DepartinentofHometand Security (OMB No 1615-0067, Expaes 01/312003, bce per mer a : ° Us. bop fone 1-589, Application for Asylum Execrtive Office for Immigration Review and for Withholdi us of Removal START HERE - Type or print in black ink. Sec the imtructions for information sbout cligibility and how to complete and fic this application, There i no filing fee for this application. NOTE: [7] Check this box f you also want to apply for withholding ef removal under the Convention Against Torte [Part A.I. Information About You 1. Alien Regisbaion Number(s) (A-Nuunbes) (fem) [2.75 Social Seawty Number (fan) JB. USCIS Ouline Accout Nusber (Fans) aas2ao242 ‘Complete Last Name SF Name Middle Name Hernandes Algarin vose ‘Alexander 7. Wha other names have you used (incTade maiden name and aliases I Revidsace inthe US. (where you pigsically resid) [Stest Number md Name [ant Number 3131 Forest Grove ct, Atwater lem Sale Zip Cole Telephone Number Merced california 98302 | 208 ) 646-7449 (NOTE: You must be resting inthe United States ro submit tts form.) 9, Malling Adress inthe US. Gf diffrent than the adress item Niowbor 8) in Care OF Wfappivcabiey “Telephone Number co [Steet Number ad Name ‘Apt Number oy Sale Zip Code 10. Genter: |] Male [X] Female [14 Marital Status: [xX] Single [|] Mamied [J Divorced |_| Widowed ia. Datsor Binh para 1S. Gly and Comty of Binh 05/29/1987 Caracas , Libertador / Venezuela Ta Present Nationality (Citzonahip) [A Naiomaliiy tba Te. Race, Hinks or Teal Group [7 Religion Venezuelan Venezuelan, Hispanic Buddhto 118. Check the Box, a through c that apples: a. L] Thave never been in Immigration Cour proce=dings Jamaow in Immigration Court proceedings. [] Tammot now in Lumigrstion Coutt proceedings, but [have beea in the past 19. Complete 19-a through e When did you last leave your comanry’? (mm‘ddsyyy) 02/02/2018 b, What is yourcurrent L394 Number, ifany? N/A ¢-Listeadh eu ito the US. beaming with your mos recent ey. List date nw). plac, and your tas for ecient Gitach addtional sheets as nested ny 330). fo r Date 09/15/2023 Place Californie Status Alien Date Status Expires Date Place Status Date Phe stars 20. What country sued your lst passpor oF F=V=l Yo. pagspart Number BC352966 2 Expl on Date Fravel Document Nnber 06/20/2033 23. What is your mtv lansuane include halet, Papplcable)? 24, Ave you Buea ia Eaglsh? 28, Win oie languages do you speak ven? spanieh Cvs fino For EOI wie only: For Action: Decisions uses IblentewDate ‘pptoval Date seouly, Asylum Officer 1D No Desial Date: Referal Date Fomi56) Edition 10122 UU DRESSY PS SP APS EAC] met[Part A.II. Information About Your Spouse and Children Your spouse [=] Tam not married. (Skip to Your Children below) ag Reeaion Nuntar(ANunbeo PagpatiD Cad Numter Dre of Bth anadns) [RUS Sei Seow Nana aan ara) ans) 5. Complete Cast Name 6. Fist Name 1. Middle Name 1 Other names used fnchade ‘meter name ane oes) 9. Date of Mariage (nn Z4d5035) 10, Place of Mariage 11. City and Comiy of ith 12, Nationality (Citenship) 13. Race, Ein, or Taal Group 14 Gender (Mate) Femme IF Toth prsooin be US? [ ves/Conpiae stocts 161024) [1] Norspectt locaton} H6,Place oft cary to he [17- Date of lst any ao the [ator Numer Gam) [1 Sats wea Int dae us US. mmddyy) Hf (sa ape Vary) 20. Whats you spomes —_[24. What ie eipion dns ofhjvier pa. you spouse h taaniadon| SW ppwiowly i ie US date of cove an Titorized sah anys onda) | eutprbesedinge potters on ae99) Ore L ™% a. IFintbs US. your spouse to beTusladed Wa i aplication? (Cheek the appropriate Dox) [L ¥es attack one pow aph of your spouse te ipper right comer of Page 9 the exer copy ofthe applica submited for as person) Cx. ‘Your Culldren, Fst al of your children, regardless of age, location, or mail stam T donot have any children, (Stipo Part 411, Information about