G-28表格翻译

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Notice of Entry of Appearance

as Attorney or Accredited Representative

Department of Homeland Security

DHS Form G-28

OMB No. 1615-0105 Expires 02/29/2016

Part 1. Information About Attorney or

Accredited Representative

Name and Address of Attorney or Accredited Representative 律师/代理委托人的姓名和地址 1.a. Family Name 姓

(Last Name)

1.b. Given Name 名

(First Name) 1.c. Middle Name 中间名

Part 2. Eligibility Information For Attorney or

Accredited Representative

(Check applicable items(s) below) 勾选以下适用项 1. □

I am an attorney eligible to practice law in, and a member in good standing of, the bar of the highest court(s) of the following State(s), possession(s), territory(ies), commonwealth(s), or the District of Columbia. 1.a.

1.b. I (choose one) am not am

subject to any order of any court or administrative agency disbarring, suspending, enjoining, restraining, or otherwise restricting me in the practice of law. (If you are subject to any order(s), explain fully in the space below.)



第一部分. 有关律师/代理委托人的信息 第二部分. 律师/代理委托人的资格信息





2. Name of Law Firm or Recognized Organization 律师事务所名或认可机构

3. Name of Law Student or Law Graduate 法律学生或法律研究生的名字4.

State Bar Number



5.a. Street Number





1.b.1.

I am an accredited representative of the following qualified nonprofit religious, charitable, social service, or similar organization established in the United States, so recognized by the Department of Justice, Board of Immigration Appeals pursuant to 8 CFR 292.2. Provide the name of the organization and the expiration date of accreditation.



5.b. Street

Name 5.c. Apt.

Ste.

Flr.

2.





5.d. City or Town 5.e. State 5.g. Postal Code

5.f. Zip Code



2.a. Name of Recognized Organization



5.h. Province



2.b. Date Accreditation expires



(mm/dd/yyyy) ►

I am associated with 3.a.

the attorney or accredited representative of record who previously filed Form G-28 in this case, and my appearance as an attorney or accredited representative is at his or her request. If you check this item, also complete number 1 (1.a. - 1.b.1.) or number 2 (2.a. - 2.b.) in Part 2 (whichever is appropriate). I am a law student or law graduate working under the direct supervision of the attorney or accredited representative of record on this form in accordance with the requirements in 8 CFR 292.1(a)(2)(iv).



5.i. Country



6.



3.

Daytime Phone Number ( )

-



7.

E-Mail Address of Attorney or Accredited Representative



4.






Part 3. Notice of Appearance as Attorney or

Accredited Representative



7.



Provide A-Number and/or Receipt Number

This appearance relates to immigration matters before (select one): 1. 1.a. 2. 2.a. 3. 3.a.

I hereby enter my appearance as attorney or accredited representative at the request of: 4.

Select only one:

Applicant



USCIS - List the form number(s)



Pursuant to the Privacy Act of 1974 and DHS policy, I hereby consent to the disclosure to the named Attorney or Accredited Representative of any record pertaining to me that appears in any system of records of USCIS, ICE, or CBP.







8.a. Signature of Applicant, Petitioner, or Respondent

ICE - List the specific matter in which appearance is entered





8.b. Date

CBP – List the specific matter in which appearance is entered

(mm/dd/yyyy) ►







Part 4. Signature of Attorney or Accredited

Representative

I have read and understand the regulations and conditions contained in 8 CFR 103.2 and 292 governing appearances and representation before the Department of Homeland Security. I declare under penalty of perjury under the laws of the United States that the information I have provided on this form is true and correct.



Petitioner

Respondent (ICE, CBP)





1.





Signature of Attorney or Accredited Representative Signature of Law Student or Law Graduate

Name of Applicant, Petitioner, or Respondent 5.a. Family Name

(Last Name) 5.b. Given Name

(First Name) 5.c. Middle Name

2. 3.





Date (mm/dd/yyyy) ►



Part 5. Additional Information

5.d. Name of Company or Organization, if applicable

1.



NOTE: Provide the mailing address of Petitioner, Applicant,or Respondent and not the address of the attorney or accredited representative, except when a safe mailing address is

permitted on an application or petition filed with Form G-28.





6.a. Street Number

and Name 6.b. Apt.







Ste. Flr.

6.c. City or Town



6.d. State 6.e. Zip Code



Form G-28 02/28/13 N

Page 2 of 2

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