Department of Homeland Security US. Citizenship and Immigration Services US, Department of Justice (OMB No, 161-0067 1-589, Application for Asylum Executive Office for Immigration Review and for Withholding of Removal START HERE - Ty ‘oF print in black ink. See the instructions for in pplication, There fs NO filing fee for this application. NOTE: Cheek this box ifyou also want to apply for withholding of removal under the Convention Against Torture. formation about eligiblty and how to complete and file this 1. Alien Registration Number(s) (A-Number) (ary) 2, US. Social Security Number (ifany) 555-555-555 3. Complete Last Name 4. First Name 's. Middle Name Doe Jose Guillermo 6, What oer names have you used (include maiden name and aliases)? None 7. Residence in the U.S. (where you physically reside) |Felephone Number oo (aid) 355588 Soot Nmr and Name pt Neer daewangsiee ror cy Sar Zip Co patie Mo ore I ating ASS EUS Anna anorney ; pone Nom Wyaitonii hendies na 7) Anta Atom = In Care OF (if applicable): (202) 000.0000 See Naor ard Nome Is None dolar ne nia cy cae Tin Co lagna pe 0 9, Gender: Male [1] Female [10. Marital Status: Single O Marrica C1 Divorced widowed 11, Date of Birth (mm/dd/yy) 12. City and Country of Birth eres Sen Savon Saad Ta Pesca Nataly (Cozens |. aol a Bir TE Roo Bis ol Gop [6 Raton TE Saser risawcer ene esate 17. Check the box, a through ¢, that applies: a, (_] 1 have never been in Immigration Court proceedings. b. [X] 1am now in Immigration Court proceedings, & F) 1am not now in Immigration Court proceedings, but I have been in the past. 18. Complee 18 a trough. ‘When did you last fave your country? (mmm/dd yyy) 9623/2011 What is your current I-94 Number, iPany? N/A ¢. List each entry into the U.S. beginning with your most recent entry, List date (mm/ddyyy), place, and your status for each entry (Attach additional sheets as needed, Date 07/21/2011 ___ Place Brownsville, TX Status EWE Date Status Expires: NA Date Place Status Date Place Status 19, What country issued your lat 120, Passport# 123456789) 21. Expiration Date passport o travel document? (mmidynyy) pl Salvador [Travel Documeat NIA oniai2014 Sr a re ag Spanish ‘Action: ‘For USCIS use only. Decis For EOIRusconls, vmenew ue aires Denil Dae Asylum Officer IDA: rete: 0 0 0 For 89 (Re. 082581)——— Your spouse {Lam not married, (Skip1o Your Children below.) 1. Alien Registration Number (A-Number 2. PaspordID CardNo.]3. Date of Binh Us Sosa Scouy No (fam) iam Gan) tnmid3y99) }4 US. Socal Security No (am) IS. Complete Last Name 6. Fir Name Middle Name 5. Maiden Name 5, Das of Mariage (nl Apny) TO, Place of Mariage TH, City and County of Bit 2 Natonaly (hizenship) 1B, Rave, ini, o ital Group oa a Pome lis This pason inthe UST 1 Yes(Compiete Block 161024) No Speci locaton 16 Pace fast ete nio ie US. [47 Date ofa entry nto the L3H No. (Far) 1D Sas when last died CS fanaa isabpe Yan) 20, What is your spouses [21. What isthe expiration date of hier [P21 Your spouse in ImmTaaHOn! 5 previously in the US, dat of Sarena authorized stay, itany? (mm/ddyyyy) | Court proceedings? previous areal (mm/ddl9) Ove wo 4. [Fin the U.S, 8 your spouse to be included in tis application? (Check the appropriate bax) 1 Yes /anach one photograph of your spouse in the upper right corer of Page 9 on the exra cay ofthe application submited for this person) No ‘Your Children, List ‘of your children, regardless of age, location, or marital status. 1 do not have any ebildren, (Skip to Part A. II, Information about your background.) (Dy Ihave children. ‘Total number of children: (NOTE: Use Form 1-589 Supplement A or tach additional sheets of paper and documentation you have more than four children.) Alien Registration Number (A-Number) 2 PassporvID CardNo, (any) ]3. Marital Status (Married Single, 4. U,S. Socal Security No. iran) Bivoreed Widowed Wary) Complete Last Name 6. First Name 7 Middle Nane a Date of Binh (mmddinn3) 9. City and Country of Bith 10, Nationality (Cizenship) | Rass, iti, or Tribal Group 2 Gender » " . ” [Mate] Female HS. Isis hid in he US. [1 Yes (Compete Blocks 15 021) ] No (Specify locaton) 14, Place oflastentry inthe US. ]18, Date oflastenuy inthe [16.194 No. (Fany) 17, Status when last admitted