Free CBP Form I-95 - Crewman's Landing Permit - Federal

OMB N0. 1651-0114 DEPARTMENT OF HOMELAND SECURITY Expires 10/31/2011 FIN or "A" No. Initial

U.S. Customs and Border Protection CREWMAN'S LANDING PERMIT
Family Name Home Address Given Name

Address in United States Hair Eyes Ht. Wt.

Date of Birth Place of Birth Passport Number/Nationality Arrived by Air Sea

CBP Form I-95 (06/09)

Arrival Date

Place of Arrival

CBP Officer Signature

CREWMAN'S LANDING PERMIT
By accepting this conditional permit to land, the holder agrees to all the conditions incident to the issuance thereof and to deportation from the United States in accordance with the provisions of section 252(b) of the Immigration and Nationality Act.

Department of Homeland Security ­ U.S. Customs and Border Protection
Completion of this form is mandatory pursuant to 8 U.S. C. 1281. Data is used by DHS for alien crewman control. By accepting this conditional permit to land, the holder agrees to all the conditions incident to the issuance thereof, and to deportation from the United States in accordance with the provisions of section 252(b) of the Immigration and Nationality Act.

CBP Form I-95 (06/09)

Paperwork Reduction Act Statement: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0114. The estimated average time to complete this application is 5 minutes. If you have any comments regarding the burden estimate you can write to U.S. th Customs and Border Protection, Office of Regulations and Rulings, 799 9 Street, NW., Washington DC 20229. Note: Form must be typed or printed legibly.

CBP Form I-95 (06/09)