i-751 - USCIS Form I-751 Petition to Remove Conditions on...

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Form I-751 11/23/15 N Page 1 of 11 For USCIS Use Only Approved under INA 216(c)(4)(C) Battered Spouse/Child Petition to Remove Conditions on Residence Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-751 OMB No. 1615-0038 Expires 11/30/2017 Receipt Action Block Remarks Reloc Sent Date (mm/dd/yyyy) / / / Reloc Received Date (mm/dd/yyyy) / / / Date (mm/dd/yyyy) / / / Date (mm/dd/yyyy) / / / Petitioner interviewed on (mm/dd/yyyy) / / / Select this box if Form G-28 is attached. Attorney State Bar Number (if applicable) Attorney or Accredited Representative USCIS ELIS Account Number (if any) To be completed by an attorney or accredited representative (if any) . START HERE - Type or print in black ink. Part 1. Information About You, the Conditional Resident 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name Other Names Used 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 4. Date of Birth (mm/dd/yyyy) 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) U.S. Social Security Number (if any) 8. Other Information A- Alien Registration Number (A-Number) (if any) 7. Married Widowed Single Divorced Marital Status USCIS ELIS Account Number (if any) 9. 6. Country of Citizenship or Nationality (provide all that apply) 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 . 5. Country of Birth
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Form I-751 11/23/15 N Page 2 of 11 Part 1. Information About You, the Conditional Resident (continued) Mailing Address In Care Of Name 15.a. 15.d. City or Town Street Number and Name 15.b. 15.c. Flr. Ste. 15.e. State 15.f. ZIP Code Apt. Physical Address 16. Is your physical address different than your mailing address? No Yes If you answered “Yes” to Item Number 16. , provide your physical address below. 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? 18. 19. Was a fee paid to anyone other than an attorney in connection with this petition? Are you in removal, deportation, or rescission proceedings? Additional Information About You Yes No Yes No Yes No In Care Of Name 17.a. 17.e. State 17.f. ZIP Code 17.d. City or Town Street Number and Name 17.b. 17.c. Apt. Flr. Ste. 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.
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