US (immiony) (Disa ype an) Tf. Wins your hts 1. Whats gcapion dane arn PO YOU Cin Tamigation Coo prosseings? urrent St Buthorzed say, any? mmddyy) Oyvs [ % uded ints application? (Check the appropriate bax) 1. [fin the US, is his child 1B i Yes cauach one photograph of our chin the upper right comer of Page 9 onthe extra copy of the application submited or this person) O wo Form F589 (Rev. OSS) Y Page 2T Alen Registration Number (A-Nunbe?) [2- PasporD Curd No. (fay) 3. Maral Status arsed Single, | 4. U.S. Social Scouty No. yan) Bored Widowed [er . Complcie Lat Name & Fist Name Middle Name Date of Binh (mndldnoy) 9 iy and Coury of Binh 10 Nationality (isenship) 4 Race, Ens or Tribal Group — [Oso = = CJ Male) Female 1s, his SUS.T LL} Ves Complete Blocks 140 21,) No (Spee location) 14 Place of latent iniothe US. YES. Dae ofa ry iniothe_]16.198 No. (Ver) 17, Status when last admitted US. (mmidd)y9y) (isa ope, any) 18, What is your child's ]19. Whats the expiration date of hiyher 20-15 You child in Irsmigration Court proceedings ‘current Matus? authorized stay, ir any? (mm/ddyy99) Ove Ow T-IFin the US,, i this child to be included inthis application? (Check ihe appropriate Box) Gi Yes (Attach one photograph of your child inthe ypper right corner of Page 9 on the extra copy ofthe application submited for this person.) Ono Ten Rginton Number (A Nobo) ten) 4. US. Social Security No, (an) 2 PassponlID Card No. (ifary)[3. Marital Status (Married, Single, Divorced Widowed) 5. Complete Last Name 6. Fist Name 7. Middle Nene a, Dats af Binh Gaming) 9 Cy and Country of ith TO: Nataly Citzenship) |. Rave, ini, or Tikal Group |P2-Gender * " | Ey Male (Female 13s ths child nthe UST Tes Complete Blocks 14 to 21) [1] No (Specify location) 14 Phas oa ein ato HeUS, ]15, Dao atthe [16.198 No. Fam) 7, Status when ast admited US. tmmiddniy) Misa npe: Vary) 120. Ts your child fw Immigration Court proceedings? Ors On fai, Trin the US, sts child Yo Be Included in tis applleaton?” (Check the appropriate Bax) (Yes (attach one photograph of your child in the upper right corner of Page 9 on the extra copy of the application submitted fr this person.) 18, Whatis your child's 19. What is the expiration date of hier current satus? authorized stay, Hany? (mn/ddiny) Ono 1. Alien Registration Number (A-Number) |2- Passport'ID Card No. (ifany) |3, Marital Status (Married, Single, _|4. U.S. Social Security No. wis} Seared Hane ss Compete Last Name Fist Nane Mia Nae Data Biah famlilny) B-Ciy and Coury of Binh 0 Nationality (Cassi |. Rac, Eo Tital Group [Gander » ” PY) Ey'Male Female 13. Is this child in the U'S. 77) ves (Complete Blocks 14 to 21.) []No (Specify location) 14, Phase oles ent in EUS. [IS Daca ety inthe [1G TENG. Fan) 17, Status when last admit S (mmiddy3y) (asa ype, Vary) 0. 1s your child in Immigration Court proceedings? Dyes (] wo Bt. TFinthe US is hid obo naTuded Ta Tis application?” (Check he appropriate Bax] [Tes attach one photograph of your child the ypper right corner of Page 9 an the extra copy ofthe application submited for ts person) No TATE TT RS 18, Whats your ils 19. Whats the expiration dae of hier current status? aulhorized say, any? (mm/ddjno9)ee 1. List your lst address where you lived before coming tothe United States. If tis isnot the country where you fear persecution, also list the last addres inthe country where you fear persecution, (List Address, Cip/Town, Deparimert, Province, or State and Country, (NOTE: Use Form I-589 Supplement B, or additional sheets of paper, ifnecessary,) ‘Number and Sireet 5 Dates Provide entabi) CityTown Department, Province, or Stats} County | sam afte) To (Molt) [37 Calle Oriente 436 San Salvador [Sen Salvador Et Salvador ovraii997 | 06/23/2011 2, Provide the Following information about your residences during the past S years. List your present address first. (NOTE: Use Form 1-589 Supplement B, or additional sheets of paper, if necessary, 5 a | mn Dates Number and Street, CityrTown Department, Province, or Stat Country From (Mo/tt) To (MoM) 1234 Morningside Dr, Apt. 101 [Hyattsville Maryland usa. oot | present IES Brownsville [Brownsvile Texas USA om oot [37 Calle Oriente 436 Sun Salvador [San Salvador EI Salvador over | ost '3. Provide