The Secretary of State of the United Stales of America

hereby ref/lleSls aJJ whom il may concern lo permit Ihe citizen/ nalionaJ 01 the United Stales named herein tOJass withollt de/ay or hindrance and in case of nee lo

give all lawl lll aid and protection.

Le Secré/aire d'Etal des Elals-Unis d'Amérif/lle

prie par Jes présentes tOlltes alltorités compé/entes de laisser passer le áJoyen 0 11 ressortissan/ des Etals-UnÍJ titulaire du présent passeporl,

sans délai ni difficulté et, en cas de besoin, de lui accorder JOllle aide et protecJion légitimes. ~

SIGNATURE ~AR.ER/SIGNA~ DU TIT ULAIRE

UNITED STATES OF AME RICA Type/Calé­ Code 01 Issulng I cOOf du pay. PASSPORT No./NO. ou PASSEPORTPASSPORT gOfle Stale USA _"eu'PASSEPORT 0404 09399 Sufame I Nom

a~¡;;MMA YO

,-ua.l,la!O,(jile

CIIS AIssue I Dale di cI1IManCI Dale ot expIra!1on / Dale d'explfalion

DEf I DEC 83 30 NOV/N OV 9 3 / Aulortt Amendmenls/

Modlflcallona, PASS POR T AGENCY SEE PAGE

MIA MI 24

P< USADIA Z<TAMAYO <MART I N«««««««« « «<

0404 09399 6USA0411 114 M9 31 1309«««««« « <6

GENERAL INFORMATION VISAS. IT IS THE RESPONSIBILITY OF THE PASSPORT BEARER TO OBTAIN THE NECESSARY VISAS.

LE TITULAIRE DU PASSEPORT EST SEUL RESPONSABLE DE L'OBTENTION DES VISAS REQUIS.

IMMUNIZATIONS. Under lhe Inlemallonal Heallh RegulaHona, a coun try may require Inlemational CertiflCales 01 Vacclnallon agalnal Yellow Fever and Cholera. Because smallpox has besn eradicaled, smallpox vaoclnalion shoold NOT be given. Check wilh health care providera or your records lo eñiUre measles. mumps, rubella, pollo, dlph\heria, letanus, and partussls Immunizalions are up 10 dale. Prophylactic medicalion lor malaria and certaln o\her preventive meaaures are advisable lor some travelers.1'IQ immunizaliona are r""ulred lo relurn lO Ihe Unlted Stales. Pertinenl íiiIormation is Included In 'Heallh Inlorma· ticn lor Inlernalional Travel," U.S. Govemmenl Printing Offiee, Washlng· ton, D.C. 20402, or may be obtalned Irom your local health department 01 physician.

HEALTH INSURANCE. Persena conslderlng loreign travel shoold deler mine whal health insuranee coverage, iI any, \hey have whila outside \he Uniled Stalea. Medicare does nol cover health cara cosls outaide \he Uniled Stalea excepl uOOer limlted circumstances In Ganada and Mexl­co.

CUSTOMS SERVICE. The pamphlel, "Know Balore Yoo Go," glvea yoo currenl pamnenl inlormalion about Cusloms requiremenla, and how \hay apply lO amcles acquired abroad. Obtain a copy Irom your naaresl Cusloms Ofllce or from \he U.S. Cusloms Service, P.O. Box 7407 Washington, D.C. 20044. The transportatlon 01 currency or bearer Instrumenl, regardless 01 \he amoun!, Is legal; however, H you take out 01 or bring inlo Ihe Uniled Stales mora Ihan $5,000 (U.S. or lorsign currancy, Iravelera checks, money ordera, or olher bearer monatary Instrumenta), yoo are required by U.S. law lo file a report wi\h \he U.s. Cualoma Service.

TREASURY. The unl!censad purchasa or Importallon 01 Cuban, North Korean, Vietnamese, or Cambodian goods ia prohiblted exeepl lor goods with a loreign markel value 01 SI00 or lesa Imported as aocompa· nied baggage dlreclly from \hosa counlries. Certaln transacllons Involv· Ing \ravel lo Cuba ara prohibiled. More inlormation: OtIice 01 Forelgn Assata control, Treasury Departmerrt, Washington, D.C. 20220.

AGRICUL TURE. Your reentry Into Ihe Unlted Stales will be spaeded If yoo bring Wiih yoo NO loreign meal, olher animal products, blrds, animal., frulta, vegetablea, planta, 8011, or olher agrtcultural Itema. It Is unlawful lo Import loreign agricultural ilema wilhout permisslon sloca \hey may carry destructive planl or animal pesls aOO diseases. For spacific inlormallon, wrile "Quarantlnes," ppo, APHIS, U.S. Department 01 Agriculture, Hyattsville, Mary1and 20782.

