| I-94入离境记录表 |   | 请您预先填写 | 
| U.S. Department of Justice OMR 1115-4077 Immigration and  Naturalization service | 美国司法部  OMR 1115-407 移民局 |   | 
| Welcome to the United State | 欢迎来到美国 |   | 
| Admission Number 233414639 09 | 登记号码  (*举例说明) 233414639 09 |   | 
| I-94 Arrival/Departure Record-Instructions | I-94  入境/离境记录说明 |   | 
| This form must be completed by all persons except U.S.  citizens,  returning resident aliens  with immigrant visas, and Canadian Citizens visiting or in transit. | 除了美国公民,美国海外侨民,永久居民和加拿大公民外,所有访问或过路的人士都必须填写此表 
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| Type or print legibly with pen in ALL CAPITAL LETTERS. Use  English. Do not write on the back of this form. | 请用大写字母打字或用钢笔或用圆珠笔清楚填写.  请用英文填写. 不要在此表背面填写任何东西. |   | 
| This form is in two parts. Please complete both the Arrival  Record (Item 1 through 13) and the Departure Record (Item 14 through 17). | 此表包括两部分,请填写入境记录  (第1项至第13项)和离境记录(第 14项至第17项)两部分. |   | 
| When all items are completed,   present this form to the U.S. Immigration and Naturalization Service  Inspector. | 填写完毕后,  请将此表交给美国移民局官员. |   | 
| Item 7– If you are entering the United States by land,  enter LAND in this space. If you are  entering the United States by ship,   enter SEA in this space. | 第7项内容说明,如果你从陆地进入美国,请在空格内填写LAND,如果你乘船进入美国,请在空格内填写SEA. |   | 
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| Form I-94(10-01-85)N | I-94表  (10-01-85)N |   | 
| Admission Number 233414639 09 | 登记号码  233414639 09 |   | 
| Immigration and Naturalization Service | 移民局 |   | 
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| I-94 Arrival Record | I-94  入境记录 |   | 
| 1. Family Name | 1.  姓 |   | 
| 2. First (Given) Name | 2.  名 |   | 
| 3. Birth Date(Day/Mo/Yr) | 3.  生日(月/日/年) |   | 
| 4. Country of Citizenship | 4.  哪个国家公民 |   | 
| 5. Sex (Male or Female) | 5.  性别(男填MALE或女填FEMALE) |   | 
| 6. Passport Number | 6.  护照号码 |   | 
| 7. Airline & Flight Number | 7.  航空公司和航班号 |   | 
| 8. Country Where You Live | 8.  你在哪个国家生活 |   | 
| 9. City Where You Boarded | 9.  你在那个城市登机 |   | 
| 10. City Where Visa Was Issued | 10.  在哪个城市得到签证 |   | 
| 11. Date Issued (Day/Mo/Yr) | 11.  得到签证的日期(日/月/年) |   | 
| 12. Address While in the United State (Number and Street) | 12.  在美国的住址(门牌号及街名) |   | 
| 13. City and State | 13.  在美国的住址(市名及州名) |   | 
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| Departure Number 233414639 09 | 离境号码  233414639 09 |   | 
| Immigration and Naturalization Service | 移民局 |   | 
| I-94 Departure Record | I-94离境记录 |   | 
| 14. Family Name | 14.  姓 |   | 
| 15. First (Given) Name | 15.  名 |   | 
| 16. Birth Date(Day/Mo/Yr) | 16.  生日(日/月/年) |   | 
| 17. County of Citizenship | 17.  哪个国家公民 |   
 
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