EFTA01598101.pdf

U.S DEPARTMENT OF HOMELAND SECURITY NOTICE TO ALIEN ORDERED REMOVED/DEPARTURE VERIFICATION Event Not FINS A-File No CIGNA Ev Date Men's name: You have been found to be inadmissible to the United States under the provisions of section 212(a) of the Immigration and Nationality Act (Act) or deportable under the provisions of section 237 of the Act as a Visa Waiver Pilot Program violator. In accordance with the provisions of section 212(a)(9) of the Act, you are prohibited from entering, attempting to enter, or being in the United States El For a period of 5 years from the date of your departure from the United States as a consequence of your having been found inadmissible as an arriving alien in proceedings under section 235(b)(1) or 240 of the Act p For a period of 10 years from the date of your departure from the United States as a consequence of your having been ordered removed in proceedings under any section of the Act other than section 235(b)(1) or 240, or of being ordered excluded under section 236 of the Act in proceedings commenced prior to April 1, 1997. El For a period of 20 years from the date of your departure from the United States as a consequence of being found inadmissible and being previously excluded, deported, or removed from the United States. n At any time because in addition to being found inadmissible, you have been convicted of a crime designated as an aggravated felony. After your removal has been effected, you must request and obtain permission from the Secretary of Homeland Security to reapply for admission to the United States during the period indicated. You must obtain such permission before commencing your travel to the United States Application forms for requesting permission to reapply for admission may be obtained by contacting any United States Consulate or U S Department of Homeland Security office Refer to the above file number when requesting forms or information WARNING FOR ALL REMOVED ALIENS: It is a crimp under Title 8 United States Code. Section 1326, for an alien who has been removed from the United Slates to enter, attempt to enter, or be found in the United States without the Secretary of Homeland Security's express consent. Depending on the circumstances of the removal, conviction for this crime can result In imprisonment of a period of from 2 to 20 years and/or a fine up to 1250,000. SPECIAL NOTICE TO SEX OFFENDERS: Federal Law requires a convicted sox offender, including an alien who has boon removed from or otherwise dopanod the United Slates and subsequently returns, to register in each jurisdiction in the United States in which ho or she resides, Is employed, or is a student. Violation Of this requirement can result in prosecution and imprisonment for up to 10 years under Title 18 United States Code. Section 2250 COP OFFICER JAMAICA, XVII YORK sr serving warning) I IT,r ATTIOPr) (Location of OHS Office) Verification of Removal (Complete this section for file copy only) Departure Date Port of Departure Manner of Departure COMMERCIAL AIR Signature of Venfying Officer Title of Officer CAP° graph of Allen x Finger erprint and photograph appear above) eking fingerprint) DHS Form I-296 (1/12) Page 1 of EFTA01598101