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Baker Combined File

The document contains multiple email communications regarding appointment confirmations for a returning resident visa for Baker Saada. The first appointment is scheduled for November 25, 2022, and the second for February 14, 2024, both at the U.S. Consulate in Nairobi. Required documents and courier details for visa delivery are also provided, along with an application for returning resident status outlining necessary evidence and personal information.

Uploaded by

lelisinabaker
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
0% found this document useful (0 votes)
21 views33 pages

Baker Combined File

The document contains multiple email communications regarding appointment confirmations for a returning resident visa for Baker Saada. The first appointment is scheduled for November 25, 2022, and the second for February 14, 2024, both at the U.S. Consulate in Nairobi. Required documents and courier details for visa delivery are also provided, along with an application for returning resident status outlining necessary evidence and personal information.

Uploaded by

lelisinabaker
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Brian Aust

From: Saada Said <saadasaid336@[Link]>


Sent: Wednesday, November 23, 2022 2:49 PM
To: Brian Aust
Subject: Fwd: Returning Resident Appointment Confirmation

Caution: External (saadasaid336@[Link])

First-Time Sender Details


Report This Email FAQ GoDaddy Advanced Email Security, Powered by INKY

---------- Forwarded message ---------


From: <donotreply@[Link]>
Date: Wed, Nov 23, 2022, 12:30 PM
Subject: Returning Resident Appointment Confirmation
To: <saadasaid336@[Link]>
Cc: <saadasaid336@[Link]>

The U.S. Department of State Consulate in Nairobi has scheduled a Consular interview to review your request for
obtaining a returning resident appointment. You must bring a copy of this email to your interview. Your appointment
details are:

Applicants
Applicant Name: Baker Saada
Passport Number: EP6222314
Consular Interview Date: 25 November, 2022, 07:00 Nairobi local time
Consular Section Location: Nairobi
Consular Section Address: United Nations Avenue Nairobi P. O. Box 606 Village Market, Nairobi, 00621, KE

Required Documents for Returning Resident Visa


 A Valid Passport
 For a complete list of required documents and fees, please visit: [Link]
visas/immigrate/[Link]#4

For additional information and requirements visit: [Link]


[Link]

Courier Selection details


1
Courier: DHL Express
Branch name: DHL Nairobi Yaya Centre
Address: Yaya Centre Ground Floor Arwings Kodhek Road, Nairobi, NI 200, KE

You only have until 25 November, 2022, 06:00 local time to change the location where your visa documents will be
delivered. After the time indicated above, the option to change the courier location will be deactivated from your
account and at this point no courier changes will be allowed.

Best regards,

The GDIT Visa Appointment and Information Service Team

2
From: Saada Said
To: Brian Aust
Subject: Fwd: Returning Resident Appointment Confirmation
Date: Thursday, January 4, 2024 [Link] PM

External (saadasaid336@[Link])

Report This Email FAQ GoDaddy Advanced Email Security, Powered by INKY

I have an appointment on Feb 14th what will they interview me about

---------- Forwarded message ---------


From: <donotreply@[Link]>
Date: Thu, 4 Jan 2024, 3:21 pm
Subject: Returning Resident Appointment Confirmation
To: <saadasaid336@[Link]>
Cc: <saadasaid336@[Link]>

The U.S. Department of State Consulate in Nairobi has scheduled a Consular interview to
review your request for obtaining a returning resident appointment. You must bring a copy of
this email to your interview. Your appointment details are:

Applicants
Applicant Name: Baker Saada
Passport Number: EP6222314
Consular Interview Date: 14 February, 2024, 06:30 Nairobi local time
Consular Section Location: Nairobi
Consular Section Address: United Nations Avenue Nairobi P. O. Box 606 Village Market,
Nairobi, 00621, KE

Required Documents for Returning


Resident Visa
A Valid Passport
For a complete list of required documents and fees, please visit:
[Link]

For additional information and requirements visit:


[Link]
Courier Selection details
Courier: DHL Express
Branch name: DHL Nairobi Yaya Centre
Address: Yaya Centre Ground Floor Arwings Kodhek Road, Nairobi, NI 200, KE

You only have until 14 February, 2024, 06:00 local time to change the location where your
visa documents will be delivered. After the time indicated above, the option to change the
courier location will be deactivated from your account and at this point no courier changes
will be allowed.

