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Forthe yearJan.1-Dec.31,2015,or othertax yearbeginning , 2015,ending See separate instructions. ~


,20
Your first name and initial Last name Your social security number

SANDRA M TRUJILLO 731-09-6136


If a joint retum, spouse's first name and initial Last name Spouse's social security number

Home address (number and street). If you have a P.O. box, see instructions. Apt. no.
. Make sure the SSN(s)above
5023 WESTWINDS DRIVE
City,town or postoffice,state,andZIPcode.If you havea foreignaddress,alsocompletespacesbelow(seeinstructions).
I and on line 6c are correct.
PresidentialElection Campaign
ORLANDO FL 32819 Checkhereifyou,oryourspouseif filing
Foreign country name I Foreign province/state/county I jointly,want$3togotothisfund.Checking
Foreignpostalcode aboxbelowwillnotchange yourtaxor
refund. 1&1You 0 Spouse
Filing Status 1 181 Single 4 0 Head of household (with qualifying person). (Seeinstructions.) If
2 0 Married filing jointly (even if only one had income) the qualifying person is a child but not your dependent, enter this
Check only one 3 0 Married filing separately. Enter spouse's SSN above child's name here. ~
box. and full name here. ~ 5 0 Qualifying widow(er) with dependent child

Exemptions
6a 181 Yourself. If someone can claim you as a dependent, do not check box 6a } Boxes checked
on 6a and 6b 1
b O Spouse No. of Children ---
c Dependents: (2) Dependent's (3)Dependenfs (4) ,/ if childunderage17 on 6cwho:
qualifyingforchildtaxcredit lived with you
(1) Firstname Lastname socialsecuritynumber relationship
to you (seeinstructions) did not live with
you due to divorce
0 or separation
If more than four (see instructions)
dependents, see
0
Dependents on 6c
instructions and 0 not entered above
check here ~ 0 0 Add numbers on ~
d Total number of exemptions claimed lines above ~ Ll.J
7 Wages, salaries, tips, etc. Attach Form(s) W-2 7 28,559.
Income
8a Taxable interest. Attach Schedule B if required 8a
b Tax-exempt interest. Do not include on line 8a . : 1'8b' I' ~
Attach Form(s)

.-
9a Ordinary dividends. Attach Schedule B if required 9a
W-2 here. Also
attach Forms b Qualified dividends : I' 9~ I' ~
W-2G and 10 Taxable refunds, credits, or offsets of state and local income taxes 10
1099-R if tax 11 Alimony received . 11
was withheld.
12 Business income or (loss). Attach Schedule C or C-EZ . 12
13 Capital gain or (loss). Attach Schedule D if required. If not required, check here ~ 0 13
If you did not 14
14 Other gains or (losses). Attach Form 4797 .
get a W-2,
see instructions. 15a IRA distributions. ~ I b Taxable amount 15b
Pensions and annuities 16a b Taxable amount 16b -;
16a
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 17
18 Farm income or (loss). Attach Schedule F . 18
19 Unemployment compensation . ..... 19
20a Social security benefits ~I I b Taxable amount 20b
21 Other income. List type and amount 21
--------------------------_.-------------------------------_.
22 Combine the amounts in the far right column for lines 7 through 21. This is your total income ~ 22 28,559.
23 Educator expenses 23 w-
Adjusted 24 Certain business expenses of reservists, performing artists, and
'~,;;-~
Gross fee-basis government officials. Attach Form 2106 or 2106-EZ 24 3,949.
Income 25 Health savings account deduction. Attach Form 8889 25
'~~S
26
27
Moving expenses. Attach Form 3903
Deductible part of self-employment tax. Attach Schedule SE .
26
27 I~',~~
'7,1
28 Self-employed SEP, SIMPLE, and qualified plans 28
~ '"
29 Self-employed health insurance deduction 29 a'~'
30 Penalty on early withdrawal of savings. 30
t
,~
31a
32
Alimony paid
IRA deduction
b Recipient's
.
SSN ~ 31a
32
\
33 Student loan interest deduction . 33
34 Tuition and fees. Attach Form 8917 . 34
~
35 Domestic production activities deduction. Attach Form 8903 35 s:
36 Add lines 23 through 35 . . '. 36 3,949.
37 Subtract line 36 from line 22. This is your adjusted gross income ~ 37 24,610.
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. BAA REV 12130/15 PRO Form 1040 (2015)
Form 1040 (2015) Page 2

.
Tax arid
38
39a
Amount from line 37 (adjusted gross income)
Check {
if:
o
o
You were born before January 2, 1951,
Spouse was born before January 2, 1951,
o
o
Blind. } Total boxes
Blind. checked ~ 39a
L 38 24,610.