your background.) Dy theve ctléea, Total number often: (NOTE: Use Form £589 Supplement 4 orattach additional sheets of paper and documentation f you have more than four children) i. Alien Registration Number (ANunbe) ]2. PasporvTD Card Number [3. Marital Status (Married Single, ]&. US. Social Secwity Number wan) aay) Dworeed, Widoved) any) ‘8. Complete Last Name 6. FisiName 7. Middle Name [8 Date ofBith (nmnidanyy) 9. City mad Country of Bish 10, Nationality (Ciizensip) [11 Race, Etc, or Tibal Group |12, Gender Mae) Female 13.15 this child inthe U.S.7 [_] Yes (Complete Blocks 14021.) |] No (Speci location): 18. What is your cults cureut satis? 79. What ste expiration date of higher 20-15 your cil Immigration Cou procestnas? suthonzed stay fay? maidd999) : ‘ mess Ors [jw 21 iintie US. this child to be included inthis applicatiou? (Check the appropracte box.) [1] ¥es (attach one phosograph of your child in the upper right corner of Page 9on the ext copy ofthe application submited for ths person.) Ono Fomi59) Edition 101 BU PREMERA SEAR LT ER] me[Part AIL, Information About Your Spouse and Children (Continued) alien Regiatou Nuuba @-Nuubed) 2. PaspoitID Cad Nuuter [Mia Sas (aried Sng, jan ‘ > rales Dnored Wicbweds 4. US. Social Secwity Number fay) Complete Last Nam & Fis Nene [7 Middle Name Ie Dae of Bh mntinayp) Gi wad Conny oF Bh 10, Ravionalty (Crizonstipy |. Race, Eile, oF Tal Group —]12. Gender CO mate 1 Femate 13, Te thie clild inthe US? L] Yes (Complete Blocks 14.10.21) [_] No Spee location 14, Place of ast exty ito te US. 15. Dag of ast en ino the [16.94 Number jan) US. (nmidaingy) 17. Seas when last admitted (Asa hpe fam) 1. What your ids caveat Sais 19: What isthe expiration date of ister 30, Ieyou childim suthonzad say. any? fmmddiogs) | Tmigration Con proceedings? O wo 21, fin the U.S. i this eid to be eToded in tis application (Check the appropriate Box) Yes (tact one plorograph of sour spouse i the upper rig comer of Page 9on the exra cop othe application submaed forts person) oO» Alien Regisiation Number (NUDE) [2 PasporID Cord Number [8 Mantal Sams (Wanted, Sigla, —[& US. Sect Seowniy Number wan) ¢ ” ihabe Dnorced Wabwad | yang) ¥ IK Complete Last Name &. Fir Name [7 Mle Name 1k Date oP Rih (manila) 9. Giy md Coty of Bath To. Natoaality (Ctzeship) | H-Race, Eis, or Diba Group | 12. Gender (Mae) Female 13, I his ald eUS.? [] Yew Complete Block [40 21) L] No Speci tocatons Ta Place ost exiiy ho He US, IS Daw of as ents iato he [16-54 Number (Fam) US. mmddyy) I. Stas wea jak admted (sa he. fam) FEW Fa ETAT Fs Wnts he appa date oe oe, byow aiid Itorzed ay any? yy) Ol v« Tmnigration Court proceedings? Ow i. Win the US. 6 this child tobe incladed in this application? (Cheek the appropiate Bax) Yes (tact one piorograph of our spouse tthe upper right comer of Page 9on the ext cop athe appicton submuted for ths person) (No Alien Regain Number Go NUDe | PasiparD Cand Number |S. Dail Same Alayied Shgla [a US. Socal Seowiiy Number ‘amy tray) Dworecd, Wdowed) ifaw) 5. Complete Last Name 6. Fist Name H-Midale Name 1& Dae of ith (ronddna09 9. Gy mad County of Bit To: Ratenaiiy(Cinzonhipy IH. Race, Ei, oF Tabal Group —]42, Grader OO waie remote 13 Ts this cild in the US.) Yes (Complete Blocks 14%0 21) _] No (Speci location) Ta Pace oft ay oto he US TS Daw of aw antyy ithe kG. 1D1 Names Ufa) US tami) y Ty, Satu when lat adiied (sa pe. fan) 18, Wha i your cals caveat wats? 19. What ise expiraion date oF hiviner [20,1 your cll authorized lay, ifany? (mnvddyyy) O vs Taaigraion Cou proceedings? CJ 0 2 in the US, is this Child tobe included in this application? (Check the appropriate bax.) (Ne [1 Yes tinach one posegraph of your spouse tn the upper right cami of Page 9 an the esta copy ofthe aplication submated for ths person) Fomi59) Edition 10 BU DREAMER GA