Table of Changes Form

TABLE OF CHANGES – FORM I-687

FORM	CURRENT	NEW
Page 1, Do not write in this block. For USCIS Use Only – Revise Page 1, START HERE - Revise Page 1, Number 2 - Revise Page 1, Number 4 - Revise Page 1, Number 8 - Delete Page 1, Number 9 – Renumber Page 1, Number 10 – Renumber Page 2, Number 11 – Renumber Page 2, Number 12 – Renumber Page 2, Number 13 – Renumber Page 2, Number 14 – Renumber Page 2, Number 15 – Renumber Page 2, Number 16 – Renumber and revise Page 2, Number 17 – Renumber Page 2, Number 18 – Renumber and revise Page 2, Number 19 – Renumber and revise Page 2, Number 20 – Renumber and revise Page 2, After Number 20 – Add Page 2, Number 30 – Revise Page 4, Number 31 – Revise Pages 4 - 5, Number 32 – Revise Pages 5 – 7, Number 33 – Revise Page 8, Number 37 – Revise Page 8, Number 38 – Revise Page 8, Number 39 – Revise and Renumber Page 9, Number 40 - Renumber Page 9, Number 41 - Renumber Page 9, Number 42 – Revise and Renumber Page 9, Number 43 – Revise and Renumber Page 9, Number 44 – Delete Page 9, Number 45 – Delete Page 9, Number 46 – Delete Page 9, Number 47 – Delete Page 9, Number 48 – Delete Page 9, Number 49 – Delete Page 9, Number 50 – Delete Page 9, Number 51 – Delete Page 9, Number 52 – Delete Page 9, Number 53 - Delete Page 9, Number 54 – Delete Page 9, Number 55 - Delete Page 10 – Delete	Action Block Fee Stamp Principal Applicant’s A# This applicant’s A# START HERE – Please type or print in capital letters in black ink. If you need more space, use a separate sheet(s) of paper. 2. Name Family Name (in capital letters) Given Name Middle Name 4. Other Names Used or Known by (Including maiden name, if married) 8. Last Address Outside the U.S. 9. Country of Citizenship 10. Place of Birth 11. Marital Status 12. Gender 13. Race 14. Have you previously applied… 15. Do you have other records… 16. When did you last come to the U.S.? 17. Manner of Entry 18. Place of last entry into U.S. 19. Mother’s Name (Give maiden name, last name, first name) {textbox} {checkbox} Living {checkbox} Deceased (year) {textbox} 20. Father’s Name (Give last name, first name) {textbox} {checkbox} Living {checkbox} Deceased (year) {textbox} 30. RESIDENCES IN THE UNITED STATES: List all of your residences in the United States since your first entry, beginning with your present address. If you need more space, attach and additional sheet(s). Indicate on the sheet(s) that the information refers to question Number 30. Street Name and Number (Apt. No.) {textbox} City {textbox} State and Zip Code {textbox} From (mm/yy) {textbox} To (mm/yy) {textbox} [Repeated 13 more times] 31. AFFILIATIONS OR ASSOCIATIONS: Please list all affiliations or associations, clubs, organizations, churches, unions, businesses, etc. to which you belong or have belonged. If you need more space, attach an additional sheet(s). Indicate on the sheet(s) that the information refers to question Number 31. 32. ABSENCES FROM THE UNITED STATES SINCE ENTRY: List most recent absence first and then all previous absences dating back to January 1, 1982. If you need more space, attach an additional sheet(s). Indicate on the sheet(s) that the information refers to question Number 32. Country {textbox} Purpose of Trip {textbox} From (mm/yy) {textbox} To (mm/yy) {textbox} [22 total textboxes) 33. EMPLOYMENT IN THE UNITED STATES SINCE ENTRY: Show most recent employment first then all previous employment dating back to January 1, 1982. If none, write “None.” If you need more space, attach an additional sheet(s). Indicate on the sheet(s) that the information refers to question Number 33. Full Name of Employer {textbox} Street Name and Number (Apt. No.) {textbox} City {textbox} State and Zip Code {textbox} Occupation {textbox} Annual Wage {textbox} Hourly Wage {textbox} From (mm/yy) {textbox} To: (mm/yy) {textbox} [Repeated 14 more times] 37. …Have you ever received a suspended sentence, been placed on probation, or been paroled? 38. Have you, or a dependent member of your immediate family, ever received public assistance from any source, including, but not limited to, the U.S. Government, any state, county, city, or municipality? {4 textboxes) 39. Have you ever: a. Within the past 10 years been a prostitute or procured anyone for prostitution, or intend to engage in such activities in the future? b. Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling? c. Knowingly encouraged, induced, assisted, abetted or aided any alien to try to enter the United States illegally? d. Illicitly trafficked in any controlled substance, or knowingly assisted, abetted, or colluded in the illicit trafficking of any controlled substance? Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited membership or funds for, or have you through any means ever assisted or provided any type of material support to any person or organization that has ever engaged or conspired to engage in sabotage, kidnapping, political assassination, hijacking, or any other form of terrorist activity? Do you intend to engage in the United States in: a. Espionage? b. Any activity a purpose of which is opposition to, or the control or overthrow of, the Government of the United States, by force, violence, or other unlawful means? c. Any activity to violate or evade any law prohibiting the export from the United States of goods, technology, or sensitive information? Have you ever been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party? Did you, during the period from March 23, 1933 to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ever order, incite, assist, or otherwise participate in the persecution of any person because of race, religion, national origin, or political opinion? Have you ever engaged in genocide, or otherwise ordered, incited, assisted, or otherwise participated in the killing of any person because of race, religion, nationality, ethnic origin, or political opinion? Have you ever been deported from the United States, or removed from the United States at government expense, excluded within the past year, or are you now in exclusion, deportation, removal, or recision proceedings? Are you under a final order of civil penalty for violating section 274C of the Immigration and Nationality Act for use of fraudulent documents or have you, by fraud or willful misrepresentation of a material fact, ever sought to procure, or procured, a visa, other documentation, entry into the United States, or any immigration benefit? Have you ever left the United States to avoid being drafted into the U.S. Armed Forces? Have you ever been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence requirement and have not yet complied with that requirement or obtained a waiver? Are you now withholding custody of a U.S. citizen child outside the United States from a person granted custody of the child? Do you plan to practice polygamy in the United States? 40. If your native alphabet… 41. Language of your native… 42. Signature and Certification of Applicant. Signature {textbox} Date {textbox} 43. Signature of person preparing form, if other than applicant. I declare under penalty of perjury that I prepared this application at the request of the above person. The answers provided are based on information of which I have personal knowledge and/or were provided to me by the above named person in response to the exact questions contained on this form. Signature {textbox} Date {textbox} Print Name {textbox} Address {2 textboxes} Telephone number with area code {textbox} 44. Recommendation: Temporary Residence 45. Recommendation: Waiver of Inadmissibility under Section 212(a) 46. Class of Admission 47. Place of Adjustment 48. Date of Adjustment 49. Recommended by (Print Name and Title) 50. ID Number 51. Date 52. Final Action: Temporary Residence 53. Director, Regional Processing Center 54. ID Number 55. Date Form I-687 Supplement	Action Block Fee Stamp Waiver of Inadmissibility under Section 212(a) {checkbox} Approved {checkbox} Denied Applicant’s A# Class of Admission Place of Admission Date of Adjustment START HERE – Type or print in capital letters in black ink. (If you need more space, use a separate sheet(s) of paper.) 2. Name Family Name (Last Name) Given Name (First Name) Middle Name 4. Other A#s and Names Used or Known By (including maiden name, if married) Delete 8. Country of Citizenship 9. Place of Birth 10. Marital Status 11. Gender 12. Race 13. Have you previously applied… 14. Do you have other records… 15. When did you first come to the U.S.? 16. Manner of Entry 17. Place of first entry into U.S. to reside: 18. Mother’s Name (Maiden Name ,Last Name, First Name) {textbox} {checkbox} Living A# {textbox} Immigration Status {textbox} {checkbox} Deceased (year) {textbox} 19. Father’s Name (Last Name, First Name) {textbox} {checkbox} Living A# {textbox} Immigration Status {textbox} {checkbox} Deceased (year) {textbox} 20. List your present and past husbands/wives and all of your sons and daughters (if additional space is needed, use separate paper). Family Name {textbox} Given Name {textbox} A# {textbox} Country of Birth {textbox} Relationship {textbox} [Repeated five more times] 30. RESIDENCES IN THE UNITED STATES: List all of your residences in the United States since your first entry, beginning with your present address. If you need more space to complete, use a separate sheet(s) of paper. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet of paper and indicate on the sheet(s) that the information refers to Number 30. Number and Street Name {textbox} Apt. # {textbox} City {textbox} State {textbox} Zip Code {textbox} From (mm/yyyy) {textbox} To (mm/yyyy) {text box} [Repeated 6 more times] 31. AFFILIATIONS OR ASSOCIATIONS: List all affiliations or associations, clubs, organizations, churches, unions, businesses, etc. to which you belong or have belonged. If you need more space to complete, use a separate sheet(s) of paper. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet of paper and indicate on the sheet(s) that the information refers to Number 31. 32. ABSENCES FROM THE UNITED STATES SINCE FIRST ENTRY: List most recent absence first and then all previous absences dating back to your first entry. If you need more space to complete, use a separate sheet(s) of paper. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet of paper and indicate on the sheet(s) that the information refers to Number 32. From (mm/yyyy) {textbox} To (mm/yyyy) {textbox} Purpose of Trip {textbox} Country {textbox} Manner of Reentry (type of visa, EWI) {textbox} [11 total textboxes] 33. EMPLOYMENT IN THE UNITED STATES SINCE FIRST ENTRY: Show most recent employment first then all previous employment dating back to your first entry. If none, write “None.” If you need more space to complete, use a separate sheet(s) of paper. