I-90 Application to Replace Permanent Resident Card

DRAFT

OMB No. 1615-0082; Expires 06/30/09

I-90, Application to Replace
Permanent Resident Card

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

FOR USCIS USE ONLY

START HERE - Please type or print in black ink.

Part 1. Information about you.
Family Name

Receipt

Returned

Given Name

Middle Initial

U.S. Mailing Address - C/O

Resubmitted

Street Number and Name

Apt. #

City
State

ZIP Code

Date of Birth(Month/
Day/Year)
Social
Security #

Country
of Birth
A#

Reloc Sent

Reloc Rec'd

Part 2. Application type.
1. My status is: (check one)
a.

Permanent Resident - (Not a Commuter)

b.

Permanent Resident - (Commuter)

c.

Conditional Permanent Resident

2. Reason for application: (check one)
I am a Permanent Resident or Conditional Permanent Resident and:

Applicant
Interviewed

Status as

Verified by

Class

Initials

a.

My card was lost, stolen or destroyed.

FD-258 forwarded on

b.

My authorized card was never received.

I-89 forwarded on

c.

My card is mutilated.

I-551 seen and returned

d.

My card was issued with incorrect information because of a USCIS administrative
error. I have attached the incorrect card and evidence of the correct information.

Photocopy of I-551 verified

e.

My name or other biographic information has changed since the card was issued.
Name

I am a Permanent Resident and:
f.

My present card has an expiration date and it is expiring.

g.

I have reached my 14th birthday since my card was issued.

h. 1.

I have taken up Commuter status.

h. 2.

I was a Commuter and am now taking up residence in the U.S.

i.

My status has been automatically converted to permanent resident.

j.

I have an old edition of the card.

Sticker #

(Initials)
(Initials)
Date

(ten-digit number)

Action Block

Part 3. Processing information.
Mother's First Name

Father's First Name

City of Residence where you applied for an
Immigrant Visa or Adjustment of Status

Consulate where Immigrant Visa was issued
or USCIS office where status was Adjusted

City/Town/Village of Birth

Date of Admission as an immigrant or
Adjustment of Status

To Be Completed by
Attorney or Representative, if any
Fill in box if G-28 is attached to
represent the applicant
VOLAG#
ATTY State License #
Form I-90 (Rev. 03/05/09)Y

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Part 3. Processing information (continued):
If you entered the U.S. with an Immigrant Visa, also complete the following:
Destination in U.S. at
time of Admission

Port of Entry where
Admitted to U.S.

Are you in removal/deportation or recission proceedings?

No

Yes

Since you were granted permanent residence, have you ever filed Form I-407, Abandonment by Alien of Status as Lawful Permanent Resident, or
otherwise been judged to have abandoned your status?
Yes
No
If you answer yes to any of the above questions, explain in detail on a separate piece of paper.

Part 4. Signature. (Read the information on penalties in the instructions before completing this section. You must file this application while in
the United States.)

I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted with it is all true and
correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs to determine eligibility for the
benefit I am seeking.
Signature

Date

Daytime Phone Number

Please Note: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you cannot be
found eligible for the requested document and this application may be denied.

Part 5. 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 of which I have knowledge.
Signature

Print Your Name

Date

Daytime Phone Number

Name and Address of Business/Organization (if applicable)

Form I-90 (Rev. 03/05/09)Y Page 2