NOTE: Please provide the following information concerning your biological parents. If you are adopted, please provide the following information on your adoptive parents. 注意：请提供以下有关您生身父母的信息。如果您是领养的，请提供下面有关您养父母的信息。 Father's Full Name and Date of Birth父亲的全名与出生日期 Surnames (e.g., Hernandez Garcia) Given Names (e.g., Juan Miguel) Date of Birth Is your father in the U.S.? 您父亲是否在美国？ Surnames (e.g., Hernandez Garcia) Given Names (e.g., Juanita Miguel) Date of Birth Is your mother in the U.S.? 您母亲是否在美国？ LI Do Not Know BA Do Not Know 01/JAN/1920 Do Not Know No Yes No Mother's Full Name and Date of Birth母亲的全名与出生日期 WANG Do Not Know MA Do Not Know 01/JAN/1922 Do Not Know No Yes No Do you have any immediate relatives, not No Yes No including parents, in the United States? 除父母以外，您在美国是否还有其他直系亲属? Do you have any other relatives in the United No Yes No
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States? 您在美国是否还有其他亲属？ Help: Immediate Relatives 直系亲属 Means fiancé/fiancée, spouse (husband/wife), child (son/daughter), or sibling (brother/sister). 指未婚夫/妻、配偶（丈夫/妻子）、子女（儿子/女儿）或者兄弟/姐妹。 Family Information: Relatives 家庭信息：亲属 NOTE: Please provide the following information concerning your biological parents. If you are adopted, please provide the following information on your adoptive parents. 注意：请提供以下有关您生身父母的信息。如果您是领养的，请提供下面有关您养父母的信息。 Do you have any immediate relatives, not No Yes No including parents, in the United States? 除父母以外，您在美国是否还有其他直系亲属? Do you have any other relatives in the United No Yes No States? 您在美国是否有其他亲属? Family Information: Spouse家庭信息：配偶 NOTE: Enter current spouse information. 注意: 输入当前配偶的信息. LIU 22
Spouse's Full Name (include Maiden Name) 配偶的全名(包含婚前用名) Spouse's Surnames配偶的姓氏
Spouse's Given Names配偶的名字 QI Spouse's Date of Birth 配偶的出生日期 17 -OCT -1958 Spouse's Nationality 配偶的国籍 CHINA Spouse's Place of Birth 配偶的出生地 City 城市 SHENYANG Do Not Know Country 国家 CHINA Spouse's Address 配偶地址 Same as Home Address Previous Work/Education/Training Information当前工作/教育/培训信息
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NOTE: Provide your employment information for the last five years, if applicable. 注意：请提供以下关于您当前工作及教育的信息。 Primary Occupation 主要职业 Present Employer or School Name 当前工作单位或学校的名称 Street Address (Line 1) 街地址 Street Address (Line 2) *Optional City 城市 State/Province 洲/省 Postal Zone/ZIP Code 邮政编码 Phone Number 电话
Government政府 SHENYANG BUREAU OF SURVEYING AND MAPPING 1 TAIYUANJIE Does Not Apply SHENYANG LIAONING 110001 Does Not Apply 024-23242558 25
Present employer or school address: 目前工作单位或学校的地址