SER BOS Paes[Part AIL Information About Your Background 4. List your last adezess where you lived before coming tothe United States tis is aot the conntny where you fee persecution, als ist the lst aaklress in Ue country whete you fer pesevution (Lit Address, Cty"Town, Department, Province, o Stale and County) (NOTE: Ese Form 1-589 Supplement 8, or adonal sheets of paper necessary.) Numier and Steet Dales (eoute pment) CityrTown, ‘Deparment, Provinee, or State | Country Tete (atom) 87-12municips Franscico |waracaibo Zulia [Venezuela 31/2017 [02/2018 2 Provide the following information about you residences during the past S years. List your present ares fist. (NOTE: Use Form £589 Supplement 8, or ditional sheets of paper, necessary.) Number and Set ciyrtom — [Dqarnent Frvine.crsate] —comry | aa oe azn) los-asmintetpio caront | cuayana oliver [Venezoeia 05/1995 [13/2017 87-12munsetpo Franscico [waracaibo Zulia \Venezvela 31/2017 [02/2018 pao Faonne vanurporan casas cououeza aava0in [00/2023 Vin RAGENTTIA ae Provincia de Penana | emma 8/202 [08/2023 BID Foreat Grove ot [nerced eattforaia ry 09/2033 | panenirs Provide the following infonnation about your edusation, besimning withthe most recent school that you attended. (NOTE: Ese Form 1-589 Supplement 2, or adinonal sheets of paper. necessary.) “Atecded ‘Name of Scicol Type of School Location (Aakiress) stom (eI to ator) U.8.N ANTONIO DE SERRIOS| ELEMENTARY Sau FeLi, c cuavaua | 02/2000 | 06/2002 U.ELN FE 7 ALEGRTA gomzoe / wxeu scuooz | vra wt rao, nonzvan | oe/z001 | 06/2002 U.E.P MANOA souroa / aren scuoon | san rsurx , c ovarana | 08/2002 |os/zo0s 4. Provide the following infornation sboul Your employment during the past yes, Lis your present employment first (NOTE: Use Form 1-389 Supplement 8, or addinonal sheets of paper, necessary.) Dates [Name and Address of Employer ‘Your Occupation stom ("hye (tor) PAPELERIA BLANIC C.A PUBLIC A7TENTION 08/2001 [10/2003 5 Provide the following information about your parents an siblings (brothers an sisters). Check the box ifthe person is decease. (NOTE: Use Form 1-589 Supplement Bor addtional sheets of paper, ifneces:ar:) Fall Nine GigyTown and Comty of Bir Court Losston [Mother yours 4eRNaNDEZ ALGAREN | MAICAO LA GUATRA, COLOMBIA [ipseaed TURLOCK o.a [Rater sos winscre i WATENO UA OUASTRA, COLOMBIA Decewed COLOMBIA sing — sibting [7 Deceasea sbi Li Deceased ‘sionne [L Deceased Fea Hie EE TIRE CREAMS RENE I me(Part B. Information About Your Application (NOTE: Use Form 1-589 Supplement B, oF atch addtional sheets of paper as needed to complete your responses to the questions contamned 0» PartB) When answering the folowiag questions about your asylum o other protection clan (withholding of removal undet 241(0X) of the INA. ‘withholdng of removal under the Convention Against Torture), you must provide a detziled and specific zecount of the basis of your claim fo asylum, or other protection, To te best of your ability, provide specific dates, places, and desctiptons about each event or action describeé. You must attach documens evidencing the general coutitioas inthe eouity fram whieh you ae seeking asylum or other protection andthe specifi fis on whist ‘you ae elying to support yous clit, If this documentation is unavailable oc you ate not providing this documentation with your application, explain ‘yim your resporses to te following questions Refer to structions, Part 1: Filing Tustrustions, Section Tl, "Basis of Eligibility,” Parts A ~D, Section V, Completing the Form,” Part B, and Section ‘VI, "Adlitional Evidence That You Should Submit," for more infermation on completing this section ofthe farm, 4. Why ae you applyiag for asylum or wiehholding of removal under section 241(0)(3) ofthe INA, or fo withholding of removal under the Convention A inst Torture? Check the appropriate box(es) below and then provide detailed answers to questions A and B below. ‘am sooking saylum or withholding of removal based on: 1 Race Potticl opinion 1 Retin [1] Mershership in pica social romp 1 Natonatisy FZ] Torte Convention |S. Hine yon, your aly, clone eens or colleges ever experienced an or ssveatment or txets in he pot by mavens? 