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READ CAREFULLY! THIS IS A PART OF YOUR SWORN STATEMENT

I am aware that the act of June 8, 1938, as amended( 52 Stat. 631; 53 Stat. 1244), provides among otherthings that every person who acts, engages in or agrees to act as a public relations counsel, publicity agent,or as agent, servant, representative, or attorney for the government or a political party of a foreign country,a person domiciled abroad, any foreign business, partnership, association, corporation, or political organiza-tion, or a domestic organization subsidized directly or indirectly in whole or in part by any of such entitiesor who receives compensation from or is under the direction of any of the foregoing shall, with certain excep-tions, file with the Secretary of State a registration statement as prescribed therein.

I am aware that this act exempts among others a duly accredited diplomatic or consular officer of a foreigngovernment only if so recognized as such by the Department of State of the United States , and any official,other than an American citizen, of a foreign government recognized by the United States as a government,or member of the staff or person employed by a duly accredited diplomatic or consular officer of a foreigngovernment who is so recognized by the Department of State , other than a public relations counsel or publicityagent, only if the status and the character of the duties as such official, member of staff, or employee are ofrecord in the Department of State .

I am further aware that any person who willfully fails to file any statement required to be filed underthis act, or in compliance with the provisions of this act, makes a false statement of material fact, or willfullyomits to state any material fact required to be stated therein shall, upon conviction thereof, be punished bya fine of not more than one thousand dollars or imprisonment for not more than 2 years, or both.

I am submitting this General Information Form in connection with an application for( check one ormore):

Suspension of my deportation in accordance with the provisions of section 19( c) of the ImmigrationAct of 1917, as amended;

Permission to depart from the United States at my own expense in lieu of deportation;

The privilege of pre- examination;

An extension of my temporary admission to the United States .

I am aware that any statements I have made in answer to the questions in this form may be used asevidence in any proceeding to determine my right to enter, reenter, pass through, or reside in the United States , and that false answers to any of the questions asked me herein may bar me from the relief which Ihave requested in my application.

I have read my answers to the questions on this General Information Form and swear( affirm) that theyare true of my own knowledge, except as to my answers to Questions 5( a)( b), 8( b)( c)( e), 9( b)( c)( e), 41( m)( o)( p), 47, 51, 53, 55, 56, and 57( a), which I swear( affirm) are true to the best of my information and belief.

Marie Juchacz

Monday

Subscribed and sworn to( affirmed) before me this Satur

( Signature of applicant)

day of February 9, 19.42

16-19234