Form DS-7656 Affidavit of Relationship

U.S. Department of State

INSTRUCTIONS - DS-7656, AFFIDAVIT OF RELATIONSHIP (AOR)
NOTE: Read these instructions carefully. If you do not follow the instructions, the U.S. Department of State, or its designated representative, may
return your AOR for clarification or correction. By completing this form you are claiming a relationship with family members overseas in order to assist
the U.S. Government in determining whether those family members are qualified to apply for admission to the United States under the U.S. Refugee
Admissions Program (USRAP). The AOR itself is not an application on behalf of your family member for admission to the U.S. as a refugee under the
USRAP or a petition for any immigration benefit under U.S. law. Completion of this AOR does not guarantee that your family members will be found
qualified to apply for refugee admission or that they ultimately will be admitted to the United States. Additionally, the information listed in this AOR may
be used and disclosed by the U.S. Department of State as described in the Privacy Act Statement on the AOR and in Part 10 of these instructions
below. The U.S. Government investigates claimed family relationships and verifies the validity of documents. Criminal prosecutions may be sought
when family relationships are falsified to obtain immigration benefits.
1. Purpose of This Form
The DS-7656 provides a means for persons in the United States who were admitted as refugees or were granted asylum to claim a relationship with
certain family members overseas and to assist the U.S. Department of State in determining whether those family members are qualified to apply for
access to the USRAP for family reunification purposes. The specific family relationships and nationalities eligible for consideration under USRAP vary
from year to year as outlined in the annual Presidential Report to Congress on Proposed Refugee Admissions. Resettlement agency representatives,
who assist persons with this form, are knowledgeable about who may file an AOR in the current year. This form also assists the U.S. Department of
Homeland Security's U.S. Citizenship and Immigration Services (USCIS) to verify family relationships during refugee case adjudication. The main
purpose of the DS-7656 is for you (the U.S.-based family member) to provide biographical information about relatives overseas who may subsequently
seek access to the USRAP for verification by the U.S. Government. The information on this form may also be used by the U.S. Government to verify
information provided by these individuals in relation to any other immigration benefit they may subsequently seek under U.S. law and other uses as
described in the Privacy Act Statement on the AOR and in Part 10 of these instructions below.
2. Who May File This Affidavit?
You may file the DS-7656 if you are at least 18 years of age, have been admitted to the United States as a refugee or granted asylum in the United
States no more than five years prior to the filing of this affidavit, and have a legal immigration status in the United States. This includes persons who
were admitted as refugees or granted asylum and are now Lawful Permanent Residents (LPR), and, in some circumstances, U.S. Citizens.
3. Who Is Qualified to Apply for Refugee Admission Based on this AOR?
Your spouse, and/or your unmarried (single, widowed or divorced) child(ren) under 21 years of age, and/or your parents, who have valid proof of
refugee registration in their country of asylum may be qualified to apply for refugee admission to the United States under the USRAP. Please list them
in Section II part A of the AOR as the Qualifying Family Member.
Spouses and unmarried children under 21 years of age of Qualifying Family Members may be included on the Qualifying Family Member’s refugee
application and may be admitted as derivative beneficiaries with the Qualifying Family Member as a refugee if otherwise admissible to the United
States. These individuals derive their refugee status from the Qualifying Family Member and do not have to independently establish a persecution
claim. Please list them in Section II of the AOR as type B relatives.
On a case-by-case basis, an individual may also be considered qualified to apply for admission in connection with a Qualifying Family Member if that
individual:
1. lived in the same household as the Qualifying Family Member in the country of nationality or, if stateless, last habitual residence; AND,
2. was part of the same economic unit as the Qualifying Family Member in the country of nationality or, if stateless, last habitual residence; AND,
3. demonstrates exceptional and compelling humanitarian circumstances that justify his/her inclusion on the Qualifying Family Member’s case.
These individuals cannot derive their refugee status from the Qualifying Family Member and therefore must independently establish that they qualify as
a refugee. Please list them in Section II of the AOR as type C relatives.
Please note:
- The relationship between you and the Qualifying Family Member must have existed on the date you were admitted to the United States as a refugee,
or granted asylum in the United States, and must continue to exist.
- If a person who is listed on this form is a child who was conceived but not yet born on the date you were admitted to the United States as a refugee,
or granted asylum in the United States, the relationship will be considered to exist as of the date you were admitted to the United States as a refugee,
or granted asylum in the United States. The mother of any such child is not a Qualifying Family Member unless the mother was married to you when
you were admitted to the United States as a refugee, or granted asylum in the United States.
- The marriage creating a stepparent or stepchild relationship must have occurred before the child's 18th birthday in order for the stepparent or
stepchild to be claimed in this AOR as a Qualifying Family Member or derivative.
- Adopted Children: In order to be claimed on this AOR as Qualifying Family Members in Section II or as a type B relative in Section II, adopted
children must have been in the legal custody of and resided with the adopting parent or parents for at least two years and:
1. been legally adopted before their 16th birthday, or
2. be the natural sibling of a child described in (1) directly above and been adopted themselves before their 18th birthday.
- In all cases, in order for your children/stepchildren/adopted children to be considered Qualifying Family Members, they must be unmarried and under
DS-7656
03-2015

