Form I-485, Application to Register Permanent Residence or ..., Exercises of Law

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1.b.

1.c.

1.a. Family Name (Last Name) Given Name (First Name) Middle Name

Your Current Legal Name (do not provide a

nickname)

Application to Register Permanent Residence

or Adjust Status

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS

Form I-

OMB No. 1615- Expires 03/31/

Priority Date:

Country Chargeable:

INA 209(a) INA 249

Section of Law

INA 245(a) INA 245(i) INA 245(m)

Sec. 13, Act of 9/11/ Cuban Adjustment Act Lawful Permanent Other Resident as of:

Date of Initial Interview:

Receipt Action Block

Interview Waived

Applicant Interviewed

Date Form I-693 Received:

Attorney State Bar Number (if applicable)

Select this box if Form G-28 is attached.

Volag Number (if any)

Attorney or Accredited Representative USCIS Online Account Number (if any)

To be completed by an attorney or accredited representative (if any).

For USCIS Use Only

► START HERE - Type or print in black ink.

NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the Instructions, U.S. Citizenship and Immigration Services (USCIS) may deny your application.

Part 1. Information About You (Person applying

for lawful permanent residence)

A-Number ► A-

NOTE: Provide all other names you have ever used, including your family name at birth, other legal names, nicknames, aliases, and assumed names. If you need extra space to complete this section, use the space provided in Part 14. Additional Information.

Other Names You Have Used Since Birth (if

applicable)

2.b.

2.c.

2.a. Family Name (Last Name) Given Name (First Name) Middle Name

3.b.

3.c.

3.a. Family Name (Last Name) Given Name (First Name) Middle Name

5. Date of Birth (mm/dd/yyyy)

NOTE: In addition to providing your actual date of birth, include any other dates of birth you have used in connection with any legal names or non-legal names in the space provided in Part 14. Additional Information.

6. Sex Male Female

INA 209(b)

4.b.

4.c.

4.a. Family Name (Last Name) Given Name (First Name) Middle Name

Preference Category:

Other Information About You

7. City or Town of Birth

8. Country of Birth 9. Country of Citizenship or Nationality

Part 1. Information About You (Person applying for lawful permanent residence) (continued)

► A-

10. Alien Registration Number (A-Number) (if any)

NOTE: If you have EVER used other A-Numbers, include the additional A-Numbers in the space provided in Part 14. Additional Information.

►

11. USCIS Online Account Number (if any)

U.S. Mailing Address

12.d. City or Town

12.e. State 12.f. ZIP Code

Street Number and Name

12.b.

12.c. Apt. Ste. Flr.

12.a. In Care Of Name (if any)

13.d. City or Town

13.e. State 13.f. ZIP Code

Street Number and Name

13.b.

13.c. Apt. Ste. Flr.

13.a. In Care Of Name (if any)

Alternate and/or Safe Mailing Address

If you are applying based on the Violence Against Women Act (VAWA) or as a special immigrant juvenile, human trafficking victim (T nonimmigrant), or victim of a qualifying crime (U nonimmigrant) and you do not want USCIS to send notices about this application to your home, you may provide an alternative and/or safe mailing address.

(USPS ZIP Code Lookup)

Social Security Card

14. Has the Social Security Administration (SSA) ever officially issued a Social Security card to you? Yes No

If you answered “Yes,” provide the information requested in Item Number 15.

15. Provide your U.S. Social Security Number (SSN). ►

Do you want the SSA to issue you a Social Security card? (You must also answer “Yes” to Item Number 17. Consent for Disclosure , to receive a card).

Yes No

Consent for Disclosure: I authorize disclosure of information from this application to the SSA as required for the purpose of assigning me an SSN and issuing me a Social Security Card.

Yes No

18. Passport Number Used at Last Arrival 19. Travel Document Number Used at Last Arrival

Recent Immigration History

20. Expiration Date of this Passport or Travel Document (mm/dd/yyyy) 21. Country that Issued this Passport or Travel Document 22. Nonimmigrant Visa Number from this Passport (if any)

23.a.

Place of Last Arrival into the United States City or Town

23.b. State

Provide the information for Item Numbers 18. - 24. if you last entered the United States using a passport or travel document.

24. Date of Last Arrival (mm/dd/yyyy)

Part 1. Information About You (Person applying for lawful permanent residence) (continued)

When I last arrived in the United States, I:

Was inspected at a port of entry and admitted as (for example, exchange visitor; visitor, waived through; temporary worker; student):

25.a.

Was inspected at a port of entry and paroled as (for example, humanitarian parole, Cuban parole):

25.b.

Came into the United States without admission or parole.

25.c.

25.d. Other:

If you were issued a Form I-94 Arrival-Departure Record Number:

26.b. Expiration Date of Authorized Stay Shown on Form I-

(mm/dd/yyyy)

26.c. Status on Form I-94 (for example, class of admission, or paroled, if paroled)

26.a. Form I-94 Arrival-Departure Record Number

►

Provide your name exactly as it appears on your Form I-94 (if any)

28.b.

