I 751 Form PDF Details

When two individuals are married, they become one in the eyes of the law. This legal document is known as a marriage certificate. A marriage certificate is an important document that records the marriage between two people. The process of obtaining a marriage certificate vary from state to state, but it is generally a fairly simple process. In most cases, you will need to provide some basic information about yourself and your spouse, pay a fee, and have your signature notarized. If you are getting married in a foreign country, you may also need to provide additional documents such as a passport or birth certificate. The I 751 form is one of the documents required for foreign nationals who wish to obtain permanent residency in the United States through their spouse.

Below is the details relating to the file you were in search of to complete. It will show you just how long it will need to finish i 751 form, exactly what fields you need to fill in and some other specific facts.

QuestionAnswer
Form NameI 751 Form
Form Length11 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min 45 sec
Other namesuscis i 751 forms, i 751 online, i 751 form, i 751 forms

Form Preview Example

 

 

 

 

 

 

 

 

Petition to Remove Conditions on Residence

 

 

 

USCIS

 

 

 

 

 

 

 

 

 

 

Form I-751

 

 

 

 

 

 

 

 

 

 

Department of Homeland Security

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OMB No. 1615-0038

 

 

 

 

 

 

 

 

 

 

U.S. Citizenship and Immigration Services

 

 

Expires 12/31/2019

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Petitioner interviewed on (mm/dd/yyyy)

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Approved under INA 216(c)(4)(C) Battered Spouse/Child

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To be completed by an

 

Select this box if

 

Attorney State Bar Number

 

Attorney or Accredited Representative

 

attorney or accredited

 

Form G-28 is

 

(if applicable)

 

 

 

 

 

USCIS Online Account Number (if any)

 

representative (if any).

 

attached.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

►START HERE - Type or print in black ink.

Part 1. Information About You, the Conditional Resident

5.Country of Birth

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

Other Names Used

List all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 11. Additional Information.

2.a. Family Name

(Last Name)

2.b. Given Name

(First Name)

2.c. Middle Name

3.a. Family Name

(Last Name)

3.b. Given Name

(First Name)

3.c. Middle Name

Other Information

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

6.Country of Citizenship or Nationality (provide all that apply)

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

A-

8.U.S. Social Security Number (if any)

9.USCIS Online Account Number (if any)

Marital Status

10.Marital Status

Single Married Divorced Widowed

11. Date of Marriage (mm/dd/yyyy)

12.Place of Marriage

13.If the marriage through which you gained conditional residence has ended, provide the date it ended (date of divorce or date of death) (mm/dd/yyyy)

14.Conditional Residence Expires On (mm/dd/yyyy)

Form I-751 Edition 12/02/19 N

Page 1 of 11

Part 1. Information About You, the Conditional

Resident (continued)

Mailing Address

15.a. In Care Of Name

15.b. Street Number

and Name

15.c. Apt. Ste. Flr.

15.d. City or Town

15.e. State

 

15.f. ZIP Code

 

 

 

16.Is your physical address different than your mailing

address?

Yes

No

 

If you answered “Yes” to Item Number 16., provide your physical address below.

Physical Address

17.a. In Care Of Name

17.b. Street Number

and Name

17.c. Apt. Ste. Flr.

17.d. City or Town

21.If you are married, is this a different marriage than the one through which you gained conditional resident status?

Yes No

22.Have you resided at any other address since you became a

permanent resident?

Yes

No

 

If you answered “Yes” to Item Number 22., provide a list of all addresses where you have resided since becoming a permanent resident and the dates you resided at those locations in the space provided in Part 11. Additional Information.

23.Is your spouse or parent's spouse currently serving with or employed by the U.S. Government and serving outside

the United States?

Yes

No

 

Part 2. 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

3.

Height

Feet

 

Inches

 

 

 

 

 

17.e. State

 

17.f. ZIP Code

 

 

 

Additional Information About You

18.Are you in removal, deportation, or rescission

proceedings?

Yes

No

 

19.Was a fee paid to anyone other than an attorney in

connection with this petition?

Yes

No

 

20.Have you ever been arrested, detained, charged, indicted, fined, or imprisoned for breaking or violating any law or ordinance (excluding traffic regulations), or committed any crime which you were not arrested in the United

States or abroad?

Yes

No

 

If you answered "Yes" to Item Number 20., provide a detailed explanation in Part 11. Additional Information or on a separate sheet of paper, and refer to the What Initial Evidence Is Required section of the Form I-751 instructions to determine what criminal history document to include with your petition.