Instruction Page 1 of 5

4. Where Do You File This Form?
The DS-7656 is prepared by you with assistance from a local resettlement agency participating in the Department of State's Refugee Reception and
Placement Program, and submitted to the U.S. Department of State by the agency's national headquarters office. AORs submitted directly to
Resettlement Support Centers (RSCs) or by you to the U.S. Government will NOT be accepted.
5. What Additional Information Must Be Provided With the DS-7656?
You must attach copies of documents that provide proof of registration in the country of asylum for the family members for whom you are applying.
Registration documents are provided by UNHCR or country of asylum.
You must attach copies of documents that provide proof of your current legal immigration status in the United States. AORs submitted without such
document(s) will NOT be accepted.
Acceptable Proof of Legal Status for Anchor:
a. Refugees and Asylees: Legible copy of both sides of your I-94, or a copy of your asylum grant letter, or immigration judge grant decision.
b. Lawful Permanent Residents: Legible copy of both sides of I-551(Permanent Resident Card - Green Card), or any temporary proof of
permanent resident status issued by the Department of Homeland Security's USCIS (or documents that were formerly issued by the Immigration and
Naturalization Service.)
c. U.S. Citizens: Legible copy of your U.S. Passport or Naturalization Certificate (Note: it is now legal to make a copy of this document for
immigration purposes.)
If you are filing for an adopted child, please provide a copy of the adoption papers, if available.
6. What Additional Information May Need to be Provided to Establish a Family Relationship?
You and your biological parents and children listed in Section II of the AOR will be required to provide a DNA sample at a later date to establish your
relationship. By signing your name on the AOR, you are agreeing to provide the DNA sample when requested by an official of the U.S. Government, or
its designated representatives. Further, by signing the AOR you are expressing your understanding that DNA testing could be requested between your
Qualifying Family Member(s) and their derivative beneficiaries. Please note that if you or your claimed family members fail to submit DNA evidence
upon request, your family members may be considered ineligible for refugee resettlement.
An officer of USCIS will make the final determination regarding whether a bona fide relationship exists between you and your relative(s) at the time of
the interview for refugee status.
7. Who will Pay the Costs of DNA Testing?
You must pay all costs associated with DNA testing required for access to the P3 program of both you and your your biological parent-child Qualifying
Family Member(s). In addition, you and/or your Qualifying Family Member(s) will be expected to pay the costs of any additional testing between your
Qualifying Family Member(s) and their derivative beneficiaries. Subject to available funds, the U.S. Government will reimburse the cost of DNA testing
that is required for access to the P3 program if such tests confirm all claimed biological relationships.
8. What Are the General Instructions for Completing the AOR?
The DS-7656 must be completed in English. Please complete using Cerenade fill program. Handwritten applications will be returned. If you need extra
space to complete any item, attach a separate continuation sheet. Indicate the item number, and date and sign each sheet.
Answer all questions fully and accurately. If you do not know the answer to a question, please write "Unknown". If questions asked do not apply to
you, please state "N/A", meaning Not Applicable. For all persons, where the Date of Birth is not known, please provide an estimate and check the box;
if the City/Country of Birth is not known, please provide the best guess and then explain in Section IV.
Please use the relationship codes provided at the end of this document to indicate relationships between persons, as requested on this form.
Please upload a passport style photo for each Qualifying Family Member listed in Section II. Frame the photo as a front view of the applicant’s full
face, from the top of the head to the shoulders with eyes open. Upload the photo in a .bmp or .tif format.
You are responsible for providing detailed information to the best of your knowledge. If you do not have all the information required BUT you can
obtain the information needed, please wait to complete the AOR until all of the information is received.
Ages and other dates: Always give exact dates of birth and of significant events, like marriage, if they are known. If you can give a best-estimated
date, please provide the best-estimated date and check the appropriate box.
Each Section of the AOR must be fully completed. The address of your relatives overseas must be as complete as possible. Provide the name of the
refugee camp if applicable. Provide a phone number if it is known.
If a family member is deceased or the present location of the family member is unknown, please indicate, and give the date of death or last contact in
the "Current or Last Known City/Country" column.
Be sure to include all relatives requested by the AOR form anywhere in the world, whether living, deceased or missing, in Section III. Use Section IV
Additions/Explanations to explain any non-biological relationships, including adoptive or foster relationships.

