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Alien Details
| Household Member | [Full Name] |
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| Current Alien Status |
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| Alien Status on Entry |
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| Date of Entry |
| End Date |
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| Country/Region of Origin | |||
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| Country/Region of Citizenship | |||
| Country/Region of Birth |
| Registration Number | INS Section | ||||||
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| Date Last Left Country |
| Date Alien Status Granted |
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| Indigent Alien | Continuously Residing in Country since Date of Entry |