TABLE OF CHANGES –FORM
Form I-212, Application for Consent to Reapply for Admission Into the United States After Deportation or Removal
OMB Number: 1615-0018
4/24/2018
Reason for Revision: 83C Revision to update standard language and include G-325A data fields. |
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[Page 1]
To be completed by an attorney or BIA-accredited representative (if any).
Select this box if Form G-28 or Form G-28I is attached.
Attorney State Bar Number (if applicable)
Attorney or Accredited Representative USCIS Online Account Number (if any)
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Pages 1-2, Part 1. Information About You |
[Page 1]
Start Here. Type or print in black ink.
Part 1. Information About You …
Your Full Name
2.a. Family Name (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name
Other Names Used
List all other names you have ever used, including maiden names, aliases, and nicknames. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.
3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name
Mailing Address
NOTE: If you are outside the United States, provide a U.S. mailing address, if available. If a U.S. mailing address is not available, provide your mailing address abroad.
4.a. In Care Of Name 4.b. Street Number and Name 4.c. Apt. Ste. Flr. 4.d. City or Town 4.e. State 4.f. ZIP Code 4.g. Province 4.h. Postal Code 4.i. Country
5. Is your mailing address the same address where you currently live (physical address)? Y/N
If you answered "No" to Item Number 5., provide your current physical address in Item Numbers 6.a. - 6.h.
[page 2]
Physical Address
6.a. Street Number and Name 6.b. Apt. Ste. Flr. 6.c. City or Town 6.d. State 6.e. ZIP Code 6.f. Province 6.g. Postal Code 6.h. Country
Other Information About You
7. U.S. Social Security Number (if any)
[new]
8. Gender M/F
9. Date of Birth (mm/dd/yyyy)
10. City or Town of Birth
11. State or Province of Birth (if applicable)
12. Country of Birth
13. Country of Citizenship or Nationality
If you seek an immigrant or nonimmigrant visa and you are or will file your application for consent to reapply with your immigrant or nonimmigrant visa application, provide the information requested in Item Numbers 14.a. - 14.b.
14.a. The Department of State (DOS) Consular Case Number (if available)
14.b. The location of the U.S. Embassy or U.S. Consulate where your application for an immigrant visa is being or will be made
City Country
If you are seeking consent to reapply in connection with your application to adjust your status to that of a lawful permanent resident, provide information in Item Numbers 15.a. - 15.c.
15.a. USCIS Receipt Number (if any)
15.b. Where did you file your application (for example, “USCIS Office Name” or “Lockbox”)?
15.c. Date Filed (mm/dd/yyyy)
16. Are you submitting Form I-601, Application for Waiver of Grounds of Inadmissibility, along with this application? Y/N
If you answered “No,” provide the information requested below about previously filed Forms I-601 (if any):
17.a. USCIS Receipt Number for Form I-601 (if any)
17.b. Where did you file your application (for example, “USCIS Office Name” or “Lockbox”)?
17.c. Date Filed (mm/dd/yyyy)
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[Page 1]
START HERE - Type or print in black ink.
Part 1. Information About You …
[no change]
Other Names Used
Provide 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 9. Additional Information.
3.a. Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name _____________________________________
4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name
Mailing Address
[no change]
5.a. In Care Of Name (if any) 5.b. Street Number and Name 5.c. Apt. Ste. Flr. 5.d. City or Town 5.e. State 5.f. ZIP Code 5.g. Province 5.h. Postal Code 5.i. Country
[Page 2]
6. Is your mailing address the same address where you currently live (physical address)? Yes/No
If you answered "No" to Item Number 6., provide your current physical address in Item Numbers 7.a. - 7.f.