DS-7656
03-2015

Instruction Page 2 of 5

Names: Use a complete name each time a name is requested. Do not use initials. If the person has a patronymic, substitute the patronymic for the
middle name. If the middle name of the person has only one letter, or if there is any different naming structure, this should be clarified in Section IV
Additions/Explanations. If anyone uses an alias, provide that information in Section IV or on a supplemental sheet.
All Dates on the AOR: All dates must comply with the following format: DD MMM YYYY (14 JAN 1965).
If there is insufficient space in any Section, please continue in Section IV or use supplemental sheets.
No agency representative or other USRAP processing partner may solicit or accept money or any other favor in order to prepare, file, or process the
DS-7656.
9. What Are the Penalties for Committing Fraud?
Title 8, United States Code, Section 1325, states that any person who knowingly enters into a marriage contract for the purpose of evading any
provision of the immigration laws shall be imprisoned for not more than five years, or fined not more than $250,000, or both.
Title 18, United States Code, Section 1001, states that whoever willfully and knowingly falsifies a material fact, makes a false statement or makes use
of a false document will be fined up to $10,000 or imprisoned up to five years, or both.
If it is determined that a genuine relationship does not exist between you and the person(s) you are claiming as your relative(s), then processing of
their admission to the United States as a refugee(s), and that of their family members, may be terminated.
Misrepresenting your relationship to an individual(s) so that such individual(s) may gain access to the refugee program could make you inadmissible to
the United States, make you ineligible for certain immigration benefits, and/or render you subject to removal.
10. What Is Our Authority for Collecting This Information and How May We Use It?
The U.S. Department of State requests the information on this form, including the agreement of the anchor relative to provide a DNA sample at a later
date, to carry out the immigration laws contained in Title 8, United States Code, Section 1157. The U.S. Department of State requests this information
to assist in determining whether a family member claimed on this form is qualified to apply for access to the U.S. Refugee Admissions Program
(USRAP) for purposes of family reunification. The information you provide may also be disclosed to a) the U.S. Department of Homeland Security for
purposes of determining whether your relatives are eligible for admission to the United States and for verifying information provided by the family
members listed on this form in any application they may make for admission to the United States under the USRAP or for any other immigration benefit
under U.S. law; b) Members of Congress or other Federal, State, and local government agencies having statutory or other lawful authority, as needed
for the formulation, amendment, administration, or enforcement of immigration, nationality, and other laws of the United States; and, c) international
organizations and resettlement agency partners that work with the USRAP to enable them to coordinate and manage refugee processing overseas and
resettlement in the United States. You do not have to complete this form and provide the requested information; however, if you refuse to give some or
all of it, your relative's access to the USRAP for refugee resettlement consideration may be denied.
11. Paperwork Reduction Act
An agency may not conduct or sponsor an information collection and a person is not required to respond to a collection of information unless it displays
a currently valid OMB control number. The public reporting burden for this collection of information is estimated to average 60 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed and completing and reviewing
the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden, to: U.S. Department of State, PRM/A, 2025 E Street, NW Washington DC, 20520. OMB No. 1405-0206.

HOW TO FILL OUT THIS FORM
SECTION I: INFORMATION ABOUT YOU, THE U.S.-BASED FAMILY MEMBER
This section is for information about you. You must be at least 18 years of age to file an AOR.
a. Enter your full name.
b. Enter your date of birth: DD MMM YYYY (day, month, year; 14 JAN 1965).
c. Enter your sex: M or F.
d. Enter your marital status: single (S), married (M), divorced (D), separated (P), widow/widower (W).
e. Enter the name of your current spouse.
f.

Provide your city and country of birth.

g. Provide your current U.S. address.
h. Provide your home telephone number, work telephone number and cellular phone number.
i.

Provide your e-mail address.

j.

Provide your date of arrival in the United States (if refugee) or Date Asylum was granted (if asylee): DD MMM YYYY (date, month, year; 14
JAN 1965)

k. Provide your current U.S. citizenship/immigration status and provide your Certificate of Naturalization Number (if applicable).
l.

If you arrived as a refugee, provide information about where you were processed as a refugee (if applicable), your overseas case number (if
known) and the name of the agency that processed your case overseas (if known). If not known, please write "unknown".

DS-7656
03-2015

Instruction Page 3 of 5

SECTION II: INFORMATION ABOUT QUALIFYING FAMILY MEMBERS SEEKING ACCESS TO THE USRAP

This section is for the Qualifying Family Members you are claiming a relationship with to support their access to the USRAP so they may apply for
admission to the United States as a refugee. Other relatives should be listed in Section III.
Please use a separate page for each Qualifying Family Member you are claiming. List the Qualifying Family Member's dependents and any members
of household/economic unit on that page. You may use as many pages as necessary to include each Qualifying Family Member you are claiming.
Please use the List of Relationship Codes to indicate the requested relationships in the "Relationship to Anchor" and "Relationship to Qualifying Family
Member Listed Above" columns.
Line 1: Please provide the requested information only for a spouse, parent, or unmarried child under age 21. If the Date of Birth is not known, please
estimate and check the box; if the City/Country of Birth is not known, please provide the best guess and then explain in Section IV. If the answer to
other questions is not known, please write "unknown." If a question is not applicable, please write N/A.
Please provide the contact information for the person listed on Line 1 where requested.
Line 2-16: Please list from oldest to youngest, the spouse and/or unmarried children under age 21 of the Qualifying Family Member named on line 1
who wish to be considered for resettlement at this time. Please enter "B" in the box under "Type" to specify that this person is a derivative of the
qualifying family member. If applicable, please also include individuals who were part of the same household/economic unit of the qualifying family
member named on Line 1 in the country of origin/nationality, and explain the exceptional and compelling circumstances justifying the inclusion in the
AOR in the Comments box. For these individuals, enter "C" in the box under "Type" to specify that this person is a member of the same economic unit
as the qualifying family member named on line 1. If the Date of Birth is not known, please estimate and check the box; if the City/County of Birth is not
known, please provide the best guess and then explain in Section IV.
Please confirm current and valid registration for all Qualifying Family Members and derivatives in country of asylum and attach documentation provided
by UNHCR or country of asylum for each individual..

