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pdfUSCIS
Form I-751
Petition to Remove Conditions on Residence
Department of Homeland Security
U.S. Citizenship and Immigration Services
Receipt
For
USCIS
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OMB No. 1615-0038
Expires 12/31/2019
Action Block
Remarks
Reloc Received
Date (mm/dd/yyyy)
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Date (mm/dd/yyyy)
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DRAFT
NOT FOR
PRODUCTION
10/01/2019
Conditional Permanent Resident interviewed on (mm/dd/yyyy)
/
/
/
Approved under INA 216(c)(4)(C) Battered Spouse/Child
To be completed by an
attorney or accredited
representative (if any).
Select this box if
Form G-28 is
attached.
Attorney State Bar Number
(if applicable)
► START HERE - Type or print in black ink.
Part 1. Information About You, the Conditional
Permanent Resident
Your Current Legal Name (do not provide a
nickname)
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
A-Number
► A-
Other Information
4.
Date of Birth (mm/dd/yyyy)
5.
Gender
6.
Country of Birth
7.
Country of Citizenship or Nationality
Male
Female
1.c. Middle Name
Other Names You Have Used Since Birth
(if applicable)
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 11.
Additional Information.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
NOTE: If you have more than one country of citizenship or
nationality, provide additional countries in the space provided in
Part 11. Additional Information.
8.
Alien Registration Number (A-Number) (if any)
► A-
9.
USCIS Online Account Number (if any)
►
10.
U.S. Social Security Number (if any)
►
2.c. Middle Name
11.
3.a. Family Name
(Last Name)
3.b. Given Name
(First Name)
Code of Admission/Adjustment (This is a 3-digit alphanumeric code found under “Category” on the front of
your Form I-551, Permanent Resident Card, also known
as a Green Card.)
►
12.
Date you became a Conditional Permanent Resident (This
is the “Resident Since” date found on your Permanent
Resident Card.)
(mm/dd/yyyy)
3.c. Middle Name
Form I-751 12/05/17
Page 1 of 16
► A-
Part 1. Information About You, the Conditional
Permanent Resident (continued)
13.
Conditional Permanent Residence Expires or Expired On
(mm/dd/yyyy)
NOTE: If the expiration date has already passed and you are
filing this petition jointly with your U.S. Citizen or lawful
permanent resident spouse or stepparent, please use the space
provided in Part 11. Additional Information to explain why
you are filing your Form I-751 late.
Address History
Provide physical addresses for everywhere you have lived since
becoming a conditional permanent resident, whether inside or
outside the United States. Provide your current address first. If
you need extra space to complete this section, use the space
provided in Part 11. Additional Information.
Physical Address 1 (current address)
19.a. Street Number and Name
Overseas on Military or Government Orders
19.b.
14.
19.c. City or Town
I am overseas based on military or government orders.
No
If you answered “Yes,” indicate on which basis you are filing.
Flr.
I am overseas for non-government business.
Yes
Your U.S. Mailing Address
19.d. State
19.e. ZIP Code
19.f. Province
Government Orders
Active Military
16.
Ste.
DRAFT
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10/01/2019
Yes
15.
Apt.
19.g. Postal Code
No
19.h. Country
(USPS ZIP Code Lookup)
17.a. In Care Of Name (if any)
Dates of Residence
20.a. Date From (mm/dd/yyyy)
17.b. Street Number and Name
20.b. Date To (mm/dd/yyyy)
21.
17.c.
Apt.
Ste.
Flr.
Have you resided at any other address since you became a
permanent resident?
Yes
No
If you answered “No,” skip to Part 2.
17.d. City or Town
17.e. State
Physical Address 2
17.f. ZIP Code
22.a. Street Number and Name
Safe Mailing Address
If you are applying for a waiver of the joint filing requirement
because you and/or your conditional permanent resident child
were subjected to battery or extreme cruelty and you do not
want U.S. Citizenship and Immigration Services (USCIS) to
send notices about this application to your home, you may
provide a safe mailing address.
22.b.
Apt.
Ste.
Flr.
22.c. City or Town
22.d. State
22.e. ZIP Code
22.f. Province
18.a. In Care Of Name
22.g. Postal Code
18.b. Street Number and Name
22.h. Country
18.c.
Dates of Residence
Apt.
Ste.
Flr.
