SAMPLE
DEPARTMENT OF HOMELAND SECURITY
U.S. Immigration and Customs Enforcement
ORDER OF RELEASE ON RECOGNIZANCE
You have been arrested and placed in removal proceedings. In accordance with section 236 of the Immigration and
Nationality Act and the applicable provisions of Title 8 of the Code of Federal Regulations, you are being released on your
own recognizance provided you comply with the following conditions:
(Name and Title of ICE Official)
Alien's Acknowledgement of Conditions of Release under an Order of Recognizance
I hereby acknowledge that I have (read) (had interpreted and explained to me in the language) the
contents of this order, a copy of which has been given to me. I understand that failure to comply with the terms of this
order may subject me to a fine, detention, or prosecution.
ICE Form I-220A (10/20) Page 1 of
File No.:
Date:Name:
You must report for any hearing or interview as directed by Immigration and Customs Enforcement or the Executive
Office for Immigration Review.
You must surrender for removal from the United States if so ordered.
Other: Your release is contingent upon your enrollment and successful participation in an Alternatives to Detention
(ATD) program as designated by the U.S. Department of Homeland Security. As part of the ATD program, you will be
subject to electronic monitoring and may be subject to a curfew. Failure to comply with the requirements of the ATD
program will result in a redetermination of your release conditions or your arrest and detention.
If fitted with a U.S. Immigration and Customs Enforcement GPS tracking ankle bracelet, do not tamper with or remove
the device. Under federal law, it is a crime to willfully damage or attempt to damage property of the United States.
Damaging or attempting to damage the GPS tracking ankle bracelet or any of its associated equipment (including, but
not limited to, the charging station, batteries, power cords, etc.) may result in your arrest, detention, and prosecution
under 18 U.S.C. § 1361 and/or 18 U.S.C. § 641, each punishable by a fine, up to ten years imprisonment, or both.
See attached sheet containing other specified conditions (Continue on separate sheet if required)
Date
You must report in (writing) (person) to Duty officer at
as directed.
If you are allowed to report in writing, the report must contain your name, alien registration number, current address, place
of employment, and other pertinent information as required by the officer listed above.
You must not change your place of residence without first securing written permission from the officer listed above.
You must not violate any local, State or Federal laws or ordinances.
You must assist Immigration and Customs Enforcement in obtaining any necessary travel documents.
on
NOTICE: Failure to comply with the conditions of this order may result in revocation of your release and your
arrest and detention by Immigration and Customs Enforcement.
I hereby cancel this order of release because:
The alien was taken into custody for removal.The alien failed to comply with the conditions of release.
Date
(Signature of ICE Official Serving Order) (Signature of Alien)
(Signature of ICE Official Cancelling Order)
4
SAMPLE
DEPARTMENT OF HOMELAND SECURITY
U.S. Immigration and Customs Enforcement
ORDER OF RELEASE ON RECOGNIZANCE
(CONTINUATION PAGE)
PERSONAL REPORT RECORD
Date Officer Comment/Changes
File Number Date
Alien's Signature
Alien's Telephone Number (if any)
Alien's Address
Picture Right Index Print
Signature Title
ICE Form I-220A (10/20) Page 2 of
4
Alien Name
VARELA-VARELA, MARIA HERMELIND
Last Name, First Name