4.Weight

5.Eye Color (Select only one box)

Black

Blue

Gray

Green

Maroon

Pink

6.Hair Color (Select only one box)

Bald (No hair)

Black

Brown

Gray

Sandy

White

Pounds

Brown

Hazel

Unknown/Other

Blond

Red

Unknown/Other

Form I-751 Edition 12/02/19 N

Page 2 of 11

Part 3. Basis for Petition

Joint Filing

My conditional residence is based on my marriage or my parent's marriage to a U.S. citizen or lawful permanent resident, and I am filing this joint petition together with (Select only one box):

1.a.

My spouse.

1.b.

My parent's spouse because I am unable to be

 

included in a joint petition filed by my parent and my

 

parent's spouse.

OR (Select all applicable boxes in the next section.)

Waiver or Individual Filing Request

My conditional residence is based on my marriage or my parent's marriage to a U.S. citizen or lawful permanent resident, I am unable to file a joint petition with my spouse or my parent's spouse, because:

1.c.

My spouse is deceased.

1.d.

My marriage was entered in good faith, but the

 

marriage was terminated through divorce or

 

annulment.

1.e.

I entered the marriage in good faith, and, during the

 

marriage, I was battered, or was the subject of

 

extreme cruelty, by my U.S. citizen or lawful

 

permanent resident spouse.

1.f.

My parent entered the marriage in good faith, and,

 

during the marriage, I was battered, or was subjected

 

to extreme cruelty, by my parent's U.S. citizen or

 

lawful permanent resident spouse or by my

 

conditional resident parent.

1.g.

The termination of my status and removal from the

 

United States would result in an extreme hardship.

Part 4. Information About the U.S. Citizen or Lawful Permanent Resident Spouse. If Filing as a Child Separately, Information About the U.S. Citizen or Lawful Permanent Resident Stepparent Through Whom You Gained Your Conditional Residence.

Relationship

1.a.

Spouse or Former Spouse

1.b.

Parent's Spouse or Former Spouse

Other Information

2.a. Family Name

(Last Name)

2.b. Given Name

(First Name)

2.c. Middle Name

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

4.U.S. Social Security Number (if any)

5.A-Number (if any)

A-

Physical Address

6.a. Street Number

and Name

6.b. Apt. Ste. Flr.

6.c. City or Town

6.d. State

 

6.e. ZIP Code

 

 

 

6.f. Province

6.g. Postal Code

6.h. Country

Part 5. Information About Your Children

Provide information on all of your children. If you need extra space to complete this section, use the space provided in Part 11. Additional Information.

Child 1

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

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

3.A-Number (if any)

A-

4.

Is this child living with you?

Yes

No

5.

Is this child applying with you?

Yes

No

Form I-751 Edition 12/02/19 N

Page 3 of 11

Part 5. Information About Your Children

(continued)

Physical Address

6.a. Street Number

and Name

6.b. Apt. Ste. Flr.

6.c. City or Town

Child 3

13.a. Family Name

(Last Name)

13.b. Given Name

(First Name)

13.c. Middle Name

14.

Date of Birth (mm/dd/yyyy)

 

 

 

 

15.

A-Number (if any)

 

 

A-

6.d. State

6.f. Province

6.e. ZIP Code

16.

Is this child living with you?

17.

Is this child applying with you?

Yes

Yes

No No

6.g. Postal Code 6.h. Country

Physical Address

18.a. Street Number

and Name

Child 2

7.a. Family Name

(Last Name)

7.b. Given Name

(First Name)

7.c. Middle Name

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

9.A-Number (if any)

A-

10.

Is this child living with you?

Yes

No

11.

Is this child applying with you?

Yes

No

Physical Address

12.a. Street Number

and Name

12.b. Apt. Ste. Flr.

12.c. City or Town

12.d. State

 

12.e. ZIP Code

 

 

 

12.f. Province

12.g. Postal Code

12.h. Country

18.b. Apt. Ste. Flr.

18.c. City or Town

18.d. State

 

18.e. ZIP Code

 

 

 

18.f. Province

18.g. Postal Code

18.h. Country

Child 4

19.a. Family Name

(Last Name)

19.b. Given Name

(First Name)

19.c. Middle Name

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

21.A-Number (if any)

A-

22.

Is this child living with you?

Yes

No

23.

Is this child applying with you?

Yes

No

Form I-751 Edition 12/02/19 N

Page 4 of 11

Part 5. Information About Your Children

(continued)

Physical Address

24.a. Street Number

and Name

24.b. Apt. Ste. Flr.

