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Notice Of Entry Of Appearance As Attorney Or Representative G-28 - Official Federal Forms
| Notice Of Entry Of Appearance As Attorney Or Representative Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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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 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name 2. Name of Law Firm or Recognized Organization Part 2. Eligibility Information For Attorney or Accredited Representative (Check applicable items(s) below) I am an attorney eligible to practice law in, and a 1. 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.) 1.b.1. 2. 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. 2.a. Name of Recognized Organization 3. Name of Law Student or Law Graduate 4. State Bar Number 5.a. Street Number 5.b. Street Name 5.c. Apt. Ste. Flr. 5.d. City or Town 5.e. State 5.g. Postal Code 5.h. Province 5.i. Country 3. 5.f. Zip Code 2.b. Date Accreditation expires (mm/dd/yyyy) I am associated with 3.a. 6. 7. Daytime Phone Number ( ) - E-Mail Address of Attorney or Accredited Representative 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). 4. 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). Form G-28 02/28/13 N American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 2 Part 3. Notice of Appearance as Attorney or Accredited Representative 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 Petitioner CBP - List the specific matter in which appearance is entered ICE - List the specific matter in which appearance is entered USCIS - List the form number(s) 7. Provide A-Number and/or Receipt Number 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 8.b. Date (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. 1. 2. Signature of Attorney or Accredited Representative Signature of Law Student or Law Graduate Respondent (ICE, CBP) Name of Applicant, Petitioner, or Respondent 5.a. Family Name (Last Name) 5.b. Given Name (First Name) 5.c. Middle Name 5.d. Name of Company or Organization, if applicable 3. Date (mm/dd/yyyy) Part 5. Additional Information 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 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2
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