Physical Address
7.a. Street Number and Name 7.b. Apt. Ste. Flr. 7.c. City or Town 7.d. State 7.e. ZIP Code 7.f. Province 7.g. Postal Code 7.h. Country
Other Information About You
8. U.S. Social Security Number (if any)
9. USCIS Online Account Number (if any)
10. Gender M/F
11. Date of Birth (mm/dd/yyyy)
12. City or Town of Birth
13. State or Province of Birth (if applicable)
14. Country of Birth
15. Country of Citizenship or Nationality
If you seek an immigrant or nonimmigrant visa and you are or will file your application for consent to reapply with your immigrant or nonimmigrant visa application, provide the information requested in Item Numbers 16. - 17.b.
16. The Department of State (DOS) Consular Case Number (if available)
The Location of the U.S. Embassy or U.S. Consulate Where Your Application for an Immigrant Visa is Being or Will Be Made
17.a. City or Town 17.b. Country
If you are seeking consent to reapply in connection with your application to adjust your status to that of a lawful permanent resident, provide information in Item Numbers 18.a. - 18.c.
18.a. USCIS Receipt Number (if any)
[Page 3]
18.b. Where did you file your application (for example, "USCIS Office Name" or "Lockbox")?
18.c. Date Filed (mm/dd/yyyy)
19. Are you submitting Form I-601, Application for Waiver of Grounds of Inadmissibility, along with this application? Y/N
If you answered "No," provide the information requested in Item Numbers 20.a. - 20.c. about previously filed Forms I-601 (if any):
20.a. USCIS Receipt Number for Form I-601 (if any)
20.b. Where did you file your application (for example, "USCIS Office Name" or "Lockbox")?
20.c. Date Filed (mm/dd/yyyy)
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Pages 2-3, Part 2. Reasons You Are Filing Form I-212 |
[Page 2]
Part 2. Reasons You Are Filing Form I-212
If you are inadmissible to the United States for the following reason, select “Yes” and then select the appropriate boxes. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.
Removal as a Arriving Alien (INA section 212(a)(9)(A)(i)) …
1.d. I have been convicted of an aggravated felony in the United States or abroad, before or after my removal from the United States. Provide information on your aggravated felony convictions in Part 8. Additional Information and include the required evidence.
[page 3]
2.a. Date you were removed from the United States (mm/dd/yyyy)
2.b. Location from where you were removed
City or Town State
Removal as a Deportable Alien (INA section 212(a)(9)(A)(ii))
3.a. I have been removed as a deportable alien under INA section 240 or any other provision of the law, or I departed the United States while an order of removal was outstanding. Y/N
3.b. I have only been removed once and my removal was less than 10 years ago.
3.c. I have been removed two or more times, and my last removal was less than 20 years ago.
3.d. I have been convicted of an aggravated felony in the United States or abroad, before or after my removal from the United States. Provide information on your aggravated felony convictions in Part 8. Additional Information and include the required evidence.
4.a. Date you were excluded, deported, or removed from the United States (mm/dd/yyyy)
4.b. Location from where you were removed
City or Town State
Entry After Unlawful Presence in the Aggregate of 1 Year (INA section 212(a)(9)(C)(i)(I))
5.a. I entered or attempted to enter the United States without being admitted or paroled, after having been unlawfully present in the United States on or after April 1, 1997, for a period of more than one year, in the aggregate. Y/N
NOTE: If you answered “Yes” to Item Number 5.a., list all the time periods during which you were unlawfully present in the United States (including any periods in which you overstayed your lawful status). Begin with your most recent period of unlawful presence. Also attach evidence demonstrating that you have remained outside the United States for 10 years since your last departure.
Periods of Unlawful Presence
5.b. From (mm/dd/yyyy) 5.c. To (mm/dd/yyyy)
6.a. Date you departed the United States after your period of unlawful presence (mm/dd/yyyy)
6.b. Location where you departed the United States after your period of unlawful presence
City or Town State
6.c. Location where you reentered or attempted to reenter the United States
City or Town State
6.d. Date you attempted to unlawfully enter or reenter the United States after period of unlawful presence (mm/dd/yyyy)
Entry After Removal (INA section 212(a)(9)(C)(i)(II))
7.a. I entered or attempted to enter the United States without being admitted or paroled after having been excluded, deported, or removed. Y/N
NOTE: If you answered “Yes” to Item Number 7.a., list all the dates when you were excluded, deported, or removed from the United States. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.