23.a. Date From (mm/dd/yyyy)
18.d. City or Town
18.e. State
Form I-751 12/05/17
18.f. ZIP Code
23.b. Date To (mm/dd/yyyy)
Page 2 of 16
► A-
Part 2. Basis for Petition
Part 3. Additional Information About You
Complete either the Joint Filing subsection OR the Waiver or
Individual Filing Request subsection below. You should fill out
only one of these subsections.
If You Are Filing Separately From Your
Conditional Resident Parent
Joint Filing
My conditional permanent resident status is based on my
marriage or my conditional permanent resident parent's marriage
to a U.S. citizen or lawful permanent resident, and I am filing
this joint petition together with (Select only one box):
1.a.
My spouse.
1.b.
My stepparent because I am unable to be included in
a joint petition filed by my parent and my stepparent.
DRAFT
NOT FOR
PRODUCTION
10/01/2019
(Please see the form instructions for further discussion of
scenarios where you may file your own Form I-751 jointly with
your stepparent.)
OR
Waiver or Individual Filing Request
My conditional permanent resident status is based on my
marriage or my conditional permanent resident parent's marriage
to a U.S. citizen or lawful permanent resident, and I am unable to
file a joint petition with my spouse or my stepparent because:
(Select ALL that apply.)
1.c.
1.d.
1.e.
1.f.
1.g.
If your conditional permanent resident status is based on your
conditional permanent resident parent's marriage and you are
filing separately from your conditional permanent resident
parent, please use the space provided in Part 11. Additional
Information to explain why you are filing separately, and also
provide evidence to support why you are filing separately. If
your conditional permanent resident status is not based on your
conditional permanent resident parent's marriage, skip to Item
Number 4.
My marriage or my conditional permanent resident
parent's marriage was entered in good faith but my
spouse or stepparent is deceased.
My marriage or my conditional permanent resident
parent's marriage was entered in good faith, but the
marriage was terminated through divorce or
annulment.
I entered the marriage in good faith. During the
marriage, I or my child was battered or subjected to
extreme cruelty by my U.S. citizen or lawful
permanent resident spouse.
My conditional permanent resident parent entered the
marriage in good faith, and, during the marriage, I
was battered or subjected to extreme cruelty by my
conditional permanent resident parent's U.S. citizen
or lawful permanent resident spouse or by my
conditional permanent resident parent.
Information about Your Conditional Permanent Resident
Parent:
Parent's Name
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
2.
Parent's A-Number
► A-
3.
Parent's Date of Birth (mm/dd/yyyy)
Your Marital Status
4.
Marital Status
Single, Never Married
Marriage Annulled
Married
Legally Separated
Divorced
Other
Widowed
5.
If you are legally separated, provide the date of separation.
(mm/dd/yyyy)
6.
How many times have you been married (including
marriages abroad, annulled marriages and subsequent
marriages to the same person)?
►
The termination of my status and removal from the
United States would result in an extreme hardship.
2.a. Has the marriage through which you gained conditional
permanent resident status been terminated through
divorce, annulment, or death?
Yes
No
2.b. If you answered “Yes”, provide the date the marriage was
terminated through divorce, annulment, or death.
(mm/dd/yyyy)
Form I-751 12/05/17
Page 3 of 16
► A-
Part 3. Additional Information About You
(continued)
Information About Your Current Marriage
(including if you are legally separated)
If you are currently married to the U.S. citizen or lawful
permanent resident spouse through whom you gained your
conditional permanent resident status, skip Item
Numbers 7.a. - 12.c.
If your current spouse is a different spouse from the one through
whom you gained your conditional permanent resident status or
if you are a conditional permanent resident child filing your
own Form I-751 and you are married at the time of filing,
provide the following information about your current spouse:
If you have been married before, whether in the United States or
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 11. Additional Information to
provide the information below.
Prior Spouse's Legal Name (provide family name before
marriage)
13.a. Family Name
(Last Name)
13.b. Given Name
(First Name)
DRAFT
NOT FOR
PRODUCTION
10/01/2019
Current Spouse's Legal Name
7.a. Family Name
(Last Name)
7.b. Given Name
(First Name)
13.c. Middle Name
14.
A-Number (if any)
► A-
15.
Prior Spouse's Date of Birth
(mm/dd/yyyy)
Prior Spouse's Place of Birth
7.c. Middle Name
8.
Information About Prior Marriages (if any)
16.a. City or Town
A-Number (if any)
► A-
9.
Current Spouse's Date of Birth
16.b. State or Province
(mm/dd/yyyy)
10.
