Petition For U Nonimmigrant Status 918 I
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USCIS Form I-918 Petition for U Nonimmigrant Status Department of Homeland Security U.S. Citizenship and Immigration Services Remarks For USCIS Use Only Action Block Receipt Validity Dates (mm/dd/yyyy) Wait Listed U.S. / / / Embassy From: Consulate To: / / / Stamp Number To be completed by an attorney or accredited representative (if any). OMB No. 1615-0104 Expires 02/28/2019 Select this box if Form G-28 is attached. Date (mm/dd/yyyy) Attorney State Bar Number (if applicable) Attorney or Accredited Representative USCIS Online Account Number (if any) ► START HERE - Type or print in black or blue ink. Part 1. Information About You (Person filing this petition as a victim) Safe Mailing Address (if other than Home Address) 4.a. In Care Of Name 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 4.b. Street Number and Name 1.c. Middle Name 4.c. Other Names Used (Include maiden name, nicknames, and aliases, if applicable) 4.d. City or Town Apt. Ste. 4.e. State 2.a. Family Name (Last Name) 2.b. Given Name (First Name) Flr. 4.f. ZIP Code 4.g. Province 4.h. Postal Code 2.c. Middle Name 4.i. Country Home Address 3.a. Street Number and Name 3.b. Apt. Other Information Ste. Flr. 5. Alien Registration Number (A-Number) (if any) ► A- 3.c. City or Town 6. 3.d. State 3.f. U.S. Social Security Number (if any) 3.e. ZIP Code Province ► 7. USCIS Online Account Number (if any) ► 3.g. Postal Code 3.h. Country 8. Marital Status Single Form I-918 02/07/17 N Married Divorced Widowed Page 1 of 11 Part 1. Information About You (continued) Male Female 9. Gender 10. Date of Birth (mm/dd/yyyy) 11. Country of Birth 12. Country of Citizenship or Nationality If you need extra space to complete Part 2., use the space provided in Part 8. Additional Information. Select "Yes" or "No," as appropriate, for each of the following questions. 1. I am a victim of criminal activity listed in the INA at section 101(a)(15)(U)(iii). Yes No 2. I have suffered substantial physical or mental abuse as a result of having been a victim of this criminal activity. Yes 13. Form I-94 Arrival-Departure Record Number 3. I possess information concerning the criminal activity of which I was a victim. Yes No 4. I am submitting Form I-918, Supplement B, U Nonimmigrant Status Certification, from a certifying official. Yes No 5. The crime of which I am a victim occurred in the United States (including Indian country and military installations) or violated the laws of the United States. ► 14. Passport Number 15. Travel Document Number 16. Country of Issuance for Passport or Travel Document 17. Date of Issuance for Passport or Travel Document (mm/dd/yyyy) 18. Expiration Date for Passport or Travel Document (mm/dd/yyyy) Place and Date of Last Entry into the United States and Date Authorized Stay Expired 19.a. City or Town 19.b. State 20. 21. 22. Date of Last Entry into the United States (mm/dd/yyyy) 6. Form I-918 02/07/17 N No Yes No Yes No If you answered "Yes," select the type of proceedings. If you were in proceedings in the past and are no longer in proceedings, provide the date of action. If you are currently in proceedings, type or print “Current” in the appropriate date field. Select all applicable boxes. Use the space provided in Part 8. Additional Information to provide an explanation. 7.b. Removal Proceedings Removal Date (mm/dd/yyyy) 7.c. Exclusion Proceedings Exclusion Date (mm/dd/yyyy) 7.d. Deportation Proceedings Deportation Date (mm/dd/yyyy) 7.e. Rescission Proceedings Rescission Date (mm/dd/yyyy) 7.f. Judicial Proceedings Judicial Date (mm/dd/yyyy) Current Immigration Status Answering “Yes” to the following questions below requires explanations and supporting documentation. Attach relevant documents in support of your claims that you are a victim of criminal activity listed in the Immigration and Nationality Act (INA) section 101(a)(15)(U)(iii). You must also attach a personal narrative statement describing the criminal activity of which you are a victim. If you are only petitioning for U derivative status for qualifying family members subsequent to your (the principal petitioner) initial filing, you are not required to submit evidence supporting the original petition with the new Form I-918. I am under 16 years of age. Yes 7.a. I was or am in immigration proceedings. Date Authorized Stay Expired (mm/dd/yyyy) Part 2. Additional Information About You No Page 2 of 11 Part 2. Additional Information About You (continued) Safe Foreign Address Where You Want Notification Sent (if other than U.S. Consulate, Pre-Flight Inspection, or Port-of-Entry) Provide the date of entry, place of entry, and status under which you entered the United States for each entry during the five years preceding the filing of this petition. 