Form I 485 – Fill Out and Use This PDF

Part 1. Information About You (Person applying for lawful permanent residence)

Your Current Legal Name (do not provide a nickname)

3.a. Family Name

(Last Name)

3.b. Given Name

(First Name)

3.c. Middle Name

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

4.a. Family Name

(Last Name)

4.b. Given Name

(First Name)

4.c. Middle Name

Other Names You Have Used Since Birth (if

applicable)

NOTE: Provide all other names you have ever used, including your family name at birth, other legal names, nicknames, aliases, and assumed names. If you need extra space to complete this section, use the space provided in Part 14. Additional Information.

2.a.

2.b.

2.c.

Other Information About You

5. Date of Birth (mm/dd/yyyy)

NOTE: In addition to providing your actual date of birth, include any other dates of birth you have used in connection with any legal names or non-legal names in the space provided in Part 14. Additional Information.

7.City or Town of Birth

Part 1. Information About You (Person applying

for lawful permanent residence) (continued)

8.Country of Birth

9.Country of Citizenship or Nationality

10.Alien Registration Number (A-Number) (if any)

►A-

NOTE: If you have EVER used other A-Numbers, include the additional A-Numbers in the space provided in Part 14. Additional Information.

11.USCIS Online Account Number (if any)

►

U.S. Mailing Address

12.a. In Care Of Name (if any)

12.b. Street Number

and Name

(USPS ZIP Code Lookup)

Alternate and/or Safe Mailing Address

If you are applying based on the Violence Against Women Act (VAWA) or as a special immigrant juvenile, human trafficking victim (T nonimmigrant), or victim of a qualifying crime (U nonimmigrant) and you do not want USCIS to send notices about this application to your home, you may provide an alternative and/or safe mailing address.

13.a. In Care Of Name (if any)

13.b. Street Number

and Name

Social Security Card

14.Has the Social Security Administration (SSA) ever officially issued a Social Security card to you?

Yes No

If you answered “Yes,” provide the information requested in Item Number 15.

15.Provide your U.S. Social Security Number (SSN).

►

16.Do you want the SSA to issue you a Social Security card? (You must also answer “Yes” to Item Number 17. Consent for Disclosure, to receive a card).

Yes No

17. Consent for Disclosure: I authorize disclosure of information from this application to the SSA as required for the purpose of assigning me an SSN and issuing me a Social Security Card.

Yes No

Recent Immigration History

Provide the information for Item Numbers 18. - 24. if you last entered the United States using a passport or travel document.

18.Passport Number Used at Last Arrival

19.Travel Document Number Used at Last Arrival

20.Expiration Date of this Passport or Travel Document

(mm/dd/yyyy)

21.Country that Issued this Passport or Travel Document

22.Nonimmigrant Visa Number from this Passport (if any)

Place of Last Arrival into the United States 23.a. City or Town

23.b. State

24. Date of Last Arrival (mm/dd/yyyy)

Part 1. Information About You (Person applying

for lawful permanent residence) (continued)

When I last arrived in the United States, I:

25.a. Was inspected at a port of entry and admitted as (for example, exchange visitor; visitor, waived through; temporary worker; student):

25.b. Was inspected at a port of entry and paroled as (for example, humanitarian parole, Cuban parole):

25.c. Came into the United States without admission or parole.

25.d. Other:

If you were issued a Form I-94 Arrival-Departure Record Number: 26.a. Form I-94 Arrival-Departure Record Number

►

26.b. Expiration Date of Authorized Stay Shown on Form I-94 (mm/dd/yyyy)

26.c. Status on Form I-94 (for example, class of admission, or paroled, if paroled)

27.What is your current immigration status (if it has changed since your arrival)?

Provide your name exactly as it appears on your Form I-94 (if any)

28.a. Family Name (Last Name)

28.b. Given Name (First Name)

28.c. Middle Name

Part 2. Application Type or Filing Category

NOTE: Attach a copy of the Form I-797 receipt or approval notice for the underlying petition or application, as appropriate.

