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typist instill ni Homeland Security I .ittl Immivrati(ln Services I t Infos matism WI %MI t NAM. . . t Hp MC'. ink Given Name Middle Name )t garrization (ii applicable) Mailing Add, « street Number and Name Apt. 1 1 ('/t ) (in care or) State or Pros ince Zip/Postal Code Country Daytime Phone # (AreaJCour !r: Code) Fax # (Aren'( 'onntry Code) C Mail Address (if anv) CI I am an anorney err reprem:ntatlye If you check this box. you must provide the !Aiming information about the person or organization for whom you are appearing. (NOTE: You must attach a Form G-28, Notice of Entry of Appearance ac Attorney or Representative.) Family Name Given Name Middle Name L Complete Name of I3usiness/Organization/School (if applicable) A # (if any) Daytime Phone # (Area/Country Code) Fax // (Areaituuntcy Code) Addrcn (if any) Part 2. I am iiiatitm about the appeal or motion. Check the box below that the best dcscribe5 your request. (Check one box.) i4Aft liortAPtr) t - Form 1-294B.\of ik of /tivi.4.:;! or ", tifprl k Number keturhttl Resulnaitfrit tree Helix Sent Date Date Refry( lux a Date I dill filing an appeal. My brief and/or additional evidence is attached. I am filing an appeal. My brief and/or additional evidence will be submitted to the AAO within 30 days. I ain tiling an appeal. No supplemental brie) anti as additional evidence will be sabenned, I am filing a motion to reopen a decision My brief and/or additional evidmce is attached. I am filing a motion to reconsider a decision. My brief is attached I am filing a motion to reopen and a motion to reconsider a decision. My brief antVor add*iortal evidence rs Ar EFTA01134231