24.c. City or Town

24.d. State

 

24.e. ZIP Code

 

 

 

24.f. Province

24.g. Postal Code

24.h. Country

Child 5

25.a. Family Name

(Last Name)

25.b. Given Name

(First Name)

25.c. Middle Name

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

27.A-Number (if any)

A-

28.

Is this child living with you?

Yes

No

29.

Is this child applying with you?

Yes

No

Physical Address

30.a. Street Number

and Name

30.b. Apt. Ste. Flr.

30.c. City or Town

30.d. State

 

30.e. ZIP Code

 

 

 

30.f. Province

30.g. Postal Code

30.h. Country

Part 6. Accommodations for Individuals With Disabilities and/or Impairments

NOTE: Read the information in the Form I-751 Instructions before completing this part.

1.Are you requesting an accommodation because of your

disabilities and/or impairments?

Yes

No

 

2.Are you requesting an accommodation because of your spouse's disabilities and/or impairments?

Yes No

3.Are you requesting an accommodation because of your included children's disabilities and/or impairments?

Yes No

If you answered "Yes" to Item Numbers 1. - 3., select any applicable box for Item Numbers 4.a. - 4.c. Provide information on the disabilities and/or impairments for each person.

4.a. I am deaf or hard of hearing and request the following accommodation. (If you are requesting a sign-language interpreter, indicate for which language (for example, American Sign Language).):

4.b. I am blind or have low vision and request the following accommodation:

4.c. I have another type of disability and/or impairment. (Describe the nature of your disability and/or impairment and the accommodation you are requesting.):

Form I-751 Edition 12/02/19 N

Page 5 of 11

Part 7. Petitioner's Statement, Contact

Information, Acknowledgement of Appointment

at USCIS Application Support Center,

Certification, and Signature

NOTE: Read the information on penalties in the Penalties section of the Form I-751 Instructions before completing this part.

NOTE: If you selected Box 1.a. in Part 3., your spouse must also read and sign the petition in Part 8. Signature of a conditional resident child under 14 years of age is not required; a parent may sign for a child.

Petitioner's Statement

NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.

1.a.

I can read and understand English, and have read and

 

understand every question and instruction on this

 

petition, as well as my answer to every question. I

 

have read and understand the Acknowledgement of

 

Appointment at USCIS Application Support

 

Center.

 

 

 

1.b.

The interpreter named in Part 9. has also read to me

 

every question and instruction on this petition, as well

 

as my answer to every question, in

 

 

 

 

,

 

a language in which I am fluent. I understand every

 

question and instruction on this petition as translated

 

to me by my interpreter, and have provided complete,

 

true, and correct responses in the language indicated

 

above. The interpreter named in Part 9. has also

 

read the Acknowledgement of Appointment at

 

USCIS Application Support Center to me, in the

 

language in which I am fluent, and I understand this

 

Application Support Center (ASC)

 

Acknowledgement as read to me by my interpreter.

2.

I have requested the services of and consented to

 

 

 

 

,

 

who

is

is not an attorney or accredited

 

representative, preparing this petition for me. This

 

person who assisted me in preparing my petition has

 

reviewed the Acknowledgement of Appointment at

 

USCIS Application Support Center with me, and I

 

understand the ASC Acknowledgement.

Petitioner's Contact Information

3.Petitioner's Daytime Telephone Number

4.Petitioner's Mobile Telephone Number (if any)

5.Petitioner's Email Address (if any)

Acknowledgement of Appointment at USCIS Application Support Center

I,

 

,

understand that the purpose of a USCIS ASC appointment is for me to provide fingerprints, photograph, and/or signature and to re-affirm that all of the information in my petition is complete, true, and correct and was provided by me. I understand that I will sign my name to the following declaration which USCIS will display to me at the time I provide my fingerprints, photograph, and/or signature during my ASC appointment.

By signing here, I declare under penalty of perjury that I have reviewed and understand my application, petition, or request as identified by the receipt number displayed on the screen above, and all supporting documents, applications, petitions, or requests filed with my application, petition, or request that I (or my attorney or accredited representative) filed with USCIS, and that all of the information in these materials is complete, true, and correct.

If conditional residence was based on a marriage, I further certify that the marriage was entered into in accordance with the laws of the place where the marriage took place and was not for the purpose of procuring an immigration benefit.