IMPORTANT INFORMATION THIS PASSPORT IS THE PROPERTY OF THE UNITED STATES GOVERNMENT. IT MUST BE SURRENDERED UPON DEMAND MADE BY AN AUTHORIZED REPRESENTATIVE OF THE U.s. GOVERN­MENT.

LOSS, THEFT OR DESTRUCTION OF PASSPORT should be raported Immedlalely lO local pollee authorilies and lo lhe Passport Servieea, Washington, D.C. 20520, or, If overaeas, to \he ne8r8s1 Amertcan· embaasy or consulele.

ALTERAnON OR MUTlLAnON OF PASSPORT. Thls passport mus! nol be allered or mutilaled in any way. Alterallon may make It INVALlD and, H willful, may aubJec1 you lo prosecution (Tilla 18, U.S. Coda, SecHon 1543). Only aulhorized officlals 01 Ihe Unlted Stalas or 01 lorelgn counlries, In conneclion wilh ofliclal matlers, may plece slamps or make stalements, nolations or addltions In Ihis passport. You may amend or updale parsenal inlormallon lor your own convenlenca on page lour.

EXPIRAnON. The explrstion date la given en \he lnalde front covar.

LOSS OF NAnONALITY. Yoo may lose your U.S. nationality by belng naturallzed In, or by taking an oa\h or maklng s declaration 01 allegiance lo, a loralgn slsla; or by serving In Ihe armad lorces or scceptlng employment under Iha govemmenl 01 a loreign slala; or by maklng a lormal renunciatlon 01 nalionallly elthar In Ihe Unilad Slates or belora a diplomalic or consular ofllcer 01 tha Unilad Slales while abroad. For detalled Inlormation, conault \he naarest Amarican embassy or consul· ate.

DUAL NA nONALS. A parsen 18 consldered a dual naUenal when he owes aUegiance lo more \han one country at \he sarne time. A clalm to alleglanoe may be basad on lacta 01 birth, marrlage, parentage or naturallzaticn. A dual nallona! may, whlle In \he Jurisdictien 01 \he o\her country which considera that parsen lis nallonal, be aub]ect 10 all 01 Ita laws, includlng being conscripled lor mllltary service. Dual nallonala who encounler problema shoold contact \he nsarest Amertcan emba8Sy or consulale.

WHEN TRAVELlNG IN DISTURBED AREAS yoo should keep In touch WI\h \he nearesl Amencan emb8SSY or consulale.

IF YOU RESIDE ABROAD or wihen travellng to remote areas you ahould regiater at \he neareat American embassy or conaulate.

NOTICE

THIS PASSPORT MUST NOT BE useo BY ANY PERSON OTHER THAN THE PEASON TO WHOM tSSUED OA IN VIOLATION OF THE CONOITIONS OA RESTAICTIONS PLAceo THEREIN OA IN VIOLAT10 N OF THE RULES AEGULATING THE ISSUANCE OF PASSPORTS. ANY WILlFUL VIOLATION OF THESE LAWS AN O AEGULATIONS WILl SUBJECT THE OFFENOE A TO PAOSECUTION UNDEA TITLE 18, UNITEQ STATES CODE, SECTION 1544.

FOR YOUR PROTECTlON PENClL IN lliE NAMES ANO ADDRESSES BELOW.

PLEASE KEEP THESE ENTRI ES UP TO DATE.

BEAAER'S ADOAESS IN THE UNITED STATES: AOAESSE DU TITULAIRE AUX ETATS·UNIS:

BEAAER'S FOAEIGN AOORESS: ACRESSE CU TlTULAIRE A L'ETRANGER;

IN CASE OF DEATH OA ACCIOENT NOTIFY THE NEA AEST AMERICAN EMBAS$Y OR CONSULATE ANO THE INDIVIDUAL NA MEO BELOW:

EN CAS DE OECES OU O'ACCIOENT, PAIEAi:: O'AVISER LE SEAVICE DIPLOMAT1QUE OU CONSULAlRE CES ETATS.UNIS LE PLUS PROCHE. AINSI QUE LA PERSONNE NOMMEE CI·CESSOUS.

Name Nom ________~~~________~~~ ____________________

Addre •• Adre • • e ______________________________________________

Telaphone TéllÍphone'___________________________________________

Visas Enlrits/Enlrlrs DqJarlures/Sorlies

----------------------------T------------~-~--·---------

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IT IS THE RESPONSIBILlTY OF THE PASSPORT BEARER TO OBTAIN TH E NECESSARY VISAS.

LE TlTULAIRE DU PASSEPORT EST SEUL RESPONSABLE DE L'OBTENTION DES VISAS REQUIS.

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__________________ _

Visas Visas Enlrits/Enlrlfs Deparlures/Sorlies Enlrits/Enlrtts Deparlures!Sorlks

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