Credits
b If your spouse itemizes on a separate return or you were a dual-status alien, check here ~ 39bO
---- I~
Standard ~ Itemized deductions (from Schedule A) or your standard deduction (see left margin) 40 6,300.
Deduction
for- 41 Subtract line 40 from line 38 41 18,310.
o People who 42 Exemptions. If line 38 is $154,950or less, multiply $4,000by the numberon line 6d. Otherwise,see instructions 42 4,000.
check any
box on line 43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- 43 14,310.
39a or 39b or 44 Tax (see instructions). Check if any from: a 0 Form(s) 8814 b 0 Form 4972 cD 44 1,688.
who can be
claimed as a 45 Alternative minimum tax (see instructions). Attach Form 6251 45
dependent,
see 46 Excess advance premium tax credit repayment. Attach Form 8962 46
instructions.
47 Add lines 44, 45, and 46 ~ 47 1,688.
o All others:
48 Foreign tax credit. Attach Form 1116 if required . 48
Single or
Married filing 49 Credit for child and dependent care expenses. Attach Form 2441 49
separately,
$6,300 50 Education credits from Form 8863, line 19 50
Married filing 51 Retirement savings contributions credit. Attach Form 8880 51
jOintly' or
QUalifYin
widow(er,
$12,600
r 52
53
Child tax credit. Attach Schedule
Residential energy credits. Attach Form 5695
8812, if required. 52
53 1,104.
:;;f~:'
Head of 54 Other credits from Form: a 0 3800 b 0 8801 cO 54
---
household, 55 Add lines 48 through 54. These are your total credits 1,104.
$9,250 55
56 Subtract line 55 from line 47. If line 55 is more than line 47, enter -0- ~ 56 584.
57 Self-employment tax. Attach Schedule SE 57
58 Unreported social security and Medicare tax from Form: 58
Other a 04137 b 08919
59 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required 59
Taxes 60a Household employment taxes from Schedule H 60a
b First-time homebuyer credit repayment. Attach Form 5405 if required 60b
61 Health care: individual responsibility (see instructions) Full-year coverage I&l 61
62 Taxes from: a 0 Form 8959 b 0 Form 8960 c 0 Instructions; enter code(s) 62
63 Add lines 56 through 62. This is your total tax ~ 63 584.
Payments 64 Federal income tax withheld from Forms W-2 and 1099 64 2,310.
65 2015 estimated tax payments and amount applied from 2014 return 65
If you have a
~a Earned income credit (EIC) No 66a I:~~!
ID:;~~~
qualifying
child, attach b Nontaxable combat pay election '16~b I v' .'t:~,~ ""! i"
Schedule EIC. 67 Additional child tax credit. Attach Schedule 8812 67
68 American opportunity credit from Form 8863, line 8 68
69 Net premium tax credit. Attach Form 8962 . 69
70 Amount paid with request for extension to file 70 ;;;

71 Excess social security and tier 1 RRTA tax withheld 71


72
73
Credit for federal tax on fuels. Attach Form 4136
CreditsfromForm:a 0 2439 b 0 Reserved c 0 8885 dO
Add lines 64, 65, 66a, and 67 through 73. These are your total payments
---
72
73
~
l~
74 74 2,310.
Refund 75 If line 74 is more than line 63, subtract line 63 from line 74. This is the amount you overpaid 75 1,726.
76a Amount of line 75 you want refunded to you. If Form 8888 is attached, check here ~O 76a 1,726.
Direct deposit? ~ b Routing number : 2: 6:7:0:8:4:1:3:1:
,
~ c Type: ~ Checking o Savings
See ~ d I I ! ! I ! !