SECTION III: INFORMATION ABOUT ALL OF YOUR RELATIVES NOT PREVIOUSLY PROVIDED IN SECTION II
This section is for all your relatives anywhere in the world, whether living, deceased or missing, that were NOT previously listed in Section II. Please
remember that these relatives are not being considered for access to the USRAP.
Please use the List of Relationship Codes to indicate the requested relationships in the “Relationship to Anchor” columns.
(A) Please provide information about your biological parents that was NOT previously provided in Section II.
(B) Please provide information about all your adoptive parents, stepparents, or foster parents that was NOT previously provided in Section II
(C) Please provide information about your spouse and all previous spouses that was NOT previously provided in Section II.
(D) Please provide information about all your children (including biological, adopted, step and foster children) from oldest to youngest that was NOT
previously provided in Section II.
(E) Please provide information about all your brothers and sisters (including biological, adopted, step and foster brothers and sisters) from oldest to
youngest that was NOT previously provided in Section II.

SECTION IV: ADDITIONS/EXPLANATIONS
Please use this section to elaborate on any extended or non-traditional relationships that may require further explanation (including adopted, half, and
step relatives), any unusual name patterns, any aliases, or any unusual circumstances that you wish to address. Please also use this section as a
continuation page for any other sections that had insufficient space.

SECTION V: SIGNATURES
Please read the certification and then sign your name, print your name, and fill in the date. You will be asked to provide valid identification to the
resettlement agency representative who assisted you to fill out this form. The resettlement agency representative will then sign the form, print his/her
name, date the form, and provide the affiliate name, address and telephone number.
By Submitting this Affidavit of Relationship I understand that I and Qualifying Family Members (parents, spouse, unmarried children under age 21) will
be requested to submit DNA evidence. I further understand that DNA testing could be suggested between my Qualifying Family Member(s) and their
derivative beneficiaries. I also understand that my family members may not be considered qualified to apply for refugee resettlement if I, or they, fail to
submit DNA evidence upon request.

DS-7656
03-2015

Instruction Page 4 of 5

LIST OF RELATIONSHIP CODES
CODE

RELATIONSHIP

CODE

RELATIONSHIP

AB

ADOPTED BROTHER

GN

GREAT GRANDSON

AD

ADOPTED DAUGHTER

GU

GUARDIAN

AF

ADOPTED FATHER

HB

HALF BROTHER

AM

ADOPTED MOTHER

HS

HALF SISTER

AR

ADOPTED SISTER

HU

HUSBAND

AS

ADOPTED SON

MC

COUSIN (MALE)

AU

AUNT

MR

RELATIVE BY MARRIAGE

BH

HUSBAND'S BROTHER

MW

MINOR WIFE

BR

BROTHER (BIOLOGICAL)

MO

MOTHER (BIOLOGICAL)

DA

DAUGHTER (BIOLOGICAL)

MI

MOTHER-IN-LAW

DI

DAUGHTER-IN-LAW

NE

NEPHEW

DR

DISTANT RELATIVE

NI

NIECE

EH

EX-HUSBAND

NF

UNION WITH FEMALE

EW

EX-WIFE

NM

UNION WITH MALE

FA

FATHER (BIOLOGICAL)

SI

SISTER (BIOLOGICAL)

FI

FATHER-IN-LAW

SO

SON (BIOLOGICAL)

FC

COUSIN (FEMALE)

SL

SON-IN-LAW

FN

FIANCE(E)

SB

STEP BROTHER

FB

FOSTER BROTHER

SD

STEP DAUGHTER

FD

FOSTER DAUGHTER

SF

STEP FATHER

FF

FOSTER FATHER

SM

STEP MOTHER

FM

FOSTER MOTHER

SS

STEP SISTER

FT

FOSTER SISTER

SN

STEP SON

FS

FOSTER SON

UK

UNKNOWN RELATIONSHIP

FR

FRIEND

UM

UNACCOMPANIED MINOR

GD

GRANDDAUGHTER

UN

UNCLE

GF

GRANDFATHER

UR

UNRELATED

GM

GRANDMOTHER

US

HUSBAND'S SISTER

GS

GRANDSON

WB

WIFE'S BROTHER

GR

GREAT GRANDDAUGHTER

WI

WIFE

GH

GREAT GRANDFATHER

WS

WIFE'S SISTER

GG

GREAT GRANDMOTHER

DS-7656
03-2015

Instruction Page 5 of 5

U.S. Department of State

OMB APPROVAL NO.1405-0206
EXPIRES: XX-XX-XXXX
ESTIMATED BURDEN: 60 minutes *

AFFIDAVIT OF RELATIONSHIP
Date Completed (dd mmm yyyy) Case File ID Number (Alien Number)

Name of National Resettlement Agency

Affiliate ID Number

IMPORTANT NOTICE: By completing this form you are claiming a relationship with family members overseas in order to assist the U.S. Government
in determining whether those family members are qualified to apply for admission to the United States under the U.S. Refugee Admissions Program.
The AOR itself is not an application on behalf of your family members for admission to the U.S. as a refugee under the U.S. Refugee Admissions
Program or a petition for any immigration benefit under U.S. law. Completion of this AOR does not guarantee that your family members will be found
qualified to apply for refugee admission or that they ultimately will be admitted to the United States. Additionally, the information listed in this AOR may
be used and disclosed by the U.S. Department of State as described in the Privacy Act statement below. The U.S. Government investigates claimed
family relationships and verifies the validity of documents. Criminal prosecutions may be sought when family relationships are falsified to obtain
immigration benefits.

