Form I-407 Record of Abandonment of Lawful Permanent Resident Statu

Record of Abandonment of
Lawful Permanent Resident Status

USCIS
Form I-407

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

OMB No. 1615-0130
Expires 07/31/2023

► START HERE - Type or print in black ink.

Part 1. Information About You
1.

Alien Registration Number (A-Number)
► A-

2.

USCIS Online Account Number (if any)
►

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3.

Your Name Exactly As It Appears On Your Permanent Resident Card

4.

Your Current Legal Name

Given Name (First Name)

Family Name (Last Name)

Middle Name

Other Information
5.

Date of Birth (mm/dd/yyyy)

8.

Date of Last Departure from
the United States (mm/dd/yyyy)

9.

Mailing Address Outside of the United States

6.

Country of Birth

7. Country of Citizenship or Nationality

In Care Of Name (if any)

Street Number and Name

Apt. Ste. Flr. Number

City or Town

State

Province

Postal Code

ZIP Code

Country

10. Email Address (if any)

NOTE: If you are outside of the United States, we recommend that you provide your email address so we can contact you if needed.
Documents Returned and Location of Submission
11. Have you returned your Permanent Resident Card?

Yes

No

12. If you did not return your Permanent Resident Card, select the reason why and select and complete the certification statement.
Lost
13.

Stolen

Mutilated

Other

I certify, under penalty of perjury under the laws of the United States of America that I no longer possess my Permanent
Resident Card for the reasons stated in this form, which I signed on (mm/dd/yyyy)

Form I-407 07/20/21

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A-Number ► A-

Part 1. Information About You (continued)
14. List other documents you returned (if any).

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15.

I am submitting Form I-407 from outside of the United States in-person.

16.

I am submitting Form I-407 from outside of the United States by mail.

17.

I am submitting Form I-407 at a U.S. Port of Entry.

18.

I am submitting Form I-407 from inside the United States to document that I abandoned my lawful permanent resident (LPR)
status in the past. I already abandoned my prior LPR status by leaving the United States intending to make my permanent
home abroad. I did not retain my LPR status. I have since returned to the United States through a port of entry by being
admitted as a nonimmigrant or by being paroled.

Certification

I knowingly, willingly, and affirmatively declare that I currently have no intention of residing permanently in the United States, and
that by signing and submitting this form, I intend to record the fact that I have knowingly and willingly abandoned my LPR status in
the United States. I have reviewed the form and its instructions, and I have been informed of and I understand my rights to a hearing
before an immigration judge about whether I have abandoned my LPR status in the United States. By signing and submitting this
form, I knowingly, willingly, and affirmatively waive my rights to such a hearing.
OR

I knowingly, willingly, and affirmatively declare that I already abandoned my prior LPR status by leaving the United States intending
to make my permanent home abroad and I did not retain my LPR status. I have since returned to the United States through a Port of
Entry by being admitted as a nonimmigrant or by being paroled. I declare that I am submitting this Form I-407 to document that I
abandoned my prior LPR status. I have reviewed the form and its instructions, and I have been informed, and I understand, that had I
not previously abandoned my LPR status, I would have a right to seek a hearing before an immigration judge to contest the
abandonment of my LPR status. By signing and submitting this form, I knowingly, willingly, and affirmatively waive my rights, if
any, to such a hearing.
AND/OR

Consent of Parents Custodial Parent, or Legal Guardian to Submit Form I-407 for Incapacitated Adult or
Minors 14 Years of Age and Younger (if applicable)
I confirm that I am the parent, custodial parent, or duly appointed legal guardian for the individual identified in Part 1. of this form.
As the parent or legal guardian of this individual, I consent to the alien minor's/incapacitated adult's submission of this form.
19. Your Name (or name of parent, custodial parent, or legal guardian, if applicable)

20. Your Signature (or signature of the parent, custodial parent, or legal guardian, if applicable)

Date of Signature (mm/dd/yyyy)

NOTE: Submission of Form I-407 is voluntary. U.S. law does not require you to complete, sign, or submit this Form I-407. You
may request a hearing before an immigration judge if you disagree with a U.S. Department of Homeland Security (DHS) claim that
you have abandoned your lawful permanent resident status.
If signed by a parent, custodial parent, or legal guardian, submit evidence to show parental, custodial parental, or legal guardianship
responsibility of the minor or incapacitated adult.

Form I-407 07/20/21

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A-Number ► A-

Part 2. Interpreter's Contact Information, Certification, and Signature
If you used anyone as an interpreter to read the Instructions and questions on this form to you in a language in which you are fluent,
the interpreter must fill out this section and sign and date the form.

Interpreter's Full Name
1.

Interpreter's Family Name (Last Name)

2.

Interpreter's Business or Organization Name (if any)

Interpreter's Given Name (First Name)

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Interpreter's Contact Information
3.

Interpreter's Daytime Telephone Number

5.

Interpreter's Email Address (if any)

4. Interpreter's Mobile Telephone Number (if any)

Interpreter Certification and Signature

I certify, under penalty of perjury, that I am fluent in English and

and I have

interpreted every question on this form and Instructions and interpreted the applicant's answers to the questions in that language, and
the form informed me that they understood every instruction, question, and answer on the form.
6.

Interpreter's Signature

Date of Signature (mm/dd/yyyy)

Part 3. Contact Information, Declaration, and Signature of the Person Preparing this Form, if Other
Than the Legal Permanent Resident (LPR)
The person who completed your form, if other than the applicant, must sign this section. If the same individual acted as your
interpreter and your preparer, then that person should complete both Part 2. and Part 3. A stamped or typewritten name in place of a
signature is not acceptable.

Preparer's Full Name
1.

Preparer's Family Name (Last Name)

2.

Preparer's Business or Organization Name (if any)

Preparer's Given Name (First Name)

Preparer's Contact Information
3.

Preparer's Daytime Telephone Number

5.

Preparer's Email Address (if any)

Form I-407 07/20/21

4. Preparer's Mobile Telephone Number (if any)

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A-Number ► A-

Part 3. Contact Information, Declaration, and Signature of the Person Preparing this Form, if Other
Than the Legal Permanent Resident (LPR) (continued)
Preparer Certification and Signature
I certify, under penalty of perjury, that I prepared this form for the applicant at their request and with express consent and that all of
the responses and information contained in and submitted with the application is complete, true, and correct and reflects only
information provided by the applicant. The applicant reviewed the responses and information and informed me that they understand
the responses and information in or submitted with the form.
6.

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Preparer's Signature

Date of Signature (mm/dd/yyyy)

Part 4. For Government Use Only

Instructions to the U.S. government official: Select Item Number 1. if you interviewed the individual identified in Part 1. If you did
not, select Item Number 2. Sign the form and provide other information requested.
1.

I certify that I personally interviewed the individual identified in Part 1., who has signed this Form I-407, and that I advised
the individual of the hearing rights specified in the Instructions. The individual stated that they fully understand the effect of
signing this Form I-407. I further certify that, if an interpreter was used, I confirmed that the individual understood the
interpreter.

2.

I certify that I reviewed this Form I-407, which was submitted by mail as indicated in Part 1. Item Number 16. Based on
the completed information, signature, and any attached documentation, the individual identified in Part 1. has declared that
they fully understand the effect of submitting this Form I-407.

3.

A copy of the signed Form I-407 was provided to this individual.

Yes

No

U.S. Government Official Information
4.

Signature of U.S. Government Official (sign in ink or use signature stamp) Date of Signature (mm/dd/yyyy)

Title of U.S. Government

Form I-407 07/20/21

Name of DHS Component, if signed by a DHS Official

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