12.a. Street Number and Name 12.b. Apt. Ste. Flr. 8.a. Date of Entry (mm/dd/yyyy) Place of Entry into the United States 12.c. City or Town 12.d. Province 8.b. City or Town 12.e. Postal Code 8.c. State 8.d. Status at the Time of Entry (for example, F-1 student, B-2 tourist, entered without inspection) 12.f. Country Part 3. Processing Information 9.a. Date of Entry (mm/dd/yyyy) Place of Entry into the United States 9.b. City or Town 9.c. State Answer the following questions about yourself. For the purposes of this petition, you must answer "Yes" to the following questions, if applicable, even if your records were sealed or otherwise cleared or if anyone, including a judge, law enforcement officer, or attorney, told you that you no longer have a record. 9.d. Status at the Time of Entry (for example, F-1 student, B-2 tourist, entered without inspection) NOTE: If you answer “Yes” to ANY question in Part 3., provide an explanation in the space provided in Part 8. Additional Information. 10.a. Date of Entry (mm/dd/yyyy) NOTE: Answering "Yes" does not necessarily mean that U.S. Citizenship and Immigration Services (USCIS) will deny your Petition for U Nonimmigrant Status. Place of Entry into the United States Have you EVER: 10.b. City or Town 1.a. Committed a crime or offense for which you have not been arrested? Yes No 10.c. State 10.d. Status at the Time of Entry (for example, F-1 student, B-2 tourist, entered without inspection) If you are outside of the United States, provide the U.S. Consulate or inspection facility or a safe foreign mailing address you want notified if this petition is approved. 11.a. Type of Office (Select only one box): U.S. Consulate Pre-Flight Inspection 1.b. Been arrested, cited, or detained by any law enforcement officer (including Department of Homeland Security (DHS), former Immigration and Naturalization Service (INS), and military officers) for any reason? Yes No 1.c. Been charged with committing any crime or offense? Yes No 1.d. Been convicted of a crime or offense (even if the violation was subsequently expunged or pardoned)? Yes No Port-of-Entry 11.b. City or Town 11.c. State 1.e. Been placed in an alternative sentencing or a rehabilitative program (for example, diversion, deferred prosecution, withheld adjudication, deferred adjudication)? Yes No 11.d. Country Form I-918 02/07/17 N Page 3 of 11 Part 3. Processing Information (continued) Have you EVER: 1.f. 4.a. Engaged in, or do you intend to engage in, prostitution or procurement of prostitution? Yes No Received a suspended sentence, been placed on probation, or been paroled? Yes No 1.g. Been in jail or prison? Yes No 1.h. Been the beneficiary of a pardon, amnesty, rehabilitation, or other act of clemency or similar action? Yes 1.i. Exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States? Yes No If you answered “Yes” to any of the above questions, respond to the questions below to provide additional details. If you need extra space, use the space provided in Part 8. Additional Information. Why were you arrested, cited, detained, or charged? 2.b. Date of arrest, citation, detention, or charge (mm/dd/yyyy) Where were you arrested, cited, detained, or charged? 2.c. City or Town 2.d. State 2.e. Country 2.f. Outcome or disposition (for example, no charges filed, charges dismissed, jail, probation) 3.a Why were you arrested, cited, detained, or charged? 3.b. Date of arrest, citation, detention, or charge (mm/dd/yyyy) Where were you arrested, cited, detained, or charged? 3.c. City or Town 3.d. State 3.e. Country 3.f. 4.c. Knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States illegally? No Information About Arrests, Citations, Detentions, or Charges 2.a 4.b. Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling? Yes No Yes No 4.d. Illicitly trafficked in any controlled substance or knowingly assisted, abetted, or colluded in the illicit trafficking of any controlled substance? Yes No Have you EVER committed, planned or prepared, participated in, threatened to, attempted to, conspired to commit, gathered information for, or solicited funds for any of the following: 5.a. Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)? Yes No 5.b. Seizing or detaining, and threatening to kill, injure, or continue to detain, another individual in order to compel a third person (including a governmental organization) to do or abstain from doing any act as an explicit or implicit condition for the release of the individual seized or detained? Yes No 5.c. Assassination? Yes No 5.d. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? Yes No 5.e. The use of any biological agent, chemical agent, nuclear weapon or device, explosive, or other weapon or dangerous device, with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? Yes No Have you EVER been a member of, solicited money or members for, provided support for, attended military training (as defined in section 2339D(c)(1) of Title 18, United States Code) by or on behalf of, or been associated with any other group of two or more individuals, whether organized or not, which has been designated as, or has engaged in or has a subgroup which has been designated as, or has engaged in: 6.a. A terrorist organization under section 219 of the INA? Yes No 6.b. Hijacking or sabotage of any conveyance (including an aircraft, vessel, or vehicle)? Yes No Outcome or disposition (for example, no charges filed, charges dismissed, jail, probation) Form I-918 02/07/17 N Page 4 of 11 Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following: Part 3. Processing Information (continued) 6.c. Seizing or detaining, and threatening to kill, injure, or continue to detain, another individual in order to compel a third person (including a governmental organization) to do or abstain from doing any act as an explicit or implicit condition for the release of the individual seized or detained? Yes No 6.d. Assassination? Yes No 6.e. The use of any firearm with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? Yes No 6.f. The use of any biological agent, chemical agent, nuclear weapon or device, explosive, or other weapon or dangerous device, with intent to endanger, directly or indirectly, the safety of one or more individuals or to cause substantial damage to property? Yes No 6.g. Soliciting money or members or otherwise providing material support to a terrorist organization? Yes Yes No 7.b. Any unlawful activity, or any activity the purpose of which is in opposition to, or the control, or overthrow of the government of the United States? Yes No 7.c. Solely, principally, or incidentally in any activity related to espionage or sabotage or to violate any law involving the export of goods, technology, or sensitive information? Yes Have you EVER been or do you continue to be a member of the Communist or other totalitarian party, except when membership was involuntary? No Yes 9. Have you EVER, during the period of March 23, 1933 to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ordered, incited, assisted or otherwise participated in the persecution of any person because of race, religion, nationality, membership in a particular social group, or political opinion? Form I-918 02/07/17 N No 10.b. Killing any person? Yes No 10.c. Intentionally and severely injuring any person? Yes No No 10.d. Engaging in any kind of sexual conduct or relations with any person who was being forced or threatened? Yes No 10.e. Limiting or denying any person's ability to exercise religious beliefs? Yes No 10.f. The persecution of any person because of race, religion, national origin, membership in a particular social group, or political opinion? Yes No 10.g. Displacing or moving any person from their residence by force, threat of force, compulsion, or duress? Yes No NOTE: If you answered "Yes" to any question in Item Numbers 10.a. - 10.g., please describe the circumstances in Part 8. Additional Information. 11. Have you EVER advocated that another person commit any of the acts described in the preceding question, urged, or encouraged another person, to commit such acts? Yes No Have you EVER been present or nearby when any person was: 12.a. Intentionally killed, tortured, beaten, or injured? No 8. Yes Yes No Do you intend to engage in the United States in: 7.a. Espionage? 10.a. Acts involving torture or genocide? Yes No 12.b. Displaced or moved from his or her residence by force, compulsion, or duress? Yes No 12.c. In any way compelled or forced to engage in any kind of sexual contact or relations? Yes No Have you EVER: 13.a. Served in, been a member of, assisted in, or participated in any military unit, paramilitary unit, police unit, selfdefense unit, vigilante unit, rebel group, guerilla group, militia, or other insurgent organization? Yes No Page 5 of 11 Part 3. Processing Information (continued) 19. 13.b. Served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that involved detaining persons? Yes No Have you EVER been ordered to be removed, excluded, or deported from the United States? Yes No 20. Have you EVER been denied a visa or denied admission to the United States? Yes No 21. Have you EVER been granted voluntary departure by an immigration officer or an immigration judge and failed to depart within the allotted time? Yes No 22. Are you NOW under a final order or civil penalty for violating section 274C of the INA (producing and/or using false documentation to unlawfully satisfy a requirement of the INA)? No Yes 23. Have you EVER, by fraud or willful misrepresentation of a material fact, sought to procure or procured a visa or other documentation, for entry into the United States or any immigration benefit? Yes No 24. Have you EVER left the United States to avoid being drafted into the U.S. Armed Forces or U.S. Coast Guard? 