DEPARTURES FROM UNITED STATES
State( yes or no)whether at the timeof your departure
you intended toreside permanently
abroad
( 0)
4
11. In the table below, state the facts concerning all of your entries into and departures from the United States .If you cannot remember the exact date of an entry or a departure, give the closest approximation.Be sure in all cases to list your first and last entries into the United States .
List, also, all other entries and departures which you have made, with the following exceptions:
( a) List only such trips to Canada or Mexico in which you were out of the United States more than 1month;
( b) If you are or have been residing in Canada or Mexico and have made short visits to the United States ,list only those visits in which you were in the United States more than 1 month.
( c) If you are or have been a seaman, list only the first and last of your entries into or departures from theUnited States as a seaman. Be sure to list all other entries and departures, however.
In all cases in which you omit to list entries and departures under exceptions( a),( b), and( c) above, explain ingeneral the nature, period, and frequency of such entries and departures in the space provided below the table.
Were you inspectedand admitted by im-migration officers?Answer yes or no
( e)
"
State( yes or no) whether you werein possession of passport. If" yes,'state name of government whichissued passport
( 1)
State whether you were in posses-sion of immigration visa, nonimmi-grant visa, transit certificate, lim-ited entry certificate, reentry per-mit, border- crossing card, or, ifother document, describe( g)
State whether you traveled aspassenger, seaman, stowaway, orif otherwise, state how
Were you admitted as permanentresident, visitor, in transit, gov-ernment official, student, treatymerchant, seaman, or, if otherwise,state how
( i)
Number ofentry
Means of transportation. ( If byship, give name. If you cannotremember name of ship, give nameof steamship line.)
Approximate date of entry.( Be as accurate as possible.)( d)
Month
Day
Year
( a)
( b)
( c)
Duc d'AU MAL MAY.
29
1941
2
3
4
сл
5
6
7
YES
NO
( SAUF de CONDUIT)
( h)
PASSENGER
VISITOR
Approximate date of departure.( Be as accurateas possible.)
Number ofdeparture
Place of departure from the UnitedStates
Destination( country)
Means of transportation. ( If byship, give name. If you cannotremember name of ship, give nameof steamship line.)
( n)
Month
Day
Year
( J)
( 1)
( m)
( k)
1
NONE
2
3
3
4
сл
5
6
7
8
6
10
Explain here the nature, period, and frequency of entries and departures omitted under exceptions( a),( b), and( c) of the instructions at the top of the page. If necessary use blank sheets at end and mark your answer Question 11.
8
9
10
16-19234