te following information about your education, beginning with the most event. (NOTE: Use Form I-589 Supplement B, or additional sheet of paper, ifnecessary.) - ‘Aended Name of School ‘Type of School Location (Address) From (Merit To (oft) |Northwestem High School High Schoo! "7000 Adelphi Rd, Hyattsville, MD 2g] 09/11 | present Colegio de Santa Rosa Grade School calle Santa Rosa, San Salvador, EL Spy] 00S | O6/tt “. Provide the following information about your employment during the past 3 years. List your present employment first (NOTE: Use Form 1-589 Supplement Bor additional sheets of paper, ifnecessary.) Dates rom (Ma/Yr) To (Mov¥i) hwa | | | Name and Address of Employer ‘Your Occupation '. Provide the following information about your parents and siblings (brothers and sisters), Check the box ithe person is deceased, (NOTE: Use Form 1-589 Supplement B, or additional sheets of paper, ifnecessary) Pall Name Ciy/Town and County of Birth Current Location Mother Ana Doe (Colonia La Gloria, San Vicente, E1Salvador—[[-] Deceased. Hyatavill, MD [Rather Carlos Doe (Colonia La Gloria, San Vicente, EI Salvador [B&] Deceased [Sibling Maria Doe San Salvador, Et Salvador 7 Deceased Hyattsville, MD sibling Yery Doe San Salvador, El Salvador IT Deceased Hyatsile, MD Sibling Julio Doe (Colonia La Gloria, San Vicente, EI Salvador [JR] Deveased Ty Deceased orm -589 (Rev, OSS) Y Paget(NOTE: Use Form 1-589 Supplement B, or attach additional sheets of paper as needed to complete your responses to the questions canained in Part B.) ‘When answering the following questions about your asylum or other protection claim (withholding of removal under 241(6)3) of the INA or withholding of removal under the Convention Against Torture), you must provide a detailed and specifi account of the basis of your claim to asylum or other protection. To the best of your ability, provide specific dates, places, and descriptions about each event or action described. You must etach documents evidencing the general conditions in the country from which you are seeking asylum or other protection and the specific facts on whieh you ae relying to support your claim, I this documentation is unavailable or you are not providing this documentation with your application, explain why in your responses to the following questions Refer to Instructions, Part 1: Filing Instructions, Section Il, “Basis of Eligibiliy,” Parts A -D, Section V, "Completing the Porm,” Part B, and Section Vil, "Additional Evidence That You Should Submit,” for more information on completing this section ofthe form, 1 Why are you applying for asylum or withnolding of removal under section 241(6)(3) of the INA, or for withholding of removal under the Convention Agaiast Torture? Check the appropriate box(es) below and then provide detailed answers to questions A and B below: am seeking asylum or withholding of removal based om: TO Race TO Potiticat opinion (Religion Membership in a particular social group D1 Nationality Torture Convention ‘A. Have you, your family, or close fends or colleagues ever experienced harm or mistreatment or threats in the past by anyone? On Ie"¥es," explain in detail: 1, What happened; 2, When the harm or mistreatment or threats oceurred; ‘3. Who caused the harm or mistreatment or threats; and 4, Why you believe the harm or mistreatment or threats occured, While I was growing up in San Salvador, my father was an active member ofthe gang Mara Salvatrucha (MS-13). He was an alcoholic who did drugs, and he would often hurt me and my family. One day when | was fourteen, my sister Yeny and |witnessed our father’ fellow gang- members brutally murder him with a machete, They did not know that we had seen them untl later because we were hiding under a table. After they left, we told the police. When the gang members found out, they swore that they would "get" me and my sister, as wells force us to pay forthe debts of our father, 'B, Do you fear harm or misteatment if you return to your home country? Cn If*Yes," explain in deta: 1, What harm or mistreatment you fear; 2. Who you believe would harm or misteat you; and 3. Why you believe you would or could be harmed or mistreated. (My sister Veny and Ihave received numerous