Best regards,

The GDIT Visa Appointment and Information Service Team


U.S. Department of State OMB CONTROL NO.1405-0091
EXPIRATION Date: 05/31/2023
APPLICATION TO DETERMINE ESTIMATED BURDEN: 30 MINUTES*
RETURNING RESIDENT STATUS
INSTRUCTIONS
This is an application for Special Immigrant Status under Section 101(a)(27)(A) of the Immigration and Nationality Act, for lawfully admitted permanent
residents who are returning from a temporary visit abroad. To qualify you must submit with this application evidence that:
(1) You had the status of an alien lawfully admitted for permanent residence at the time of departure from the United States;
(2) You departed from the United States with the intention of returning and you have not abandoned this intention; and
(3) You are returning to the United States from a temporary visit abroad and, if the stay abroad was protracted, this was caused by reasons
beyond your control and for which you are not responsible.
Applicants must submit evidence with this application to support the above requirements, including proof of lawful permanent residence
(Examples: Form I-151, I-551, Reentry Permit, etc.), dates of travel outside of the United States (Examples: airline tickets, passport stamps, etc.), proof
of ties to the United States and intention to return (Examples: tax returns, and evidence of economic, family and social ties to the United States), and
proof a protracted stay was for reasons beyond the applicant's control (Examples: medical incapacitation, employment with a U.S. company,
accompanying a U.S. citizen spouse, etc.) All documents will be returned to you.
1. Family Name First Name Middle Name
BAKER Saada Said
2. Other Names Used, Aliases (If Married Woman, Give Maiden Name)

3. Current Home Address and Telephone Number

Eastleigh, Section 1, Nairobi, Kenya; +254 796665111

4. Place of Birth (City, Province, Country) 5. Date of Birth (mm-dd-yyyy)


Nairobi, Kenya 11-18-2000
6. Marital Status
Married ✘ Single (Never Married) Widowed Divorced
If married, information about spouse
a. Name (Last, First, MI) N/A N/A N/A
b. Address N/A
c. Place of Birth N/A
d. Date of Birth (mm-dd-yyyy)
e. U.S. Residence Status, if any (U.S. Citizen, Legal Permanent Resident, Etc.) Legal Permanent Resident
f. Date of Marriage to You (mm-dd-yyyy)

7. List Below All Close Family Members in the United States (Continue on Separate Page if Necessary.)
Full Name Relationship Resident Status Place of Residence
Said Bakri ABDULLAHI Father U.S. Citizen Minneapolis, MN, USA
Sumeya Said BAKRII Sister U.S. Citizen Minneapolis, MN, USA
Ahmed Said ALI Brother U.S. Citizen Minneapolis, MN, USA
Sumrah Said SAID Sister U.S. Citizen Minneapolis, MN, USA
8. Previous Immigration Record
a. DHS "A" Number 063891998 b. Immigration Category IR2
c. Previous Immigrant Visa d. Adjustment of Status
Date of Issue (mm-dd-yyyy) Place of Issue Date of Adjustment of Status Place of Adjustment of
with DHS (IF ANY) (mm-dd-yyyy) Status with DHS (IF ANY)
12-01-2014 Addis Ababa, Ethiopia

e. Initial Entry into the United as Lawful Permanent Resident f. Last Entry into the United States as Lawful Permanent Resident
Date of Entry (mm-dd-yyyy) Port of Entry Date of Entry (mm-dd-yyyy) Port of Entry
12-11-2014 Washington, DC 12-11-2014 Washington, DC
9. Most Recent Departure from the United States
Date of Departure (mm-dd-yyyy) 06-21-2017 Destination Ethiopia
Reason To visit relatives
10. What continuing ties have you maintained with the United States? What efforts have you made to avoid abandoning your permanent resident
status in the United States?
I am HIV positive. I kept in touch with my doctor from HCMC. She was the one who was failing to lawyer, migrants office even with the Office
Congressperson Ilhan Omar.

DS-117 Page 1 of 3
10-2019
11. Reasons for not returning to the United States until time of this application.
See addendum.

