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Get USCIS I-918 Supplement B 2013

Type or print in black ink. For USCIS Use Only Returned Receipt Part 1. Victim Information Family Name Given Name Middle Name Date Date Other Names Used (Include maiden name/nickname) Resubmitted Date of Birth (mm/dd/yyyy) Date Gender Male Female Part 2. Agency Information Date Reloc Sent Name of Certifying Agency Date Name of Certifying Official Title and Division/Office of Certifying Official Date Reloc Rec'd Date Name of Head of Certifying Agency Date Suite No. Agency Addr.

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