J I I L
LANAM
J L
FIR
J L
COU
ST
ALIENS SHOULD READ INSTRUCTIONS BELOW BEFORE FILLING OUT
OTHER PART OF CARD (BLOCKS ARE FOR GOVERNMENT USE ONLY)
INSTRUCTIONS
ITEM (2)--LOOK AT THE NUMBER ON YOUR ALIEN CARD.    THE
NUMBER MAY HAVE THE LETTER "A" BEFORE IT.   COPY ON THIS
CARD THE LETTER AND NUMBER EXACTLY AS THEY APPEAR ON
YOUR ALIEN CARD.
ITEM (3)--IF YOU ARE A PERMANENT RESIDENT OF THE UNITED
STATES, STATE YOUR PERMANENT ADDRESS, IF NOT, SHOW
YOUR ADDRESS IN THE UNITED STATES AS OF THE DATE OF
THIS REPORT.
J L
YOB
J L
NAT
J L
OCC
ITEMS02) AND(13)—IF YOU HAVE EVER BEEN EMPLOYED IN
THE UNITED STATES, STATE YOUR OCCUPATION AND THE NAME
AND ADDRESS OF YOUR PRESENT OR MOST   RECENT EMPLOYER.
IF NEVER EMPLOYED WRITE NONE IN ITEMS (12) AND (13).
WHEN  COMPLETED-HAND THIS CARD
TO CLERK IN ANY  U.S. POST OFFICE.
DO NOT MAIL
DO NOT  FOLD OR TEAR'
1965   ALIEN  ADDRESS REPORT
Complete ail items.
Type or print answers.
(I) MY   NAME IS
Hi
(FfiMlliY)
i)N
M.
(MIDDLE)
(3) MY ADDRESS IN THE UNITED STATES IS (FILL IN ALL APPROPRIATE ITEMS)
(2) MY REGISTRATION LETTER
ANO NUMBER ARE
(IN CARE OF)
(4) MY SEX IS
QMALE      M FEMALE
TES IS (FILL IN ALL APPROPRIATE ITEMS) ^ / i /
*0RNIN(C0UNTRY)|(6) THE DATE OF MY BIRTH IS [ (7) I AM A CITIZElTOF (COUNTRY)
(APARTMENT NUMBER)    /(I
(5) I WAS BORNIN(COUNTRY)|
(8) I ENTERED THE UNITED STATES AT
(PLACE OF ENTRY)	
(II) I HAVE LIVED AT THE
ADDRESS SHOWN IN tTEM (3)
FOR 	
(NUMBER OF YEARS)
4)    A, 21 1   gjQ'Wfl-
(9) I ENTERED THE UNITED STATES ON
(DAY) (MONTH)        (YEAR)
(12) OCCUPATION
Mtrw^i/E^
(10) l AM IN THE UNITED STATES AS
(CHECK ONE)
rt?l PERMANENT RESIDENT     □ STUDENT
□ VISITOR a EXCHANGE ALIEN
□ CREWMAN
□other	
(13) MY PRESENT OR MOST RECENT EMPLOYER IN THE UNITED STATES IS
(NAME OF FIRM OR COMPANY) (STREET ADDRESS)
(14) I CERTIFY   THAT  THE  ABOVE STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE
SIGNATURE OF ALIEN (IF UNDER 14 YEARS OF AGE,
SIGNATURE OF PARENT OR <?UA^WtlJ)    / y"    y DATE      f
SIGN YOUR NAME AND INSERT THE DATE ON WHICH YOU FILLED OUT THIS CARD
685471  BSC
VNITED   STATES DEPARTMENT OF JUSTICE   IMMIGRATION AND NATURALIZATION SERVICE