I am applying to register lawful permanent residence or adjust status to that of a lawful permanent resident based on the following immigrant category (select only one box). (See the Form I-485 Instructions for more information, including any Additional Instructions that relate to the immigrant category you select.):

1.a. Family-based

Immediate relative of a U.S. citizen, Form I-130

Other relative of a U.S. citizen or relative of a lawful permanent resident under the family-based preference categories, Form I-130

Person admitted to the United States as a fiancé(e) or child of a fiancé(e) of a U.S. citizen, Form I-129F (K-1/K-2 Nonimmigrant)

Widow or widower of a U.S. citizen, Form I-360 VAWA self-petitioner, Form I-360

1.b. Employment-based

Alien worker, Form I-140

Alien entrepreneur, Form I-526

1.c. Special Immigrant

Religious worker, Form I-360

Special immigrant juvenile, Form I-360 Certain Afghan or Iraqi national, Form I-360 Certain international broadcaster, Form I-360

Certain G-4 international organization or family member or NATO-6 employee or family member, Form I-360

1.d. Asylee or Refugee

Asylum status (INA section 208), Form I-589 or Form I-730

Refugee status (INA section 207), Form I-590 or Form I-730

1.e. Human Trafficking Victim or Crime Victim

Part 2. Application Type or Filing Category

(continued)

1.f. Special Programs Based on Certain Public Laws

The Cuban Adjustment Act

The Cuban Adjustment Act for battered spouses and children

Dependent status under the Haitian Refugee Immigrant Fairness Act

Dependent status under the Haitian Refugee Immigrant Fairness Act for battered spouses and children

Lautenberg Parolees

Diplomats or high ranking officials unable to return home (Section 13 of the Act of September 11, 1957)

Indochinese Parole Adjustment Act of 2000

1.g. Additional Options

Diversity Visa program

Continuous residence in the United States since before January 1, 1972 ("Registry")

Individual born in the United States under diplomatic status

Other eligibility

2.Are you applying for adjustment based on the Immigration and Nationality Act (INA) section 245(i)?

Yes No

NOTE: If you answered "Yes" to Item Number 2., you must have selected a family-based, employment-based, special immigrant, or Diversity Visa immigrant category listed above in Item Numbers 1.a. - 1.g. as the basis for your application for adjustment of status. Fill out the rest of this application and Supplement A to Form I-485, Adjustment of Status Under Section 245(i) (Supplement A). For detailed filing instructions, read the Form I-485 Instructions (including any Additional Instructions that relate to the immigrant category that you selected in Item Numbers 1.a. - 1.g.) and Supplement A Instructions.

Information About Your Immigrant Category

If you are the principal applicant, provide the following information.

3.Receipt Number of Underlying Petition (if any)

4.Priority Date from Underlying Petition (if any)

(mm/dd/yyyy)

If you are a derivative applicant (the spouse or unmarried child under 21 years of age of a principal applicant), provide the following information for the principal applicant.

Principal Applicant's Name

5.a. Family Name (Last Name)

5.b. Given Name (First Name)

5.c. Middle Name

6.Principal Applicant's A-Number (if any)

► A-

7.Principal Applicant's Date of Birth

(mm/dd/yyyy)

8.Receipt Number of Principal's Underlying Petition (if any)

►

9.Priority Date of Principal Applicant's Underlying Petition

(if any) (mm/dd/yyyy)

Part 3. Additional Information About You

1.Have you ever applied for an immigrant visa to obtain permanent resident status at a U.S. Embassy or U.S.

If you answered "Yes" to Item Number 1., complete Item Numbers 2.a. - 4. below. If you need extra space to complete this section, use the space provided in Part 14. Additional Information.

Location of U.S. Embassy or U.S. Consulate

3.Decision (for example, approved, refused, denied, withdrawn)

Part 3. Additional Information About You

(continued)

Address History

Provide physical addresses for everywhere you have lived during the last five years, whether inside or outside the United States. Provide your current address first. If you need extra space to complete this section, use the space provided in Part 14. Additional Information.

Physical Address 1 (current address)

Dates of Residence

Provide your most recent address outside the United States where you lived for more than one year (if not already listed above).

Dates of Residence

10.a. From (mm/dd/yyyy)

10.b. To (mm/dd/yyyy)

Employment History

Provide your employment history for the last five years, whether inside or outside the United States. Provide the most recent employment first. If you need extra space to complete this section, use the space provided in Part 14. Additional Information.