Date of Marriage to Current Spouse
16.c. Country
(mm/dd/yyyy)
Current Spouse's Place of Birth
17.
Date of Marriage to Prior Spouse
(mm/dd/yyyy)
11.a. City or Town
Place of Marriage to Prior Spouse
11.b. State or Province
11.c. Country
Place of Marriage to Current Spouse
18.a. City or Town
18.b. State or Province
18.c. Country
12.a. City or Town
19.
12.b. State or Province
Date Marriage with Prior Spouse Legally Ended
(mm/dd/yyyy)
12.c. Country
Form I-751 12/05/17
Page 4 of 16
► A-
25.
Part 3. Additional Information About You
(continued)
Employment History
If you answered "Yes" to any of the questions in Item
Numbers 23. - 25., provide a detailed explanation in
Part 11. Additional Information, and refer to the What
Evidence Must You Submit section of the Form I-751
Instructions to determine what evidence to include with
your petition.
Provide your employment history since becoming a conditional
permanent resident, whether inside or outside the United States.
Provide the most recent employment first. If you need to provide
information about more than one employer, use the space
provided in Part 11. Additional Information. If you have not
been employed since becoming a conditional permanent resident,
skip to Item Number 23.
Employer 1 (current or most recent)
20.
Have you ever been arrested, detained, charged, indicted,
fined, or imprisoned for breaking or violating any law or
ordinance (excluding traffic regulations), or committed
any crime for which you were not arrested in the United
Yes
No
States or abroad?
Part 4. Your Biographic Information
DRAFT
NOT FOR
PRODUCTION
10/01/2019
Name of Employer/Company
1.
Address of Employer or Company
Ethnicity (Select only one box)
Hispanic or Latino
Not Hispanic or Latino
21.a. In Care Of Name
2.
21.b. Street Number and Name
Race (Select all applicable boxes)
White
Asian
Black or African American
American Indian or Alaska Native
21.c.
Apt.
Ste.
Flr.
Native Hawaiian or Other Pacific Islander
21.d. City or Town
21.e. State
21.g. Province
21.f. ZIP Code
3.
Height
Feet
4.
Weight
5.
Eye Color (Select only one box)
Inches
Pounds
21.h. Postal Code
Black
Gray
Blue
Brown
Green
Hazel
21.i. Country
Maroon
Pink
Unknown/Other
6.
Hair Color (Select only one box)
Bald (No hair)
Brown
Sandy
Dates of Employment
22.a. Date From (mm/dd/yyyy)
Black
Gray
White
Blond
Red
Unknown/Other
22.b. Date To (mm/dd/yyyy)
Other Information
23.
Are you in removal, deportation, or rescission proceedings?
Yes
No
24.a. Did you or anyone else pay a fee or other consideration to
the petitioning spouse or anyone else in order to enter into
the marriage that formed the basis for this petition?
Yes
Part 5. Information About the U.S. Citizen or
Lawful Permanent Resident Spouse or
Stepparent Through Whom You Gained Your
Conditional Permanent Residence
Relationship
1.a.
Spouse/Former Spouse
1.b.
Stepparent/Former Stepparent
No
24.b. Was the marriage entered into solely for immigration
Yes
No
purposes?
Form I-751 12/05/17
Page 5 of 16
► A-
Part 5. Information About the U.S. Citizen or
Lawful Permanent Resident Spouse or
Stepparent Through Whom You Gained Your
Conditional Permanent Residence (continued)
Other Information for Spouse/Former Spouse or
Stepparent/Former Stepparent
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
Dates of Residence
8.a. Date From (mm/dd/yyyy)
8.b. Date To (mm/dd/yyyy)
9.
Has your U.S. Citizen or lawful permanent resident
spouse or stepparent resided at any other address since
you become a permanent resident?
Yes
No
Physical Address 2
10.a. Street Number and Name
2.c. Middle Name
DRAFT
NOT FOR
PRODUCTION
10/01/2019
10.b.
3.
Date of Birth (mm/dd/yyyy)
4.
U.S. Social Security Number (if any)
►
5.
A-Number (if any)
► A-
6.
Is your spouse or stepparent through whom you gained
conditional permanent resident status currently serving
with or employed by the U.S. Government and serving
outside the United States?
