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Get USCIS I-693 2013

Part 1. Information About You (To be completed by the person requesting a medical examination, not the civil surgeon) Family Name (Last Name) Given Name (First Name) Home Address: Street Number and Name Gender: Male Phone Number Apt. Number State City Full Middle Name Zip Code ( Date of Birth (mm/dd/yyyy) Place of Birth (City/Town/Village) ) Female - A-Number (if any) Country of Birth A- Applicant's Certification I certify under penalty of perjury under United States law that I a.

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