MATERIAL WITNESS INFORMATION SHEET CASE INFORMATION Case Name: U.S. v. AUSA Name: Case Agent: Case No. AUSA Telephone: Agency: INFORMATION ABOUT THE MATERIAL WITNESS Name: Date of Birth: Foreign Address: Did The Material Witness Sign An I-826? Relationship to Defendant: A-Number: Immigration Status: PERSON MATERIAL WITNESS WILL RESIDE WITH DURING PENDENCY OF THE CASE Name: Home Address: Business Address: Home Telephone: Business Telephone: Relationship to Witness: RELATIVE OF THE MATERIAL WITNESS RESIDING IN THE U.S. Name: Home Address: Business Address: Home Telephone: Business Telephone: Relationship to Witness: ATTORNEY FOR THE MATERIAL WITNESS Name: Address: Tel: Fax: INFORMATION ABOUT THE SURETY Name: Immigration Status: Home Address: Business Address: Home Telephone: Does The Surety Have An Immigration Record (if so, the charges): Does The Surety Have A Criminal Record (if so, the charges): FOR INS USE ONLY 1. 2. Signature 2005 Relationship to Witness: Relationship to Defendant: Business Telephone: MATERIAL WITNESS G SURRENDERED G Date FAILED TO APPEAR G American LegalNet, Inc. www.USCourtForms.com