Employer 1 (current or most recent)

11.Name of Employer or Company

Address of Employer or Company

12.a. Street Number

and Name 12.b. Apt.

12.c. City or Town 12.d. State

12.f. Province

12.g. Postal Code

12.h. Country

Ste. Flr.

12.e. ZIP Code

13.Your Occupation

Part 3. Additional Information About You

(continued)

Dates of Employment

14.a. From (mm/dd/yyyy)

14.b. To (mm/dd/yyyy)

Employer 2

15.Name of Employer or Company

Address of Employer or Company

16.a. Street Number

and Name

16.b. Apt. Ste. Flr. 16.c. City or Town

16.d. State 16.e. ZIP Code

16.f. Province

16.g. Postal Code

16.h. Country

17.Your Occupation

Dates of Employment

18.a. From (mm/dd/yyyy)

18.b. To (mm/dd/yyyy)

Provide your most recent employment outside of the United States (if not already listed above).

19.Name of Employer or Company

Address of Employer or Company

20.a. Street Number

and Name

21.Your Occupation

Dates of Employment

22.a. From (mm/dd/yyyy)

22.b. To (mm/dd/yyyy)

Part 4. Information About Your Parents

Information About Your Parent 1

Parent 1's Legal Name

Parent 1's Name at Birth (if different than above)

5.City or Town of Birth

Part 4. Information About Your Parents

(continued)

7.Current City or Town of Residence (if living)

3.How many times have you been married (including annulled marriages and marriages to the same person)?

8.Current Country of Residence (if living)

Information About Your Parent 2

Parent 2's Legal Name

Parent 2's Name at Birth (if different than above)

10.a. Family Name (Last Name)

10.b. Given Name (First Name)

10.c. Middle Name

13.City or Town of Birth

14.Country of Birth

15.Current City or Town of Residence (if living)

16.Current Country of Residence (if living)

Part 5. Information About Your Marital History

1.What is your current marital status?

Widowed Marriage Annulled

Legally Separated

2.If you are married, is your spouse a current member of the U.S. armed forces or U.S. Coast Guard?

N/A Yes No

Information About Your Current Marriage

(including if you are legally separated)

If you are currently married, provide the following information about your current spouse.

Current Spouse's Legal Name

4.a. Family Name (Last Name)

4.b. Given Name (First Name)

4.c. Middle Name

5.A-Number (if any)

► A-

6.Current Spouse's Date of Birth (mm/dd/yyyy)

7.Date of Marriage to Current Spouse (mm/dd/yyyy)

Current Spouse's Place of Birth 8.a. City or Town

8.b. State or Province

8.c. Country

Place of Marriage to Current Spouse 9.a. City or Town

9.b. State or Province

9.c. Country

10.Is your current spouse applying with you?

Yes No

Part 5. Information About Your Marital History (continued)

Information About Prior Marriages (if any)

If you have been married before, whether in the United States or in any other country, provide the following information about your prior spouse. If you have had more than one previous marriage, use the space provided in Part 14. Additional Information to provide the information below.

Prior Spouse's Legal Name (provide family name before marriage)

11.a. Family Name (Last Name)

11.b. Given Name (First Name)

11.c. Middle Name

12.Prior Spouse's Date of Birth (mm/dd/yyyy)

13.Date of Marriage to Prior Spouse (mm/dd/yyyy)

Place of Marriage to Prior Spouse 14.a. City or Town

14.b. State or Province

14.c. Country

15.Date Marriage with Prior Spouse Legally Ended

(mm/dd/yyyy)

Place Where Marriage with Prior Spouse Legally Ended 16.a. City or Town

16.b. State or Province

Part 6. Information About Your Children

1.Indicate the total number of ALL living children (including adult sons and daughters) that you have.

NOTE: The term “children” includes all biological or legally adopted children, as well as current stepchildren, of any age, whether born in the United States or other countries, married or unmarried, living with you or elsewhere and includes any missing children and those born to you outside of marriage.

Provide the following information for each of your children. If you have more than three children, use the space provided in Part 14. Additional Information.