28.c.

28.a. Family Name (Last Name) Given Name (First Name) Middle Name

Part 2. Application Type or Filing Category

NOTE: Attach a copy of the Form I-797 receipt or approval notice for the underlying petition or application, as appropriate. I am applying to register lawful permanent residence or adjust status to that of a lawful permanent resident based on the following immigrant category (select only one box). (See the Form I-485 Instructions for more information, including any Additional Instructions that relate to the immigrant category you select.):

1.a. Family-based Immediate relative of a U.S. citizen, Form I- Other relative of a U.S. citizen or relative of a lawful permanent resident under the family-based preference categories, Form I- Person admitted to the United States as a fiancé(e) or child of a fiancé(e) of a U.S. citizen, Form I-129F (K-1/K-2 Nonimmigrant) Widow or widower of a U.S. citizen, Form I- VAWA self-petitioner, Form I-

Alien worker, Form I- Alien entrepreneur, Form I-

1.b. Employment-based

Special Immigrant

Special immigrant juvenile, Form I- Certain Afghan or Iraqi National, Form I-360 or Form DS-

Religious worker, Form I-

Certain international broadcaster, Form I- Certain G-4 international organization or family member or NATO-6 employee or family member, Form I-

1.c.

What is your current immigration status (if it has changed since your arrival)?

Asylee or Refugee Asylum status (INA section 208), Form I-589 or Form I- Refugee status (INA section 207), Form I-590 or Form I-

1.d.

Human Trafficking Victim or Crime Victim

Crime victim (U Nonimmigrant), Form I-918, derivative family member, Form I-918A, or qualifying family member, Form I-

Human trafficking victim (T Nonimmigrant), Form I-914 or derivative family member, Form I-914A

1.e.

Dependent status under the Haitian Refugee Immigrant Fairness Act for battered spouses and children

Diplomats or high ranking officials unable to return home (Section 13 of the Act of September 11, 1957)

Lautenberg Parolees

Dependent status under the Haitian Refugee Immigrant Fairness Act

Indochinese Parole Adjustment Act of 2000

The Cuban Adjustment Act for battered spouses and children

The Cuban Adjustment Act

1.f. Special Programs Based on Certain Public Laws

Additional Options Diversity Visa program

Individual born in the United States under diplomatic status

Continuous residence in the United States since before January 1, 1972 ("Registry")

Other eligibility

1.g.

Are you applying for adjustment based on the Immigration and Nationality Act (INA) section 245(i)? Yes No

NOTE: If you answered "Yes" to Item Number 2. , you must have selected a family-based, employment-based, special immigrant, or Diversity Visa immigrant category listed above in Item Numbers 1.a. - 1.g. as the basis for your application for adjustment of status. Fill out the rest of this application and Supplement A to Form I-485, Adjustment of Status Under Section 245(i) (Supplement A). For detailed filing instructions, read the Form I- Instructions (including any Additional Instructions that relate to the immigrant category that you selected in Item Numbers 1.a. - 1.g. ) and Supplement A Instructions.

Information About Your Immigrant Category

If you are the principal applicant , provide the following information.

3. Receipt Number of Underlying Petition (if any) 4. Priority Date from Underlying Petition (if any) (mm/dd/yyyy)

If you are a derivative applicant (the spouse or unmarried child under 21 years of age of a principal applicant), provide the following information for the principal applicant.

Principal Applicant's Name

5.b.

5.c.

5.a. Family Name (Last Name) Given Name (First Name) Middle Name

► A-

6. Principal Applicant's A-Number (if any) 7. Principal Applicant's Date of Birth (mm/dd/yyyy) 8. Receipt Number of Principal's Underlying Petition (if any) 9. Priority Date of Principal Applicant's Underlying Petition

►

(if any) (mm/dd/yyyy)

Part 2. Application Type or Filing Category (continued)

Part 3. Additional Information About You

1. Have you ever applied for an immigrant visa to obtain permanent resident status at a U.S. Embassy or U.S. Consulate abroad? (^) Yes No

If you answered "Yes" to Item Number 1. , complete Item Numbers 2.a. - 4. below. If you need extra space to complete this section, use the space provided in Part 14. Additional Information. Location of U.S. Embassy or U.S. Consulate

2.a. City

2.b.^ Country

Decision (for example, approved, refused, denied, withdrawn)

4. Date of Decision (mm/dd/yyyy)

Address History

Provide physical addresses for everywhere you have lived during the last five years, 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 14. Additional Information.

5.c. City or Town

5.f.

5.h.

Province

Country

5.g. Postal Code

5.d. State 5.e. ZIP Code

Street Number and Name

5.a.

5.b. Apt. Ste. Flr.

