1. FULL NAME

SEN, SELMA

2. DATE AND PLACE OF BIRTH

Date of Birth: 18 July 1979

Place of Birth: Balikesir, Turkey

3. THE APPLICANT'S NATIVE COUNTRY IF DIFFERENT FROM COUNTRY OF BIRTH

4. NAME, DATE AND PLACE OF BIRTH OF THE APPLICANT'S SPOUSE AND CHILDREN (IF ANY)

Spouse:

Name: SEN, MEHMET

Date of Birth : 06 September 1970

Place of Birth: Balikesir, Turkey

Child:

Name: SEN, ZEYNEP NUR

Date of Birth: 20 May 1997

Place of Birth: Syracuse, Onondoga, USA

5. FULL MAILING ADDRESS

116 Blossom Road Apt 3

Syracuse, NY 13224

6. PHOTOGRAPH.

7. SIGNATURE.