SECTION I: INFORMATION ABOUT YOU, THE U.S.-BASED FAMILY MEMBER
(a) Your Name (Last, First, Middle)

(c) Sex

(b) Your Date of Birth (dd mmm yyyy)
If estimated, check box
(d) Current Marital Status

Male

Female

Single

Married

(e) Current Spouse (Last, First, Middle)

Divorced

Separated

Widow(er)

(f) Your City/Country of Birth

(g) Current U.S. Address
Street

City

State

ZIP

(h) Phone Number
Home

Work

(i) E-mail Address

(k) Your Current U.S. Immigration Status (Check One)
U.S. Citizen - Certificate Number:

Cellular
(j) Your Date of Arrival in the U.S. (if refugee) or Date Asylum was Granted (if
asylee) (dd mmm yyyy)
(l) If you arrived as a refugee, please complete the following:
Your Country of Processing

Lawful Permanent Resident

Your Overseas Case Number, if known

Asylee

Agency that processed your case overseas, if known

Refugee
Other (Please explain)
Privacy Act Statement
AUTHORITIES: The information is sought pursuant to carring out the immigration laws contained in Title 8, United States Code, Section 1157.
PURPOSE: The information solicited on this form, including the agreement of the qualifying parent who claims a biological relationship to provide a DNA sample at a later
date, will be used to assist in determining whether a child claimed on this form is qualified to apply for access to the U.S. Refugee Admissions Program (USRAP) for
purposes of family reunification.
ROUTINE USES:The information on this form maybe shared with the U.S. Department of Homeland Security for purposes of determining whether your parents and
child(ren) and their derivatives are eligible for admission to the United States and for verifying information provided by the parents and child(ren) listed on this form in any
application they may make for admission to the United States under the USRAP or for any other immigration benefit under U.S. law. The information may also be made
available to Members of Congress or other Federal, State, and local government agencies having statutory or other lawful authority, as needed for the formulation,
amendment, administration, or enforcement of immigration, nationality, and other laws of the United States and to international organizations and resettlement agency
partners that work with the USRAP to enable them to coordinate and manage refugee processing overseas and resettlement in the United States. More information on the
Routine Uses for the system can be found in the System of Records Notice State-59, Refugee Case Records.
DISCLOSURE: Providing this information is voluntary. Failure to provide the information requested on this form may result in denied consideration for your relative's access
to the USRAP for refugee resettlement.

Paperwork Reduction Act
Public reporting burden for this collection of information is estimated to average 60 minutes per response, including time required for searching existing data sources,
gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information
unless this collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it,
please send them to: U.S. Department of State, PRM/A, 2025 E Street, NW Washington DC, 20520. OMB No. 1405-0206.

DS-7656
02-2013

Page 1 of 5

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

SECTION II: INFORMATION ABOUT QUALIFYING FAMILY MEMBERS SEEKING ACCESS TO THE USRAP
A. You may claim only parents, spouse, and unmarried children under age 21 as a Qualifying Family Member
Name
Last

Sex

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

City/Country
of Birth

Nationality

Marital Status

& Valid
Relationship to Current
in
U.S.-Based Registration
Country
of
Family Member
Asylum

Upload
Photo

1
CURRENT SPOUSE OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Name of Current Spouse

Date of Marriage

Sec II
Photo
Page

Place of Marriage

PREVIOUS SPOUSES OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

MAILING ADDRESS OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Street Address

City

State/Province

Telephone Number

Cellular Phone Number

Postal Code

Country

E-mail Address

ALTERNATE CONTACT ADDRESS OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Street Address

City

State/Province

Telephone Number

Cellular Phone Number

For each entry, choose B. Derivative of Qualifying Family Member in Section II A of this page
Name
Sex

Type
Last

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

Father's Name

Postal Code

Country

E-mail Address
OR

C. Members of the Same Economic Unit

Mother's Name

City/Country
of Birth

Nationality

Marital
Status

Rel to
Curr &
Rel to
US
Val
QFM
BFM
Reg

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Sec II
Photo
Page

COMMENTS/ADDITIONS/EXPLANATIONS

ADD ADDITIONAL PAGES AS NEEDED FOR EACH ADDITIONAL QUALIFYING FAMILY MEMBER YOU ARE CLAIMING.

DS-7656
03-2015

Page 2 of 5

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

SECTION II A: INFORMATION ABOUT QUALIFYING FAMILY MEMBERS SEEKING ACCESS TO THE USRAP
A. You may claim only parents, spouse, and unmarried children under age 21 as a Qualifying Family Member
Name
Last

Sex

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

City/Country
of Birth

Nationality

Marital Status

& Valid
Relationship to Current
in
U.S.-Based Registration
Country
of
Family Member
Asylum

Upload
Photo

1
CURRENT SPOUSE OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Name of Current Spouse

Date of Marriage

Sec II A
Photo
Page

Place of Marriage

PREVIOUS SPOUSES OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

MAILING ADDRESS OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Street Address

City

State/Province

Telephone Number

Cellular Phone Number

Postal Code

Country

E-mail Address

ALTERNATE CONTACT ADDRESS OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Street Address

City

State/Province

Telephone Number

Cellular Phone Number

For each entry, choose B. Derivative of Qualifying Family Member in Section II A of this page
Name
Sex

Type
Last

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

Father's Name

Postal Code

Country

E-mail Address
OR

C. Members of the Same Economic Unit

Mother's Name

City/Country
of Birth

Nationality

Rel to
Curr &
Marital
Rel to
US
Val
Status
QFM
BFM
Reg

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Sec II A
Photo
Page

COMMENTS/ADDITIONS/EXPLANATIONS

ADD ADDITIONAL PAGES AS NEEDED FOR EACH ADDITIONAL QUALIFYING FAMILY MEMBER YOU ARE CLAIMING.