Yes
No
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
Dates of Residence
Address History for your U.S. Citizen or Lawful
Permanent Resident Spouse or Stepparent
Provide physical addresses for everywhere your U.S. Citizen or
lawful permanent resident spouse or stepparent has lived since
you became a conditional permanent resident, whether inside or
outside the United States. Provide the current address first. If
you need extra space to complete this section, use the space
provided in Part 11. Additional Information.
Physical Address 1 (current address)
7.a. Street Number and Name
7.b.
Apt.
Ste.
Flr.
7.c. City or Town
11.a. Date From (mm/dd/yyyy)
11.b. Date To (mm/dd/yyyy)
Employment History for your U.S. Citizen of
Lawful Permanent Resident Spouse or Stepparent
Provide your U.S. citizen or lawful permanent resident spouse or
stepparent's employment history since you became a conditional
permanent resident, whether inside or outside the United States.
Provide the most recent employment first. If you need to provide
information about more than one employer, use the space
provided in Part 11. Additional Information. If your U.S.
citizen or lawful permanent resident spouse or stepparent has not
been employed since you became a conditional permanent
resident, skip to Part 6.
Employer 1 (current or most recent)
7.d. State
7.f.
7.e. ZIP Code
12.
Name of Employer/Company
Province
7.g. Postal Code
7.h. Country
Form I-751 12/05/17
Page 6 of 16
► A-
Part 5. Information About the U.S. Citizen or
Lawful Permanent Resident Spouse or
Stepparent Through Whom You Gained Your
Conditional Permanent Residence (continued)
Dates of Employment
19.a. Date From (mm/dd/yyyy)
19.b. Date To (mm/dd/yyyy)
Address of Employer or Company
13.a. Street Number and Name
Part 6. Information About Your Children
1.
13.b.
Apt.
Ste.
13.f. Province
DRAFT
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PRODUCTION
10/01/2019
13.e. ZIP Code
Information About Your Children Who Have
Conditional Permanent Resident Status
2.
14.
No
Provide the total number of your conditional permanent
resident children and provide the requested information for
each child. If you need extra space to complete this section, use
the space provided in Part 11. Additional Information.
13.g. Postal Code
13.h. Country
Yes
If you answered “No,” skip to Part 7. Conditional
Permanent Resident's Statement, Contact Information,
Certification, and Signature.
Flr.
13.c. City or Town
13.d. State
Do you have any children?
Occupation
Total number of your children who have conditional
permanent resident status.
►
Child 1
Dates of Employment
15.a. Date From (mm/dd/yyyy)
15.b. Date To (mm/dd/yyyy)
Employer 2
16.
Current Legal Name
3.a. Family Name
(Last Name)
3.b. Given Name
(First Name)
3.c. Middle Name
Name of Employer/Company
4.
Date of Birth (mm/dd/yyyy)
5.
Country of Birth
6.
Gender
7.
A-Number
8.
Code of Admission/Adjustment (This is a 3-digit alphanumeric code found under “Category” on the front of
your child's Permanent Resident Card.)
►
9.
Date your child became a Conditional Permanent
Resident (This is the “Resident Since” date found on your
child's Permanent Resident Card.)
Address of Employer or Company
17.a. Street Number and Name
17.b.
Apt.
Ste.
Flr.
17.c. City or Town
17.d. State
17.e. ZIP Code
17.f. Province
17.g. Postal Code
17.h. Country
Male
Female
► A-
(mm/dd/yyyy)
10.
Conditional Permanent Residence Expires On
(mm/dd/yyyy)
18.
Occupation
Form I-751 12/05/17
Page 7 of 16
► A-
You may skip Item Numbers 16. - 17.f. unless you are applying
for a waiver of the joint filing requirement because you and/or
your conditional permanent resident child were subjected to
battery or extreme cruelty.
Part 6. Information About Your Children
(continued)
11.
Is this child living with you at the physical address
indicated in Part 1., Item Numbers 19.a. - 19.h.?
Yes
16.
No
If you answered “No,” provide the child's physical
address in Item Numbers 12.a. - 12.h.
If you are applying for a waiver of the joint filing
requirement because you and/or your conditional
permanent resident child were subjected to battery or
extreme cruelty, is the child's safe address the same safe
address indicated in Part 1., Item Numbers 18.a. - 18.f.?
Yes
Physical Address
No
If you answered “No,” provide the child's safe address in Item
Numbers 17.a. - 17.f.
12.a. Street Number and Name
17.a. In Care Of Name (if any)
12.b.
Apt.
