// -~ t?ffi /_,.., 1'./r; Iv' J I • I ; •• I ' V, l· ~ , , , • ....,,, ~,.,., _,, / r
ALL OTHER NAMES USED (Including names by previous marriages) CITY AND COUNTRY OF BIRTH SOCIAL SECURITY NO
PH I j ,I-·. ·ft\/ (: i'nf-t? /Vh/i;C j .ie:.A t\lTFt' li-D ::,~ /r/-.-·r!tn' (If anyl c' ,. v , ...
FAMILY NAME FIRST NAME DATE, CITY AND COUNTRY OF BIRTH (If knownj CITY AND COUNTRY OF RESIDENCE.
/,.//-,./ --FATHER I
r,,.'f.' I'" .'
MOTHER (Maiden name) Fv A~.: [.i(? lL , /;\1 .. ,-.::./ ;, HUSBAND (II none, so state, FAMILY NAME FIRST NAME BIRTHDATE CITY & COUNTRY OF BIRTH DATE OF MARRIAGE PLACE OF MARRIAGE
OR (For wife. give maiden name) ~ I ,7 • //- j7Hte°,; 1-<.it,/f}':K. I /- - c _ ~-1 lvl;IA,/ .YCA:;;::_:-WIFE
[l'J}OA /-IL • . .-,/(,/,;:,/ ,,;r1 1¢; ,~,, 1 Ft<1 t~l-':.- 1 1".;,1,J"J. i .::.:.. _.. I ? t rt 1 -·- l ueA
FORMER HUSBANDS OR WIVES Iii none. so state) I
! FAMILY NAME (For wife, give maiden name) FIRST NAME BIRTHDATE I nAn: ~ Pi Ar'r:: rn: !WlCtir.;F nnr:: ~~1n Pl M'~ ,,. m, ,~ lHO• IAf'C'
.:Si '. f 2 It to ( 5 1i:C'A, IN t-t5A
lt!!:f/J/$- -:f Rr':T£'flctv APPLICANT'S RESIDENCE LAST FIVE YEARS. LIST PRESEr I - ""-' FROM I TO
STREET AND NUMBER i CITY PROVINCE OR STATE COUNTRY MONTH YEAR MONTH YEAR
it; IV CJ 1\/t) I CAtlP v~ ...q 111 j/ ,f,,, fa·,:!/ PRESENTTIME
l:S'h'c K h1 A A/ t 'A.k:5 - C,41.../;:::- i/_:A /'v)~i I(: 7/f:,; .A i/G B9 AIYL /'\/ y i.l~ A c;e, r tft-.7 Pr<G' r ~ Ni -
i
I I
APPLICANT'S LAST ADDRESS OUTSIDE THE UNITED STATES OF MORE THAN ONE YEAR FROM TO
I STREET AND NUMBER i CITY : I
PROVINCE OR STATE COUNTRY MONTH YEAR MONTH YEAR
I B'~y.; ,V7;:: ti ~,r;_; - tf ''-' ?" >i t< I CJ t'A".JAO,t;j Y'1St) 6•1,,q.e lo/~7 APPLICANT'S EMPLOYMENT LAST FIVE YEARS. (IF NONE, SO STATE) LIST PRESENT EMPLOYMENT FIRST FROM TO
FULL NAME AND ADDRESS OF EMPLOYER OCCUPATION (SPECIFY) MONTH YEAR MONTH YEAR
NBC. · .? 0 l;:t1c..!!'6 F"!! t-l~ /,';:,,t: 2A , I,./ 7 /• .. J ·::i' / t; I l Z A'- rt1<_ ~epr, ,•~g:,, PRESENTTIME
~ St!.LcP· (v,r·) 1ovs ;;; f', 1 r.J ,1_ r ,./Ere; c '· _r::,c. rc;k? , ,,-:f; "7'"1 rf'c~-:: ~/Jr" ,,. j,,tJ /;:' I 7';-d /<'
Show below last occupation abroad if not shown above. (Include all informarion requested above.)