Physical Address 1 (current address)

Dates of Residence

From (mm/dd/yyyy)

To (mm/dd/yyyy)

6.a.

6.b.

7.c. City or Town

7.f.

7.h.

Province

Country

7.g. Postal Code

7.d. State 7.e. ZIP Code

Street Number and Name

7.a.

7.b. Apt. Ste. Flr.

Physical Address 2

Part 3. Additional Information About You (continued)

Dates of Residence

From (mm/dd/yyyy)

To (mm/dd/yyyy)

8.a.

8.b.

Provide your most recent address outside the United States where you lived for more than one year (if not already listed above).

9.c. City or Town

9.f.

9.h.

Province

Country

9.g. Postal Code

9.d. State 9.e. ZIP Code

Street Number and Name

9.a.

9.b. Apt. Ste. Flr.

Dates of Residence

From (mm/dd/yyyy)

To (mm/dd/yyyy)

10.a.

10.b.

Provide your employment history for the last five years, whether inside or outside the United States. Provide the most recent employment first. If you need extra space to complete this section, use the space provided in Part 14. Additional Information.

Name of Employer or Company

Employer 1 (current or most recent)

Employment History

Address of Employer or Company

12.c. City or Town

12.f.

12.h.

Province

Country

12.g. Postal Code

12.d. State 12.e. ZIP Code

Street Number and Name

12.a.

12.b. Apt. Ste. Flr.

13. Your Occupation

Part 3. Additional Information About You (continued)

Dates of Employment

From (mm/dd/yyyy)

To (mm/dd/yyyy)

14.a.

14.b.

15. Name of Employer or Company

Employer 2

16.c. City or Town

16.f.

16.h.

Province

Country

16.g. Postal Code

16.d. State 16.e. ZIP Code

Street Number and Name

16.a.

16.b. Apt. Ste. Flr.

Address of Employer or Company

17. Your Occupation

Dates of Employment

From (mm/dd/yyyy)

To (mm/dd/yyyy)

18.a.

18.b.

Provide your most recent employment outside of the United States (if not already listed above).

19. Name of Employer or Company

20.c. City or Town

20.f.

20.h.

Province

Country

20.g. Postal Code

20.d. State 20.e. ZIP Code

Street Number and Name

20.a.

20.b. Apt. Ste. Flr.

Address of Employer or Company

21. Your Occupation

Dates of Employment

From (mm/dd/yyyy)

To (mm/dd/yyyy)

22.a.

22.b.

Part 4. Information About Your Parents

Parent 1's Legal Name

Information About Your Parent 1

1.b.

1.c.

1.a. Family Name (Last Name) Given Name (First Name) Middle Name

Parent 1's Name at Birth (if different than above)

2.b.

2.c.

2.a. Family Name (Last Name) Given Name (First Name) Middle Name

3. Date of Birth (mm/dd/yyyy) 4. Sex Male Female 5. City or Town of Birth 6. Country of Birth

8. Current Country of Residence (if living) 7. Current City or Town of Residence (if living)

Information About Your Parent 2

Parent 2's Legal Name

9.b.

9.c.

9.a. Family Name (Last Name) Given Name (First Name) Middle Name

City or Town of Birth

11. Date of Birth (mm/dd/yyyy)

Parent 2's Name at Birth (if different than above)

10.b.

10.c.

10.a. Family Name (Last Name) Given Name (First Name) Middle Name

16. Current Country of Residence (if living) 15. Current City or Town of Residence (if living) 14. Country of Birth 12. Sex Male Female

Part 4. Information About Your Parents (continued)

Part 5. Information About Your Marital History

1. What is your current marital status?

Single, Never Married Divorced Widowed

Married Marriage Annulled Legally Separated If you are married, is your spouse a current member of the U.S. armed forces or U.S. Coast Guard?

N/A Yes No

How many times have you been married (including annulled marriages and marriages to the same person)?

If you are currently married, provide the following information about your current spouse.

Information About Your Current Marriage (including if you are legally separated)

4.b.

4.c.

4.a. Family Name (Last Name) Given Name (First Name) Middle Name

Current Spouse's Legal Name

6. Current Spouse's Date of Birth (mm/dd/yyyy) 7. Date of Marriage to Current Spouse (mm/dd/yyyy)

A-Number (if any)

► A-

Current Spouse's Place of Birth

8.c. Country

8.b. State or Province

8.a. City or Town

Place of Marriage to Current Spouse

9.c. Country

9.b. State or Province

9.a. City or Town

10. Is your current spouse applying with you? Yes No

Prior Spouse's Legal Name (provide family name before marriage)

11.b.

11.c.

11.a. Family Name (Last Name) Given Name (First Name) Middle Name

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 14. Additional Information to provide the information below.