1 wo Yes" expan in dt 1. Whathippenod 2 When he han oruistreatmeat ortireat ocume '3. Who caused the harm or mistreatment or threats; and ‘4. Why you believe the harm or mistreatinent or threats occured 'B, Do you fear am or misteatnenti'yonretum te yourhome county? [ 1 "Yes," explin in dota: 4, What harm or misteatment you fer: 2. Who you believe would harm or mstreat you: and |3. Whi you telieve you would cr could be harmed or mistreated. Fomi59) Edition 101 ABU DELP: EP SS AE | me‘Part B. Information About Your Application (Continued) Have your your family members ever been accused, charged, arrested, detained, interrogated, convicted and sentenced or imprisoned in ay ‘country other in the United States (including fr an immigration law violation)? (no 1f Yes,” explain the citeumstances and reasons for the ation |A.A. Have you or your family members ever belonged to or bez associated with any orgauizatiens or groups in your home county, sueh as, but aot limited to, a political paty student group, labor union, religious organization, military or paramilitary group, evil parol, guerilla orgsuization, cetinie group, human rights group. othe pressor mea? [ne 1Yes" describe fr each person the level of participation, uy leadership ot other potions eld athe length of time you or your fanily renbers were involve in exch crganzaion or asi {MB Do you or your family members continue to participate in any way in these organizations or groups? Cres 1£"¥es," deseribe fr exch person your or your family members’ current level of participation, any leadership or other pesitions currently held, and the length of time yon or your family members have heen involved in each ofganization or aroun, 4. Are you afta of being subjected to torture in your home coustry or any other country to witch you may be returned? Ono fos," explain why you are afraid and doserite the nature of torture you fexr, by whom, and why it would be inflicted. Fomi59) Edition 101 UU DRELRASI ne Pate ESS | meeSS ‘Part C. Additional Information About Your Application (NOTE: Use Form £389 Supplement 8, ov attach addironal sheet of paper as needed fo complete your responses to the questions contained in Parte) 1 Have you, you spouse, your iden), your patents or your stings ever applied othe U.S. Goverment for efiuge stats, asym, of withholding of emoval? Baro Ove 1T0¥ex"explin the decision and wht happened to my ss you, your poe, your child(en), your parents, your slings received a2 result ofthat decision, tadiate wet of tot you were ited ina parent or spose’ application. Tf 30, ihe yous parent or spote's ‘Acuber iu your respause. fu have been denied asym by an inigrationdge rte Board of tnneration Apps, deste ay chiange() in conditions in your eouuty or Your own personal ireunstaases since he date ofthe dana thal ray affest your elit for asylan, 2LA., Alter leaving the conti frm which you are claiming asylum, id you or your spouse a dil) who are wow inthe United States travel {hucrgh reside i anyother county befor catering the Unked Sats? Uve 2.8, Have yon, your spouse, Your chide), or other family members, suchas Your patents or siblings, ever applied for or received auy lawl sats in any country other than the one frm wich you ae now elaine asyhn? Ove If'"¥es"' either both questions (28 andor 28), prove for each person the following he mame of exch country andthe Tenth of say he person's satus while there, the reasons for leaving, whether ornot