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet of paper and indicate on the sheet(s) that the information refers to Number 33. Full Name of Employer {textbox} Number and Street Name {textbox} Suite # {textbox} City {textbox} State {textbox} Zip Code {textbox} Occupation {textbox} Annual Wage {textbox} Hourly Wage {textbox} From (mm/yyyy) {textbox} To: (mm/yyyy) {textbox} [Repeated 9 more times] 37. …Have you ever received a suspended sentence, been placed on probation, or been paroled? If you answered “Yes” to any of Number 37, completed the following table. If you need more space to complete, use a separate sheet(s) of paper. Write your name and Alien Registration Number (A-Number), if any, at the top of each sheet of paper and indicate on the sheet(s) that the information refers to Number 37. Why were you arrested, cited, detained, or charged? {3 textboxes} Date arrested, cited, detained, or charged (mm/dd/yyyy) {3 textboxes} Where were you arrested, cited, detained, or charged? (City, State, Country) {3 textboxes} Outcome or disposition of the arrest, citation, detention, or charge {3 textboxes) Attach all certified police reports, indictments, and certified court dispositions for any arrests, citations, detentions, charges, or imprisonment. 38. Have you, or a dependent member of your immediate family, ever received public assistance from any source, including, but not limited to, the United States Government, any state, county, city, or municipality? [Delete 4 textboxes] 39. Have you ever: Within the past 10 years been a prostitute or procured anyone for prostitution, or intend to engage in such activities in the future? Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling? Knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States illegally? Illicitly trafficked in any controlled substance, or knowingly assisted, abetted, or colluded in the illicit trafficking of any controlled substance? Engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited membership or funds for, or have you through any means ever assisted or provided any type of material support to any person or organization that has ever engaged or conspired to engage in sabotage, kidnapping, political assassination, hijacking, or any other form of terrorist activity? Been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party? Engaged in genocide, or otherwise ordered, incited, assisted, or otherwise participated in the killing of any person because of race, religion, nationality, ethnic origin, or political opinion? Been deported, excluded, or removed from the United States at government expense, or have you ever been or are you now in exclusion, deportation, removal, or rescission proceedings? Left the United States to avoid being drafted into the United States Armed Forces? Been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence requirement and have not yet complied with that requirement or obtained a waiver? 40. Do you intend to engage in the United States in: A. Espionage? B. Any activity a purpose of which is opposition to, or the control or overthrow of, the government of the United States, by force, violence, or other unlawful means? C. Any activity to violate or evade any law prohibiting the export from the United States of goods, technology, or sensitive information? 41. Did you, during the period from March 23, 1933 to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ever order, incite, assist, or otherwise participate in the persecution of any person because of race, religion, national origin, or political opinion? 42. Are you under a final order of civil penalty for violating section 274C of the Immigration and Nationality Act for use of fraudulent documents or have you, by fraud or willful misrepresentation of a material fact, ever sought to procure, or procured, a visa, other documentation, entry into the United States, or any immigration benefit? 43. Are you now withholding custody of a United States citizen child outside the United States from a person granted custody of the child? 44. Do you plan to practice polygamy in the United States? 45. If your native alphabet… 46. Language of your native… 47. Signature and Certification of Applicant (sign below) Signature {textbox} Date (mm/dd/yyyy) {textbox} 48. Signature of Person Preparing Form if Other Than Above (sign below) I declare that I prepared this application at the request of the above person, and it is based on all information provided to me by the person. I have not knowingly withheld any material information that would affect the outcome of this application. Attorney or Representative Only: In the event of a Request for Evidence (RFE), may USCIS contact you by fax or e-mail? {checkbox} Yes {checkbox} No Preparer’s Signature {textbox} Date (mm/dd/yyyy) {textbox} Print Preparer’s Family Name (Last Name) {textbox} Print Preparer’s Given Name (First Name) {textbox} Print Preparer’s Middle Name {textbox} Preparer’s Firm Name (if applicable) {textbox} Preparer’s Address {textbox} Daytime Phone Number (with area code) {textbox} Fax Number (with area code) {textbox} USCIS Account # (if any) {textbox} E-mail Address (if any) {textbox} Delete Delete Delete Delete Delete Delete Delete Delete Delete Delete Delete Delete Delete