Information About Prior Marriages (if any)

12. Prior Spouse's Date of Birth (mm/dd/yyyy) 13. Date of Marriage to Prior Spouse (mm/dd/yyyy)

Place of Marriage to Prior Spouse

14.c. Country

14.b. State or Province

14.a. City or Town

15. Date Marriage with Prior Spouse Legally Ended

(mm/dd/yyyy)

Part 5. Information About Your Marital History (continued)

Place Where Marriage with Prior Spouse Legally Ended

16.a. City or Town

16.b. State or Province

16.c. Country

Indicate the total number of ALL living children (including adult sons and daughters) that you have.

Part 6. Information About Your Children

NOTE: The term “children” includes all biological or legally adopted children, as well as current stepchildren, of any age, whether born in the United States or other countries, married or unmarried, living with you or elsewhere and includes any missing children and those born to you outside of marriage.

Provide the following information for each of your children. If you have more than three children, use the space provided in Part 14. Additional Information.

Child 1 Current Legal Name

2.b.

2.c.

2.a. Family Name (Last Name) Given Name (First Name) Middle Name

3. A-Number (if any) 4. Date of Birth (mm/dd/yyyy) 5. Country of Birth 6. Is this child applying with you? Yes No

► A-

Child 2 Current Legal Name

7.b.

7.c.

7.a. Family Name (Last Name) Given Name (First Name) Middle Name

8. A-Number (if any) 9. Date of Birth (mm/dd/yyyy) 10. Country of Birth 11. Is this child applying with you? Yes No

► A-

Child 3

Current Legal Name

12.b.

12.c.

12.a. Family Name (Last Name) Given Name (First Name) Middle Name

13. A-Number (if any) 14. Date of Birth (mm/dd/yyyy) 15. Country of Birth 16. Is this child applying with you? Yes No 1. Ethnicity (Select only one box)

Part 7. Biographic Information

2. Race (Select all applicable boxes)

Hispanic or Latino Not Hispanic or Latino

Asian

White

Black or African American American Indian or Alaska Native Native Hawaiian or Other Pacific Islander

► A-

Part 6. Information About Your Children (continued)

Height

4. Weight 3. Feet Inches

Pounds

5. Eye Color (Select only one box) 6. Hair Color (Select only one box)

Black Blue Brown Gray Green Hazel Maroon Pink Unknown/Other

Bald (No hair) Black Blond Brown Gray Red Sandy White Unknown/Other

Part 8. General Eligibility and Inadmissibility Grounds

1. Have you EVER been a member of, involved in, or in any way associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other location in the world including any military service? (^) Yes No

If you answered "Yes" to Item Number 1. , complete Item Numbers 2. - 13.b. below. If you need extra space to complete this section, use the space provided in Part 14. Additional Information. If you answered "No," but are unsure of your answer, provide an explanation of the events and circumstances in the space provided in Part 14. Additional Information.

Organization 1

2. Name of Organization

3.c. Country

3.b. State or Province

3.a. City or Town

4. Nature of Group

Dates of Membership or Dates of Involvement

From (mm/dd/yyyy)

To (mm/dd/yyyy)

5.a.

5.b.

Organization 2

6. Name of Organization

7.c. Country

7.b. State or Province

7.a. City or Town

8. Nature of Group

Dates of Membership or Dates of Involvement

From (mm/dd/yyyy)

To (mm/dd/yyyy)

Organization 3

10. Name of Organization

11.a. City or Town

9.a.

9.b.

11.c. Country

12. Nature of Group

11.b. State or Province

Dates of Membership or Dates of Involvement

From (mm/dd/yyyy)

To (mm/dd/yyyy)

13.a.

13.b.

Part 8. General Eligibility and Inadmissibility Grounds (continued)

Answer Item Numbers 14. - 80.b. Choose the answer that you think is correct. If you answer “Yes” to any questions (or if you answer "No," but are unsure of your answer) , provide an explanation of the events and circumstances in the space provided in Part 14. Additional Information.

Have you EVER worked in the United States without authorization?

Have you EVER been denied a visa to the United States?

Have you EVER been denied admission to the United States?

Have you EVER violated the terms or conditions of your nonimmigrant status?

Yes No

Yes No

Yes No

Yes No

18. Are you presently or have you EVER been in removal, exclusion, rescission, or deportation proceedings? Yes No

Have you EVER held lawful permanent resident status which was later rescinded?

Have you EVER had a prior final order of exclusion, deportation, or removal reinstated? (^) Yes No

Yes No

22. Have you EVER been granted voluntary departure by an immigration officer or an immigration judge but failed to depart within the allotted time? (^) Yes No

Yes No

Have you EVER applied for any kind of relief or protection from removal, exclusion, or deportation?

24.a. Have you EVER been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence requirement? (^) Yes No

If you answered "Yes" to Item Number 24.a. , complete Item Numbers 24.b. - 24.c. If you answered "No" to Item Number 24.a. , skip to Item Number 25.