13.c. Served in, been a member of, assisted in, or participated in any group, unit, or organization of any kind in which you or other persons transported, possessed, or used any type of weapon? Yes No NOTE: If you answered "Yes" to any question in Item Numbers 13.a. - 13.c., please describe the circumstances in Part 8. Additional Information. Have you EVER: 14.a. Received any type of military, paramilitary, or weapons training? Yes No 14.b. Been a member of, assisted in, or participated in any group, unit, or organization of any kind in which you or other persons used any type of weapon against any person or threatened to do so? Yes No 14.c. Assisted or participated in selling or providing weapons to any person who to your knowledge used them against another person, or in transporting weapons to any person who to your knowledge used them against another person? Yes No Yes 25. Have you EVER been a J nonimmigrant exchange visitor who was subject to the 2-year foreign residence requirement and not yet complied with that requirement or obtained a waiver of such? Yes No 26. Have you EVER detained, retained, or withheld the custody of a child, having a lawful claim to United States citizenship, outside the United States from a United States citizen granted custody? Yes No 27. Do you plan to practice polygamy in the United States? NOTE: If you answered "Yes" to any question in Item Numbers 14.a. - 14.c., please describe the circumstances in Part 8. Additional Information. Have you EVER: 15.a. Recruited, enlisted, conscripted, or used any person under 15 years of age to serve in or help an armed force or group? Yes No 15.b. Used any person under 15 years of age to take part in hostilities, or to help or provide services to people in combat? Yes No 16. Are you NOW in removal, exclusion, rescission, or deportation proceedings? Yes No 17. Have you EVER had removal, exclusion, rescission, or deportation proceedings initiated against you? Yes 18. No Have you EVER been removed, excluded, or deported from the United States? Yes No Form I-918 02/07/17 N No Yes 28. No Have you EVER entered the United States as a stowaway? Yes No 29.a. Do you NOW have a communicable disease of public health significance? Yes No 29.b. Do you NOW have or have you EVER had a physical or mental disorder and behavior (or a history of behavior that is likely to recur) associated with the disorder which has posed or may pose a threat to the property, safety, or welfare of yourself or others? Yes No 29.c. Are you NOW or have you EVER been a drug abuser or drug addict? Yes No Page 6 of 11 Part 4. Information About Your Spouse and/or Children If you need extra space to complete Part 4., use the space provided in Part 8. Additional Information. 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 16.a. Family Name (Last Name) 16.b. Given Name (First Name) 16.c. Middle Name 17. Date of Birth (mm/dd/yyyy) 18. Country of Birth 19. Relationship 20. Current Location 1.c. Middle Name 2. Date of Birth (mm/dd/yyyy) 3. Country of Birth 4. Relationship 5. Current Location 21.a. Family Name (Last Name) 21.b. Given Name (First Name) 21.c. Middle Name 6.a. Family Name (Last Name) 6.b. Given Name (First Name) 22. Date of Birth (mm/dd/yyyy) 23. Country of Birth 24. Relationship 25. Current Location 6.c. Middle Name 7. Date of Birth (mm/dd/yyyy) 8. Country of Birth 9. Relationship Filing On Behalf of Family Members 10. Current Location 11.a. Family Name (Last Name) 11.b. Given Name (First Name) 26. I am petitioning for one or more qualifying family members. Yes No NOTE: If you answered “Yes” to 26., you must complete and include Supplement A for each family member for whom you are petitioning. 11.c. Middle Name 12. Date of Birth (mm/dd/yyyy) 13. Country of Birth 14. Relationship 15. Current Location Form I-918 02/07/17 N Page 7 of 11 I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that: Part 5. Petitioner's Statement, Contact Information, Declaration, and Signature NOTE: Read the Penalties section of the Form I-918 Instructions before completing this part. 1) I provided or authorized all of the information contained in, and submitted with, my petition; 2) I reviewed and understood all of the information in, and submitted with, my petition; and 3) All of this information was complete, true, and correct at the time of filing. Petitioner's Statement NOTE: Select the box for either 1.a. or 1.b. If applicable, select the box for 2. 1.a. I can read and understand English, and I have read and understand every question and instruction on this petition and my answer to every question. 1.b. The interpreter named in Part 6. read to me every question and instruction on this petition and my answer to every question in , a language in which I am fluent, and I understood everything. 