I also understand that when I sign my name, provide my fingerprints, and am photographed at the USCIS ASC, I will be re-affirming that I willingly submit this petition; I have reviewed the contents of this petition; all of the information in my petition and all supporting documents submitted with my petition were provided by me and are complete, true, and correct; and if I was assisted in completing this petition, the person assisting me also reviewed this Acknowledgement of Appointment at USCIS

Application Support Center with me.

Form I-751 Edition 12/02/19 N

Page 6 of 11

Part 7. Petitioner's Statement, Contact

Information, Acknowledgement of Appointment

at USCIS Application Support Center,

Certification, and Signature (continued)

Petitioner's Certification

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.

I furthermore authorize release of information contained in this petition, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws.

I certify under penalty of perjury, that the information in my petition, my responses to each question, and any document submitted with my petition were provided by me and are complete, true, and correct.

Petitioner's Signature

6.a. Petitioner's Signature

6.b. Date of Signature (mm/dd/yyyy)

NOTE TO ALL PETITIONERS: If you do not completely fill out this petition or fail to submit required documents listed in the Instructions, USCIS may deny your petition.

NOTE: If you are filing based on claims of having been battered or subjected to extreme cruelty waiver or individual filing, you are not required to have the spouse's or individual listed in Part 4's signature.

Part 8. Spouse's or Individual Listed in Part 4.'s Statement, Contact Information, Acknowledgement of Appointment USCIS Application Support Center, Certification, and

Signature (if applicable)

Provide the following information about the spouse or individual listed in Part 4.

NOTE: Read the information on penalties in the Penalties section of the Form I-751 Instructions before completing this part.

Spouse's or Individual's Statement

NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.

1.a.

I can read and understand English, and have read and

 

understand every question and instruction on this

 

petition, as well as the petitioner's answer to every

 

question. I have read and understand the

 

Acknowledgement of Appointment at USCIS

 

Application Support Center.

1.b.

The interpreter named in Part 9. has also read to me

 

every question and instruction on this petition, as

 

well as the petitioner's answer to every question, in

 

 

 

 

,

 

a language in which I am fluent. I understand every

 

question and instruction on this petition as translated

 

to me by my interpreter, and have provided complete,

 

true, and correct responses in the language indicated

 

above. The interpreter named in Part 9. has also

 

read the Acknowledgement of Appointment at

 

USCIS Application Support Center to me, in the

 

language in which I am fluent, and I understand this

 

Application Support Center (ASC)

 

Acknowledgement as read to me by my interpreter.

2.

I have requested the services of and consented to

 

 

 

 

,

 

who

is

is not an attorney or accredited

 

representative, preparing this petition for me. This

 

person who assisted me in preparing my petition has

 

reviewed the Acknowledgement of Appointment at

USCIS Application Support Center with me, and I

understand the ASC Acknowledgement.

Spouse's or Individual's Contact Information

3.Spouse's or Individual's Daytime Telephone Number

4.Spouse's or Individual's Mobile Telephone Number (if any)

5.Spouse's or Individual's Email Address (if any)

Form I-751 Edition 12/02/19 N

Page 7 of 11

Part 8. Spouse's or Individual Listed in Part 4.'s Statement, Contact Information, Acknowledgement of Appointment USCIS Application Support Center, Certification, and Signature (if applicable) (continued)

Acknowledgement of Appointment at USCIS Application Support Center

I,

 

,

understand that the purpose of a USCIS ASC appointment is

 

for me to provide my fingerprints, photograph, and/or

 

signature and to re-affirm that all of the information in my

 

petition is complete, true, and correct and was provided by me.

 

I understand that I will sign my name to the following

 

declaration which USCIS will display to me at the time I

 

provide my fingerprints, photograph, and/or signature during

 

my ASC appointment.

 

By signing here, I declare under penalty of perjury that I have reviewed and understand my application, petition, or request as identified by the receipt number displayed on the screen above, and all supporting documents, applications, petitions, or requests filed with my application, petition, or request that I (or my attorney or accredited representative) filed with USCIS, and that all of the information in these materials is complete, true, and correct.

I also understand that when I sign my name, provide my fingerprints, and am photographed at the USCIS ASC, I will be re-affirming that I willingly submit this petition; I have reviewed the contents of this petition; all of the information in my petition and all supporting documents submitted with my petition were provided by me and are complete, true, and correct; and if I was assisted in completing this petition, the person assisting me also reviewed this Acknowledgement of Appointment at USCIS

Application Support Center with me.

Spouse's or Individual's Certification

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek.

I furthermore authorize release of information contained in this petition, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws.

I certify under penalty of perjury, that the information in my petition, my responses to each question, and any document submitted with my petition were provided by me and are complete, true, and correct.

