Fill and Sign the Verification Number Form

OMB # 1115-0122 Document Verification Re quest 6. Verification Number To: Immigration and Naturalization Service 7. Photocopy of Document Attached. (If printed on both sides, attach a copy of the front and of the back.) Other Information Attached (Specify documents). 8. Organization (specify) From: Typed or Stamped Name and Address of Submitting Agency Attn: Status Verifier 1. Alien Registration or I-94 Number 2. Applicant's Name (Last, First, Middle) 9. Name of Submitting Official 3. Nationality 10. Title of Submitting Official 4. Date of Birth (Month/Day/Year) 11. Date 5. Social Security Number 12. Telephone Number INS RESPONSE: From the documents or information submitted and/or a review of our records we find that: 1. This document appears valid and relates to an alien who is a conditional entrant. This document appears valid and relates to a Lawful Permanent Resident alien of the United States. 8. 9. 2. 10. This document appears valid and relates to an alien not authorized employment in the United States. 3. Full-Time 11. Continue to process as legal alien. INS is searching indices for further information. a. Part-Time b. No Expiration 12. This document is not valid because it appears to c. d. Expires on be (check all that apply) Expired (specify Month/Day/Year, below) a. Altered b. This document appears valid and relates to an alien who has an application pending for Counterfeit 4. (speci fy INS bene fit below ) INS Stamp This document relates to an alien having been granted asylum/refugee status in the United States. 5. This document appears valid and relates to an alien paroled into the United States pursuant to Section 212 of the I&N Act. 6. 7. Please see reverse for additional comments. U.S. Department of Justice Immigration and Naturalization Service Section A - to be completed by the submitting agency. Section B - to be completed by INS. (INS may use above address with a #20 window envelope.) This document appears valid and relates to a Conditional Resident alien of the United States. This document appears valid and relates to an alien authorized employment as indicated below: This document appears valid and relates to an alien who is a Cuban/Haitian entrant. This document appears valid and relates to an alien who is a nonimmigrant. (specify type or class below) c. Form G-845 (Rev. (06/14/00) Y .Comments No determination can be made from the information submitted. Please obtain a copy of the original alien registration documentation and resubmit. 14. No determination can be made without seeing both sides of the document submitted (please resubmit request). 15.Copy of document is not readable (please resubmit request). "PRUCOL" 16. INS actively pursues the expulsion of an alien in this class/category. 17.INS is not actively pursuing the expulsion of an alien in this class/category, at this time. 18. Other Instructions Submit copies of both front and back of alien's original documentation. . Make certain a complete return address has been entered in the ''From" portion of the form. The Alien Registration Number ("A" Number) is the letter "A" followed by a series of (7) or (8) digits. Also in this block may be recorded the number found on Form I-94. (Check the front and back of the I-94 document and if the "A" Number appears, record that number when requesting information instead of the longer admission number as the "A" Number refers to the most integral record available.) If Form G-845 is submitted without copies of applicant's original documentation, it will be returned to the submitting agency without any action taken. Address this verification request to the local office of the Immigration and Naturalization Service. 13. For Purposes Of Determining If Alien Is Permanently Residing Under Color Of Law Only! . . . . Form G-845 (Rev. (06/14/00) Y Page 2