THIS FORM IS SUBMITTED IN CONNECTION WITH APPLICATION FOR DATE S,G~';:Jjff' / . - ··-· ~-,..,,.., &ATURALIZATION OTHER (SPECIFY):
.· r ~,. ~ , ,,,,.,.~;,, h .. .rf' .,,/"
7-:l.1-&f . :; '4' .-;,.'. / ';4' ;/;,-,r . / • STATUS AS PERMANENT RESIDENT ,./ / ./ ,•¼1;itw1¾~:'lr,/ ,f_,..<1"" ~fr 1/ .. . l tr
·g ff YOUR NATJV[ ALPHABE1 IS IN OTHER THAN ROMAN LE'TTERS, WRITE YOUR NAME IN YOUR NAf1VF. Al PHAf!ET IN THIS SPACE
Are all copies legible? Yes
PENALTIES: SEVERE PENALTIES ARE PROVIDED llY LAW FOR KNOWINGLY AND WILLFULLY FALSIFYING OR CONCEALING A MATERIAL f'ACt
APPLICANT: COMPLETE THIS BOX (Famlly nall'IIQ
BE SURE TO PUT YOUR NAME AND ALIEN REGISTRATION NUMBER IN THE BOX OUTLINED BY HEAVY BORDER BELOW.
(Given name)
/'
l-l i /_. I
(Middle name) (Allen registration number)
(b)(6)
(OTHER AGENCY USE) INS USE (Office of Origin)
OFFICE CODE:
TYPE OF CASE:
DATE:
/ /
. Form G-325 (Rev 10-i -82) Y
27
I
ORIGl1'.AL
(INS COPY)
- -UNITED STATES DEPARTMENT OF JUSTICE IMMIGRATION AND l\ATURALIZA TION SERVICE
DECLARATION OF INTENDING CITIZEN (This declaration is not evidence of lawful
admission for permanent residence)
(I) My full, true, and correct name is _J1_'ff_f_l_/_/J __ /ii_D_M_~_/Z._D __ H,_~ __ !._M ___ -ft;_N,_'N ___ _ (rull, true and correC1 name, without abbreviation.)
(2J Other name(s) used PHIL- HA-1<-T/VJAN {S"rA-GG N~Me)
( 3) My present place of residence is _.,1 ____________________ ,.IL-___ (:__b_:)_(:__6_:) ___ _ (Number and street)
q131b (City or TownJ (County) (State) (ZIP Code)
(4) Alien Registration Number(s) ..:.A.:___·._ _____________________________ ~
(5) 1 am an alien residing in the United States who:
(A) has been lawfully admitted for permanent residence; or
(B) has been granted the statu~ of an alien lawfully admitted for temporary residence under section 245A (a) (I) of the
Immigration and Nationality Act: or
(C) has been admitted as a refugee under section 207 of the Immigration and Nationality Act: or
(D) has been granted asylum under section 208 of the Immigration and Nationality Act.
(6) I hereby declare my intention in good faith to bec;:ome a citizen of the United States.
l do swear ( affirm) that the statements I have made and the intention I have expressed in this Declaration of Intending Citizen
subscribed b~ me are true to the best of my knowledge and belief.
~~~---(Si~n•ture of Declarant)
PEJl,ALTIES H>R SUBMITTl!'-G FALSE INFORMATION
fede1 ct 1 lav. provide~ !or impr!~unment and, or fine for any false statcn1t:r.U madt m connection with ;Ju:, Dcclan1ti(HL
Received and filed by
(INS Officer)
a! (>n ttm
dav of 19
J·:;rn.1-~'"":,fo~· 07
t: r i ~ ·5-011~
28
(,encrnl Information
i :1. , . . . t ,i;_:"·!a{ Li\ I\'.:-,
i'", u.r, t.d1:..:1i Vi'hv hcL": t:~··::r ac!1n1tt::t1 a~.<., ceiugc:...'
Linder ~t:ctlu1~ 2L-; o: !h~' Inin;i~;at1un df"IC
·\~itlt.Jncd!t~ :\cl. or
i cl) ~di r1licn \vhu ha~ ht:t:n gr~;ntr.:O ct:-.\·lun~ under \Cct:un 20~ u! Uv.: '.tnrT1:~rc.t1~ni ;.1nd \·~:~i 1.)!1Lt1i1:\
,\c'..
lnstru,:tiom for the Alien
\r. <llitT wiH, lalb ,1i1hir: one o! 1t1c iour group~ li.\tCG ;n tnt (:ulurrir: le th~· !~i:. rna~ hu~ i:-- not rt~u1red tu.