Have you complied with the foreign residence requirement? (^) Yes No

24.b.

Have you EVER been issued a final order of exclusion, deportation, or removal?

Yes No

Yes

Have you been granted a waiver or has Department of State issued a favorable waiver recommendation letter for you? (^) No

24.c.

For Item Numbers 25. - 45. , you must answer "Yes" to any question that applies to you, even if your records were sealed or otherwise cleared, or even if anyone, including a judge, law enforcement officer, or attorney, told you that you no longer have a record. You must also answer "Yes" to the following questions whether the action or offense occurred here in the United States or anywhere else in the world. If you answer "Yes" to Item Numbers 25. - 45. , use the space provided in Part 14. Additional Information to provide an explanation that includes why you were arrested, cited, detained, or charged; where you were arrested, cited, detained, or charged; when (date) the event occurred; and the outcome or disposition (for example, no charges filed, charges dismissed, jail, probation, community service).

Criminal Acts and Violations

25. Have you EVER been arrested, cited, charged, or detained for any reason by any law enforcement official (including but not limited to any U.S. immigration official or any official of the U.S. armed forces or U.S. Coast Guard)? (^) Yes No

Have you EVER committed a crime of any kind (even if you were not arrested, cited, charged with, or tried for that crime)? (^) Yes No

Part 8. General Eligibility and Inadmissibility Grounds (continued)

27. Have you EVER pled guilty to or been convicted of a crime or offense (even if the violation was subsequently expunged or sealed by a court, or if you were granted a pardon, amnesty, a rehabilitation decree, or other act of clemency)? (^) Yes No

NOTE: If you were the beneficiary of a pardon, amnesty, a rehabilitation decree, or other act of clemency, provide documentation of that post-conviction action. Have you EVER been ordered punished by a judge or had conditions imposed on you that restrained your liberty (such as a prison sentence, suspended sentence, house arrest, parole, alternative sentencing, drug or alcohol treatment, rehabilitative programs or classes, probation, or community service)?

Yes No

29. Have you EVER been a defendant or the accused in a criminal proceeding (including pre-trial diversion, deferred prosecution, deferred adjudication, or any withheld adjudication)? (^) Yes No

Yes No

30. Have you EVER violated (or attempted or conspired to violate) any controlled substance law or regulation of a state, the United States, or a foreign country?

Yes No

32. Have you EVER illicitly (illegally) trafficked or benefited from the trafficking of any controlled substances, such as chemicals, illegal drugs, or narcotics?

33.

Yes No

Have you EVER knowingly aided, abetted, assisted, conspired, or colluded in the illicit trafficking of any illegal narcotic or other controlled substances?

No

Have you EVER been convicted of two or more offenses (other than purely political offenses) for which the combined sentences to confinement were five years or more? (^) Yes

No

Are you the spouse, son, or daughter of a foreign national who illicitly trafficked or aided (or otherwise abetted, assisted, conspired, or colluded) in the illicit trafficking of a controlled substance, such as chemicals, illegal drugs, or narcotics and you obtained, within the last five years, any financial or other benefit from the illegal activity of your spouse or parent, although you knew or reasonably should have known that the financial or other benefit resulted from the illicit activity of your spouse or parent? Yes

Yes No

35. Have you EVER engaged in prostitution or are you coming to the United States to engage in prostitution? 36. Have you EVER directly or indirectly procured (or attempted to procure) or imported prostitutes or persons for the purpose of prostitution? (^) Yes No

37. No

Have you EVER received any proceeds or money from prostitution? (^) Yes

38. Do you intend to engage in illegal gambling or any other form of commercialized vice, such as prostitution, bootlegging, or the sale of child pornography, while in the United States? (^) Yes No

No

Have you EVER exercised immunity (diplomatic or otherwise) to avoid being prosecuted for a criminal offense in the United States? (^) Yes

Yes No

Have you EVER , while serving as a foreign government official, been responsible for or directly carried out violations of religious freedoms?

Yes No

41. Have you^ EVER^ induced by force, fraud, or coercion (or otherwise been involved in) the trafficking of persons for commercial sex acts?

42.

No

Yes No

Yes

Have you EVER trafficked a person into involuntary servitude, peonage, debt bondage, or slavery? Trafficking includes recruiting, harboring, transporting, providing, or obtaining a person for labor or services through the use of force, fraud, or coercion.

Have you EVER knowingly aided, abetted, assisted, conspired, or colluded with others in trafficking persons for commercial sex acts or involuntary servitude, peonage, debt bondage, or slavery?

44.

Yes No

Are you the spouse, son or daughter of a foreign national who engaged in the trafficking of persons and have received or obtained, within the last five years, any financial or other benefits from the illicit activity of your spouse or your parent, although you knew or reasonably should have known that this benefit resulted from the illicit activity of your spouse or parent?

45.