DRAFT
NOT FOR
PRODUCTION
10/01/2019
Ste.
Flr.
17.b. Street Number and Name
12.c. City or Town
12.d. State
12.e. ZIP Code
17.c.
12.f. Province
Apt.
Ste.
Flr.
17.d. City or Town
12.g. Postal Code
12.h. Country
17.e. State
17.f. ZIP Code
Child 2
13.
Is this child applying with you on this Form I-751? (Do not
select “Yes” if the child is filing a separate Form I-751.)
Yes
No
NOTE: You must include a separate biometric services
fee for your child if you answer “Yes,” regardless of age.
14.
Is this child's mailing address the same as the mailing
address indicated in Part 1., Item Numbers 17.a. - 17.f.?
Yes
No
Current Legal Name
18.a. Family Name
(Last Name)
18.b. Given Name
(First Name)
18.c. Middle Name
19.
Date of Birth (mm/dd/yyyy)
20.
Country of Birth
21.
Gender
22.
A-Number
23.
Code of Admission/Adjustment (This is a 3-digit alphanumeric code found under “Category” on the front of
your child's Permanent Resident Card.)
If you answered “No,” provide the child's mailing address in
Item Numbers 15.a. - 15.f.
U.S. Mailing Address
15.a. In Care Of Name (if any)
15.b. Street Number and Name
Male
Female
► A-
►
15.c.
Apt.
Ste.
Flr.
24.
15.d. City or Town
Date your child became a Conditional Permanent
Resident (This is the “Resident Since” date found on your
child's Permanent Resident Card.)
(mm/dd/yyyy)
15.e. State
15.f. ZIP Code
25.
Conditional Permanent Residence Expires On
(mm/dd/yyyy)
Form I-751 12/05/17
Page 8 of 16
► A-
You may skip Item Numbers 31. - 32.f. unless you are
applying for a waiver of the joint filing requirement because
you and/or your conditional permanent resident child were
subjected to battery or extreme cruelty.
Part 6. Information About Your Children
(continued)
26.
Is this child living with you at the physical address
indicated in Part 1., Item Numbers 19.a. - 19.h.?
Yes
31.
No
If you answered “No,” provide the child's physical address in
Item Numbers 27.a. - 27.h.
If you are applying for a waiver of the joint filing
requirement because you and/or your conditional
permanent resident child were subjected to battery or
extreme cruelty, is the child's safe address the same safe
address indicated in Part 1., Item Numbers 18.a. - 18.f.?
Yes
Physical Address
No
If you answered “No,” provide the child's safe address in Item
Numbers 32.a. - 32.f.
27.a. Street Number and Name
32.a. In Care Of Name (if any)
27.b.
Apt.
DRAFT
NOT FOR
PRODUCTION
10/01/2019
Ste.
Flr.
32.b. Street Number and Name
27.c. City or Town
27.d. State
27.e. ZIP Code
32.c.
27.f. Province
Apt.
Ste.
Flr.
32.d. City or Town
27.g. Postal Code
27.h. Country
32.e. State
32.f. ZIP Code
Child 3
28.
Is this child applying with you on this Form I-751? (Do
not select “Yes” if the child is filing a separate Form
Yes
No
I-751.)
NOTE: You must include a separate biometric services
fee for your child if you answer “Yes.”
29.
Is this child's mailing address the same as the mailing
address indicated in Part 1., Item Numbers 17.a. - 17.f.?
Yes
No
If you answered “No,” provide the child's mailing address in
Item Numbers 30.a. - 30.f.
Mailing Address
30.a. In Care Of Name (if any)
Current Legal Name
33.a. Family Name
(Last Name)
33.b. Given Name
(First Name)
33.c. Middle Name
34.
Date of Birth (mm/dd/yyyy)
35.
Country of Birth
36.
Gender
37.
A-Number
38.
Code of Admission/Adjustment (This is a 3-digit alphanumeric code found under “Category” on the front of
your child's Permanent Resident Card.)
►
39.
Date your child became a Conditional Permanent
Resident (This is the “Resident Since” date found on your
child's Permanent Resident Card.)
30.b. Street Number and Name
30.c.
Apt.
Ste.
Flr.
30.d. City or Town
30.e. State
Male
Female
► A-
(mm/dd/yyyy)
30.f. ZIP Code
40.