L(lmpbc' (il!, Lk-:1ar~lli0n o1 lnL:nd1n~ Ci:;z:::r1. The 1iiing
:'!~ .. -:. 1 ~''..:. !·;,.>\\t'\ ;:; . i> \Hit: ni ~!h pr~T~ljdl~ite:-i r..:~tabli:--hcd b~- ~~-,~:::. 1 ~: :748 uf the lrLn1:f.~·;;1:1u:! :.tuc \at:onaiit;. _,\cl
','.'Hf' ; t\l'• ; 0 • ' •• ,., , \ •· • i • •• ', • ,.,~ I • \• ,' : "1' t 1 , :t)\ ~\I-1 ,:\ ..... , 11, ,,,;_ ,.). lll;,.. t--,~1 .. 1.p, 11",li,.,l~ lli lil'.. 11... \ ,(
c!~"ii:'.·! ~~ Cl(di~\ (lj d;~'---'!·::·rllnHti{:,f; on the b;.,t"lL\ ,y' ci:l/l'i:~,hir;
.. ,1~nu ti'ici~·; ~:JJ1 ~1,,;~::1un. S::-.:::on 2741~ 1J'. :t1: •\,l.'t lur'.hcr p; H.J::. 1.!:.:il in n!·d~:; 1o! an ~di::r \1'hu h ~~iigihit" for
112P,ltr:•1::/al1ur: le· hi.: ahk Hi fik· a citl1~T1\htp di:"ll'.rirn\n~1~ ti{,f 1 .:i~ii:r Lind::.:~· thi·· . .t\c:. !1~ or »he rnust ::!ppl:\ fnI natu~ali.1,::10:, \\'ith1:: :-.i.\ nH;n:h~ u1 Lh~-z:a.te thr: ai1er1 fi:·:it
ntL·orn1~-:-. :._•t1~1nk HJ appiy. :\it 1:r apri_\·1nf for naturaL/a-
11or oii :_i 'UIT!.t"I\' b,;;1"',;~, 1hc :dit:n !TIU'.)l aho Lave been uaturt.1i::1.cC \\ nhin 1-\tu ~~ar~ after the date ol appllcatioIL it: (>roe: t,, ht al11c ,,, ii1c :, rni,rns111p di.,cr1minai1(,n clam: u11der 1h1, .1\ct. unl:::s,, tili:: aiicn can e~tahll\h that he
~tLlte:, lfia~ U1c urnc c..:-.irhurr1ed in the ~)t;-, L.::::\ proct~,~~:n~ the appilcaLiori iur 11<nur,dizati(JL sl1aL nu, b,: cuu;rnx1 ui-...i..,ard the ~,\\,1..,-veai ptr1ud.
lni~ Dcda:ation 01 !nknd:ng Citi1en i.s. not n.:u,uired a~ a ba~i, ",ur iiiin~, a retil\\)n lo: natura\init,on. :''iOr sh<.1li th1~ Lkcl,ffa:,un b( rcgard(:d a, cunJcrnng r,r having cc,nkrrcd uron thc f)(T,on wh<• filed it United State, cit11•~Ibilip or na1iunai1t1 •:H the right tu l nited State~. c1ti1en,hip or natiolialit,. nor shall t!ii~ Declaration be: n:gJrdt:d a:. e\·1d:.:n:.::~ u! ~,uch p('r,1..,un·.·. 1~1'Nful adn1i'.'l\iun
L·lr pcnT1t.n1•.::nt re~td~·nce
l:t1i))r[i'. . .f;:,;f; rro\iji_:,(: ~: 1n; (\i1··n nr, t.h-~ f)e:_•;;_!'."tdH'! {1! ~l11t'ndl!1f ('i;:1'.:f'I !!' I't~'-f10r1\C 1,() par<-i1;raph1... (I} (2) t_l) and (4,l
,h:,u,(i b,~ 1,:,ped ur printui kg1bh ,:1 1111'. l pu11 c:m1p'.t:t1nt ,!1~ :\lrrn. the: ak:1, ,twu1d wr,d the u~il-!ina! and the attached duplicate Ci'P\ lo lht ldf1ee 111 th:: lrnrntg,ation ,rnci \atural:1at101, ~;e,·vicc ha\in1:2 JUrt\diclion mer the: alien\ rlacc o1 i·(~1tLnc1:- ,\ftc~ ~1n lnir-r11gra;i11r: an:) \i:itu1·alL'(ll.'11n Scr\·1cc 1/f'iccr rc\ic\,;.··-, dnd fil(''~ :hi.., I):,·c~aratinn. 1hc nffir('r v,:j1J \end
tLL' cJup!1(.·att: C(Jr~ bacL tu tne ~ii~r., ·rl1t: :dH .. 'P ~J1quld rc~ain the dup!u.:atc.
