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A. DOS DV Case Number KCC Case Number 2. c. LPR Spouse 2. d. LPR Parent DV Program Selectee s Full Name If you are a derivative and your parent or spouse is the DV Program Selectee 2. Flr. 7. d. City or Town 7. e. State 4. c. Middle Name Apt. 7. f. ZIP Code Is your current physical address the same as your mailing address Yes No If you answered No to Item Number 8. B. 9. c. City or Town 9. d. State 9. e. ZIP Code Other Information Gender Date of Birth mm/dd/yyyy Male Female Form I-601A...
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