Spouse's or Individual's Signature

6.a. Spouse's or Individual's Signature

6.b. Date of Signature (mm/dd/yyyy)

NOTE TO ALL SPOUSES OR INDIVIDUALS: If you do

not completely fill out this petition or fail to submit required documents listed in the instructions, USCIS may deny your petition.

Part 9. Interpreter's Contact Information, Certification, and Signature

Provide the following information about the interpreter.

Interpreter's Full Name

1.a. Interpreter's Family Name (Last Name)

1.b. Interpreter's Given Name (First Name)

2.Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address

3.a. Street Number

and Name

3.b. Apt. Ste. Flr.

3.c. City or Town

3.d. State

 

3.e. ZIP Code

 

 

 

3.f. Province

3.g. Postal Code

3.h. Country

Interpreter's Contact Information

4.Interpreter's Daytime Telephone Number

5.Interpreter's Email Address (if any)

Form I-751 Edition 12/02/19 N

Page 8 of 11

Part 9. Interpreter's Contact Information, Certification, and Signature (continued)

Interpreter's Certification

I certify that:

 

I am fluent in English and

, which

is the same language provided in Part 7., Item Number 1.b.;

I have read to this petitioner every question and instruction on this petition, as well as the answer to every question, in the language provided in Part 7., Item Number 1.b.; and

I have read the Acknowledgement of Appointment at USCIS Application Support Center to the petitioner in the same language provided in Part 7., Item Number 1.b.

The petitioner has informed me that he or she understands every instruction and question on the petition, as well as the answer to every question, and the petitioner verified the accuracy of every answer; and

The petitioner has also informed me that he or she understands the ASC Acknowledgement and that by appearing for a USCIS ASC biometric services appointment and providing his or her fingerprints, photograph, and/or signature, he or she is re-affirming that the contents of this petition and all supporting documentation are complete, true, and correct.

Preparer's Mailing Address

3.a. Street Number

and Name

3.b. Apt. Ste. Flr.

3.c. City or Town

3.d. State

 

3.e. ZIP Code

 

 

 

3.f. Province

3.g. Postal Code

3.h. Country

Preparer's Contact Information

4.Preparer's Daytime Telephone Number

5.Preparer's Fax Number

6.Preparer's Email Address (if any)

Interpreter's Signature

6.a. Interpreter's Signature

6.b. Date of Signature (mm/dd/yyyy)

Part 10. Contact Information, Statement, Certification, and Signature of the Person Preparing this Petition, If Other Than the Petitioner

Provide the following information about the preparer.

Preparer's Full Name

1.a. Preparer's Family Name (Last Name)

1.b. Preparer's Given Name (First Name)

2.Preparer's Business or Organization Name (if any)

Preparer's Statement

7.a.

I am not an attorney or accredited representative

 

but have prepared this petition on behalf of the

 

petitioner and with the petitioner's consent.

7.b.

I am an attorney or accredited representative and

 

my representation of the petitioner in this case

 

extends

does not extend beyond the

preparation of this petition.

NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this petition, you must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this petition.

Form I-751 Edition 12/02/19 N

Page 9 of 11

Part 10. Contact Information, Statement,

Certification, and Signature of the Person

Preparing this Petition, If Other Than the

Petitioner (continued)

Preparer's Certification

By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this petition on behalf of, at the request of, and with the express consent of the petitioner. I completed this petition based only on responses the petitioner provided to me. After completing the petition, I reviewed it and all of the petitioner's responses with the petitioner, who agreed with every answer on the petition. If the petitioner supplied additional information concerning a question on the petition, I recorded it on the petition. I have also read the Acknowledgement of

Appointment at USCIS Application Support Center to the

petitioner and the petitioner has informed me that he or she understands the ASC Acknowledgement

Preparer's Signature

8.a. Preparer's Signature

8.b. Date of Signature (mm/dd/yyyy)

Form I-751 Edition 12/02/19 N

Page 10 of 11

Part 11. Additional Information

If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.

5.a. Page Number 5.b. Part Number 5.c. Item Number

5.d.

Your Full Name

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

2.A-Number (if any)

A-

3.a. Page Number 3.b. Part Number 3.c. Item Number

3.d.

4.a. Page Number 4.b. Part Number 4.c. Item Number

4.d.

6.a. Page Number 6.b. Part Number 6.c. Item Number

6.d.

7.a. Page Number 7.b. Part Number 7.c. Item Number

7.d.

Form I-751 Edition 12/02/19 N

Page 11 of 11

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