Yes No

Have you EVER engaged in money laundering or have you EVER knowingly aided, assisted, conspired, or colluded with others in money laundering or do you seek to enter the United States to engage in such activity?

Part 8. General Eligibility and Inadmissibility Grounds (continued)

Security and Related

Do you intend to:

Yes No

46.a. Engage in any activity that violates or evades any law relating to espionage (including spying) or sabotage in the United States?

46.b. Engage in any activity in the United States that violates or evades any law prohibiting the export from the United States of goods, technology, or sensitive information? Yes No

46.c. Engage in any activity whose purpose includes opposing, controlling, or overthrowing the U.S. Government by force, violence, or other unlawful means while in the United States? (^) Yes No

46.d. Engage in any activity that could endanger the welfare, safety, or security of the United States? Yes No

46.e. Engage in any other unlawful activity? Yes No

47. Are you engaged in or, upon your entry into the United States, do you intend to engage in any activity that could have potentially serious adverse foreign policy consequences for the United States? (^) Yes No

48.a. Committed, threatened to commit, attempted to commit, conspired to commit, incited, endorsed, advocated, planned, or prepared any of the following: hijacking, sabotage, kidnapping, political assassination, or use of a weapon or explosive to harm another individual or cause substantial damage to property? (^) Yes No

Have you EVER :

Yes No

Participated in, or been a member of, a group or organization that did any of the activities described in Item Number 48.a.?

48.b.

49. Have you EVER received any type of military, paramilitary, or weapons training? (^) Yes No

Yes No

Recruited members or asked for money or things of value for a group or organization that did any of the activities described in Item Number 48.a.?

48.c.

48.d. Provided money, a thing of value, services or labor, or any other assistance or support for any of the activities described in Item Number 48.a.? (^) Yes No

50. Do you intend to engage in any of the activities listed in any part of Item Numbers 48.a. - 49.? (^) Yes No

48.e. Provided money, a thing of value, services or labor, or any other assistance or support for an individual, group, or organization who did any of the activities described in Item Number 48.a.? (^) Yes No

NOTE: If you answered “Yes” to any part of Item Numbers 46.a. - 50. , explain what you did, including the dates and location of the circumstances, or what you intend to do in the space provided in Part 14. Additional Information.

Yes No

Committed, threatened to commit, attempted to commit, conspired to commit, incited, endorsed, advocated, planned, or prepared any of the following: hijacking, sabotage, kidnapping, political assassination, or use of a weapon or explosive to harm another individual or cause substantial damage to property?

51.a.

Are you the spouse or child of an individual who EVER :

Yes No

Participated in, or been a member or a representative of a group or organization that did any of the activities described in Item Number 51.a.?

51.b.

Yes No

Recruited members, or asked for money or things of value, for a group or organization that did any of the activities described in Item Number 51.a.?

51.c.

Provided money, a thing of value, services or labor, or any other assistance or support for any of the activities described in Item Number 51.a.? (^) Yes No

51.d.

Yes No

Provided money, a thing of value, services or labor, or any other assistance or support to an individual, group, or organization who did any of the activities described in Item Number 51.a.?

51.e.

Yes No

Received any type of military, paramilitary, or weapons training from a group or organization that did any of the activities described in Item Number 51.a.?

51.f.

NOTE: If you answered “Yes” to any part of Item Number

51. , explain the relationship and what occurred, including the dates and location of the circumstances, in the space provided in Part 14. Additional Information.

Part 8. General Eligibility and Inadmissibility Grounds (continued)

Yes No

Have you EVER worked, volunteered, or otherwise served in any prison, jail, prison camp, detention facility, labor camp, or any other situation that involved detaining persons?

52. Have you EVER assisted or participated in selling, providing, or transporting weapons to any person who, to your knowledge, used them against another person? Yes No 54. Have you EVER been a member of, assisted, or participated in any group, unit, or organization of any kind in which you or other persons used any type of weapon against any person or threatened to do so? Yes No

Yes No

Have you EVER served in, been a member of, assisted, or participated in any military unit, paramilitary unit, police unit, self-defense unit, vigilante unit, rebel group, guerilla group, militia, insurgent organization, or any other armed group?

Yes No

Have you EVER been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party (in the United States or abroad)?

57. During the period from March 23, 1933 to May 8, 1945, did you ever order, incite, assist, or otherwise participate in the persecution of any person because of race, religion, national origin, or political opinion, in association with either the Nazi government of Germany or any organization or government associated or allied with the Nazi government of Germany? (^) Yes No

58.e. Limiting or denying any person's ability to exercise religious beliefs? (^) Yes No

59. Have you EVER recruited, enlisted, conscripted, or used any person under 15 years of age to serve in or help an armed force or group? (^) Yes No

Yes No

60. Have you EVER used any person under 15 years of age to take part in hostilities, or to help or provide services to people in combat?