DS-7656
03-2015

Page 2a of 5

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

SECTION II B: INFORMATION ABOUT QUALIFYING FAMILY MEMBERS SEEKING ACCESS TO THE USRAP
A. You may claim only parents, spouse, and unmarried children under age 21 as a Qualifying Family Member
Name
Last

Sex

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

City/Country
of Birth

Nationality

Marital Status

& Valid
Relationship to Current
in
U.S.-Based Registration
Country
of
Family Member
Asylum

Upload
Photo

1
CURRENT SPOUSE OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Name of Current Spouse

Date of Marriage

Sec II B
Photo
Page

Place of Marriage

PREVIOUS SPOUSES OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

MAILING ADDRESS OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Street Address

City

State/Province

Telephone Number

Cellular Phone Number

Postal Code

Country

E-mail Address

ALTERNATE CONTACT ADDRESS OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Street Address

City

State/Province

Telephone Number

Cellular Phone Number

For each entry, choose B. Derivative of Qualifying Family Member in Section II A of this page
Name
Sex

Type
Last

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

Father's Name

Postal Code

Country

E-mail Address
OR

C. Members of the Same Economic Unit

Mother's Name

City/Country
of Birth

Nationality

Rel to
Curr &
Marital
Rel to
US
Val
Status
QFM
BFM
Reg

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Sec II B
Photo
Page

COMMENTS/ADDITIONS/EXPLANATIONS

ADD ADDITIONAL PAGES AS NEEDED FOR EACH ADDITIONAL QUALIFYING FAMILY MEMBER YOU ARE CLAIMING.

DS-7656
03-2015

Page 2b of 5

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

SECTION II C: INFORMATION ABOUT QUALIFYING FAMILY MEMBERS SEEKING ACCESS TO THE USRAP
A. You may claim only parents, spouse, and unmarried children under age 21 as a Qualifying Family Member
Name
Last

Sex

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

City/Country
of Birth

Nationality

Marital Status

& Valid
Relationship to Current
in
U.S.-Based Registration
Country
of
Family Member
Asylum

Upload
Photo

1
CURRENT SPOUSE OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Name of Current Spouse

Date of Marriage

Sec II C
Photo
Page

Place of Marriage

PREVIOUS SPOUSES OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

MAILING ADDRESS OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Street Address

City

State/Province

Telephone Number

Cellular Phone Number

Postal Code

Country

E-mail Address

ALTERNATE CONTACT ADDRESS OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Street Address

City

State/Province

Telephone Number

Cellular Phone Number

For each entry, choose B. Derivative of Qualifying Family Member in Section II A of this page
Name
Sex

Type
Last

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

Father's Name

Postal Code

Country

E-mail Address
OR

C. Members of the Same Economic Unit

Mother's Name

City/Country
of Birth

Nationality

Rel to
Curr &
Marital
Rel to
US
Val
Status
QFM
BFM
Reg

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Sec II C
Photo
Page

COMMENTS/ADDITIONS/EXPLANATIONS

ADD ADDITIONAL PAGES AS NEEDED FOR EACH ADDITIONAL QUALIFYING FAMILY MEMBER YOU ARE CLAIMING.

DS-7656
03-2015

Page 2c of 5

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

SECTION II D: INFORMATION ABOUT QUALIFYING FAMILY MEMBERS SEEKING ACCESS TO THE USRAP
A. You may claim only parents, spouse, and unmarried children under age 21 as a Qualifying Family Member
Name
Last

Sex

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

City/Country
of Birth

Nationality

Marital Status

& Valid
Relationship to Current
in
U.S.-Based Registration
Country
of
Family Member
Asylum

Upload
Photo

1
CURRENT SPOUSE OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Name of Current Spouse

Date of Marriage

Sec II D
Photo
Page

Place of Marriage

PREVIOUS SPOUSES OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

MAILING ADDRESS OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Street Address

City

State/Province

Telephone Number

Cellular Phone Number

Postal Code

Country

E-mail Address

ALTERNATE CONTACT ADDRESS OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Street Address

City

State/Province

Telephone Number

Cellular Phone Number

For each entry, choose B. Derivative of Qualifying Family Member in Section II A of this page
Name
Sex

Type
Last

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

Father's Name

Postal Code

Country

E-mail Address
OR

C. Members of the Same Economic Unit

Mother's Name

City/Country
of Birth

Nationality

Rel to
Curr &
Marital
Rel to
US
Val
Status
QFM
BFM
Reg

Upload
Photo

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Sec II D
Photo
Page

COMMENTS/ADDITIONS/EXPLANATIONS

ADD ADDITIONAL PAGES AS NEEDED FOR EACH ADDITIONAL QUALIFYING FAMILY MEMBER YOU ARE CLAIMING.