~I
Account number ; 6iOi3i9i3[9i9i5i5i ! ;
instructions.
77 Amount of line 75 you want applied to your 2016 estimated tax ~ 77
Amount 78 Amount you owe. Subtract line 74 from line 63. For details on how to pay, see instructions ~
You Owe 79 Estimated tax penalty (see instructions) . . . . . . . I 79 I '11; ,c'JIfj i1:~. ~~
Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)? 0 Yes. Complete below. I&l No
Designee Designee'S Phone Personal identification
name ~ no. ~ number (PIN) ~
Sign Underpenaltiesof perjury,I declarethat I haveexaminedthis returnand accompanyingschedulesand statements,and to the best of my knowledgeand belief,
they aretrue, correct, and complete.Declarationof preparer(otherthan taxpayer)is basedon all informationof which preparerhas any knowledge.
Here Your signature Date Your occupation Daytime phone number
Joint return?See ~
instructions.
Keepa copy for
yourrecords.
r
Spouse's signature. If a joint return, both must sign. Date
ARTS
Spouse's occupation IftheIRSsentyouanIdentityProtection
PIN,enterit
here(seeins!.)I I
Printrrype preparer's name I Preparer's signature
Paid I Date Check 0 if II PTIN
RICHARD TORO self-employed PO 13 99048
Preparer
Use Only Firm's name ~ International Accountinq Consultants Firm's EIN ~ 59-0624485
Firm's address ~ 10300 SW 72 Street STE # 305 Miami FL 33173 Phone no.
www.irs.gov/form1040 REV 12130/15 PRO Form 1040 (2015)
~~

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DEPARTM";l'H of.$,IA~'
CONSULAR ELECTRONIC APPLICATION CENTER
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Payment Receipts for IV Case GTM2016613019


IV Fee Payment Receipt Details

Principal Applicant DELMI SUCHITE FRANCO


Payment of Services Initiated 8-JUN-2016 15:57:58
Payment Processed Date
Payment Amount $325.00
Payer trujlllo suchite, sandra m
Payer Email smagaly18@hotmail.com
Transaction 10 25RTBEOO

Applicant IV Fee Payment Fee


Status Amount
DELMI FRANCISCA SUCHITE IN PROCESS $325.00
FRANCO

Next Steps
If your payment status shows that it is IN PROCESS, wait two to three business days
for the payment to clear. Then sign into the system again to check for a status
update.

If your payment status shows a status other than IN PROCESSor PAID, sign in to the
Immigrant Visa Invoice Payment Center page
https:/lceac.state.gov/CTRAClInvoice/Signon.aspx and click on Get Help.

If you receive a notice that your case has entered termination, do not attempt to
pay any fees. You must contact the National Visa Center (NVC) immediately to
resume processing of your petition. You can find NVC contact information at
nvc.state.gov/ask

Wh-:en the IV fee payment status is PAID:

1. Each applicant must complete and submit an Online Immigrant Visa and Alien
Registration Application (DS-260). To submit your application, go to
http://ceac.state.gov/iv,andsignin.ReadtheSummarylnformation.Click on
the IV APPLICATION tab and follow the application instructions.
2. To review specific U.S. Embassy or Consulate instructions and options that may
apply to your case, go to nvc.state.gov/document. You will find the information
in a downloadable PDF format at the bottom of the page.
3. To complete your Immigrant Visa Application, you must submit copies of all
supporting documents. Go to nvc.state.gov/submit. You will find instructions if
you are required to email your documents, as well as the processing and mailing
information.
4. If you are required to submit physical copies of your documents, you must
include a barcoded cover sheet to identify your documents.

If you received an Instruction Packet from the NVC, it contains a cover sheet.
You can send that cover sheet or a copy of the cover sheet .
If you need a new cover sheet, print one by clicking the Print Document Cover
Sheet button on the Receipt page.
If you cannot print a cover sheet, click the Email Document Cover Sheet button.
Then send an electronic copy to an email address where you can print it.

