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Get ICE I-312 2019-2023

Notary Public State of My commission expires Notary Seal ICE Form I-312 9/16 Page 1 of 2 Privacy Statement Authority and Purpose The Immigration and Nationality Act as amended 8 U.S.C. DEPARTMENT OF HOMELAND SECURITY U*S* Immigration and Customs Enforcement OMB No* 1653-0041 Exp* 11/30/2018 DESIGNATION OF ATTORNEY IN FACT To accept on Obligor s behalf the return of cash or United States bonds or notes deposited to secure an immigration bond upon cancelation of the bond for performance by Obligor. Bonded Alien A-File No* Receipt No* From Form I-305 I of Obligor as principal have made constituted Address and appointed and by these presents do make constitute and appoint Attorney in Fact my true and lawful attorney for me and in my name place and stead to receive a refund of the deposit of cash or government obligations in the penal sum of made by me on as security for an immigration bond for the release of giving and granting unto my said attorney full power and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done in and about the premises as fully to all intents and purposes as I might or could do if personally present hereby ratifying and confirming all that my said attorney shall lawfully do or cause to be done by virtue hereof* This designation will not be effective unless it is properly notarized and until the original form is received by the Bonds Section at Financial Operations - Burlington U*S* Immigration and Customs Enforcement P. O. Box 5000 Williston VT 05495 its validity confirmed and it is entered into an ICE database. If this designation is invalid the Bonds Section will return it with a brief explanation of why it is not acceptable. IN WITNESS WHEREOF I have hereto set my hand and seal on the day of in the year. Signature of Obligor Principal Name Address TIN or SSN for Attorney in Fact STATE OF COUNTY On the before me personally came Obligor to me known and known to me to be the individual described in and who executed the foregoing instrument and acknowledged to me that s/he executed the same for the use and purpose therein contained* DATE EXAMINED AND APPROVED AS TO LEGAL FORM AND EXECUTION AND ACCEPTED. 1103 1183 1226 1229c and 1363 authorizes the collection of this information to provide for the posting maintenance cancellation and breach of an immigration surety bond and for associated financial management activities including collection of unpaid monies reimbursement of the bond principal and the calculation payment and reporting of interest. The Internal Revenue Code 26 U*S*C. 6109 authorizes the collection of the Social Security number SSN. Disclosure Furnishing this information is voluntary. For cash bonds your SSN is necessary to pay interest through the U*S*Treasury Department and to comply with Internal Revenue Service requirements to report interest payments. Routine Uses This information will be used by and disclosed to DHS personnel and contractors or other agents who need the information to support the enforcement of immigration laws and the provision of immigration benefits.

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