| Date of Intended departure(Month/Day/Year)10/31/95 | Expected length of trip1 week to 10 days |
| Are you, or any person included in this application, now in exclusion or deportation proceedings?☐No ☐Yes, at(give office name) |
| If applying for an Advance Parole Document,skip to Part7. |
| Have you ever before been issued a Reentry Permit or Refugee Travel Document?☐No ☐Yes(give the following for the last document issued to you) |
| N/A | Date Issued | Disposition(attached, lost, etc.) |
Form I-131 (Rev. 12/10/91) N
# FOR INS USE ONLY
| Returned | Receipt |
| :--- | :--- |
| ___ | ___ |
| Resubmitted | ___ |
| ___ | ___ |
| Reloc Sent | ___ |
| ___ | ___ |
| Reloc Rec’d | ___ |
| ___ | ___ |
| □ Applicant Interviewed on | |
**Document Issued:**
- □ Reentry Permit
- □ Refugee Travel Document
- □ Single Advance Parole
- □ Multiple Advance Parole
Validity to ___
**If Reentry Permit or Refugee Travel Document**
- □ Mail to Address in Part 2
- □ Mail to American Consulate
- □ Mail to INS overseas office
AT
**Remarks:**
- □ Document Hand Delivered
On By
**Action Block**
*Denied*
Assured as expected
10/17/15
MC 1018195
**To Be Completed by Attorney or Representative, if any**
- □ Fill in box if G-28 is attached to represent the applicant
**VOLAG#**
**ATTY State ID:** SONYE_GM_00000733
EFTA_00114817
EFTA01263139
# Part 3. Processing Information. (continued)
Where do you want this travel document sent? (check one) N/A
a. □ Address in Part 2, above
b. American Consulate at (give City and Country, below)
c. INS overseas office at (give City and Country, below)
City Country
If you checked b. or c., above, give your overseas address:
## Part 4. Information about the Proposed Travel. N/A
Purpose of trip. If you need more room, continue on a separate sheet of paper.
List the countries you intend to visit.
## Part 5. Complete only if applying for a Reentry Permit. N/A
Since becoming a Permanent Resident (or during the past five years, whichever is less) how much total time have you spent outside the United States?
□ less than 6 months □ 2 to 3 years
□ 6 months to 1 year □ 3 to 4 years
□ 1 to 2 years □ more than 4 years
Since you became a Permanent Resident, have you ever filed a federal income tax return as a nonresident, or failed to file a federal return because you considered yourself to be a nonresident? (if yes, give details on a separate sheet of paper)
□ Yes □ No
## Part 6. Complete only if applying for a Refugee Travel Document. N/A
Country from which you are a refugee or asylie:
If you answer yes to any of the following questions, explain on a separate sheet of paper.
Do you plan to travel to the above-named country?
□ Yes □ No
Since you were accorded Refugee/Ayyle status, have you ever: returned to the above-named country; applied for prior obtained a national passport, passport renewal, or entry permit into the country; or applied for prior received any benefit from such country (for example, health insurance benefits)?
□ Yes □ No
Since being accorded Refugee/Ayyle status, have you, by any legal procedure or voluntary act, re-acquired the nationality of the above-named country, acquired a new nationality, or been granted refugee or ayyle status in any other country?
□ Yes □ No
## Part 7. Complete only if applying for an Advance Parole.
On a separate sheet of paper, please explain how you qualify for an Advance Parole and what circumstances warrant issuance of Advance Parole. Include copies of any documents you will consider. (See instructions.)
□ 1 trip More than 1 trip
For how may trips do you intend to use this document?
If outside the U.S., at right give the U.S. Consulate or IRS office you wish notified if this application is approved.
## Part 8. Signature.
Read the information on penalties in the instructions before completing this section. You must file this application when in the United States if filing for a reentry permit or refugee travel document.
I certify under penalty of perury under the laws of the United States of America that this petition, and the evidence submitted with it, is a true and correct.
I authorize the release of any information from my records which the Immigration and Naturalization Service needs to determine eligibility for the benefit I am seeking.
Signature Date 10/6/95 Detime Telephone #
Please Note: If you do not completely fill out this form, or fail to submit required documents listed in the instructions, you may not be found eligible for the requested document and this application will have to be denied.
## Part 9. Signature of person preparing form if other than above. (sign below)
I declare that I prepared this application at the request of the above person and it is based on all information of which I have knowledge.
Signature Print Your Name Date
Firth Name Daytime Telephone #
and Address ( )
EFTA01263140
Part 3. Processing Information. (continued)
# Part 4. Information about the Proposed Travel.
N/A
Purpose of trip. If you need more room, continue on a separate sheet of paper.
List the countries you intend to visit.
## Part 5. Complete only if applying for a Reentry Permit.
N/A
Since becoming a Permanent Resident (or during the past five years, whichever is less) how much total time have you spent outside the United States?
□ less than 6 months
□ 6 months to 1 year
□ 1 to 2 years
□ more than 4 years
Since you became a Permanent Resident, have you ever filed a federal income tax return as a nonresident, or tailed to file a federal return because you considered yourself to be a nonresident? If yes, give details on a separate sheet of paper.
□ Yes
□ No
## Part 6. Complete only if applying for a Refugee Travel Document.
N/A
Country from which you are a refugee or asylee:
If you answer yes to any of the following questions, explain on a separate sheet of paper.
Do you plan to travel to the above-named country?
□ Yes
□ No
Since you were accorded Refugee/Aysee status, have you ever: returned to the above-named country, applied for an avior obtained a national passport, passport renewal, or entry permit into this country, or applied for an avior received any benefit from such country (for example, health insurance benefits)?
□ Yes
□ No
Since being accorded Refugee/Aysee status, have you, by any legal procedure or voluntary act, re-acquired the nationality of the above-named country, acquired a new nationality, or been granted refugee or asylee status in any other country?
□ Yes
□ No
## Part 7. Complete only if applying for an Advance Parole.
On a separate sheet of paper, please explain how you qualify for an Advance Parole and what circumstances warrant issuance of Advance Parole. Include copies of any documents you wish considered. (See instructions.)
For how may trips do you intend to use this document?
□ 1 trip
□ More than 1 trip
If outside the U.S., at right give the U.S. Consultate or INS office you wish notified if this application is approved.
Signature
Date
10/6/95
Please Note: If you do not completely fill out this form, or fail to submit required documents listed in the instructions, you may not be found eligible for the requested document and this application will have to be denied.
## Part 8. Signature of person preparing form if other than above. (sign below)
I declare that I prepared this application at the request of the above person and is based on all information of which I have knowledge.
Signature
Print Your Name
Date
Firm Name
Daytime Telephone #
and Address
( )
★ U.S. GPO:1994-301-164/92741
SDNY.GM.0000735
EFTA_00114819