NOTE: If you answered “Yes” to any part of Item Numbers

52. - 60. , explain what occurred, including the dates and location of the circumstances, in the space provided in Part 14. Additional Information.

Public Assistance

61. Have you received public assistance in the United States from any source, including the U.S. Government or any state, county, city, or municipality (other than emergency medical treatment)? (^) Yes No 62. Are you likely to receive public assistance in the future in the United States from any source, including the U.S. Government or any state, county, city, or municipality (other than emergency medical treatment)? Yes No

Illegal Entries and Other Immigration Violations

No

Yes No

Yes

Have you EVER failed or refused to attend or to remain in attendance at any removal proceeding filed against you on or after April 1, 1997?

63.a.

63.b. If your answer to Item Number 63.a. is "Yes," do you believe you had reasonable cause?

Have you EVER ordered, incited, called for, committed, assisted, helped with, or otherwise participated in any of the following:

58.a. Acts involving torture or genocide? Yes No

58.b. Killing any person? Yes No

58.c. Intentionally and severely injuring any person?

Yes No

Yes No

Engaging in any kind of sexual contact or relations with any person who did not consent or was unable to consent, or was being forced or threatened?

58.d.

If your answer to Item Number 63.b. is "Yes," attach a written statement explaining why you had reasonable cause.

63.c.

64. Have you EVER submitted fraudulent or counterfeit documentation to any U.S. Government official to obtain or attempt to obtain any immigration benefit, including a visa or entry into the United States? (^) Yes No

Yes No

Have you EVER lied about, concealed, or misrepresented any information on an application or petition to obtain a visa, other documentation required for entry into the United States, admission to the United States, or any other kind of immigration benefit?

66. Have you EVER falsely claimed to be a U.S. citizen (in writing or any other way)? (^) Yes No

Yes No

Have you EVER been a stowaway on a vessel or aircraft arriving in the United States?

Part 8. General Eligibility and Inadmissibility Grounds (continued)

72.a. For more than 180 days but less than a year, and then departed the United States? (^) No

Since April 1, 1997, have you been unlawfully present in the United States:

Yes

Yes No

72.b. For one year or more and then departed the United States?

Removal, Unlawful Presence, or Illegal Reentry After Previous Immigration Violations

No

71. Have you EVER entered the United States without being inspected and admitted or paroled? (^) Yes No

Yes

Have you EVER been excluded, deported, or removed from the United States or have you ever departed the United States on your own after having been ordered excluded, deported, or removed from the United States?

NOTE: You were unlawfully present in the United States if you entered the United States without being inspected and admitted or inspected and paroled, or if you legally entered the United States but you stayed longer than permitted.

68. Have you EVER knowingly encouraged, induced, assisted, abetted, or aided any foreign national to enter or to try to enter the United States illegally (alien smuggling)? Yes No

Yes No

Are you under a final order of civil penalty for violating INA section 274C for use of fraudulent documents?

Having been unlawfully present in the United States for more than one year in the aggregate?

73.a.

Yes No

Having been deported, excluded, or removed from the United States?

73.b.

Yes No

Since April 1, 1997, have you EVER reentered or attempted to reenter the United States without being inspected and admitted or paroled after:

Are you accompanying another foreign national who requires your protection or guardianship but who is inadmissible after being certified by a medical officer as being helpless from sickness, physical or mental disability, or infancy, as described in INA section 232(c)?

Miscellaneous Conduct

74. Do you plan to practice polygamy in the United States? Yes No

Yes No

76. Have you EVER assisted in detaining, retaining, or withholding custody of a U.S. citizen child outside the United States from a U.S. citizen who has been granted custody of the child? (^) Yes No

Yes No

Have you EVER voted in violation of any Federal, state, or local constitutional provision, statute, ordinance, or regulation in the United States?

78. Have you EVER renounced U.S. citizenship to avoid being taxed by the United States? (^) Yes No

Have you EVER: 79.a. Applied for exemption or discharge from training or service in the U.S. armed forces or in the U.S. National Security Training Corps on the ground that you are a foreign national? (^) Yes No

79.b. Been relieved or discharged from such training or service on the ground that you are a foreign national? Yes No

79.c. Been convicted of desertion from the U.S. armed forces? Yes No

If your answer to Item Number 80.a. is “Yes,” what was your nationality or immigration status immediately before you left (for example, U.S. citizen or national, lawful permanent resident, nonimmigrant, parolee, present without admission or parole, or any other status)?

80.b.

80.a. Have you EVER left or remained outside the United States to avoid or evade training or service in the U.S. armed forces in time of war or a period declared by the President to be a national emergency? (^) Yes No

2.a. I am deaf or hard of hearing and request the following accommodation. (If you are requesting a sign-language interpreter, indicate for which language (for example, American Sign Language).):

I have another type of disability and/or impairment. (Describe the nature of your disability and/or impairment and the accommodation you are requesting.)