Child 1

Current Legal Name

2.a. Family Name (Last Name)

2.b. Given Name (First Name)

2.c. Middle Name

3.A-Number (if any)

► A-

4. Date of Birth (mm/dd/yyyy)

5.Country of Birth

Child 2

Current Legal Name

7.a. Family Name

(Last Name)

7.b. Given Name

(First Name)

7.c. Middle Name

8.A-Number (if any)

16.c. Country

► A-

9. Date of Birth (mm/dd/yyyy)

10. Country of Birth

11.Is this child applying with you?

Yes

No

Part 6. Information About Your Children

(continued)

Child 3

Current Legal Name

12.a. Family Name

(Last Name)

12.b. Given Name

(First Name)

12.c. Middle Name

13.A-Number (if any)

► A-

14. Date of Birth (mm/dd/yyyy)

15.Country of Birth

Part 7. Biographic Information

1.Ethnicity (Select only one box) Hispanic or Latino

Not Hispanic or Latino

2.Race (Select all applicable boxes)

White

Asian

Black or African American

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

5.Eye Color (Select only one box)

6.Hair Color (Select only one box)

Part 8. General Eligibility and Inadmissibility Grounds

1.Have you EVER been a member of, involved in, or in any way associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other location in the world

If you answered "Yes" to Item Number 1., complete Item Numbers 2. - 13.b. below. If you need extra space to complete this section, use the space provided in Part 14. Additional Information. If you answered "No," but are unsure of your answer, provide an explanation of the events and circumstances in the space provided in Part 14. Additional Information.

Organization 1

2.Name of Organization

3.a. City or Town

3.b. State or Province

3.c. Country

4.Nature of Group

Dates of Membership or Dates of Involvement

5.a. From (mm/dd/yyyy)

5.b. To (mm/dd/yyyy)

Organization 2

6.Name of Organization

7.a. City or Town

7.b. State or Province

7.c. Country

8.Nature of Group

Part 8. General Eligibility and Inadmissibility

Grounds (continued)

Dates of Membership or Dates of Involvement 9.a. From (mm/dd/yyyy)

9.b. To (mm/dd/yyyy)

20.Have you EVER had a prior final order of exclusion,

21.Have you EVER held lawful permanent resident status

22.Have you EVER been granted voluntary departure by an immigration officer or an immigration judge but failed to

No

11.a. City or Town

11.b. State or Province

11.c. Country

12.Nature of Group

Dates of Membership or Dates of Involvement 13.a. From (mm/dd/yyyy)

13.b. To (mm/dd/yyyy)

Answer Item Numbers 14. - 80.b. Choose the answer that you think is correct. If you answer “Yes” to any questions (or if you answer "No," but are unsure of your answer), provide an explanation of the events and circumstances in the space provided in Part 14. Additional Information.

14.Have you EVER been denied admission to the United

15.Have you EVER been denied a visa to the United States?

Yes No

16.Have you EVER worked in the United States without

17.Have you EVER violated the terms or conditions of your

18.Are you presently or have you EVER been in removal, exclusion, rescission, or deportation proceedings?

Yes No

19.Have you EVER been issued a final order of exclusion,

24.a. Have you EVER been a J nonimmigrant exchange visitor

If you answered "Yes" to Item Number 24.a., complete Item Numbers 24.b. - 24.c. If you answered "No" to Item Number 24.a., skip to Item Number 25.

24.c. Have you been granted a waiver or has Department of State issued a favorable waiver recommendation letter

Criminal Acts and Violations

For Item Numbers 25. - 45., you must answer "Yes" to any question that applies to you, even if your records were sealed or otherwise cleared, or even if anyone, including a judge, law enforcement officer, or attorney, told you that you no longer have a record. You must also answer "Yes" to the following questions whether the action or offense occurred here in the United States or anywhere else in the world. If you answer "Yes" to Item Numbers 25. - 45., use the space provided in Part 14. Additional Information to provide an explanation that includes why you were arrested, cited, detained, or charged; where you were arrested, cited, detained, or charged; when (date) the event occurred; and the outcome or disposition (for example, no charges filed, charges dismissed, jail, probation, community service).

25.Have you EVER been arrested, cited, charged, or detained for any reason by any law enforcement official (including but not limited to any U.S. immigration official or any official of the U.S. armed forces or U.S.

26.Have you EVER committed a crime of any kind (even if you were not arrested, cited, charged with, or tried for that