th person seattle to retum for lf residence purposes, and wither the person applied for refgee stats or for asyhim while there, sad if not, why he or she didnot do so ‘3. Have you, your spouse o your child(ren) ever odeted, incited, assisted or otherwise particpeted in causing ann or sufering to any person ‘because of his or her ace, religion, nationality, membership in a particular social group or belie in a particular political opinion? Ove 1£¥e5," deseribe in deal each such incident and your own, your spouse's, or your childrens involvement Pree? Fomi59) Edition 101 UU REE SSE SET EP |SS [Part C. Additional Information About Your Application (Continued) 44. Affe you tet the county where you vere harmed or fear baa, did you retu fo la county? no Ore IF"Yes." deseribe in deal the circumstances of your visi(s) (or example, the date(s) ofthe tit), the purpose(s) ofthe trp(s), and the Teng of ine you rmnsined in that country fx to visi(s)) Are you dling this application move than 1 yearafter your last artval inthe United States? Ove {Yes expan why you di ot file within the fst year afte youamived. You must be epaed to expan youintervew orheming why ‘ou di sot fle you spun application within te fest year afer ou aves, Fer guidance in asenag ths qbeston, ee LStCGOEs, Pt Filing Intrcions, Section "Completing the Form,” Pat C 6, Have you or my member of your family included in the appicatioa ever commuted auy crime and/or been anested, charged, convicted, or senteticed for any crimes inthe United States (neluding for an immigration law violation)? Ne Ove Lf "¥es," french instance, specify in our response: wat occurred and the circumstances, dates, length of sentence receive, location the uration of the detention or imprisonment, reasons) fo te detention or conviction, any fomnal charges that were lodged against you of your relatives inched in you application, and the reasons) fo release, Attach doctments refering to these incidents if they re avaible, o aa explanation of why docaments are not available Fom IS ation 1011 UU DREAMER DRAPE TOS] mee[Part F. To Be Completed at Asylum Interview, if Applicable NOTE: You vil be asked o complete this part when you appear for examination before an asym efficer of the Deparment of Homeland Security US. Ctzenship and Immigration Services (USCIS) 1 swear (affirm) that Low the conteats ofthis application that lam signing including theatached documents and supplements, that they ae Clantave or (1 not att ue to he tet of ay tnowledge and that comectio(s) auntered to Were ade by not a my equeat ‘Fusheroce, am swvaee thet if am detemied to have knowingly msde ahivolousepplicaion fr aijita wil be permanently neLible for any benefits under the Immigration and Nationality Act, and that [may not avoid a fvolous finding simply because someone advised me w provide {alse information in my asylum application, ‘Sigued and swom to before me by the above named applicant on: ‘Sigua oF Appl Date fnmididinay) ‘Waite Your Name iu Your Native Alphabet ‘Signature oF Agglum Ofieer ‘Part G. To Be Completed at Removal Hearing, if Applicable NOTE: You willbe asked to complete thes Part when you appear before an mmisration judge of the US. Department of Justice, Executive Ofice for inmigration Review (EOIR), for a hearing. {swear (affirm) that Tow the eonteats ofthis application that Tam signing, including the attached documents and supplements, that they are Date or [) aot all tre to the best of my knowledge and that correction(s) mumbered __to_were made by me or at my request Furthermore, fam aware thet iT am determined to have knowingly made atrivolous application for as¥um I will be permmently ineligible for any benefits nde the Immigration and Nationality Act, and that I may not avoid frivolous finding simply because someone advised me to