Académique Documents
Professionnel Documents
Culture Documents
Form I-751
For
USCIS
Use
Only
Action Block
Reloc Sent
Reloc Received
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
/
/
/
/
/
/
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
/
/
/
/
/
/
Petitioner interviewed on (mm/dd/yyyy)
To be completed by an
attorney or accredited
representative (if any).
Remarks
5.
Country of Birth
6.
7.
8.
List 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.
9.
Marital Status
10.
Divorced
Widowed
11.
12.
Place of Marriage
13.
14.
Other Information
4.
Marital Status
Single
Married
Page 1 of 11
21.
Mailing Address
22.
Yes
Apt.
Ste.
Flr.
23.
Physical Address
2.
No
Apt.
Flr.
3.
Height
4.
Weight
5.
Feet
Inches
No
No
6.
Pounds
Black
Gray
Blue
Green
Hazel
Maroon
Pink
Unknown/Other
Brown
Black
Gray
White
Blond
Red
Unknown/Other
Page 2 of 11
Other Information
Joint Filing
1.b.
My spouse.
3.
4.
My spouse is deceased.
1.d.
1.e.
1.f.
1.g.
5.
Physical Address
6.a. Street Number
and Name
6.b.
Apt.
Ste.
Flr.
Province
3.
4.
5.
Yes
Yes
No
No
Page 3 of 11
Child 3
Physical Address
6.a. Street Number
and Name
6.b.
Apt.
Flr.
14.
15.
6.d. State
6.f.
Yes
No
17.
Yes
No
Province
Physical Address
6.h. Country
18.d. State
Flr.
18.f. Province
8.
9.
A10.
Yes
No
11.
Yes
No
Physical Address
12.a. Street Number
and Name
Apt.
Ste.
12.b.
Apt.
18.b.
Child 4
19.a. Family Name
(Last Name)
19.b. Given Name
(First Name)
19.c. Middle Name
Ste.
Flr.
20.
21.
12.d. State
Yes
No
23.
Yes
No
12.f. Province
12.g. Postal Code
12.h. Country
Page 4 of 11
Physical Address
24.b.
Ste.
2.
Flr.
1.
Yes
24.f. Province
No
No
24.h. Country
Child 5
25.a. Family Name
(Last Name)
25.b. Given Name
(First Name)
4.a.
4.b.
4.c.
27.
28.
Yes
No
29.
Yes
No
Physical Address
30.a. Street Number
and Name
30.b.
Apt.
Ste.
Flr.
30.f. Province
30.g. Postal Code
30.h. Country
Page 5 of 11
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
1.b.
2.
4.
5.
Petitioner's Statement
1.a.
3.
I,
,
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 petition 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 ASC appointment.
By signing here, 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.
If conditional residence was based on a marriage, I further
certify that the marriage was entered into in accordance with the
laws of the place where the marriage took place and was not for
the purpose of procuring an immigration benefit.
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 petition; I have reviewed
the contents of this petition; all of the information in my petition
and all supporting documents submitted with my petition were
provided by me and are complete, true, and correct; and if I was
assisted in completing this petition, the person assisting me also
reviewed this Acknowledgement of Appointment at USCIS
Application Support Center with me.
Page 6 of 11
Petitioner'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.
1.b.
Petitioner's Signature
2.
,
a language in which I am fluent. I understand every
question and instruction on this petition 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 9. has also
read the Acknowledgement of Appointment at
USCIS Application Support Center 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.
4.
5.
Page 7 of 11
Apt.
Ste.
Flr.
Province
5.
Page 8 of 11
Apt.
3.d. State
3.f.
3.h. Country
Interpreter's Signature
6.a. Interpreter's Signature
Province
5.
6.
Preparer's Statement
7.a.
7.b.
Flr.
Ste.
Page 9 of 11
Preparer's Signature
8.a. Preparer's Signature
Page 10 of 11
5.d.
6.d.
3.c. Item Number
3.d.
7.d.
4.a. Page Number
4.d.
Page 11 of 11