U.S. Department of Justice
OMR 1115-4077
Immigration and Naturalization service |
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OMR 1115-407
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| Welcome
to the United State |
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Åwªï¨Ó¨ì¬ü°ê |
Admission
Number
890738531 01 |
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µn°O¸¹½X
(*Á|¨Ò»¡©ú)
890738531 01
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| I-94
Arrival/Departure Record-Instructions |
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I-94
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This
form must be completed by all persons except U.S. citizens,
returning resident aliens with immigrant visas, and Canadian
Citizens visiting or in transit.
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°£¤F¬ü°ê¤½¥Á, ¬ü°ê®ü¥~¹´¥Á, ¥Ã¤[©~¥Á©M¥[®³¤j¤½¥Á¥~, ©Ò¦³³X°Ý ©Î¹L¸ôªº¤H¤h³£¥²¶·¶ñ¼g¦¹ªí |
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Type
or print legibly with pen in ALL CAPITAL LETTERS. Use English.
Do not write on the back of this form.
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½Ð¥Î¤j¼g¦r¥À¥´¦r©Î¥Î¿ûµ§©Î¥Î¶ê¯]µ§²M·¡¶ñ¼g.
½Ð¥Î^¤å¶ñ¼g. ¤£n ¦b¦¹ªíI±¶ñ¼g¥ô¦óªF¦è. |
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This
form is in two parts. Please complete both the Arrival Record
(Item 1 through 13) and the Departure Record (Item 14 through
17).
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¦¹ªí¥]¬A¨â³¡¤À,
½Ð¶ñ¼g¤J¹Ò°O¿ý (²Ä1¶µ¦Ü²Ä13¶µ)©MÂ÷¹Ò°O¿ý(²Ä 14¶µ¦Ü²Ä17¶µ)¨â³¡¤À. |
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When
all items are completed, present this form to the U.S. Immigration
and Naturalization Service Inspector.
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¶ñ¼g§¹²¦«á,
½Ð±N¦¹ªí¥æµ¹¬ü°ê²¾¥Á§½©xû. |
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Item
7 ¨C If you are entering the United States by land, enter
LAND in this space. If you are entering the United States
by ship, enter SEA in this space.
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²Ä7¶µ¤º®e»¡©ú
- ¦pªG§A±q³°¦a¶i¤J¬ü°ê, ½Ð¦bªÅ®æ¤º¶ñ¼gLAND, ¦pªG §A¼²î¶i¤J¬ü°ê, ½Ð¦bªÅ®æ¤º¶ñ¼gSEA. |
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Form
I-94(10-01-85)N
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I-94ªí (10-01-85)N |
Admission
Number
697385031 01
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µn°O¸¹½X |
Immigration
and Naturalization Service
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I-94
Arrival Record |
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I-94
¤J¹Ò°O¿ý |
| 1.
Family Name |
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1.
©m |
| 2.
First (Given) Name |
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2.
¦W |
| 3.
Birth Date(Day/Mo/Yr) |
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3.
¥Í¤é(¤ë/¤é/¦~) |
| 4.
Country of Citizenship |
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4.
þÓ°ê®a¤½¥Á |
| 5.
Sex (Male or Female) |
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5.
©Ê§O(¨k Male ©Î¤k Female ) |
| 6.
Passport Number |
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6.
Å@·Ó¸¹½X |
| 7.
Airline & Flight Number |
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7.
¯èªÅ¤½¥q©M¯è¯Z¸¹ |
| 8.
Country Where You Live |
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8.
§A¦bþÓ°ê®a©~¦í |
| 9.
City Where You Boarded |
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9.
§A¦bþÓ«°¥«°¸¨ |
| 10.
City Where Visa Was Issued |
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10.
¦bþÓ«°¥«±o¨ìñÃÒ |
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| 11.
Date Issued (Day/Mo/Yr) |
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11.
±o¨ìñÃÒªº¤é´Á(¤é/¤ë/¦~) |
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| 12.
Address While in the United State (Number and Street)
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12.
¦b¬ü°êªº¦í§}(ªùµP¸¹¤Îµó¦W) |
| 13.
City and State |
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13.
¦b¬ü°êªº¦í§}(¥«¦W¤Î¦{¦W) |
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Departure
Number
890738531
01 |
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Â÷¹Ò¸¹½X
890738531 01 |
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| Immigration
and Naturalization Service |
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²¾¥Á§½ |
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I-94
Departure Record |
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I-94
Â÷¹Ò°O¿ý |
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| 14.
Family Name |
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14.
©m |
| 15.
First (Given) Name
¡³
16. Birth Date(Day/Mo/Yr) |
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15.
¦W ¡³ 16. ¥Í¤é(¤é/¤ë/¦~) |
| 17.
County of Citizenship |
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17.
þÓ°ê®a¤½¥Á |