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pdfUSCIS
Form I-751
Petition to Remove Conditions on Residence
Department of Homeland Security
U.S. Citizenship and Immigration Services
Receipt
For
USCIS
Use
Only
Action Block
Reloc Sent
Reloc Received
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
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Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
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Petitioner interviewed on (mm/dd/yyyy)
To be completed by an
attorney or accredited
representative (if any).
Select this box if
Form G-28 is
attached.
OMB No. 1615-0038
Expires 12/31/2019
/
/
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Remarks
Approved under INA 216(c)(4)(C) Battered Spouse/Child
Attorney State Bar Number
(if applicable)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
►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)
6.
Country of Citizenship or Nationality (provide all that
apply)
1.c. Middle Name
7.
Alien Registration Number (A-Number) (if any)
► A-
Other Names Used
8.
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.
U.S. Social Security Number (if any)
►
9.
USCIS Online Account Number (if any)
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
►
Marital Status
10.
2.c. Middle Name
3.a. Family Name
(Last Name)
3.b. Given Name
(First Name)
3.c. Middle Name
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)
Other Information
4.
Date of Birth (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
21.
Yes
22.
15.a. In Care Of Name
Apt.
Ste.
Flr.
23.
15.d. City or Town
15.e. State
16.
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
No
1.
Ethnicity (Select only one box)
Hispanic or Latino
Not Hispanic or Latino
2.
Race (Select all applicable boxes)
White
Asian
If you answered “Yes” to Item Number 16., provide your
physical address below.
Physical Address
17.a. In Care Of Name
Black or African American
American Indian or Alaska Native
17.b. Street Number
and Name
17.c.
Have you resided at any other address since you became a
permanent resident?
Yes
No
15.f. ZIP Code
Is your physical address different than your mailing
address?
Yes
Apt.
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.
15.b. Street Number
and Name
15.c.
If you are married, is this a different marriage than the
one through which you gained conditional resident status?
Native Hawaiian or Other Pacific Islander
Ste.
Flr.
3.
Height
4.
Weight
5.
Eye Color (Select only one box)
Feet
Inches
17.d. City or Town
17.e. State
17.f. ZIP Code
Additional Information About You
18.
19.
20.
Are you in removal, deportation, or rescission
proceedings?
Yes
No
Was a fee paid to anyone other than an attorney in
connection with this petition?
Yes
No
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
6.
Pounds
Black
Gray
Blue
Brown
Green
Hazel
Maroon
Pink
Unknown/Other
Hair Color (Select only one box)
Bald (No hair)
Brown
Sandy
Black
Gray
White
Blond
Red
Unknown/Other
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.
Form I-751 Edition 12/02/19 N
Page 2 of 11
Part 3. Basis for Petition
Other Information
Joint Filing
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
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):
2.c. Middle Name
1.a.
My spouse.
3.
Date of Birth (mm/dd/yyyy)
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.
4.
U.S. Social Security Number (if any)
OR (Select all applicable boxes in the next section.)
►
5.
A-Number (if any)
► A-
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.
1.f.
1.g.
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.
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.
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.
Physical Address
6.a. Street Number
and Name
6.b.
Apt.
Ste.
Flr.
6.c. City or Town
6.d. State
6.f.
6.e. ZIP Code
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)
Relationship
1.a.
Spouse or Former Spouse
1.b.
Parent's Spouse or Former Spouse
Form I-751 Edition 12/02/19 N
► A4.
Is this child living with you?
Yes
No
5.
Is this child applying with you?
Yes
No
Page 3 of 11
Child 3
Part 5. Information About Your Children
(continued)
13.a. Family Name
(Last Name)
13.b. Given Name
(First Name)
Physical Address
6.a. Street Number
and Name
6.b.
Apt.
13.c. Middle Name
Ste.
Flr.
6.c. City or Town
Date of Birth (mm/dd/yyyy)
15.
A-Number (if any)
► A-
6.d. State
6.f.
14.
6.e. ZIP Code
16.
Is this child living with you?
Yes
No
17.
Is this child applying with you?
Yes
No
Province
6.g. Postal Code
Physical Address
6.h. Country
18.a. Street Number
and Name
Child 2
18.d. State
Date of Birth (mm/dd/yyyy)
9.
A-Number (if any)
18.e. ZIP Code
18.g. Postal Code
18.h. Country
► A10.
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
Child 4
19.a. Family Name
(Last Name)
19.b. Given Name
(First Name)
19.c. Middle Name
Ste.
Flr.
12.c. City or Town
12.d. State
Flr.
18.f. Province
8.
Apt.
Ste.
18.c. City or Town
7.c. Middle Name
12.b.
Apt.
18.b.
7.a. Family Name
(Last Name)
7.b. Given Name
(First Name)
20.
Date of Birth (mm/dd/yyyy)
21.
A-Number (if any)
► A-
12.e. ZIP Code
22.
Is this child living with you?
Yes
No
23.
Is this child applying with you?
Yes
No
12.f. Province
12.g. Postal Code
12.h. Country
Form I-751 Edition 12/02/19 N
Page 4 of 11
Part 5. Information About Your Children
(continued)
Part 6. Accommodations for Individuals With
Disabilities and/or Impairments
Physical Address
NOTE: Read the information in the Form I-751 Instructions
before completing this part.
24.a. Street Number
and Name
Apt.
24.b.
Ste.
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?
Flr.
24.c. City or Town
24.d. State
Yes
24.e. ZIP Code
3.
24.f. Province
Are you requesting an accommodation because of your
included children's disabilities and/or impairments?
Yes
24.g. Postal Code
No
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.
24.h. Country
Child 5
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.):
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
Form I-751 Edition 12/02/19 N
Page 5 of 11
Petitioner's Contact Information
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.
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
1.b.
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.
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.
Form I-751 Edition 12/02/19 N
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
Petitioner's Statement
1.a.
3.
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.
Page 6 of 11
Part 7. Petitioner's Statement, Contact
Information, Acknowledgement of Appointment
at USCIS Application Support Center,
Certification, and Signature (continued)
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
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.
,
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.
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
2.
,
is
is not an attorney or accredited
who
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.
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)
I have requested the services of and consented to
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)
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.
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.
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.f.
3.e. ZIP Code
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)
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.
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
Preparer's Mailing Address
3.a. Street Number
and Name
3.b.
Apt.
Ste.
Flr.
I certify that:
3.c. City or Town
I am fluent in English and
, which
is the same language provided in Part 7., Item Number 1.b.;
3.d. State
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
3.f.
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.h. Country
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.
3.e. ZIP Code
Province
3.g. Postal Code
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
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.
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
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.
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)
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
5.a. Page Number
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.b. Part Number
5.c. Item Number
6.b. Part Number
6.c. Item Number
7.b. Part Number
7.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.
6.a. Page Number
A-Number (if any)
A3.a. Page Number
3.b. Part Number
6.d.
3.c. Item Number
3.d.
7.a. Page Number
7.d.
4.a. Page Number
4.b. Part Number
4.c. Item Number
4.d.
Form I-751 Edition 12/02/19 N
Page 11 of 11