Form N-300 Application to File Declaration of Intention

OMB No. 1615-0034; Expires 06/30/07

I-694, Notice of Appeal of
Decision Under Section 210 or 245A

Department of Homeland Security
U.S. Citizenship and Immigration Services

For USCIS use Only
Fee Stamp

Action Block

APPELLANT - START HERE: Please type or print in black ink.
File Number:

In the Matter of:

Application for:

APermanent Residence
Temporary Residence
Waiver of Grounds of Inadmissibility

I hereby appeal to the USCIS Director from the decision, dated

in the above entitled case.

My written brief or statement is attached.
I waive the right to submit a written brief or statement.
I will submit a brief within 30 calendar days.

Summarize the reasons for this appeal.

Appellant (or Attorney or Representative): Please complete the following.
Name (Type or Print in Black Ink.)
Address ( Street Name and Number)
(City or Town)

Telephone Number With Area Code
(State)

(Zip Code)

Title or Relationship to Appellant, If Other Than Appellant.
Signature

Date:
Form I-694 (Rev. 07/30/07) Y