Form I-131 04/24/19 Page 1 of 5 For USCIS Use OnlyUSCIS Form I-131 OMB No. 1615-0013 Expires 04/30/2022 Application for Travel Document Department of Homeland Security U.S. Citizenship and Immigration Services Part 1. Information About YouStart Here. Type or Print in Black Ink3. A-Alien Registration Number (A-Number) 1.b. 1.c. 2.a.1.a.Family Name (Last Name) Given Name (First Name) Middle Name Physical Address In Care of Name ZIP Code2.f.State2.e.City or Town2.d.2.h.2.i.ProvinceCountry 2.g.Postal Code 8.(mm/dd/yyyy)Date of Birth Other Information5.Country of Citizenship4.Country of Birth9. U.S. Social Security Number (if any) Class of Admission6. Female MaleGender7. Street Number and Name2.b. 2.c.Apt. Flr. Ste. Address in Part 1 US Consulate at: Intl DHS Ofc at: Action BlockReceipt To Be Completed by an Attorney/ Representative, if any.Fill in box if G-28 is attached to represent the applicant.Attorney State License Number: By: Date: / / /Document Hand Delivered Document IssuedRe-entry Permit (Update "Mail To" Section) Multiple Advance Parole Valid Until: / / / Single Advance Parole Refugee Travel Document (Update "Mail To" Section) Mail To (Re-entry & Refugee Only) (USPS ZIP Code Lookup) American LegalNet, Inc. www.FormsWorkFlow.com Form I-131 04/24/19 Page 2 of 5 Part 2. Application TypeI am a permanent resident or conditional resident of the United States, and I am applying for a reentry permit.1.a.1.b. I now hold U.S. refugee or asylee status, and I am applying for a Refugee Travel Document.1.c. I am a permanent resident as a direct result of refugee or asylee status, and I am applying for a Refugee Travel Document.I am applying for an Advance Parole Document to allow me to return to the United States after temporary foreign travel.1.d. 1.f.I am applying for an Advance Parole Document for a person who is outside the United States.I am outside the United States, and I am applying for an Advance Parole Document. 1.e. 2.b. 2.c. 2.a.1.2.3.a.4.a.4.c.4.b.3.b.Family Name (Last Name) Given Name (First Name) Middle Name2.f.Country of Citizenship2.e.Country of Birth2.d.(mm/dd/yyyy)(mm/dd/yyyy)(mm/dd/yyyy)Date of BirthDaytime Phone Number2.g.2.h. Physical Address (If you checked box 1.f.) In Care of Name City or Town2.k.2.o.2.p.ProvinceCountry 2.n.Postal Code ZIP Code2.m.State2.l. Part 3. Processing InformationDate of Intended Departure Expected Length of Trip (in days)If you are applying for a non-DACA related Advance Parole Document, skip to Part 7; DACA recipients must complete Part 4 before skipping to Part 7.If "Yes", Name of DHS office:Are you, or any person included in this application, now in240exclusion, deportation, removal, or rescission proceedings?Have you ever before been issued a reentry permit or Refugee Travel Document? (If "Yes" give the following information for the last document issued to you):Date IssuedDisposition (attached, lost, etc.): Yes NoStreet Number and Name2.i.If you checked box "1.f." provide the following information about that person in 2.a. through 2.p. ()- 2.j.Apt. Flr. Ste. Yes No American LegalNet, Inc. www.FormsWorkFlow.com Form I-131 04/24/19 Page 3 of 5 To a DHS office overseas at:7. If you checked "6" or "7", where should the notice to pick up the travel document be sent?To the address shown in Part 2 (2.h. through 2.p.) of this form. 2 to 3 yearsmore than 4 years3 to 4 years6 months to 1 year1 to 2 years8.7.b.Country 7.a.City or TownCity or Town6.a. Country 6.b.To the address shown in Part 3 (10.a. through 10.i.) of this form.:9.10.a.1.a.1.b. In Care of Name City or Town10.d.ZIP Code10.f.State10.e.10.h.10.i. ProvinceCountry 10.g. Postal Code Daytime Phone Number10.j. Part 4. Information About Your Proposed Travel Purpose of trip. (If you need more space, continue on a separate sheet of paper.)List the countries you intend to visit. (If you need more space, continue on a separate sheet of paper.) Part 5. Complete Only If Applying for a Re-entry PermitSince you became a permanent resident of the United States, have you ever filed a Federal income tax return as