7.b. Date you were excluded, deported, or removed from the United States (mm/dd/yyyy)
8.a. Location where you reentered or attempted to reenter the United States after your exclusion, deportation, or removal
City or Town State
8.b. Date you entered or attempted to reenter the United States after exclusion, deportation, or removal (mm/dd/yyyy)
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[Page 3]
Part 2. Reasons You Are Filing Form I-212
If you are inadmissible to the United States for the following reason, select “Yes” and then select the appropriate boxes. If you need extra space to complete this section, use the space provided in Part 9. Additional Information.
[Page 4]
Removal as a Arriving Alien (INA Section 212(a)(9)(A)(i)) …
1.d. I have been convicted of an aggravated felony in the United States or abroad, before or after my removal from the United States. Provide information on your aggravated felony convictions in Part 9. Additional Information and include the required evidence.
2. Date you were removed from the United States (mm/dd/yyyy)
Location From Where You Were Removed
3. City or Town 4. State
Removal as a Deportable Alien (INA Section 212(a)(9)(A)(ii))
5.a. I have been removed as a deportable alien under INA section 240 or any other provision of the law, or I departed the United States while an order of removal was outstanding. Y/N
5.b. I have only been removed once and my removal was less than 10 years ago.
5.c. I have been removed two or more times, and my last removal was less than 20 years ago.
5.d. I have been convicted of an aggravated felony in the United States or abroad, before or after my removal from the United States. Provide information on your aggravated felony convictions in Part 9. Additional Information and include the required evidence.
6. Date you were excluded, deported, or removed from the United States (mm/dd/yyyy)
Location From Where You Were Removed
7.a. City or Town 7.b. State
Entry After Unlawful Presence in the Aggregate of 1 Year (INA Section 212(a)(9)(C)(i)(I))
8. I entered or attempted to enter the United States without being admitted or paroled, after having been unlawfully present in the United States on or after April 1, 1997, for a period of more than one year, in the aggregate. Y/N
NOTE: If you answered "Yes" to Item Number 8., list all the time periods during which you were unlawfully present in the United States (including any periods in which you overstayed your lawful status). Begin with your most recent period of unlawful presence. Also attach evidence demonstrating that you have remained outside the United States for 10 years since your last departure.
Periods of Unlawful Presence
9.b.
To (mm/dd/yyyy)
[Page 5]
Entry After Removal (INA Section 212(a)(9)(C)(i)(II))
14. I entered or attempted to enter the United States without being admitted or paroled after having been excluded, deported, or removed. Y/N
NOTE: If you answered “Yes”
to Item Number 14.,
list all the dates when you were excluded, deported, or removed
from the United States. If you need extra space to complete this
section, use the space provided in Part 9.
Additional Information. 15. Date You Were Excluded, Deported, or Removed From the United States (mm/dd/yyyy)
Location Where You Reentered or Attempted to Reenter the United States After Your Exclusion, Deportation, or Removal
16.a. City or Town 16.a.
State
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Page 4, Part 3. Reasons For Your Request For Permission to Reapply |
[Page 4]
Part 3. Reasons For Your Request For Permission to Reapply …
2. Explain Why You Would Like to Reenter the United States
NOTE: If you need extra space to complete this section, use the space provided in Part 8. Additional Information.
U.S. Citizen or Lawful Permanent Resident Family Members (if any)
NOTE: If you need extra space to complete this section, use the space provided in Part 8. Additional Information. …
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[Page 5]
Part 3. Reasons For Your Request For Permission to Reapply …
2. Explain Why You Would Like to Reenter the United States
NOTE: If you need extra space to complete this section, use the space provided in Part 9. Additional Information.
