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U.S. DEPARTMENT of LABOR 
Immigration Service 

Refer to
File No. 

Office of
Commissioner of Immigration 
Ellis Island, New York Harbor
New York 

Referring to application for an extension of temporary admission in this country, such application must, in accordance with instructions of the Secretary of Labor, Washington, D.C., be made under oath by the alien concerned and contain information as to the port, date and steamship (if any) of arrival in the United States, and the grounds upon which the application is based. 

After the application has been properly executed, in duplicate, both copies must be forwarded to the immigration official in charge at the last port of entry for action. 

Please do not mail passports unless on special request. 

Commissioner of Immigration 
New York District 
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