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The Immigration Law Office of David N. Simmons (303) 806-0202
Intake Form

General Information: please fill in all required fields!

Date:
Name:
Address:
Home Phone:
Cell Phone:
Email Address: (required)
Other Names Used:
SSN:
DOB:
Place of Birth:
Marital Status:




Passport:
Date Began Residing in USA
A#:

Section 2:___________________________________________________________________________

Absenses from the US:
Date Last Arrived to US:
Current Status::
Status Expiration::
I-94 #:
US Visa Classification:
Visa Issue Date:
Visa Issue Post:
Visa Exp. Date:

Parent or Grandparent
Citizen?
US Citizen Relatives?:

Permanent Resident
Relatives?

Section 3: ___________________________________________________________________________

Job/Profession:
Education:
Criminal Arrests/Convictions:
DUI?:



Previous Deportations/
Proceedings :
Permanent Address:
Employer's Name:
Contact Person?:

Employers Address:
Employers IRS:
Employers Phone:
Length of time w/
that employer

Section 4: Spouse _____________________________________________________________________

Name of Spouse:
SSN:
Spouse DOB:
Place of Birth:
Date of Marriage:

(month/day/year)
Place:
Spouse Citizenship
Spouse Education/
Degrees :
Spouse Job:
Other Names:
Other Marriages
Children: (Names, Dates,
Places of Birth)
   

___________________________________________________________________________________
   
Referred By:

Deadlines:
Client Remarks:
   
 

security code
Enter Security Code:
   
Client-Imposed:
Notes:
False Representation to
USC on I-90:

 

 


  

The Immigration Law Office of David N. Simmons • (303) 806-0202 • email: inquiries@davidnsimmons.com
 
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