U.S. Citizen or Lawful Permanent Resident Family Members (if any)
NOTE: If you need extra space to complete this section, use the space provided in Part 9. Additional Information. …
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[Page 5]
Part 5. Additional Information if Filing with CBP
If you are filing this application with Customs and Border Protection (CBP), provide the information requested in Item Numbers 1.a. -40.c.
Address History
Provide physical addresses for everywhere you have lived during the last ten years, whether inside or outside the United States. Provide your current address first. If you are unsure of the exact date, provide the closest approximate date to the best of your knowledge. If you need extra space to complete this section, use the space provided in Part 9. Additional Information.
Physical Address 1 (current address)
1.a. Street Number and Name 1.b. Apt. Ste. Flr. 1.c. City or Town 1.d. State 1.e. ZIP Code 1.f. Province 1.g. Postal Code 1.h. Country
Dates of Residence
2.a. From (mm/dd/yyyy) 2.b. To (mm/dd/yyyy) [Present] ____________________________________
Physical Address 2
3.a. Street Number and Name 3.b. Apt. Ste. Flr. 3.c. City or Town 3.d. State 3.e. ZIP Code 3.f. Province 3.g. Postal Code 3.h. Country
Dates of Residence
4.a. From (mm/dd/yyyy) 4.b. To (mm/dd/yyyy)
Employment History
Provide your employment history for the last five years, whether inside or outside the United States. Provide the most recent employment first. If you are unsure of the exact employment date, provide the closest approximate date to the best of your knowledge. If you need extra space to complete this section, use the space provided in Part 9. Additional Information.
Employer 1 (current or most recent)
5. Name of Employer or Company
Address of Employer or Company
6.a. Street Number and Name 6.b. Apt. Ste. Flr. 6.c. City or Town 6.d. State 6.e. ZIP Code 6.f. Province 6.g. Postal Code 6.h. Country
7. Your Occupation
Dates of Employment
8.a. From (mm/dd/yyyy) 8.b. To (mm/dd/yyyy) ______________________________________
[Page 6]
Employer 2
9. Name of Employer or Company
Address of Employer or Company
10.a. Street Number and Name 10.b. Apt. Ste. Flr. 10.c. City or Town 10.d. State 10.e. ZIP Code 10.f. Province 10.g. Postal Code 10.h. Country
11. Your Occupation
Dates of Employment
12.a. From (mm/dd/yyyy) 12.b. To (mm/dd/yyyy)
Information About Your Parents
Information About Your Mother
Mother's Legal Name
13.a. Family Name (Last Name) 13.b. Given Name (First Name) 13.c. Middle Name
Mother's Name at Birth (if different than above)
14.a. Family Name (Last Name) 14.b. Given Name (First Name) 14.c. Middle Name
15. Date of Birth (mm/dd/yyyy)
16. City or Town of Birth
17. Country of Birth
18. Current City or Town of Residence (if living)
19. Current Country of Residence (if living)
Information About Your Father
Father's Legal Name
20.a. Family Name (Last Name) 20.b. Given Name (First Name) 20.c. Middle Name
Father's Name at Birth (if different than above)
21.a. Family Name (Last Name) 21.b. Given Name (First Name) 21.c. Middle Name
22. Date of Birth (mm/dd/yyyy)
23. City or Town of Birth
24. Country of Birth
25. Current City or Town of Residence (if living)
26. Current Country of Residence (if living)
Information About Your Marital History
27. What is your current marital status?
Single, Never Married Married Divorced Widowed Legally Separated Marriage Annulled Other
28. How many times have you been married (including annulled marriages and marriages to the same person)?
Information About Your Current Marriage (including if you are legally separated)
If you are currently married, provide the following information about your current spouse.