- a 29
ORIGII\AL
(INS COPY)
- -UNITED STATES DEPARTMENT OF JUSTICE IMMIGRATION AND NATURALIZATION SERVICE
DECLARATION OF INTENDING CITIZEN (This declaration is not evidence of lawful
admission for permanent residence)
( 1) My fulL true, and correct name is _Pi_w--,----1 l_!_P_G._D _____ W_,'1_,e._D __ /l,~tA_f!!._T._/11_.fn_M_'N __ (Full. true and correct name. without abhrcviat,on.J
(2) Other name(s) used: __ P_H_I L-_H_A-:'------12-_T /11--------"-'A-N---'----U~>_7i_~'------'------"-------N___c__Ai_M_e_).,,,__ __ _
(3) My present place of residence is J I (b)(6) tirnmB : ans .hi&()
ENCINO q/3/b (Clly or Town) (County) (Slate) (ZIP Code}
(4) Alien Registration Number(s): 3:.A~-._ ________ ..._ __________________ _
(5) lam an alien residing in the United States who:
(A) has been lawfully admitted for permanent residence; or
(BJ has been granted the status of an alien lawfully admitted for temporary residence under ~ect1on 245A (a) ( l) of the
Immigration and Nationality Act; or (C) has been admitted as a refugee under section 207 of the Immigration and Nationality Act: or (D) has been granted asylum under section 208 of the Immigration and Nationality Act.
(6) I hereby declare my intention in good faith to beyome a citizen of the United States.
I do swear (affirm) that the statements I have made and the intention I have expressed in this Declaration of Intending Citizen
;ubscrihed by me are true to the best of my knowledge and belief
-·-~ (Si~nature of Declarant)
PEJ\ALTIES FOR St:BMITTING FALSE INFORMATION
FeJe1ai law provide, for 1mpri,onmcnt and,'or fin~ for any false statement, made 1n corrncct1or, 11ilh :hi:• Ded;,rat",1,
rPrrT !-T'2!07 07 '67)
U ,,rn t: ' ! ! S-0 I 3X
Received and filed b)
at
day of
(I NS Officer)
!9
30
DECLARATIO'', or ll\TL\Dlr-..;(; C!TIZE'\
READ THE FOLL0\\'11\(; 1r--;Fmn,1A'il0!\ ( /1,RUTLL\
;;en::,al lnformation
iii:: ,i:11f u! UH~ 1Ji::claruu .. 1r; ul lnLC.:JH.Ln~ ( '1t1/i:n v, i~h tht iti:.::·::gra~iun UriU \,~~:..::·{li~/LH1or. Ser\ 1cc .~ rcljuir::d in
i1 u-__·. at: ~t~1cn. \,\·bt:; iJl~ \\ :th1r: !1il~ uf thl.' four~: dt1p> i:.-.l... ~- '.1':;c•\\. :(, t1~:t1.:n {; :.,..:lJ.:rr1 ol lL:--.c~in11n;:~tiuC OP the
t,;_~\: 1 '. ,..:_:L't.'.'!bh1.p ';~~i~Lh ur:d:..'!' ... t·:._·11~1!: 27 48 d1 lh~ ~t 01. and '\::.:1tl(li1al:~~ /\(~. C•nl: ih~ lodo\\ill~
,1 1Jr,. ~i:u.::n~ rna\ a:-;:,s.:n i,u._.·(: Chcn!l!ina:1(1!1 1..,:lairn:-·
ii, an ~:lien whc! ha~ ht::.:11 gr~1ntcd th'...' :-1:atu:1 oi an aiier: iav.-full~\ acitnit1.1.·J L>i" ~'.::tnporar:, rrsidc:t,.:e
u.nder ~ection 2-.+5,~. fa\ (I) pf th:: Irn1niy_rali()n ano \mi,malit:- •\c: or
11.:; 1.tn alien \\·ho ha;) ~)t'en ad :nitted a~, J refugt':.:
LH1dtr :,ect1or. 20-· ui tht: lmrni5'catiun ..:nd
\ dtionaJ.it:~ /\ct: or
id 1 :.i,1 alien whu hJ., hecn grnntl'.d a,ylum undu ~i.:,.;\i(Jn 2U~ u: th•c !mrnigr:ni,.111 and \,ttio11ali1:, /\ct.
