TABLE OF CHANGES – FORM
Form G-325A, Biographic Information (for Deferred Action)
OMB Number: 1615-0008
09/26/2023
Reason for Revision: 83C Project Phase: OMBReview
Legend for Proposed Text:
Expires 08/31/2025 Edition Date 08/30/2022 |
Current Page Number and Section |
Current Text |
Proposed Text |
Page 1, Biographic Information |
[Page 1]
Family Name First Name Middle Name
Male Female
Date of Birth (mm/dd/yyyy)
Citizenship/Nationality
File Number
All Other Names Used (include names by previous marriages)
City and Country of Birth
U.S. Social Security No. (if any)
Father Family Name First Name Date of Birth (mm/dd/yyyy) City, and Country of Birth (if known) City and Country of Residence
Mother Family Name (Maiden Name) First Name Date of Birth (mm/dd/yyyy) City, and Country of Birth (if known) City and Country of Residence
Current Husband or Wife (If none, type or print “none”) Family Name (For wife, give maiden name) First Name Date of Birth (mm/dd/yyyy) City, and Country of Birth Date of Marriage Place of Marriage
Former Husbands or Wives (If none, type or print “none”) Family Name (For wife, give maiden name) First Name Date of Birth (mm/dd/yyyy) Date and Place of Marriage Date and Place of Termination of Marriage
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[no change] |
Page 1, Applicant’s residence |
[Page 1]
Applicant’s residence last five years. List present address first.
[Table 5 entries] Street Name and Number City Province or State
Country From Month Year To Month Year [“Present Time” in 1st entry] |
Applicant’s residence last five years. List present address first.
[Table 5 entries] Street Name and Number City Province or State ZIP Code/Postal Code Country From Month Year To Month Year [“Present Time” in 1st entry] |
Page 1, Applicant’s last address |
[Page 1]
Applicant’s last address outside the United States of more than 1 year.
Street Name and Number City Province or State
Country From Month Year To Month Year
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Applicant’s last address outside the United States of more than 1 year.
Street Name and Number City Province or State ZIP Code/Postal Code Country From Month Year To Month Year
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Page 1, Applicant’s employment |
[Page 1]
Applicant’s employment last five years. (If none, type or print “none.”) List present employment first.
[Table 5 entries] Full Name and Address of Employer Occupation (Specify) From Month Year To Month Year [“Present Time” in 1st entry]
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[no change] |
Page 1, Last occupation |
[Page 1]
Last occupation abroad if not shown above. (Include all information requested above.)
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[no change] |
Page 1, This form is submitted for |
[Page 1]
This form is submitted for: [x] Deferred Action Request
Signature of Applicant Date
If your native alphabet is in other than Roman letters, write your name in your native alphabet below: [Fillable field]
Penalties: Severe penalties are provided by law for knowingly and willfully falsifying or concealing a material fact.
Applicant: Print your name and Alien Registration Number in the box outlined by heavy border below.
Complete This box (Family Name) (Given Name) (Middle Name)
(Alien Registration Number)
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[no change] |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Valentine, Brian R |
File Modified | 0000-00-00 |
File Created | 2023-10-12 |