DS-7656
03-2015

Page 2d of 5

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

SECTION II E: INFORMATION ABOUT QUALIFYING FAMILY MEMBERS SEEKING ACCESS TO THE USRAP
A. You may claim only parents, spouse, and unmarried children under age 21 as a Qualifying Family Member
Name
Last

Sex

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

City/Country
of Birth

Nationality

Marital Status

& Valid
Relationship to Current
in
U.S.-Based Registration
Country
of
Family Member
Asylum

Upload
Photo

1
CURRENT SPOUSE OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Name of Current Spouse

Date of Marriage

Sec II E
Photo
Page

Place of Marriage

PREVIOUS SPOUSES OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

Name of Previous Spouse

Date of Marriage (dd mmm yyyy) Place of Marriage

Date of Termination (dd mmm yyyy) Place of Termination

MAILING ADDRESS OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Street Address

City

State/Province

Telephone Number

Cellular Phone Number

Postal Code

Country

E-mail Address

ALTERNATE CONTACT ADDRESS OF THE QUALIFYING FAMILY MEMBER LISTED ABOVE
Street Address

City

State/Province

Telephone Number

Cellular Phone Number

For each entry, choose B. Derivative of Qualifying Family Member in Section II A of this page
Name
Sex

Type
Last

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

Father's Name

Postal Code

Country

E-mail Address
OR

C. Members of the Same Economic Unit

Mother's Name

City/Country
of Birth

Nationality

Rel to
Curr &
Marital
Rel to
US
Val
Status
QFM
BFM
Reg

Upload
Photo

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Sec II E
Photo
Page

COMMENTS/ADDITIONS/EXPLANATIONS

ADD ADDITIONAL PAGES AS NEEDED FOR EACH ADDITIONAL QUALIFYING FAMILY MEMBER YOU ARE CLAIMING.

DS-7656
03-2015

Page 2e of 5

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

SECTION III: INFORMATION ABOUT ALL OF YOUR RELATIVE(S) NOT PREVIOUSLY PROVIDED IN SECTION II
In this section please provide information about your parents; adopted parents/stepparents/foster parents; current and former spouses; children (including biological,
adopted, step and foster children); and, brothers and sisters (including biological, adopted, step and foster brothers and sisters) if you have NOT previously provided this
information under Section II. Please list whether living (L), deceased (D), or unknown (U). If the relative is deceased, please indicate the date of death in the Current or Last
Known City/Country column.
(A) PARENTS
Date of Birth
(dd mmm yyyy)
If estimated,
check box

Name
Last

First

Middle

City/Country
of Birth

Marital
Status

Date/Place
of Marriage
(dd mmm yyyy)
If estimated,
check box

Date of Marriage
Termination
(dd mmm yyyy)
If estimated,
check box

Current or
Last Known
City/Country

L,
D,
U

Father

Mother
(B) ADOPTIVE PARENTS/STEPPARENTS/FOSTER PARENTS
Name
Last

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

City/Country
of Birth

Date of Birth
(dd mmm yyyy)
If estimated,
check box

City/Country
of Birth

Marital
Status

Date/Place of Marriage
(dd mmm yyyy)
If estimated,
check box

Date of Marriage
Termination
(dd mmm yyyy)
If estimated,
check box

Current or Last
Known
City/Country

L,
D,
U

Relationship
to Anchor
Relative

1

2

3

4

5

6

7

8
(C) SPOUSES (CURRENT AND FORMER)
Name
Last

First

Middle

Status
(Select
One)

Date/Place of Marriage
(dd mmm yyyy)
If estimated,
check box

Date of Marriage
Termination
(dd mmm yyyy)
If estimated,
check box

Current or Last
Known
City/Country

L,
D,
U

1

2

3

4

5

6
DS-7656
03-2015

Page 3 of 5

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

SECTION III: INFORMATION ABOUT ALL OF YOUR RELATIVES NOT PREVIOUSLY PROVIDED IN SECTION II (Continued)
In this section please provide information for your parents and stepparents; current and former spouses; children; and, brothers and sisters if you have not previously
provided this information under Section II. Please list whether living (L), deceased (D), or unknown (U). If the relative is deceased, please indicate the date of death in the
Current or Last Known City/Country column.
For children and brothers/sisters, please list from oldest to youngest.

(D) CHILDREN (Biological, Adopted, Step and Foster Children) (PLEASE LIST OLDEST TO YOUNGEST)
Sex

Name
Last

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

City/Country
of Birth

Marital
Status

Current or Last
Known City/Country

L,
D,
U

Relationship
to Anchor
Relative

L,
D,
U

Relationship
to Anchor
Relative

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
(E) BROTHERS AND SISTERS (Biological, Adopted, Step and Foster Brothers/Sisters) (PLEASE LIST OLDEST TO YOUNGEST)
Sex

Name
Last

First

Middle

Date of Birth
(dd mmm yyyy)
If estimated,
check box

City/Country of Birth

Marital
Status

Current or Last
Known City/Country

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
DS-7656
03-2015

Page 4 of 5

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

SECTION IV: ADDITIONS/EXPLANATIONS
Identify for which section, number and name the information is being provided.

SECTION V: SIGNATURES
I certify, under penalty of perjury under the laws of the United States of America, that all of the foregoing information given in this affidavit is true and
correct to the best of my knowledge. I understand that the information listed in this Affidavit of Relationship may be used by the U.S. Department of
State or the U.S. Department of Homeland Security in the manner described in the Privacy Act statement.
By submitting this Affidavit of Relationship I understand that I and certain Qualifying Family Members (parents, spouse, unmarried children under age
21) will be requested to submit DNA evidence to verify our claimed family relationships. I agree that I will submit DNA evidence at such time it is
requested, and I agree to pay all necessary fees associated with that expense and the expenses associated with the submittal of DNA evidence by
any of the Qualifying Family Members I am claiming on this form. I further understand that DNA testing may be requested between my Qualifying
Family Member(s) and their derivative beneficiaries at no expense to the U.S. Government. I also understand that my family members may not be
considered qualified to apply for refugee resettlement if I, or they, fail to submit DNA evidence upon request.
Your Signature

Print Name

Date (dd mmm yyyy)

NAME AND SIGNATURE OF PERSON WHO ASSISTED IN PREPARING THIS FORM
I affirm that I assisted the anchor listed above in completing this form and that the anchor listed above provided valid identification issued by a U.S.
federal or state agency.

