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Get Fillable Form I 918 Supplement A 02 07 17

Or print in black ink. Part 1. For USCIS Use Only. Receipt Returned Victim information. Family Name Given Name Middle Name Date Resubmitted Other Names Used (Include maiden name/nickname) Date of Birth (mm/dd/yyyy) Date Gender Female Male Part 2. Agency information. Name of Certifying Agency Date Reloc Sent Date Name of Certifying Official Title and Division/Office of Certifying Official Date Reloc Rec'd Date Name of Head of Certifying Agency Suite # Agency Address - Street.

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