12. List below all periods that you have lived outside of the United States for six months or longer since your initial entry into the United States as a
permanent resident.
Dates (mm-dd-yyyy)
Country
From To

06-21-2017 07-18-2022 Ethiopia


02-09-2022 07-21-2022 Kenya

13. Have you been employed outside of the United States since your most recent departure? Yes ✘ No
If "Yes" complete the following:

Name of Employer Address From (mm-dd-yyyy) To (mm-dd-yyyy)

14. I wish to return to the United States on or about


08-25-2022
Date (mm-dd-yyyy)
15. By typing my name in the field below, I swear or affirm that all statements which appear on this application are true and complete to the best of my
knowledge and belief. I understand that any false or misleading statement or willful concealment of a material fact may subject me to permanent
exclusion from the United States. I understand that if this application for special immigrant status is approved, I must apply for an immigrant visa within
six months from the date of approval.
Saada Said Baker 07-20-2022
Name of Applicant Date (mm-dd-yyyy)
DO NOT WRITE BELOW THIS SPACE - OFFICIAL USE ONLY

Approved 101(a)(27)(A) Disapproved


Reason

0 Will add electronic signature when converted to pdf at


Type Name of Consular Officer Signature of Consular Officer Date (mm-dd-yyyy) Post

Reviewed Concur Do NOT Concur

0 Will add electronic signature when converted to pdf


Type Name of Reviewing Officer Signature of Reviewing Officer Date (mm-dd-yyyy)

DS-117 Page 2 of 3
Privacy Act Statements
AUTHORITIES: The information is sought pursuant to 8 U.S.C. § 1101 et seq, 8 U.S.C. §§ 1201-1202, and by regulations issued pursuant to 8 CFR
211.1 and 22 CFR 42.22.

PURPOSE: The information solicited on this form will be used to determine your eligibility for returning resident status.

ROUTINE USES: The information on this form maybe shared with federal, state, and local government agencies, members of Congress, and officials of
foreign governments in accordance with certain approved routine uses. More information on the Routine Uses for the system can be found in the
System of Records Notice State-39, Visa Records.

DISCLOSURE: Providing this information is mandatory. Failure to provide the information requested on this form may result in the applicant's inability to
receive returning resident status.
Confidentiality Statement
INA Section 222(f) provides that visa issuance and refusal records shall be considered confidential and shall be used only for the formulation,
amendment, administration, or enforcement of the immigration, nationality, and other laws of the United States. Certified copies of visa records may be
made available to a court which certifies that the information contained in such records is needed in a case pending before the court.

DS-117 Page 3 of 3
1/16/23, 10:22 AM Immigrant Visa and Alien Registration - Confirmation Page

Online Immigrant Visa and Alien Registration Application (DS-260)

Immigrant Visa and Alien Registration Application Confirmation


Thank You
You have successfully submitted an Immigrant Visa and Alien Registration Application (Form DS-260). You must bring
to your visa interview proof that you submitted this form by printing a confirmation page using the below button. Do
not print a copy of this screen; use the below PRINT CONFIRMATION button to print a page with a unique barcode
related to your visa application. You can print a confirmation from this website at any time.

Next Step
Your Immigrant Visa and Alien Registration Application (Form DS-260) was sent to the National Visa Center (NVC) for
review. However, NVC will not review your Form DS-260 until they have received the required financial
and civil documents that you must also submit. If you have not sent NVC those items, please do so now. Visit
[Link] (English) or [Link] (Spanish) and review Steps 4-6 for instructions.

NVC will review your DS-260 IV application, financial, and civil documents upon receipt of all documents. If the
documents you submitted are insufficient or incomplete, NVC will send instructions on how to correct your
submission. NVC cannot schedule your visa interview until your supporting documentation is complete.

Your Visa Interview


Once you have a visa interview appointment, you need to:

1. Obtain and submit photographs that meet the Department of State’s visa requirements.
2. Review the information for the U.S. Embassy where your visa interview will occur.

Please use the buttons below for information on these items as well as instructions for submitting documents to NVC.

During the interview with a consular officer, you will be required to sign your application by providing a “biometric
signature” – in other words, your fingerprints. By providing this biometric signature, you are certifying under penalty
of perjury that you have read and understood the questions in your immigrant visa application. You are also certifying
that all statements that appear in your immigrant visa application have been made by you and are true and complete
to the best of your knowledge and belief. At the time of your interview, you will also be required to certify under
penalty of perjury that all statements in your application and those made during your interview are true and complete
to the best of your knowledge and belief.