threats from the MS-13. They sill come to our mothers house and say that they wil Kill us if they find us. When we told the police about the threats, they refused to help. I believe that if return to EI Salvador, the MS-13 will find me, force me to pay for my fathers debts, and kill me for having sought the assistance ofthe police. Yes Form F509 (Rev OSS) Y Page 5 AAOee 2, Have you or your family members ever been accused, charged, arested, detained, interrogated, convicted and sentenced, or imprisoned ‘in any country other than the United States? Ono If "Yes," explain the circumstances and reasons fr the action. [My father was arested once in San Salvador, El Salvador for abusing my mother. Twas litle and do nat know how much time he spent in jail 43.A. Have you or your family members ever belonged to or been associated with any organizations or groups in your home country, such 8s, but not limited to, apolitical pany, student group, labor union, religious organization, military or paramilitary group, civil patrol, guerilla organization, ethnic group, human rights group, or the press or media? Oe IF "Yes," describe foreach person the level of participation, any leadership or other positions held, and the length of ime you or your family members were involved in each organization or activity [Twas a member of the soccer team of El Colegio Sante Rosa: Team Captain, rom September 2010 to June 2011. My father was a member ofthe [gang MS-13, but T don't know when he joined; I believe he was & member until he was killed, 'B Do you or your family members continue to participate in any way in these organizations or groups? ByNo Oves IF "Yes," describe for each person your or your Family members’ curent level of participation, ny leadership or other positions currently held and the length of time you or your family members have been involved in each organization or group. 4, Are you afraid of being subjected to torture in your home county or any other country to which you may be returned? Dino ves explain why you ae afaid and describe the natute of torture you fear, by whom, and why it would be inflicted. [My fathers fellow members of the gang MS-13 have said they will harm me and my sister Yeny because of our fathers debis and because we told police of our father’s murder. We saw them use a machete to torture our father before cutting his throat, and we think tat they wil do the same or worse tous. The police did not help us when we advised them of the threats we were receiving, and they wil do nothing if we return. Form 59 (Rev 05571) Y Pages(NOTE: Use Form 1-589 SwplementB, or attach additonal shets of paper as needed to complete your responses tothe questions contained in Part) 1. Have you your spouse, your dle), your parents or your siblings cver applied othe US. Government for refuge tats, asylum, or witolding of removal? Ove If "Yes" explain the decision and what happened to any status you, your spouse, your child(ren), your parents, or your siblings received as a result ofthat decision, Indiate whether or aot you were include in a parent or spouse's application. Iso, include your parent o spouse's A- ‘number in your response. Ifyou have been denied asylum by an immigration judge or the Board of Immigration Appeals, describe any change(s) in conditions in your country or your own personal cizcumstances since the date ofthe denial that may affect your eligibility for asylum. 2..A. After leaving the country from which you are claiming asylum, did you or your spouse or child(ren) who are now in the United Stats travel ‘through of reside in any other country before entering the United States? Cl wo ixlves BB Have you, your spouse, your child(ren), or other family members, suchas your parents or siblings, ever applied for or received any lawful status in any country othr than the one ftom which you are now claiming asylum? Bw Ove If"Yes" to either or both questions (2A and/or 2B), provide for each person the following: the name of each country andthe Length of sty, the person's status while there, the reasons for leaving, whether or not the person is entitled to return for lawful residence purposes, and ‘whether the person applied for refugee status or for asylum