IMPORTANT NOTES:

If you decide to file Form I-60lA, Application for Provisional Unlawful Presence
Waiver with USCIS, you must include a copy of this fee payment receipt or
USCIS will reject your Form I-60lA.
Please keep this receipt for your records. If you can't print the receipt now,
return to the Receipt Screen and email a copy to an address where you can print
it later.
Do not let more than one-year pass without contacting the NVC about your
immigrant visa petition. If a period of one-year passes from the last date of
contact, all submitted forms and fees will expire and you must resubmit them to
resume processing.
You will find the next steps about AOS fee payments on the AOS fee payment
receipt.
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Online Choice of Address and Agent (OS-261)

Choice of Address and Agent Confirmation


Thank You
Your Choice of Address and Agent form (Form DS-261) has been forwarded to the National Visa Center (NVC). After
NVC processes your DS-261, your agent will receive an invoice or "fee bill" asking you to pay the immigrant visa
processing fee(s). You must pay these fees before NVC can continue processing your petition. You cannot access
the immigrant visa application form until these fees are paid.

Next Step
Please allow two weeks for NVC to process your DS-261. NVC will then send you an invoice that includes an Invoice
Identification Number that you need to pay your fees. When you have that number, you or your agent should return
to this website and, after signing in with the Case Number and Invoice Identification Number, pay the fee(s) due by
clicking Fee Payment and following the instructions.

Important
If your agent receives an invoice after having paid the fee(s), he or she should ignore that invoice. DO NOT pay the
fee(s) twice.

This confirms the submission of the Choice of Address and Agent form:

Completed On: 02 MAY 2016


Case No: GTM2016613019
Confirmation No: AA005XZYZY

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THIS IS NOT A VISA Version 01.01.00


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Online Immigrant Visa and Alien Registration Application (OS-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
http://nvc.state.gov (English) or http://nvc.state.gov/espanol (Spanish) and review Steps 4-6 for instructions.

When NVC has your DS-260, financial documents, and civil documents, they will review these items. Please allow 30
days for NVC to complete their review. If the documents you submit 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: SUCHITE FRANCO, DELMI FRANCISCA


Country/Region of Origin GUATEMALA
(Nationality):
Completed On: 16 JUN 2016
Case No: GTM2016613019
Confirmation No: AA005XZZOO

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THIS IS NOT A VISA Version 01.01.00
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Online Immigrant Visa and Alien Registration Application (DS-260)

Personal, Address, and Phone Information

Note: You have completed data entry for your 'Immigrant Visa and Alien Registration' application. Before submitting the
application, please review your entries below. To navigate to the next section to be reviewed, click the 'Next' button on the
bottom of the page. If an entry is incorrect, click on the links on the right side of the page, which will direct you to the page
where you entered the data. Once you have reviewed all sections, you will be directed to the Sign and Submit page to
complete the application process.

Name Provided: SUCHITE FRANCO, DELMI FRANCISCA

Full Name in Native Language: DOES NOT APPLY!TECHNOLOGYNOT AVAILABLE

Other Names Used: NO

Sex: FEMALE

Current Marital Status: SINGLE

Date of Birth: 10 SEPTEMBER1970

City of Birth: ZACAPAGUATEMALA

State/Province of Birth: ZACAPA

Country/Region of Birth: GUATEMALA

Country/Region of Origin (Nationality): GUATEMALA

Document Type: PASSPORT

Document ID: 1712241161901

Country/Authority that Issued Document: GUATEMALA

Issuance Date: 03 MAY 2016

Expiration Date: 02 MAY 2021

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

Present Address: BARRANCOCOLORADOSAN JORGE

City: ZACAPAGUATEMALA

State/Province: ZACAPA

Postal Zone/ZIP Code: DOES NOT APPLY

Country/Region: GUATEMALA

From Date: SEPTEMBER1970

Have you lived anywhere other than this address since the NO
age of sixteen?