This confirms the submission of the Immigrant Visa and Alien Registration application for:

Name Provided: SAADA SAID, BAKER


Country/Region of Origin ETHIOPIA
(Nationality):
Completed On: 16 JAN 2023
Case No: NRB2022327001
Confirmation No: AA00BI5VCB

THIS IS NOT A VISA Version 1.4

[Link] 1/1
1/16/23, 10:22 AM Consular Electronic Application Center - Print Application

Online Immigrant Visa and Alien Registration Application (DS-260)

Application - Sensitive But Unclassified(SBU)

Case Confirmation
Number: Number:

Personal, Address and Phone Information

Name Provided: SAADA SAID , BAKER

Full Name in Native Language: DOES NOT APPLY/TECHNOLOGY NOT


AVAILABLE

Other Names Used: NO

Sex: FEMALE

Current Marital Status: SINGLE

Date of Birth: 18 NOVEMBER 2000

City of Birth: NAIROBI

State/Province of Birth: DOES NOT APPLY

Country/Region of Birth: KENYA

Country/Region of Origin (Nationality): ETHIOPIA

Document Type: PASSPORT

Document ID: EP6222314

Country/Authority that Issued Document: ETHIOPIA

Issuance Date: 21 OCTOBER 2020

Expiration Date: 20 OCTOBER 2025

Do you hold or have you held any nationality other than the one you NO
have indicated above?

Present Address: EASTLEIGH SECTION 1

City: NAIROBI

State/Province: DOES NOT APPLY

Postal Zone/ZIP Code: 0600

Country/Region: KENYA

From Date: FEBRUARY 2022

Have you lived anywhere other than this address since the age of YES
sixteen?

Previous Address (1): AREA LEGAHARE

City DIRE DAWA

[Link] 1/6
1/16/23, 10:22 AM Consular Electronic Application Center - Print Application

State/Province: DOES NOT APPLY

Postal Zone/ZIP Code: DOES NOT APPLY

Country/Region: ETHIOPIA

From: JUNE 2017

To: FEBRUARY 2022

Previous Address (2): 3412 BLOOMINGTON AVE SOUTH

APT. 4

City MINNEAPOLIS

State/Province: MINNESOTA

Postal Zone/ZIP Code: 55407

Country/Region: UNITED STATES OF AMERICA

From: DECEMBER 2014

To: JUNE 2017

Primary Phone Number: 254796665111

Secondary Phone Number: DOES NOT APPLY

Work Phone Number: DOES NOT APPLY

Other Telephone Numbers Used: NO

Email Address: saadasaid336@[Link]

Other Email Addresses Used: YES

Additional Email Address (1): NAIMABONA35@[Link]

Additional Email Address (2): LELISINABAKER@[Link]

Additional Email Address (3): SBAK2002@[Link]

Additional Email Address (4): SBAK2002@[Link]

Social Media Provider/Platform: INSTAGRAM

Social Media Identifier: SAADA_MODEL

Social Media Provider/Platform: FACEBOOK

Social Media Identifier: SARAH DREEZY

Other Social Media Used: NO

Is your Mailing Address the same as your Present Address? YES

Permanent Address

Name of person currently living at address: SAID ABDULLAHI

U.S. Address: 3412 BLOOMINGTON AVENUE SOUTH

APT. 4

BLOOMINGTON, MINNESOTA 55407

Phone Number: (612)703-3146

Is this address where you want your Permanent Residence Card YES
(Green Card) mailed?

Family Information

Father's Surnames: ABDULLAHI

[Link] 2/6
1/16/23, 10:22 AM Consular Electronic Application Center - Print Application

Father's Given Names: SAID BAKRI

Date of Birth: 01 JULY 1979

City of Birth: DIRE DIWA

State/Province of Birth: DO NOT KNOW

Country/Region of Birth: ETHIOPIA

Is your father still living? YES

Current Address: 3412 BLOOMINGTON AVE SOUTH

City: MINNEAPOLIS

State/Province: MINNESOTA

Postal Zone/ZIP Code: 55407

Country/Region: UNITED STATES OF AMERICA

Mother's Surnames at Birth: HASSAN OMER

Mother's Given Names: HAYAT

Date of Birth: DO NOT KNOW

City of Birth: DO NOT KNOW

State/Province of Birth: DO NOT KNOW

Country/Region of Birth: ETHIOPIA

Is your mother still living? NO

Year of death: 2003

Do you have any Previous Spouses? NO

Do you have any children? NO

Previous U.S. Travel Information


Have you ever been in the U.S.? YES

Were you issued an Alien Registration Number by the Department YES


of Homeland Security?