while there, and if nol, why he or she did not do so, My sister and Traveled through Guatemala and Mexivo by bus. We spent only a few days in each place -I don't know exactly how many ~ and we did not request asylum. We do not have a visa or other legal means to return to either country. {3 Have you, your spouse or your child(ren) ever ordered, incited, assisted or otherwise participated in causing harm or suffering to any person because of his or her race, religion, nationality, membership in a particular socal group or belief ina particular political opinion? Oves "Yes," describe in detail each such incident and your own, your spouse's, or your child(ren)'s involvement. Form 509 (Rev 0551) Y Page 74, After you lft the country where you were harmed or fear harm, did you return to that eountry? No Oves If*Yes." deseribe in detail the circumstances of your visi(s) (for example, the date(s) ofthe tris), the purposes) of the trip(s), and the length oftime you remained in that county forthe visit()) '. Are you filing this application more than 1 year after your last arrival inthe United States? (No ves Ir "¥es," explain why you dd no file within the frst yer after you arrived. You must be prepared to explain at your interview o hearing ‘wy you did not file your asylum application within the first year after you arived. For guidance in answering this question, see Instructions, Part 1: Filing nsieuctions, Section V. "Completing the Form,” Part C. Tam filing this application more than one year after | arrived in the US. on Tuy 21, 2011 Twas designated an unaccompanied alien child and vas detained at IES from July until September 23, 2011, when we went to live with my mother in Hyattsville. I was referred to KIND, but didnot meet with them fora legal sereening until April 15, 2012, and I did not get a pro bono lawyer until August 1, 2012, Iam fling my application as soon as could aftr getting a lawyer. 6. Have you or any member of your Family included inthe application ever commited any crime andor been arrested, charged, convicted, or sentenced for any crimes inthe United States? No Ove IE "Yes, for each instance, specify in you response: what occurred andthe circumstanes, dates, length of sentence received, location, the duration of the detention or imprisonment, reason(s) forthe detention or conviction, any formal charges that were lodged against you or "your relatives included in your application, and the reason(s) for release. Attach documents referring to these incident, if they are available, of an explanation of why documents ere not available NN Form 1-589 (Rev. 05/25/11) ¥ Page 8evidence submitted with it ae all tue and correc. Title 18, United States Code, Section 1546(a, provides in part ‘Whoever knowingly makes under oath, or as permitted under penalty of perjury under Section 1746 of Tile 28, United States Code, knowingly subseribes as true, any false statement with respect to a material fact in any| pplication, affidavit, or other document required by the immigration laws or regulations prescribed thereunder, or knowingly presents any such application, affidavit, or other document containing any such false statement or} Which fils to contain any reasonable basis in law or fact ~ shell be fined in accordance with this ttle or} imprisoned for up to 25 years. I authorize the release of any information from my immigration record that U.S, Citizenship and Immigration Services (USCIS) needs to determine eligibility forthe benelit I um seeking, & Potro x Oo "sp ne ety af ey ie of ed es Anti Beinn |g Photo Staple your photograph here or the photograph of the family ‘member tobe included on the extra copy of the application submitted for that person. WARNING: Applicants who are a the United States illegally are subject to removal if their asylum or withholding claims are not granted by an asylum officer or an immigration judge. Any information provided in completing this application may be used asa basis for the institution of, or as evidence in, removal proceedings even if the application is later withdrawn. Applicants determined to have knowingly ‘made a frivolous application for asylum will be permanently ineligible for any benefits under the Immigration and