provide false information in my asylim application. ‘Signed and swom to before me by the above samed applicat on ‘Signature of Applicant Date frmmiaaaa7 "Wits Your Name in Vaur Native Alphabet ‘ignatius of Tmmaration dae Fom IS ation 1011 AU EELS AC PS S| meeSupplement A, Form 1-589 ES (ARNumber (Favailable) Date ‘Appheaats Name Appliaat's Signatare \List All of Your Children, Regardless of Age or Marital Status |(NOTE: Use thisform and attach addtional pages and documentation as needed, if you have more than fou cileben) i. isn Reaiiaton Naber Numba) 2 Passport iD Card Namber arany) [Marital Stans (aryied Sele Dworced Hower) 1s US, Social Seoaty Number feny) 5. Complete Last Name & Fins Name [7 dae Name '& Date of bh rma) US fmitdnss) 9 Ciy ead Conny oF Bh 0: aonsy (Cimzoshipy [AT Rave, ii, or Tb Group |, Gender Mae 0 Female 13, We ihisclildin the S.C] Yes (Complete Blocks 1410 21) _[] No (Speci location i Place of st easy Bho EUS 18, Dabe oflast qny nto te 16. 1-94 Numbex amy) 17. San when jas adnited (so pe. ifm) Ts. What is your childs carent atu FO. Whats te expiration date FRE tuthorized ta ay? (mar 399) 20.1 you childim O ys Tmigration Court prosesdings? Ow (x0 21 inibe US, is tis cid tobe isloded in is applisatica? (Check the appropiate Box) [Yes datach one poiograph of your din ihe upper right corer of Page 9 onthe extra copy ofthe appictton submited for ths person) Alien Registration Number (A-Nuniber) ‘ew Passport 1D Card Namie way) Dworeed. Wiebre Sara Sa eed Svea EUS, Soot Sooty Nuno tifa) Is) Complete Lat Name & FisiName [7 MiddteNeme (8 Date of Bu oma) 9. City ead Conatiy BD 0 Nationality (Cinzenshipy 1, Race, Ete, oF Tribal Group 2, Gender CO ae 1) Female 13, [sds didn the US.? ] Yes (Complete Blocks 14 21.) Oo [No (Speci focation): 19, Pace of iastexny tio te US 5. Da of at eary nto he US gumiddsso) re. 94 Number any) 7, Status when Int adnited (sa ype van) 18, Wha is your eis current status? FES: What ihe expat date oF Or authorized stay, if any? mura yyy) 20.15 your child in O vs Immigration Court proceedings? Ow 21. inthe US, (0 this child tobe ncined inthis pplication? (Check the approprice Ba) [1 ves canach one poograph of your cid mthe upper righ comer of Page 9 onthe exe copy ofthe epicaon submited for ahs parson.) Form i56) SaplematA Eaion 1012 BEL IREERASS RES e RE REESR| Pee llSupplement B, Form 1-589 SS |Additional Information About Your Claim to Asylum. [A-Namiber favailable) [Date ‘Appliaats Name Applicants Signatas NOTE: Lise this asa continuation paze fr amy adetional information requested Copy and complete as needed. Past Question [page 5 section a) 4 was matreated various times by means of harasenent, physical and mental abuse py police officers, knowing of my innocence. I believed to have had experienced this due to my jparticipation in the political groups and in efforts to discontinue my political views against our (corrupt goverment. lrage 5 section b) Yes, because of the continuous threats and harassnent I received during my time living there, 1 m certain to be a victim of the same police men who continously hurt me lpage 6 question 2. Yes, I vas falsly arrested in my honetown and tortured in efforts pursuade my [political views. lrage 6 question 3A. Yes, I was associated with a student group, namely "E1 Nuevo Tiempo", and am Ino longer participating. lpage 6 question 4. Given the chain of events including physical abuse in my country, I' m certain \to be subject of torture by policemen or any other government affiliated persons upon my return. FomI39) SqplemeatB Edition 1012 DU ERE EAGPES ESI ASSRY SBRS| mee[Part D. Your Signature ‘eettify, under penalty of pecjury unde the las ofthe United States of Ametica, that this application andthe evidence submited with it areal re and correct, Title 18, United States