a nonresident or failed to file a Federal income tax return because you considered yourself to be a nonresident? (If "Yes" give details on a separate sheet of paper.)Since becoming a permanent resident of the United States (or during the past 5 years, whichever is less) how much total time have you spent outside the United States?1.a.less than 6 months1.b.1.c.1.d.1.e.1.f.2. Yes NoTo the U.S. address shown in Part 1 (2.a through 2.i.) of this form.Where do you want this travel document sent?240(Check one)6.To a U.S. Embassy or consulate at: 5. Part 3. Processing Information (continued)Street Number and Name10.b. 10.c.Apt. Flr. Ste. ()- American LegalNet, Inc. www.FormsWorkFlow.com Form I-131 04/24/19 Page 4 of 5 Applied for and/or obtained a national passport, passport renewal, or entry permit of that country?Applied for and/or received any benefit from such country (for example, health insurance benefits)?Since you were accorded refugee/asylee status, have you, by any legal procedure or voluntary act: Been granted refugee or asylee status in any other country?Acquired a new nationality?240Reacquired the nationality of the country named above?3.b.3.c.1.4.a.4.c.4.b. No Yes One Trip No Yes No Yes No Yes No More than one trip YesIf the travel document will be delivered to an overseas office, where should the notice to pick up the document be sent?:To the address shown in Part 2 (2.h. through 2.p.) of this form.To the address shown in Part 7 (4.a. through 4.i.) of this form.How many trips do you intend to use this document?If the person intended to receive an Advance Parole Document is outside the United States, provide the location (City or Town and Country)240of the U.S. Embassy or consulate or the DHS overseas office that you want us to notify.On a separate sheet of paper, explain how you qualify for an Advance Parole Document, and what circumstances warrant issuance of advance parole.240Include copies of any documents you wish considered. (See instructions.) Part 7. Complete Only If Applying for Advance Parole3. 4. City or Town2.a.Country 2.b.4.a.In Care of Name City or Town4.d.ZIP Code4.f.State4.e.4.h.4.i. ProvinceCountry 4.g. Postal Code Daytime Phone Number4.j.1.2.3.a. No Yes No Yes Part 6. Complete Only If Applying for a Refugee Travel DocumentDo you plan to travel to the country named above?If you answer "Yes" to any of the following questions, you must explain on a separate sheet of paper. Include your Name and A-Number on the top of each sheet.Country from which you are a refugee or asylee:Returned to the country named above?240Since you were accorded refugee/asylee status, have you ever:240240Street Number and Name4.b. 4.c.Apt. Ste. Flr. ()- American LegalNet, Inc. www.FormsWorkFlow.com Form I-131 04/24/19 Page 5 of 5 To be completed by all preparers, including attorneys and authorized representatives: I declare that I prepared this benefit request at the request of the applicant, that it is based on all the information of which I have knowledge, and that the information is true to the best of my knowledge.DeclarationNOTE: If you require more space to provide any additional information, use a separate sheet of paper. You must include your Name and A-Number on the top of each sheet. Part 9. Information About Person Who Prepared This Application, If Other Than the Applicant Preparer's Full NameProvide the following information concerning the preparer:1.a. Preparer's Family Name (Last Name) 1.b.Preparer's Given Name (First Name) 2.Preparer's Business or Organization Name 3.d.State3.e. ZIP Code3.f. Postal Code3.g.Province3.h.Country Preparer's Contact Information4.Preparer's Daytime Phone NumberExtension 5.Preparer's E-mail Address (if any) NOTE: If you are an attorney or representative, you must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with this application. Preparer's Mailing Address3.c. City or Town6.a. Signature of Preparer 6.b.Date of Signature(mm/dd/yyyy)I certify, under penalty of perjury under the laws of the United States of America, that this application and the eviden