Conditional Permanent Residence Expires On
(mm/dd/yyyy)
Form I-751 12/05/17
Page 9 of 16
► A-
You may skip Item Numbers 46. - 47.f. unless you are
applying for a waiver of the joint filing requirement because
you and/or your conditional permanent resident child were
subjected to battery or extreme cruelty.
Part 6. Information About Your Children
(continued)
41.
Is this child living with you at the physical address
indicated in Part 1., Item Numbers 19.a. - 19.h.?
Yes
46.
No
If you answered “No,” provide the child's physical address in
Item Numbers 42.a. - 42.h.
If you are applying for a waiver of the joint filing
requirement because you and/or your conditional
permanent resident child were subjected to battery or
extreme cruelty, is the child's safe address the same safe
address indicated in Part 1., Item Numbers 18.a. - 18.f.?
Yes
Physical Address
No
If you answered “No,” provide the child's safe address in Item
Numbers 47.a. - 47.f.
42.a. Street Number and Name
47.a. In Care Of Name (if any)
42.b.
Apt.
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PRODUCTION
10/01/2019
Ste.
Flr.
47.b. Street Number and Name
42.c. City or Town
42.d. State
42.e. ZIP Code
47.c.
42.f. Province
Apt.
Ste.
Flr.
47.d. City or Town
42.g. Postal Code
42.h. Country
43.
47.e. State
Is this child applying with you on this Form I-751? (Do
not select “Yes” if the child is filing a separate Form
I-751.)
Yes
No
NOTE: You must include a separate biometric services
fee for your child if you answer “Yes,” regardless of age.
44.
Is this child's mailing address the same as the mailing
address indicated in Part 1., Item Numbers 17.a. - 17.f.?
Yes
Information About Your Children Who Are Not
Conditional Permanent Residents
Provide the total number of all of your children who do not
have conditional permanent resident status and provide the
requested information for each child. If you need extra space to
complete this section, use the space provided in Part 11.
Additional Information.
48.
No
If you answered “No,” provide the child's mailing address in
Item Numbers 45.a. - 45.f.
Number of children who are not conditional permanent
residents (including adult sons and daughters).
►
Child 1
45.a. In Care Of Name (if any)
Current Legal Name
49.a. Family Name
(Last Name)
49.b. Given Name
(First Name)
45.b. Street Number and Name
49.c. Middle Name
Mailing Address
45.c.
Apt.
Ste.
Form I-751 12/05/17
50.
Date of Birth (mm/dd/yyyy)
51.
Gender
52.
Country of Birth
Flr.
45.d. City or Town
45.e. State
47.f. ZIP Code
Male
Female
45.f. ZIP Code
Page 10 of 16
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Physical Address
Part 6. Information About Your Children
(continued)
53.
A-Number (if any) ► A-
54.
Is this child living with you?
Yes
62.a. Street Number and Name
No
62.b.
Apt.
If you answered “No,” provide the child's physical address in
Item Numbers 55.a. - 55.h.
62.c. City or Town
Physical Address
62.d. State
55.a. Street Number and Name
62.f. Province
Ste.
Flr.
62.e. ZIP Code
62.g. Postal Code
55.b.
Apt.
Ste.
Flr.
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62.h. Country
55.c. City or Town
55.d. State
55.f. Province
55.e. ZIP Code
Child 3
Current Legal Name
63.a. Family Name
(Last Name)
63.b. Given Name
(First Name)
55.g. Postal Code
55.h. Country
63.c. Middle Name
Child 2
64.
Date of Birth (mm/dd/yyyy)
65.
Gender
66.
Country of Birth
56.c. Middle Name
67.
A-Number (if any) ► A-
57.
Date of Birth (mm/dd/yyyy)
68.
Is this child living with you?
58.
Gender
59.
Country of Birth
Current Legal Name
56.a. Family Name
(Last Name)
56.b. Given Name
(First Name)
Male
Female
Male
Female
Yes
No
If you answered “No,” provide the child's physical address in
Item Numbers 69.a. - 69.h.
Physical Address
69.a. Street Number and Name
60.
A-Number (if any) ► A-
61.
Is this child living with you?
Yes
No
If you answered “No,” provide the child's physical address in
Item Numbers 62.a. - 62.h.
69.b.
Apt.
Ste.
Flr.
69.c. City or Town
69.d. State
69.e. ZIP Code
69.f. Province
69.g. Postal Code
69.h. Country
Form I-751 12/05/17
Page 11 of 16
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Part 7. Conditional Permanent Resident's
Statement, Contact Information, Certification,
and Signature
I furthermore authorize release of information contained in this
petition, 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.
