11/30/2010

1234567890 ROME ITALY ROME

ITALY 25 SEPTEMBER 2001 25 OCTOBER 2011

DOALLY

JANE JOAN

NONE

23 FEBRUARY 1975
NONE
ITALY
ROME ITALY ROME

VIA FAA DI BRUNO 24

NONE ROME, ROME 0100
X ITALY

39 1 123 4568 39 1 123 4555 39 1 123 4568

NONE NONE NONE

X NONE

123 VIVA BUENO

INTEL ROME, ITALY 00130

MYEMAIL@ EMAIL.COM
ENGINEER

183 GORE CREEK DRIVE

VAIL, COLORADO 81658

Y1P83S8CD0
JOHN JERRY SMITH 123 456 7890

321 654 0987 NONE

MARRIAGE AND RELOCATION TO THE USA

PERMANENTLY

X
MYSELF
25 FEBRUARY 2008 (See page 3)
2 WEEKS

11-2007
 X X

X X
WITH WORK AUTHORIZATION, EMPLOYER UNKNOWN

NONE

X X

X X US CITIZEN

X
X

X
 U.S. Department of State
SUPPLEMENT TO
NONIMMIGRANT VISA APPLICATION

PLEASE BE SURE TO SUBMIT THIS PAGE WITH THE REST OF YOUR APPLICATION

DO NOT MARK OR WRITE IN THIS SPACE

JANE JOAN DOALLY

Barcode Number: Y1P83S8CD0

29. Additional Visits to the U.S.: 15 JAN 2007, 3 WEEKS

30. Additional Visa Issuances:

31. Additional Visa Refusals:

FILTERED NAMES
When 'None' or 'NA' are entered into any of the following the fields: 'Other Surnames Used', 'Other First
and Middle Names Used', and 'National Identification Number', the text will be removed by the EVAF
software from the data in the 2D barcode. If the applicant's name actually is None or NA the post must
enter the name manually into NIV or RDS. The following fields have been removed:

- 'NONE' was removed from the 2D barcode for Item 8 (Other Surnames Used)
- 'NONE' was removed from the 2D barcode for Item 9 (Other First and Middle Names Used)
- 'NONE' was removed from the 2D barcode for Item 14 (National Identification Number)

EVAF 02.02.10