Nationality Act. You may not avoid a frivolous finding simply because someone advised you to provide false information in your asylum application. If fling with USCIS, unexcused failure to appear for an appointment to provide biometrics (such as fingerprints) and your biographical formation within the time allowed may result in an asylum officer dismissing your asylum application or referring i to an immigration judge. Failure without good eause to provide DHS with biometrics or other biographical information while in removal proceedings may ‘result in your application being found abandoned by the immigration judge. See seetions 208(d)(5)(A) and 208(d)(6) of the INA and 8 CER. sections 208.10, 1208.10, 208.20, 1003.47(d) and 1208.20, Prin your complete name. wate your name in your atv alphabet Jose Guillermo Doe Jose (yy !\er Pot Did your spouse, parent, oF cildren) assist you in completing this application? [X] No [7] Yes (If Yes," list the name and relationship) ane} (Relationship) Wane) Relationship) ation? Ono Yes (f"Yes,"complete Part E) Asylum applicants may be represented by counsel. Have you been provided with alist of persons who may be available to assist you, a litle or no cost, with your asylum elaim? — [} No Did someone other than your spouse, parent, or child(ren) prepare this appl Yes Signature of Applicant (The person in Part A.) a [ aid Ik ] roi2/2012 Date (nimlddinag) T declare that I have prepared this application a the request ofthe person named in Pat D, that the responses provided are based on all information of which I have knowledge, or which was provided to me by the applicant, and that the completed application was read t the applicant in his ot her native language ora language he ot she understands for verification before he or she signed the application in my presence. {arm aware that the ‘knowing placement of false information on the Form I-589 may also subject me to eivil penalties under 8 U.S.C. 1324e andlor criminal penalties under 18 U.S.C. 1546(. Signature of Preparer | Cinna. Utgnty [Daytime Telephone Number Print Complete Name of Preparer Anna Attorney Adress of Proparer: Street Number and Name (( 202) 000-0000 100 Law Firm Place |Apt. No. city state Zip Code Washington pe 2000 Tu mui il ll Foam 1589 (Rew. 05/25/11) Y Page 9—_— NOTE: You wil be asked to complete thls part when you appear for examination before an asylum officer of the Department of Homeland Security, US. Citizenship and Immigration Services (USCIS). [ swear (affirm) that I know the contents ofthis application that I am signing, including the attached documents end supplements that they are [Jal true or (not all tue to the best of my knowledge and that correction(s) numbered to were made by me or at my request sya will be permanently ineligible for any Furthermore, Iam aware that if | am determined to have knowingly made a frivolous application for benefits under the Immigration and Nationality Act, and that I may not avoid a frivolous finding simply because someone advised me to provide false information in my asylum application. Signed and sworn to before me by the above named applicant on ‘Signature of Applicant Das (mmmldoaay ‘Write Vour Name ia Your Native Alphabet ‘Signature of Asylum Officer ‘NOTE: You will be asked to complete this Part when you appear before an immigration judge of the U.S. Department of Justice, Executtve Office {far Immigration Review (EOIR), fora hearing. ‘TSwear (ffir hat imow the contents of This application that Tam signing, including the afached documents and supplements, at Wey are Clit true or [not all iruc to the best of my knowledge and that cortecton(s) numbered __to_were made by me o at my request. Forthermore, Tam aware that if am determined to have knowingly made a frivolous application for ayTansT willbe permanently ineligible for any benefits under the Immigration and Nationality Act, and that I may not avoid frivolous finding simply because someone advised me to provide {alse information in my asylum application. ‘Signed and sworn to before me by the above named applicant on: ‘Signature of Applicant Date (mindy) ‘Wate Your Name in Your Native Alphabet ‘Signature of immigration Fudge Form -S89 (Rey. 0825/1) Page 10