I 751 Form – Fill Out and Use This PDF

►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.

2.b.

2.c.

3.a.

3.b.

3.c.

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

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)

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

16.Is your physical address different than your mailing

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

Physical Address

17.a. In Care Of Name

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

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

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

Additional Information About You

18.Are you in removal, deportation, or rescission

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

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

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)

6.Hair Color (Select only one box)

Inches

Pounds

Brown

Hazel

Unknown/Other

Blond

Red

Unknown/Other

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):

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

Waiver or Individual Filing Request

My conditional residence is based on my marriage or my

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

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:

6.a. Street Number

and Name

6.b. Apt. 6.c. City or Town 6.d. State

6.f. Province

6.g. Postal Code

6.h. Country

Ste. Flr.

6.e. ZIP Code

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

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-

Part 5. Information About Your Children

(continued)

Physical Address

Child 3

13.a. Family Name

(Last Name)

13.b. Given Name

(First Name)

6.a. Street Number

and Name

6.b. Apt. 6.c. City or Town 6.d. State

6.f. Province

6.g. Postal Code

6.h. Country

Ste. Flr.

6.e. ZIP Code

13.c. Middle Name

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

15.A-Number (if any)

► A-

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-

Physical Address

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)

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

19.c. Middle Name

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

21.A-Number (if any)

► A-

Part 5. Information About Your Children

(continued)

Physical Address

24.a. Street Number

and Name

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-

Physical Address

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

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.c. I have another type of disability and/or impairment. (Describe the nature of your disability and/or

30.a. Street Number

and Name 30.b. Apt.

30.c. City or Town 30.d. State

30.f. Province

30.g. Postal Code

30.h. Country

Ste. Flr.

30.e. ZIP Code

impairment and the accommodation you are requesting.):

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.

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

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.

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.

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)

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

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

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

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

3.a. Street Number

and Name

3.b. Apt. 3.c. City or Town 3.d. State

3.f. Province

3.g. Postal Code

3.h. Country

Ste. Flr.

3.e. ZIP Code

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.

Interpreter's Contact Information

4.Interpreter's Daytime Telephone Number

5.Interpreter's Email Address (if any)

Part 9. Interpreter's Contact Information,

Preparer's Mailing Address

Certification, and Signature (continued)

Interpreter's Certification

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.

3.a. Street Number

and Name

3.b. Apt. 3.c. City or Town 3.d. State

3.f. Province

3.g. Postal Code

3.h. Country

Ste. Flr.

3.e. ZIP Code

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 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

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.