Instruction~ for the Alien
\r, alien Vlhu rall,c, \,irnin om o: H;c· 1ou; group, l1,tl'ci in :he L'.ulun1rr tz; th:.· lei: rna~. ru~ 1: nut r~LJuin.:d to. ~-uinpl~tL· thls I)t.\.:laratiun of lnl· .. ~n<.lin~ c·i:izcn. rh~- fiiing ul thi:_, i\J:Tn \\Jti". lnt· lnnrdf!l"d\t(,!· ~:n(\ \aturali1.auor1
h:,. i"\.<:tior: ~-4H :,d !li:: lr~·~ni:~~-?!:._;r, ~:nrJ ,,.,·•~auunaiil> ;\c~ , /i~l: 1 1_': :tr ~~iicn 1L (;qc \ 1~ th: I:=;·c:.:p· ii'}1ed ~t- .h-.· le!· 1
• ::
it,\\lT1 d t..:lUi!Tl t.ifJi~~·r·1!l1:I~d.lh; un UH' :·id'.'>.l:) t";' .:.::.·(,.''. ~1~,hlp
pru\ I\.!:::· tliaL 1r; (;!'dt:: :{ 1r <.Hi ali·.~1 ~Tn: 1:•, l
t1cnurJ'.:1at;on tc\ he ai1\c lt~ t"uc, ::_: c1L/~~nsi11p di.-,i..'!llTili'ii.\
li(ln l'lanr ur1d~r th~~ /\,~;· r1c en· .'111·: rnust appl> i'o:
ndturcdi/(tti(JL \\ ith:r \:.) rnn::1 h~ t:! 1h:." cL1tr th~: ai!cI1 fi>,l
hc":t;r11t.:•,
~ion un a tin1ely b:t~i,... 1hr aii~:Ij rnu:·•/ a.1;,~, Len< bt.·::n r;aLL;raL,1ed \\'ithtn l\'>.J :,·.:ar:•, after :Ile date o~ aprl1c..:a1icn. 1n order to ht a.i'>lt Li.I filt· a ci~11<..:nshir, di,')cn1n1nat1or. cl,urn und~r 1hi, .!\ct. Ulib,, ,ht alicr, ,:~n ::s\ablht·, •.hat he
state~ tha1 the 1i1ne (.'Ori:)un1td 1n the Set\ i:.::__·\ pr;s>~~\~ln~1
the arpllc;.dion ior nr. .. tu:-tdii~1tior: shaL nut t,c cuuntt:d 1;.waid the :,hH't:ar pt:nud
l l1i,~ !Jeclarat1on u1 lnt::nd:ng ( iu1el! i\ nut rn,1u,red a~ c:
ba,ic for filing d p·:tit1\ln i,ir naturalin1t1on. 1,or shall tt11:. Licclaration he r::garlicci a, n,nferrin!-' m ha 1, ing ,;1,r,
terTl'd u pl,n the per,, lll wr1( 1 ii kd It t., nitcd Sta tee citi/cn,hir ,,: nationaiil\ ur thl rigin tu l nitcd ~talc' citilrnship nr nat1on,1lit1, nor cha!! tlii~ Ucclaratinn b, n:garch~d u~, e\·ldencc uf >iuch pt:r.')un·.\ L.1\vlui adrr1i:-J.,ior;
for pern1ancnt residence
1 ti[ nc,,,,r1,,r1 b:. 1he alien r,n th:.' j)et·la~·atiun 1)/ intending. (·i1i1r.:n in rt:~:p(ln<.,t· tu n:ir,i,on,n1" ~.1) and (4~
,h,uic he 1.\pcd 01 [liintn1 kgihly in ink. l pon cornpkting the furm. the aii::n ,ll(luid ,::ncl the original and the attached dur!i~a1c n 1py to the Pi!iec c1i the lrmnigration and l\aturali1a1ior1 Ser\ 1cc having Juri,diction o,t:r ,he alien\ piact ui !'( 'J;dcncr :.\ftc~ an ;n1rn:gr~1tH!f~1 a;1d \atui-ali1,ntion Scn;icc \1tficcr rt,\ il'Vv:-S and fil::--.. thi:-. I )cclaratH1r. the officer \\'ill :..('ntl
tiw duri;ca,c ;;op:1 h;ick tu the aiicn. The alil'n ~lrnuld retain the duplicate.
31
•:· ;, i 7·. )'"' .._,. ,:·: ...... ,i. i\ !,,' ::: .... , ,;:,
(-.!
: · .. , ____ _. ,il. . ·w, .:1.' '!!"'
!...IC.
!? .. , .. ,... ,1,/ •••
.. 1::. ~::. ?-. . L l :::, [' .. ,. ;·\;,..;
:o FTF'.:
; •• l
: .. :' .. .! . 'i'
Hi:::: ... : .. : . ....
(b)(6)
: .. , ,,)
: )'!'!'"'
:,: .:. : ••• /.J
32
i ~-· ., ::) !
,-,, . ' ✓' ~ /
-~ fT'\ rr, r
(b)(6)
33