Signature

Affiliate Name and Address

DS-7656
03-2015

Print Full Name

Date (dd mmm yyyy)

Phone Number

Page 5 of 5

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

Section IMAGES - Section II
II
QUALIFYING FAMILY MEMBER

Name
DOB

Name
Rel To USBFM

Name
DOB

DS-7656
03-2015

DOB

DOB

DOB

Name
Rel To QFM

DOB

DOB

DOB

Rel To QFM

DOB

Rel To QFM

Name
Rel To QFM

Name
Rel To QFM

DOB

Name
Rel To QFM

Name
Rel To QFM

Name
Rel To QFM

DOB

Name
Rel To QFM

Name
Rel To QFM

Name
DOB

Name
Rel To QFM

Name
Rel To QFM

Name
DOB

DOB

DOB

Rel To QFM

Name
Rel To QFM

DOB

Rel To QFM

Photo Page 1 of 6

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

Section IMAGES - Section II A
II A
QUALIFYING FAMILY MEMBER

Name
DOB

Name
Rel To USBFM

Name
DOB

DS-7656
03-2015

DOB

DOB

DOB

Name
Rel To QFM

DOB

DOB

DOB

Rel To QFM

DOB

Rel To QFM

Name
Rel To QFM

Name
Rel To QFM

DOB

Name
Rel To QFM

Name
Rel To QFM

Name
Rel To QFM

DOB

Name
Rel To QFM

Name
Rel To QFM

Name
DOB

Name
Rel To QFM

Name
Rel To QFM

Name
DOB

DOB

DOB

Rel To QFM

Name
Rel To QFM

DOB

Rel To QFM

Photo Page 2 of 6

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

Section IMAGES - Section II B
II B
QUALIFYING FAMILY MEMBER

Name
DOB

Name
Rel To USBFM

Name
DOB

DS-7656
03-2015

DOB

DOB

DOB

Name
Rel To QFM

DOB

DOB

DOB

Rel To QFM

DOB

Rel To QFM

Name
Rel To QFM

Name
Rel To QFM

DOB

Name
Rel To QFM

Name
Rel To QFM

Name
Rel To QFM

DOB

Name
Rel To QFM

Name
Rel To QFM

Name
DOB

Name
Rel To QFM

Name
Rel To QFM

Name
DOB

DOB

DOB

Rel To QFM

Name
Rel To QFM

DOB

Rel To QFM

Photo Page 3 of 6

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

Section IMAGES - Section II C
II C
QUALIFYING FAMILY MEMBER

Name
DOB

Name
Rel To USBFM

Name
DOB

DS-7656
03-2015

DOB

DOB

DOB

Name
Rel To QFM

DOB

DOB

DOB

Rel To QFM

DOB

Rel To QFM

Name
Rel To QFM

Name
Rel To QFM

DOB

Name
Rel To QFM

Name
Rel To QFM

Name
Rel To QFM

DOB

Name
Rel To QFM

Name
Rel To QFM

Name
DOB

Name
Rel To QFM

Name
Rel To QFM

Name
DOB

DOB

DOB

Rel To QFM

Name
Rel To QFM

DOB

Rel To QFM

Photo Page 4 of 6

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

Section IMAGES - Section II D
II D
QUALIFYING FAMILY MEMBER

Name
DOB

Name
Rel To USBFM

Name
DOB

DS-7656
03-2015

DOB

DOB

DOB

Name
Rel To QFM

DOB

DOB

DOB

Rel To QFM

DOB

Rel To QFM

Name
Rel To QFM

Name
Rel To QFM

DOB

Name
Rel To QFM

Name
Rel To QFM

Name
Rel To QFM

DOB

Name
Rel To QFM

Name
Rel To QFM

Name
DOB

Name
Rel To QFM

Name
Rel To QFM

Name
DOB

DOB

DOB

Rel To QFM

Name
Rel To QFM

DOB

Rel To QFM

Photo Page 5 of 6

U.S.-Based Family Member's Name (Last, First, Middle)

Case File ID Number (Alien Number)

Date of Birth (dd mmm yyyy)

Section IMAGES - Section II E
II E
QUALIFYING FAMILY MEMBER

Name
DOB

Name
Rel To USBFM

Name
DOB

DS-7656
03-2015

DOB

DOB

DOB

Name
Rel To QFM

DOB

DOB

DOB

Rel To QFM

DOB

Rel To QFM

Name
Rel To QFM

Name
Rel To QFM

DOB

Name
Rel To QFM

Name
Rel To QFM

Name
Rel To QFM

DOB

Name
Rel To QFM

Name
Rel To QFM

Name
DOB

Name
Rel To QFM

Name
Rel To QFM

Name
DOB

DOB

DOB

Rel To QFM

Name
Rel To QFM

DOB

Rel To QFM

Photo Page 6 of 6