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pdfDEPARTMENT OF HOMELAND SECURITY
U.S. Immigration and Customs Enforcement
NONIMMIGRATION CHECKOUT LETTER
OMB No. 1653-0020
(Expires 08/31/2008)
DHS Office Address
File Number
Date
This Section To Be Completed by the Office of Detention and Removal
The records of this office of the Department of Homeland Security show that permission was granted to
to remain in the United States for a temporary period.
The office has no records of his, her, or their departure from the United States.
To assist in the completion of our records relating to the departure of temporary visitors, you are requested to complete
this form and:
Return it in the attached self-addressed envelope. No postage is required if mailed from anywhere in the United States.
Mail or take it to the office of the nearest American Consul and ask him or her to return it to this office.
Your cooperation in this matter is appreciated.
This Section To Be Completed By Any Authorized U.S. Official
Select and complete all parts of the statement below that accurately reflect your knowledge about this person(s).
(NOTE: If Form I-94, Arrival-Departure Record, is available, please attach it to this form.)
The person(s) inquired about:
Departed from the United States at
Port of Departure
On
via
Date
Name of Vessel or other means of transportation
Applied for or has been granted an extension of temporary stay at the
Location
Office of the Department of Homeland Security.
Applied for adjustment of status at the
Location
Office of the Department of Homeland Security.
Did not depart from the United States.
Can be contacted at the following address:
Address
City
State or Province
Zip Code
Country
Has or have the following friends or relatives in the United States who may have information concerning his, her, or
their whereabouts:
Name
Address
City
State
Zip Code
Name
Address
City
State
Zip Code
ICE Form G-146 (Rev. 08/08)
None of the above items apply but the following information is provided:
(Attach additional sheet(s) of paper if necessary.)
None of the above items apply and I have no information to provide relating to this person(s).
Printed Name and Signature
Address
City
State
Zip Code
NOTE: The provision for collecting this information is voluntary. You are under no legal obligation to complete this form.
Paperwork Reduction Act Notice
An agency may not conduct or sponsor an information collection, and a person is not required to respond to an
information collection, unless it displays a valid OMB control number. The average time to complete this collection of
information is estimated as follows: 1) learning about the form, 3 minutes; 2) completing and assembling and mailing of
the form, 7 minutes, for a total of 10 minutes per response. If you have comments regarding the accuracy of this estimate
or suggestions for making this form simpler, you can write to the Department of Homeland Security; Immigration and
Customs Enforcement; 425 I St, NW, Room 1122; Washington, DC 20536; and reference OMB No. 1653-0020. Do not
mail your completed form to this address.
ICE Form G-146 (Rev. 08/08)
File Type | application/pdf |
File Title | DEPARTMENT OF HOMELAND SECURITY |
Author | rawagner |
File Modified | 2008-08-12 |
File Created | 2008-08-12 |