I-510

CBP I-510 (3).doc

Guarantee of Payment

I-510

OMB: 1651-0127

Document [doc]
Download: doc | pdf

DEPARTMENT OF HOMELAND SECURITY

U.S. Customs and Border Protection

OMB No. 1653-0024


GUARANTEE OF PAYMENT




Port of Entry



File No.


Pursuant to the provisions of section 253 of the Immigration and Nationality Act,


I, _______________________________________________________________________________________________

Name (First) (Initial) (Last)


as _________________________________________________________________________________________________________

(Owner, agent, consignee, commanding officer, or master)


of the vessel or aircraft _______________________________________________________________________________________


employing the alien crewman _________________________________________________________________________________


who upon the arrival at the port of _____________________________________________________________________


on __________________________________________ was found to be afflicted with, or suspected of being afflicted with


_________________________________________________________________________________________________


________________________________________________________________________________________________ .


I hereby guarantee to pay any and all expenses incurred or to be incurred for the hospitalization, care, and treatment, and


for burial in the event of death, of the said alien crewman.


Dated at ________________________________________this ______________ day of __________________________

(month/year)


______________________________________________

(Signature of guarantor)












Approved this ______ day of _________________________________________________________________________

(month/year)


______________________________________________________

(Signature of Officer)


______________________________________________________

(Title of Officer)




CBP Form I-510 (08/05)

File Typeapplication/msword
File TitleDEPARTMENT OF HOMELAND SECURITY
AuthorAuthorized User
Last Modified Bylwshirkey
File Modified2006-12-14
File Created2006-12-14

© 2024 OMB.report | Privacy Policy