Current Spouse's Legal Name
29.a. Family Name (Last Name) 29.b. Given Name (First Name) 29.c. Middle Name
30. A-Number (if any)
31. Current Spouse's Date of Birth (mm/dd/yyyy)
32. Date of Marriage to Current Spouse (mm/dd/yyyy)
Current Spouse's Place of Birth
33.a. City or Town 33.b. State or Province 33.c. Country
[Page 7]
Place of Marriage to Current Spouse
34.a. City or Town 34.b. State or Province 34.c. Country
Information About Prior Marriages (if any)
If you have been married before, whether in the United States or in any other country, provide the following information about your prior spouse. If you have had more than one previous marriage, use the space provided in Part 9. Additional Information to provide the information below.
Prior Spouse's Legal Name (provide family name before marriage)
35.a. Family Name (Last Name) 35.b. Given Name (First Name) 35.c. Middle Name
36. Prior Spouse's Date of Birth (mm/dd/yyyy)
37. Date of Marriage to Prior Spouse (mm/dd/yyyy)
Place of Marriage to Prior Spouse
38.a. City or Town 38.b. State or Province 38.c. Country
39. Date Marriage with Prior Spouse Legally Ended (mm/dd/yyyy)
Place Where Marriage with Prior Spouse Legally Ended
40.a. City or Town 40.b. State or Province 40.c. Country
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Pages 4-5, Part 5. Applicant’s Statement, Contact Information, Certification, Acknowledgement of Appointment at USCIS Application Support Center, Certification, and Signature
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[Page 4]
Part 5. Applicant’s Statement, Contact Information, Certification, 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-212 Instructions before completing this part.
Applicant'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 application, as well as my 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 6. has read to me every question and instruction on this application, as well as my answer to each question, in [Fillable Field], a language in which I am fluent. I understand each and every question and instruction on this application 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 6. has also read the Acknowledgement of Required Appointment at USCIS ASC 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 [Fillable Field], who is/is not an attorney or accredited representative, preparing this application for me. This person who assisted me in preparing my application has reviewed the Acknowledgement of Appointment at USCIS Application Support Center with me, and I understand the ASC Acknowledgement.
[Page 5]
Applicant’s Contact Information
3. Applicant’s Daytime Telephone Number
4 Applicant’s Mobile Telephone Number (if any)
5. Applicant’s Email Address (if any)
Acknowledgement of Appointment at USCIS Application Support Center
I, [Auto-populate Field with Applicant's Full Name], 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 application 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 USCIS ASC appointment.
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 application; I have reviewed the contents of this application; all of the information in my application and all supporting documents submitted with my application were provide by me and are complete, true, and correct; and if I was assisted in completing this application, the person assisting me also reviewed this Acknowledgement of Appointment at USCIS Application Support Center with me.
Applicant’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 application, 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.
I certify, under penalty of perjury, that the information in my application and any document submitted with my application were provided by me and are complete, true, and correct.
Applicant’s Signature
6.a. Applicant’s Signature 6.b. Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the instructions, USCIS may deny your application.
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[Page 7]
Part 6. Applicant’s Statement, Contact Information, Declaration, Certification, and Signature
NOTE: Read the Penalties section of the Form I-212 Instructions before completing this part.
[no change]
1.a. I can read and understand English, and I have read and understand every question and instruction on this application and my answer to every question.
1.b. The interpreter named in Part 7. read to me every question and instruction on this application and my answer to every question in [Fillable Field], a language in which I am fluent, and I understood everything.
2. At my request, the preparer named in Part 8., [Fillable Field], prepared this application for me based only upon information I provided or authorized.
[no change]
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[Page 8]
Applicant’s Declaration and Certification
[no change]
I furthermore authorize release of information contained in this application, in supporting documents, and in my USCIS records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law.
I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that:
1) I reviewed and understood all of the information contained in, and submitted with, my application; and
2) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that all of the information in my application and any document submitted with it were provided or authorized by me, that I reviewed and understand all of the information contained in, and submitted with, my application and that all of this information is complete, true, and correct.