Primary Phone Number: 50231028912

Secondary Phone Number: 3212800673

Work Phone Number: DOES NOT APPLY

Email Address: smagaly18@hotmaiLcom

Is your Mailing Address the same as your Present Address? NO


Mailing Address: 5023 WESTWINDS DR

City: ORLANDO

State/Province: FL

Postal Zone/ZIP Code: 32819

Country/Region: UNITED STATES OF AMERICA

Permanent Address

Name of person currently living at address: SANDRA MAGALY TRUJILLO SUCHITE

u.s. Address: 5023 WESTWINDS DR

ORLANDO, FLORIDA 32819

Phone Number: (321)280-0673

Is this address where you want your Permanent Residence YES


Card (Green Card) mailed?
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Online Immigrant Visa and Alien Registration Application (DS-260)

Social Security Number Information

Have you ever applied for a Social Security number? NO

Do you want the Social Security Administration to issue a Social Security number and a card? YES

Do you authorize disclosure of information from this form to the Department of Homeland Security, YES
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?
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Online Immigrant Visa and Alien Registration Application (DS-260)

Petitioner Information

Petitioner is my: CHILD

Petitioner Name: TRUJILLO SUCHITE , SANDRA MAGALY

Petitioner Address: 5023 WESTWINDS DR

City: ORLANDO

State/Province: FL

Postal Zone/ZIP Code: 32819

Country/Region: UNITED STATES OF AMERICA

Telephone: 3212800673

Mobile/Cell Telephone: 3212800673

Email Address: smagaly18@hotmail.com


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

Work / Education / Training Information

Primary Occupation: NOT EMPLOYED

In which occupation do you intend to work in the u.s.? NOT EMPLOYED

Were you previously employed? NO

Have you attended any educational institutions at a NO


secondary level or above?

Have you ever served in the military? NO


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

Family Information

Father's Surnames: SUCHITE REYES

Father's Given Names: RIGOBERTO

Date of Birth: 19 JUNE 1936

City of Birth: BARRANCO COLORADO ZA

State/Province of Birth: ZACAPA

Country/Region of Birth: GUATEMALA

Is your father still living? YES

Current Address: BARRANCO COLORADO SAN JORGE

City: ZACAPA GUATEMALA

State/Province: ZACAPA

Postal Zone/ZIP Code: DOES NOT APPLY

Country/Region: GUATEMALA

Surnames at Birth: FRANCO UMA

Mother's Given Names: ROSA EUDA

Date of Birth: 03 FEBRUARY 1939

City of Birth: SAN JORGE ZACAPA GUA

State/Province of Birth: ZACAPA

Country/Region of Birth: GUATEMALA

Is your mother still living? YES

Is your mother's address the same as your father's? NO

Current Address: COLONIA TIERRA VERDE

City: SIQUINALA

State/Province: ESCUINTLA

Postal Zone/ZIP Code: DOES NOT APPLY

Country/Region: GUATEMALA

Do you have any Previous Spouses? NO

[3l Do you have any children? YES

Number of Children: 3

Child Name (1): TRUJILLO SUCHITE , SANDRA MAGALY

Date of Birth: 06 JULY 1988

City of Birth: ZACAPA GUATEMALA

State of Birth: ZACAPA

Country/Region of Birth: GUATEMALA

Dose this child live with you? NO

Address: 5023 WESTWINDS DR


City: ORLANDO

State/Province: FL

Postal Zone/ZIP Code: 32819

Country/Region: UNITED STATESOF AMERICA

Is this child immigrating to the u.s. with you"? NO

Is this child immigrating to the U.S. at a later date to join NO


you?

Child Name (2): SUCHITE, DELMYGABRIELA

Date of Birth: 08 DECEMBER1991

City of Birth: GUATEMALA

State of Birth: GUATEMALA

Country/Region of Birth: GUATEMALA

Dose this child live with you? YES

Is this child immigrating to the U.s. with you? NO

Is this child immigrating to the U.S. at a later date to join NO


you?

Child Name (3): CHOCOOJSUCHITE , JOSUEROLANDO

Date of Birth: 16 DECEMBER1998

City of Birth: GUATEMALA

State of Birth: GUATEMALA

Country/Region of Birth: GUATEMALA

Dose this child live with you? YES

Is this child immigrating to the U.S. with you? NO

Is this child immigrating to the U.S. at a later date to join NO


you"?
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Online Immigrant Visa and Alien Registration Application (OS-260)

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? NO

Explain: NOT YET, NOT SURE WHAT VACCINATION SHOULD I GET.

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 NO
trafficking 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 NO
you 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 NO
human 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

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
poiitical 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 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 30, 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?

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