Alien Registration Number: A063891998

Provide information on your last five U.S. visits.

Date Arrived: (1) : 11 DECEMBER 2014

Length of Stay: 3 YEAR(S)

Have you ever been issued a U.S. Visa? NO

Have you ever been refused a U.S. Visa, been refused admission to NO
the United States, or withdrawn your application for admission at the
port of entry?

Work/Education/Training Information
Primary Occupation: NOT EMPLOYED

Explain:

In which occupation do you intend to work in the U.S.? STUDENT

Were you previously employed? NO

Have you attended any educational institutions? YES

Number of Educational Institutions Attended: 1

Name of Institution (1): ROOSEVELT HIGH SCHOOL

Address of Institution: 4029 28TH AVENUE SOUTH

City: MINNEAPOLIS

[Link] 3/6
1/16/23, 10:22 AM Consular Electronic Application Center - Print Application

State/Province: MINNESOTA

Postal Zone/ZIP Code: 55406

Country/Region: UNITED STATES OF AMERICA

Course of Study: ACADEMIC

Degree or Diploma: NOT COMPLETED

Date of Attendance From: 01 SEPTEMBER 2016

Date of Attendance To: 01 JUNE 2017

Have you traveled to any countries/regions within the last five YES
years?

Name of Country/Region(1): KENYA

Name of Country/Region(2): ETHIOPIA

Have you ever served in the military? NO

Petitioner Information
Petitioner is my: SELF

Security and Background Information


Do you have a communicable disease of public health significance such as tuberculosis (TB)? NO

Do you have documentation to establish that you have received vaccinations in accordance with U.S. law? YES

Explain:

Do you have a mental or physical disorder that poses or is likely to pose a threat to the safety or welfare NO
of yourself or others?

Are you or have you ever been a drug abuser or addict? NO

Have you ever been arrested or convicted for any offense or crime, even though subject of a pardon, NO
amnesty, or other similar action?

Have you ever violated, or engaged in a conspiracy to violate, any law relating to controlled substances? NO

Are you the spouse, son, or daughter of an individual who has violated any controlled substance trafficking NO
law, and have knowingly benefited from the trafficking activities in the past five years?

Are you coming to the United States to engage in prostitution or unlawful commercialized vice or have you NO
been engaged in prostitution or procuring prostitutes within the past 10 years?

Have you ever been involved in, or do you seek to engage in, money laundering? NO

Have you ever committed or conspired to commit a human trafficking offense in the United States or NO
outside the United States?

Have you ever knowingly aided, abetted, assisted, or colluded with an individual who has been identified NO
by the President of the United States as a person who plays a significant role in a severe form of
trafficking in persons?

Are you the spouse, son, or daughter of an individual who has committed or conspired to commit a human NO
trafficking offense in the United States or outside the United States and have you within the last five
years, knowingly benefited from the trafficking activities?

Do you seek to engage in espionage, sabotage, export control violations, or any other illegal activity while NO
in the United States?

Do you seek to engage in terrorist activities while in the United States or have you ever engaged in NO
terrorist activities?

Have you ever or do you intend to provide financial assistance or other support to terrorists or terrorist NO
organizations?

Are you a member or representative of a terrorist organization? NO

Are you the spouse, son, or daughter of an individual who has engaged in terrorist activity, including NO
providing financial assistance or other support to terrorists or terrorist organizations, in the last five years?

[Link] 4/6
1/16/23, 10:22 AM Consular Electronic Application Center - Print Application

Have you ever ordered, incited, committed, assisted, or otherwise participated in genocide? NO

Have you ever committed, ordered, incited, assisted, or otherwise participated in torture? NO

Have you committed, ordered, incited, assisted, or otherwise participated in extrajudicial killings, political NO
killings, or other acts of violence?

Have you ever engaged in the recruitment of or the use of child soldiers? NO

Have you, while serving as a government official, been responsible for or directly carried out, at any time, NO
particularly severe violations of religious freedom?

Are you a member of or affiliated with the Communist or other totalitarian party? NO

Have you ever directly or indirectly assisted or supported any of the groups in Columbia known as the NO
Revolutionary Armed Forces of Columbia (FARC), National Liberation Army (ELN), or United Self-Defense
Forces of Columbia (AUC)?

Have you ever, through abuse of governmental or political position converted for personal gain, NO
confiscated or expropriated property in a foreign nation to which a United States national had claim of
ownership?