2. I certify, under penalty of perjury, that all of the information in my petition and any document submitted with it were provided or authorized by me, that I reviewed and understand all of the information contained in, and submitted with, my petition, and that all of this information is complete, true, and correct. Petitioner's Signature 6.a. Petitioner's Signature At my request, the preparer named in Part 7., , prepared this petition for me based only upon information I provided or authorized. Petitioner's Contact Information 3. Petitioner's Daytime Telephone Number 4. Petitioner's Mobile Telephone Number (if any) 5. Petitioner's Email Address (if any) 6.b. Date of Signature (mm/dd/yyyy) NOTE TO ALL PETITIONERS: If you do not completely fill out this petition or fail to submit required documents listed in the Instructions, USCIS may deny your petition. NOTE: A parent or legal guardian may sign for a person who is less than 14 years of age. A legal guardian may sign for a mentally incompetent person. Part 6. Interpreter's Contact Information, Certification, and Signature Provide the following information about the interpreter. Interpreter's Full Name Petitioner's Declaration and Certification Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of my records that USCIS may need to determine my eligibility for the immigration benefit I seek. 1.a. Interpreter's Family Name (Last Name) 1.b. Interpreter's Given Name (First Name) 2. Interpreter's Business or Organization Name (if any) I further authorize release of information contained in this petition, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws. Form I-918 02/07/17 N Page 8 of 11 Part 6. Interpreter's Contact Information, Certification, and Signature (continued) Interpreter's Mailing Address Provide the following information about the preparer. 3.a. Street Number and Name 3.b. Apt. Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Petition, if Other Than the Petitioner Ste. Flr. Preparer's Full Name 1.a. Preparer's Family Name (Last Name) 3.c. City or Town 3.d. State 3.f. 3.e. ZIP Code 1.b. Preparer's Given Name (First Name) Province 3.g. Postal Code 2. Preparer's Business or Organization Name (if any) 3.h. Country Preparer's Mailing Address Interpreter's Contact Information 3.a. Street Number and Name 4. 3.b. Interpreter's Daytime Telephone Number Apt. Ste. Flr. 3.c. City or Town 5. Interpreter's Mobile Telephone Number (if any) 6. Interpreter's Email Address (if any) 3.d. State 3.f. 3.e. ZIP Code Province 3.g. Postal Code Interpreter's Certification I certify, under penalty of perjury, that: I am fluent in English and , which is the same language specified in Part 5., 1.b., and I have read to this petitioner in the identified language every question and instruction on this petition and his or her answer to every question. The petitioner informed me that he or she understands every instruction, question, and answer on the petition, including the Petitioner's Declaration and Certification, and has verified the accuracy of every answer. 3.h. Country Preparer's Contact Information 4. Preparer's Daytime Telephone Number 5. Preparer's Mobile Telephone Number (if any) 6. Preparer's Email Address (if any) Interpreter's Signature 7.a. Interpreter's Signature (sign in ink) 7.b. Date of Signature (mm/dd/yyyy) Form I-918 02/07/17 N Page 9 of 11 Preparer's Statement 7.a. I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and with the petitioner's consent. 7.b. I am an attorney or accredited representative and my representation of the petitioner in this case extends does not extend beyond the preparation of this petition. NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this petition, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this petition. Preparer's Certification By my signature, I certify, under penalty of perjury, that I prepared this petition at the request of the petitioner. The petitioner then reviewed this completed petition and informed me that he or she understands all of the information contained in, and submitted with, his or her petition, including the Petitioner's Declaration and Certification, and that all of this information is complete, true, and correct. I completed this petition based only on information that the petitioner provided to me or authorized me to obtain or use. Preparer's Signature 8.a. Preparer's Signature (sign in ink) 8.b. Date of Signature (mm/dd/yyyy) Form I-918 02/07/17 N Page 10 of 11 5.a. Page Number Part 8. Additional Information If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Include your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet. 5.b. Part Number 5.c. Item Number 6.b. Part Number 6.c. Item Number 7.b. Part Number 7.c. Item Number 5.d. 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name 2. A-Number (if any) ► A- 3.a. Page Number 3.b. Part Number 3.c. Item Number 3.d. 4.a. Page Number 6.a. Page Number 6.d. 4.b. Part Number 4.d. Form I-918 02/07/17 N 4.c. Item Number 7.a. Page Number 7.d. Page 11 of 11
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