[no change]
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the Instructions, USCIS may deny your application. |
Pages 5-6, Part 6. Interpreter’s Contact Information, Certification, and Signature |
[Page 5]
Part 6. Interpreter’s Contact Information, Certification, and Signature …
[Page 6]
Interpreter’s Contact Information
4. Interpreter’s Daytime Telephone Number
[new]
5. Interpreter’s Email Address (if any)
Interpreter’s Certification
I certify that:
I am fluent in English and [Fillable Field], which is the same language provided in Part 5., Item Number 1.b.;
I have read to this applicant every question and instruction on this application, as well as the answer to every question, in the language provided in Part 5., Item Number 1.b.; and
I have read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant in the same language provided in Part 5., Item Number 1.b.
The applicant has informed me that he or she understands every instruction and question on the application, as well as the answer to every question, and the applicant verified the accuracy of every answer; and
The applicant 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 application and all supporting documentation are complete, true, and correct.
Interpreter’s Signature
6.a. Interpreter’s Signature 6.b. Date of Signature (mm/dd/yyyy)
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[Page 8]
Part 7. Interpreter’s Contact Information, Certification, and Signature …
Interpreter’s Contact Information
4. Interpreter’s Daytime Telephone Number
5. Interpreter’s Mobile Telephone Number (if any)
6. Interpreter’s Email Address (if any)
Interpreter’s Certification
I certify, under penalty of perjury, that:
I am fluent in English and [Fillable Field], which is the same language specified in Part 6., Item Number 1.b., and I have read to this applicant in the identified language every question and instruction on this application and his or her answer to every question. The applicant informed me that he or she understands every instruction, question, and answer on the application, including the Applicant’s Declaration and Certification, and has verified the accuracy of every answer.
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[Page 9]
Interpreter’s Signature
7.a. Interpreter’s Signature 7.b. Date of Signature (mm/dd/yyyy)
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Pages 6-7, Part 7. Contact Information, Statement, Certification, and Signature of the Person Preparing this Application, If Other Than the Applicant |
[Page 6]
Part 7. Contact Information, Statement, Certification, and Signature of the Person Preparing this Application, If Other Than the Applicant …
Preparer’s Contact Information
4. Preparer’s Daytime Telephone Number
5. Preparer’s Fax Number (if any)
6. Preparer’s Email Address (if any)
[Page 7]
Preparer’s Statement …
NOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this application you must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, or G-28I, Notice of Entry of Appearance as Attorney In Matters Outside the Geographical Confines of the United States, with this application.
Preparer’s Certification
By my signature, I certify, swear, or affirm, under penalty of perjury, that I prepared this application on behalf of, at the request of, and with the express consent of the applicant. I completed this application based only on responses the applicant provided to me. After completing the application, I reviewed it and all of the applicant’s responses with the applicant, who agreed with every answer on the application. If the applicant supplied additional information concerning a question on the application, I recorded it on the application. I have also read the Acknowledgement of Appointment at USCIS Application Support Center to the applicant and the applicant 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)
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[Page 9]
Part 8. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant
…
Preparer’s Contact Information
4. Preparer’s Daytime Telephone Number
5. Preparer’s Mobile Telephone Number (if any)
6. Preparer’s Email Address (if any)
Preparer’s Statement …
NOTE: If you are an attorney or accredited representative, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, or Form G-28I, Notice of Entry of Appearance as Attorney In Matters Outside the Geographical Confines of the United States, with this application.
Preparer’s Certification
By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted with, his or her application, including the Applicant’s Declaration and Certification, and that all of this information is complete, true, and correct. I completed this application based only on information that the applicant provided to me or authorized me to obtain or use.
[no change]
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Page 8, Part 8. Additional Information |
[Page 8]
Part 8. Additional Information
If you need extra space to provide any additional information within this application, 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 application or attach a separate sheet of paper. Include 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. …
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Part 9. Additional Information
If you need extra space to provide any additional information within this application, 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 application 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. …
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | TABLE OF CHANGE – FORM I-687 |
| Author | jdimpera |
| File Modified | 0000-00-00 |
| File Created | 2021-01-21 |