Are you the spouse, minor child, or agent of an individual who has through abuse of governmental or NO
political position converted for personal gain, confiscated or expropriated property in a foreign nation to
which a United States national had claim of ownership?

Have you ever been directly involved in the establishment or enforcement of population controls forcing a NO
woman to undergo an abortion against her free choice or a man or a woman to undergo sterilization
against his or her free choice?

Have you ever disclosed or trafficked in confidential U.S. business information obtained in connection with NO
U.S. participation in the Chemical Weapons Convention?

Are you the spouse, minor child, or agent of an individual who has disclosed or trafficked in confidential NO
U.S. business information obtained in connection with U.S. participation in the Chemical Weapons
Convention?

Have you ever sought to obtain or assist others to obtain a visa, entry into the United States, or any other NO
United States immigration benefit by fraud or willful misrepresentation or other unlawful means?

Have you ever been removed or deported from any country? NO

Have you ever been the subject of a removal or deportation hearing? NO

Have you failed to attend a hearing on removability or inadmissibility within the last five years? NO

Have you ever been unlawfully present, overstayed the amount of time granted by an immigration official NO
or otherwise violated the terms of a U.S. visa?

Are you subject to a civil penalty under INA 274C? NO

Have you been ordered removed from the U.S. during the last five years? NO

Have you been ordered removed from the U.S. for a second time within the last 20 years? NO

Have you ever been unlawfully present and ordered removed from the U.S. during the last ten years? NO

Have you ever been convicted of an aggravated felony and been ordered removed from the U.S.? NO

Have you ever been unlawfully present in the U.S. for more than 180 days (but no more than one year) NO
and have voluntarily departed the U.S. within the last three years?

Have you ever been unlawfully present in the U.S. for more than one year or more than one year in the NO
aggregate at any time during the last 10 years?

Have you ever withheld custody of a U.S. citizen child outside the United States from a person granted NO
legal custody by a U.S. court?

Have you ever intentionally assisted another person in withholding custody of a U.S. citizen child outside NO
the United States from a person granted legal custody by a U.S. court?

Have you voted in the United States in violation of any law or regulation? NO

Have you ever renounced United States citizenship for the purpose of avoiding taxation? NO

Have you attended a public elementary school or a public secondary school on student (F) status after NO
November 40, 1996 without reimbursing the school?

Do you seek to enter the United States for the purpose of performing skilled or unskilled labor but have NO
not yet been certified by the Secretary of Labor?

Are you a graduate of a foreign medical school seeking to perform medical services in the United States NO
but have not yet passed the National Board of Medical Examiners examination or its equivalent?

[Link] 5/6
1/16/23, 10:22 AM Consular Electronic Application Center - Print Application

Are you a health care worker seeking to perform such work in the United States but have not yet received NO
certification from the Commission on Graduates of Foreign Nursing Schools or from an equivalent
approved independent credentialing organization?

Are you permanently ineligible for U.S. citizenship? NO

Have you ever departed the United States in order to evade military service during a time of war? NO

Are you coming to the U.S. to practice polygamy? NO

Are you a former exchange visitor (J) who has not yet fulfilled the two-year foreign residence NO
requirement?

Has the Secretary of Homeland Security of the United States ever determined that you knowingly made a NO
frivolous application for asylum?

Are you likely to become a public charge after you are admitted to the United States? NO

Social Security Number Information


Have you ever applied for a Social Security number? YES

Were you issued a number? YES

Social Security Number: 719-38-3328

Do you need a new card issued? NO

Do you authorize disclosure of information from this form to the NO


Department of Homeland Security, the Social Security Administration,
and such other U.S. Government agencies as may be required for the
purposes of assigning you a social security number (SSN) and issuing
you a Social Security card and do you authorize the Social Security
Administration to share your SSN with the Department of Homeland
Security?

Preparer of Application:
Did anyone assist you in filling out this application? YES

Preparer Surnames: AUST

Preparer Given Names: BRIAN LINCOLN

Organization Name: AUST SCHMIECHEN

Street Address: 825 NICOLLET MALL

SUITE 623

City: MINNEAPOLIS

State/Province: MN

Postal Zone/ZIP Code: 55402-2612

Country/Region: UNITED STATES OF AMERICA

Relationship to You: ATTORNEY

[Link] 6/6
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