| Date of Intended departure(Month/Day/Year)10/17/95 | 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
Continued on back.
$$\begin{array}{l}
08.11 \\
2 \\
370.00
\end{array}$$
# FOR INS USE ONLY
| Returned | Receipt |
| :--- | :--- |
| ___ | ___ |
| Resubmitted | ___ |
| ___ | ___ |
| Reloc Sent | RECEIVED 3rd FLOOR CASHIER OCT 17 1995 Immigration and Naturalization Service New York, N.Y. |
| ___ | ___ |
| Reloc Rec'd | ___ |
| ___ | ___ |
| □ Applicant Interviewed on | |
**Document Issued**
- □ Reentry Permit
- □ Refugee Travel Document
- □ Single Advance Parole
- □ Multiple Advance Parole
Validity to **OCT 17, 1996**
**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**
**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:** M_00000737
APPROVED
OCT 17 1995
NYC | 5329
EFTA_00114821
EFTA01263143
# 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
- [ ] 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 becoming a Permanent Resident (or during the past five years, whichever is less) how much total time have you spent outside the United States?
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 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/Asylee status, have you ever: returned to the above-named country; applied for an/or obtained a national passport, passport renewal, or entry permit into this country; or applied for an/or received any benefit from such country(for example, health insurance benefits)? | Yes | No |
| Since being accorded Refugee/Asylee 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. Consulate or INS office you wish notified if this application is approved.
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. Consulate or INS 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 while in the United States if filing for a reentry permit or refugee travel document.
I certify under penalty of perjury under the laws of the United States of America that this petition, and the evidence submitted with it, is all 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 10/16/95
Daytime Telephone # (212) 750-9895
**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)