Cede, Section 1546(@), provides in pat ‘Whoever knowingly makes under ost, or as permitted under penaky of perjury under Saction 1746 ef Tite 28, | Staple your photograph eve United States Code, knowingly subscribes as true, any false statement with respect toa maecil fact in any the photograph ofthe family application, amidavit, or omer document required by the immigration las or regulations prescribed ieretnder, or | member to be included on the Smowingly presents any such application, afidevit, or other document containing any such false statement or extra copy ofthe application ‘which fas to contain say reasonable basis in law or faet- shal be fined in accordance with this tle or submitted for tat persou, imprisoned for up 0 25 years. Tcetify thas Tame physieally present in the United States or secking admission ata ort of Eatry winen I execute this application. 1 authorize the release of any iafonatioa ftom my immigration record that U.S. Citizenship and Immigration Services (USCIS) needs to determine eligibility for the benefit Tam seeking. WARNING: Applicants who ave in the United States unlawfully are subject (o removal if thelr asylum or withholding claims granted by an asylum officer or an immigration jadge. Any information provided in completing this application may be used as a basis for the institution of, or as evidence in, removal proceedings even if the application slater withdrawn, Applicants determined to have kaorringly made a frivolous application for asylum will be permanently ineligible for any benefits wader the Immigration and Nationality ‘Act. You may not avold a frivolous finding simply because someone advised you to provide false information n your asylum application. If ‘aling With USCIS, unexcused fullure to appear for an appolutnent to provide biomettics (such as fingerprints) and your biograpbicat Information withia the time allowed may vesult in an asylum officer dismissing your asylum application ov refering it to an immigration judge. Failure without good cause to provide DHS with biometrics or other biographical information while in removal proceedings may result in your application being found abandoned by the immigratiou judge. See sections 208(4(8)(A) and 208(0X6) of the [NA and 8 CFR sections 208.10, 1208.10, 268.20, 1003.47(8) and 1208.20, Print your complete ane ‘Wile yournane in your naive alphabet Dic yourspouse, parent, or children) assis: you in completing this application? [52] no [) Yes af -Yes,” is she name and velarionshp ) Bane ehiorahpy ‘ane WRelationsipy Did someone other than your spouse, paren, o hires) prepare this application? No [1] ves ay"¥es, "complete Part) No [ve Asyhum applicants may be represented by counsel, Have you been provided witha list of [persons who may be available to assist you at litle ar no cost, with your asylum claim? ‘Signature of Applicant (The person in Par.) = ] ‘igi Your nanbe so tall appears within the brackets Date famiddiyyyy) [Part E, Declaration of Person Preparing Form, if Other Than Applicant, Spouse, Parent, or Child declare that "have prepared this application atthe request ofthe person named in Pat D, that the responses provided are based on all information of ‘which Thave inowledge, or whic was provided to me by the applicant, and thatthe completed epplication was rea tothe applicant in his or her native angtnge ota language he a she understands foe verification before he or she signed the application in my presence. T ama aware thatthe ‘knowing placement of false information on the Form-S89 may also subject me te civil penalties under 8 U.S.C, 1324 andr criminal penalties imder ISUS.C. 154600. ——— ——— we ane ne — ca i, este noses Form G-28is applicable) ‘USCIS Online Account Number (if any rans representative (if any). Fomi56) Edition 101 BU RELAPSE PER SB] me