Form I-508F Waiver of Rights, Privileges, Exemptions and Immunities

OMB No. 1615-0025; Expires 11/30/2011

Form I-508F, Waiver of Rights, Privileges,
Exemptions, and Immunities

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

Instructions
Form I-508F is used to comply with Section 247(b) of the Immigration and Nationality Act (INA), and the Convention between the
United States of America and the French Republic with respect to taxes on income and property. Form I-508F is used by French
Nationals receiving a salary from the Republic of France. A French national intending to file this form must also complete Form
I-508 and submit both forms together to the same U.S. Citizenship and Immigrations Services (USCIS) office where he or she is
submitting the related Form I-485 or Form I-131.
Alien Registration
Number A#

Last Name

First Name

Middle Name

I,
a French national, believe that I have an occupational status that entitles me to a nonimmigrant classification as a Government
Official or International Organization Representative under Section 101(a), paragraphs 15(A) and 15(G), of the Immigration and
Nationality Act (INA), and I receive a salary from the French Republic. I desire to acquire or retain the status of an alien lawfully
admitted for permanent residence. In order to do so, I waive all rights, privileges, exemptions, and immunities that I would be
entitled to under and U.S. law or executive order because of my occupational status, except as I indicate by selecting one box below.

You are required to choose either waiving or retaining your U.S. tax exemptions under the Convention by checking (and initialing)
only one of the blocks below.
Check
Initial

Check
Initial

I do not waive the benefits conferred by Articles 16 and 21 of the Convention between the United States of America
and the French Republic with respect to taxes on Income and Property. This means that I will not be required to pay
U.S. taxes on the salary paid to me by the French Republic. By taking this action, I agree that my immigrant status
will remain unchanged. However, because I have not waived any benefits under the INA, any calendar year or
portion of a calendar year shall not count as time for calculating periods of residence or physical presence in the
United States as required for naturalization under U.S. immigration and nationality laws.

I do waive the exemption from taxation provided by Articles 16 and 21 of the Convention between the United States
of America and the French Republic with respect to taxes on income and property. This means that I will be required
to pay U.S. taxes on the salary paid to me by the French Republic. I understand that this waiver qualifies me to
include the time during which the waiver is in effect for calculating the periods of residence and physical presence in
the United States as required for naturalization under U.S. immigration and nationality laws.

Signature

Date

I-508F (Rev. 11/17/09)Y