NOTE: Read the Penalties section of the Form I-751
Instructions before completing this section.
I understand that USCIS will require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, I will be required to sign an
oath reaffirming that:
NOTE: If you selected Item Number 1.a. or 1.b. in Part 2.,
your spouse or stepparent must also read and sign the petition in
Part 8. Signature of a conditional permanent resident child under
14 years of age is not required; a parent may sign for a child.
1) I reviewed and provided or authorized all of the
information in my petition;
Conditional Permanent Resident's Statement
2) I understood all of the information contained in, and
submitted with, my petition; and
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
3) All of this information was complete, true, and correct
at the time of filing.
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1.a.
I can read and understand English, and I have read
and understand every question and instruction on this
petition, and my answer to every question.
1.b.
The interpreter named in Part 9. read to me every
question and instruction on this petition and my
answer to every question in
I certify, under penalty of perjury, that I provided or authorized
all of the information in my petition, I understand all of the
information contained in, and submitted with, my petition, and
that all of this information is complete, true, and correct.
Conditional Permanent Resident's Signature
,
6.a. Conditional Permanent Resident's Signature
a language in which I am fluent, and I understood
everything.
2.
6.b. Date of Signature (mm/dd/yyyy)
At my request, the preparer named in Part 10.,
,
prepared this petition for me based only upon
information I provided or authorized.
Conditional Permanent Resident's Contact
Information
NOTE TO ALL CONDITIONAL PERMANENT
RESIDENTS: If you do not completely fill out this petition or
fail to submit required documents listed in the Instructions,
USCIS may deny your petition.
3.
Conditional Permanent Resident's Daytime Telephone
Number
Part 8. Spouse's or Stepparent's Statement,
Contact Information, Certification, and
Signature (if applicable)
4.
Conditional Permanent Resident's Mobile Telephone
Number (if any)
If you are filing this petition jointly with your spouse or
stepparent, the spouse or stepparent listed in Part 5. must
complete and sign this section.
5.
Conditional Permanent Resident's Email Address (if any)
Conditional Permanent Resident'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.
Form I-751 12/05/17
NOTE: If you selected Item Numbers 1.c. - 1.g. in the Waiver
subsection in Part 2. Basis for Petition, you do not need to fill
out the items relating to or acquire signatures from your U.S.
Citizen or lawful permanent resident spouse or stepparent in
Part 7.
NOTE: Read the Penalties section of the Form I-751
Instructions before completing this section.
Page 12 of 16
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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:
Part 8. Spouse's or Stepparent's Statement,
Contact Information, Certification, and
Signature (if applicable) (continued)
Spouse's or Stepparent's Statement
1) I reviewed and provided or authorized all of the
information in my petition;
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
2) I understood all of the information contained in, and
submitted with, my petition; and
1.a.
I can read and understand English, and I have read
and understand every question and instruction on this
petition and my answer to every question.
3) All of this information was complete, true, and correct
at the time of filing.
1.b.
The interpreter named in Part 9. read to me every
question and instruction on this petition and my
answer to every question in
I certify, under penalty of perjury, that all of the information in
my petition 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 petition and
that all of this information is complete, true, and correct.
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,
Spouse's or Stepparent's Contact Information
NOTE: If you have been or are being forced into marriage, you
are not at fault and you have not violated any U.S. laws by
entering into the marriage. For more information about forced
marriage, including options available to you, visit the USCIS
web page on forced marriage at https://www.uscis.gov/
humanitarian/forced-marriage and the U.S. Department of
State's web page on forced marriage at https://travel.state.gov/
content/travel/en/international-travel/emergencies/forcedmarriage.html.
3.
Spouse's or Stepparent's Daytime Telephone Number
Spouse's or Stepparent's Signature
4.
Spouse's or Stepparent's Mobile Telephone Number (if any)
5.
Spouse's or Stepparent's Email Address (if any)
a language in which I am fluent, and I understood
everything.
2.
At my request, the preparer named in Part 10.,
,
prepared this petition for me based only upon
information I provided or authorized.
6.a. Spouse's or Stepparent's Signature
6.b. Date of Signature (mm/dd/yyyy)
Spouse's or Stepparent'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
petition, 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.
NOTE TO ALL SPOUSES OR STEPPARENTS: If you do
not completely fill out this petition or fail to submit required
documents listed in the Instructions, USCIS may deny your
petition.