2.c.

I am blind or have low vision and request the following accommodation:

2.b.

Part 10. Applicant's Statement, Contact Information, Declaration, Certification, and Signature

NOTE: Read the Penalties section of the Form I- Instructions before completing this part. You must file Form I-485 while in the United States.

2. At my request, the preparer named in Part 12. ,

prepared this application for me based only upon information I provided or authorized.

,

The interpreter named in Part 11. read to me every question and instruction on this application and my answer to every question in

1.b.

a language in which I am fluent, and I understood everything.

,

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.a.

NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.

Applicant's Statement

Part 9. Accommodations for Individuals With Disabilities and/or Impairments

NOTE: Read the information in the Form I-485 Instructions before completing this part.

Are you requesting an accommodation because of your disabilities and/or impairments? (^) Yes No

If you answered "Yes" to Item Number 1. , select any applicable box in Item Numbers 2.a. - 2.c. and provide an answer.

3. Applicant's Daytime Telephone Number

Applicant's Contact Information

4. Applicant's Mobile Telephone Number (if any) 5. Applicant's Email Address (if any)

Applicant's Declaration and 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 understand that if I am a male who is 18 to 26 years of age, submitting this application will automatically register me with the Selective Service System as required by the Military Selective Service Act. 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.

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.

2. Interpreter's Business or Organization Name (if any)

1.b. Interpreter's Given Name (First Name)

1.a. Interpreter's Family Name (Last Name)

Interpreter's Full Name

Part 11. Interpreter's Contact Information, Certification, and Signature

Provide the following information about the interpreter.

Applicant's Signature

6.b. Date of Signature (mm/dd/yyyy)

6.a. Applicant's Signature (sign in ink)

Part 10. Applicant's Statement, Contact Information, Declaration, Certification, and Signature (continued)

Interpreter's Mailing Address

3.c. City or Town

3.d. State 3.e. ZIP Code

3.f.

Postal Code

Street Number and Name

3.a.

3.b. Apt. Ste. Flr.

3.g.

3.h. Country

Province

Interpreter's Contact Information

4. Interpreter's Daytime Telephone Number 6. Interpreter's Email Address (if any) 5. Interpreter's Mobile Telephone Number (if any)

Interpreter's Certification

I am fluent in English and which is the same language specified in Part 10. , 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.

I certify, under penalty of perjury, that:

,

Interpreter's Signature

7.b. Date of Signature (mm/dd/yyyy)

7.a.^ Interpreter's Signature (sign in ink)

1.b. Preparer's Given Name (First Name)

2. Preparer's Business or Organization Name (if any)

Preparer's Full Name

Provide the following information about the preparer.

1.a. Preparer's Family Name (Last Name)

Part 12. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant

Preparer's Mailing Address

3.c. City or Town

3.d. State 3.e. ZIP Code

3.f.

Postal Code

Street Number and Name

3.a.

3.b. Apt. Ste. Flr.

3.g.

3.h. Country

Province

Preparer's Contact Information

5. Preparer's Mobile Telephone Number (if any) 4. Preparer's Daytime Telephone Number 6. Preparer's Email Address (if any)

Part 12. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant (continued)

Preparer's Statement

I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant's consent.

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 application.

I am an attorney or accredited representative and my representation of the applicant in this case extends does not extend beyond the

7.a.

7.b.

preparation of 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.

Preparer's Signature

8.a. Preparer's Signature (sign in ink)

8.b. Date of Signature (mm/dd/yyyy)

Part 13. Signature at Interview

I swear (affirm) and certify under penalty of perjury under the laws of the United States of America that I know that the contents of this Form I-485, Application to Register Permanent Residence or Adjust Status, subscribed by me, including the

Subscribed to and sworn to (affirmed) before me

USCIS Officer's Printed Name or Stamp

Applicant's Signature (sign in ink)

Date of Signature (mm/dd/yyyy)

USCIS Officer's Signature (sign in ink)

additional pages submitted by me with this Form I-485, on

corrections made to this application, numbered through , are complete, true, and correct. All

true, and correct. All documents submitted at this interview were provided by me and are complete, true, and correct.

numbered pages through are complete,

NOTE: Do not complete Part 13. until the USCIS Officer instructs you to do so at the interview.

Part 14. 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.

A-Number (if any) ► A-

3.a.

Page Number 3.b. Part Number 3.c. Item Number

3.d.

Page Number Part Number Item Number

5.a. Page Number Part Number Item Number

Page Number

5.b.

Part Number

5.c.

Item Number

5.d.

Page Number Part Number Item Number

1.b.

1.c.

1.a. Family Name (Last Name) Given Name (First Name) Middle Name

4.b. 4.c.

4.d.

4.a.

6.d.

6.a. 6.b. 6.c.

7.a. 7.b. 7.c.

7.d.