Part 9. Interpreter's Contact Information,
Certification, and Signature
Provide the following information about the interpreter.
Interpreter's Full Name
1.a. Interpreter's Family Name (Last Name)
1.b. Interpreter's Given Name (First Name)
2.
Form I-751 12/05/17
Interpreter's Business or Organization Name (if any)
Page 13 of 16
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Part 9. Interpreter's Contact Information,
Certification, and Signature (continued)
Part 10. Contact Information, Declaration, and
Signature of the Person Preparing this Petition, If
Other Than the Conditional Permanent Resident
Interpreter's Mailing Address
Provide the following information about the preparer.
3.a. Street Number and Name
Preparer's Full Name
3.b.
Apt.
Ste.
1.a. Preparer's Family Name (Last Name)
Flr.
3.c. City or Town
3.d. State
3.f.
Province
1.b. Preparer's Given Name (First Name)
3.e. ZIP Code
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2.
Preparer's Business or Organization Name (if any)
3.g. Postal Code
3.h. Country
Preparer's Mailing Address
3.a. Street Number and Name
Interpreter's Contact Information
4.
3.b.
Interpreter's Daytime Telephone Number
Apt.
Ste.
Flr.
3.c. City or Town
5.
Interpreter's Mobile Telephone Number (if any)
6.
Interpreter's Email Address (if any)
3.d. State
3.f.
3.e. ZIP Code
Province
3.g. Postal Code
3.h. Country
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and
which is the same language specified in Part 7., Item Number
1.b., and I have read to this conditional permanent resident in
the identified language every question and instruction on this
petition and his or her answer to every question. The
conditional permanent resident informed me that he or she
understands every instruction, question, and answer on the
petition, including the Conditional Permanent Resident's
Certification, and has verified the accuracy of every answer.
,
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)
Interpreter's Signature
7.a. Interpreter's Signature
7.b. Date of Signature (mm/dd/yyyy)
Form I-751 12/05/17
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Part 10. Contact Information, Declaration, and
Signature of the Person Preparing this Petition,
If Other Than the Conditional Permanent
Resident (continued)
Preparer's Signature
8.a. Preparer's Signature
8.b. Date of Signature (mm/dd/yyyy)
Preparer's Statement
7.a.
I am not an attorney or accredited representative but
have prepared this petition on behalf of the
conditional permanent resident and with the
conditional permanent resident's consent.
7.b.
I am an attorney or accredited representative and my
representation of the conditional permanent resident
in this case
extends
does not extend beyond the
preparation of this petition.
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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, with this petition.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I
prepared this petition at the request of the conditional permanent
resident with his or her consent, and without using force, fraud,
or coercion. The conditional permanent resident then reviewed
this completed petition and informed me that he or she
understands all of the information contained in, and submitted
with, his or her petition, including the Conditional Permanent
Resident's Certification, and that all of this information is
complete, true, and correct. I completed this petition based only
on information that the conditional permanent resident provided
to me or authorized me to obtain or use.
I further certify, under penalty of perjury, that I am aware of the
following:
1.
The United States government considers forced marriage
to be a serious human rights abuse. In some states of the
United States, forced marriage is a crime, and in all U.S.
states, a person who forces someone to marry may be
charged with violating state laws, including those against
domestic violence, child abuse, rape, assault, kidnapping,
threats of violence, stalking, and/or coercion; and
2.
A person who forces someone to marry may also face
significant immigration consequences, such as being
inadmissible to or removable from the United States.
Form I-751 12/05/17
Page 15 of 16
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5.a. Page Number
Part 11. Additional Information
If you need extra space to provide any additional information
within this petition, 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 petition 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.
5.b. Part Number
5.c. Item Number
5.d.
Your Full Name
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
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1.c. Middle Name
2.
A-Number (if any)
► A-
3.a. Page Number
3.d.
6.a. Page Number
3.b. Part Number
6.b. Part Number
6.c. Item Number
7.b. Part Number
7.c. Item Number
6.d.
3.c. Item Number
7.a. Page Number
7.d.
4.a. Page Number
4.b. Part Number
4.c. Item Number
4.d.
Form I-751 12/05/17
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| File Type | application/pdf |
| File Title | I-751, Petition to Remove Conditions on Residence |
| Author | USCIS |
| File Modified | 2019-10-01 |
| File Created | 2019-09-30 |