Form I-485 Form I-485 Application to Register Permanent Residence or Adjust St

OMB No. 1615-0023; Expires 11/30/2011

I-485, Application to Register
Permanent Residence or Adjust Status

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

For USCIS Use Only

START HERE - Type or print in black ink.
Part 1. Information About You
Family Name

Given Name

Receipt

Returned
Middle Name

Address- C/O
Resubmitted
Street Number
and Name

Apt. #

City
Reloc Sent
State

Zip Code

Date of Birth (mm/dd/yyyy) Country of Birth:
Country of Citizenship/Nationality:
U.S. Social Security #

A # (if any)

Date of Last Arrival (mm/dd/yyyy)

I-94 #

Current USCIS Status

Expires on (mm/dd/yyyy)

Part 2.

DRAFT

Application Type (Check one)

I am applying for an adjustment to permanent resident status because:
a.

b.

An immigrant petition giving me an immediately available immigrant visa number that has
been approved. (Attach a copy of the approval notice, or a relative, special immigrant juvenile,
or special immigrant military visa petition filed with this application that will give you an
immediately available visa number, if approved.)
My spouse or parent applied for adjustment of status or was granted lawful permanent
residence in an immigrant visa category that allows derivative status for spouses and children.

Reloc Rec'd

Applicant
Interviewed

Section of Law
Sec. 209(b), INA
Sec. 13, Act of 9/11/57
Sec. 245, INA
Sec. 249, INA
Sec. 1 Act of 11/2/66
Sec. 2 Act of 11/2/66
Other

c.

I entered as a K-1 fiancé(e) of a U.S. citizen whom I married within 90 days of entry, or I am
the K-2 child of such a fiancé(e). (Attach a copy of the fiancé(e) petition approval notice and
the marriage certificate).

Country Chargeable

d.

I was granted asylum or derivative asylum status as the spouse or child of a person granted
asylum and am eligible for adjustment.

Eligibility Under Sec. 245

e.

I am a native or citizen of Cuba admitted or paroled into the United States after January 1,
1959, and thereafter have been physically present in the United States for at least one year.

f.

I am the husband, wife, or minor unmarried child of a Cuban described above in (e), and I am
residing with that person, and was admitted or paroled into the United States after January 1,
1959, and thereafter have been physically present in the United States for at least one year.

g.

I have continuously resided in the United States since before January 1, 1972.

h.

Other basis of eligibility. Explain (for example, I was admitted as a refugee, my status has not
been terminated, and I have been physically present in the United States for one year after
admission). If additional space is needed, use a separate piece of paper.

Approved Visa Petition
Dependent of Principal Alien
Special Immigrant
Other

Preference
Action Block

I am already a permanent resident and am applying to have the date I was granted permanent

residence adjusted to the date I originally arrived in the United States as a nonimmigrant or
parolee, or as of May 2, 1964, whichever date is later, and: (Check one)
i.

I am a native or citizen of Cuba and meet the description in (e) above.

j.

I am the husband, wife, or minor unmarried child of a Cuban and meet the description in (f)
above.

To be Completed by
Attorney or Representative, if any
Fill in box if G-28 is attached to represent the
applicant.
VOLAG #
ATTY State License #
Form I-485 (Rev. 12/05/08) Y

Part 3. Processing Information
A. City/Town/Village of Birth

Current Occupation

Your Mother's First Name

Your Father's First Name

Give your name exactly as it appears on your Arrival-Departure Record (Form I-94)
Place of Last Entry Into the United States (City/State)

In what status did you last enter? (Visitor, student, exchange
alien, crewman, temporary worker, without inspection, etc.)

Were you inspected by a U.S. Immigration Officer?

Yes

No

Nonimmigrant Visa Number
Date Visa Was Issued
(mm/dd/yyyy)

Consulate Where Visa Was Issued

Gender:

Male

Female

Have you ever before applied for permanent resident status in the U.S.?

Marital
Status:

Married

No

Single

Divorced

Widowed

Yes. If you checked "Yes," give date and place of
filing and final disposition.

B. List your present husband/wife, all of your sons and daughters (If you have none, write "None." If additional space is needed, use separate paper).
Family Name

Given Name

Middle Initial

Date of Birth (mm/dd/yyyy)

Country of Birth

Relationship

A
#

Applying with you?
Yes
No

Family Name

Given Name

Middle Initial

Date of Birth (mm/dd/yyyy)

Country of Birth

Relationship

A
#

Applying with you?

Family Name

Given Name

Middle Initial

Date of Birth (mm/dd/yyyy)

Country of Birth

Relationship

A
#

Applying with you?

DRAFT

Yes

Yes

No

No

Family Name

Given Name

Middle Initial

Date of Birth (mm/dd/yyyy)

Country of Birth

Relationship

A
#

Applying with you?
Yes

No

Family Name

Given Name

Middle Initial

Date of Birth (mm/dd/yyyy)

Country of Birth

Relationship

A
#

Applying with you?
Yes

No

C. List your present and past membership in or affiliation with every organization, association, fund, foundation, party, club, society, or similar group
in the United States or in other places since your 16th birthday. Include any foreign military service in this part. If none, write "None." Include the
name(s) of organization(s), location(s), dates of membership from and to, and the nature of the organization(s). If additional space is needed, use a
separate piece of paper.

Form I-485 (Rev. 12/05/08) Y Page 2

Part 3. Processing Information (Continued)
Answer the following questions. (If your answer is "Yes" on any one of these questions, explain on a separate piece of paper and refer to "What Are
the General Filing Instructions? Initial Evidence" to determine what documentation to include with your application. Answering "Yes" does not
necessarily mean that you are not entitled to adjust status or register for permanent residence.)
1. Have you ever, in or outside the United States:
a.

Knowingly committed any crime of moral turpitude or a drug-related offense for which you have not been arrested?

Yes

No

b. Been arrested, cited, charged, indicted, fined, or imprisoned for breaking or violating any law or ordinance,
excluding traffic violations?

Yes

No

c.

Yes

No

Yes

No

Yes

No

Yes

No

b. Engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling?

Yes

No

c.

Knowingly encouraged, induced, assisted, abetted, or aided any alien to try to enter the United States illegally?

Yes

No

d. Illicitly trafficked in any controlled substance, or knowingly assisted, abetted, or colluded in the illicit trafficking of
any controlled substance?

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

6. Have you ever been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party?

Yes

No

7. Did you, during the period from March 23, 1933, to May 8, 1945, in association with either the Nazi Government of
Germany or any organization or government associated or allied with the Nazi Government of Germany, ever order, incite,
assist, or otherwise participate in the persecution of any person because of race, religion, national origin, or political opinion?

Yes

No

8. Have you ever engaged in genocide, or otherwise ordered, incited, assisted, or otherwise participated in the killing of any
person because of race, religion, nationality, ethnic origin, or political opinion?

Yes

No

9. Have you ever been deported from the United States, or removed from the United States at government expense, excluded
within the past year, or are you now in exclusion, deportation, removal, or rescission proceedings?

Yes

No

10. Are you under a final order of civil penalty for violating section 274C of the Immigration and Nationality Act for use of
fraudulent documents or have you, by fraud or willful misrepresentation of a material fact, ever sought to procure, or
procured, a visa, other documentation, entry into the United States, or any immigration benefit?

Yes

No

11. Have you ever left the United States to avoid being drafted into the U.S. Armed Forces?

Yes

No

12. Have you ever been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence requirement and
have not yet complied with that requirement or obtained a waiver?

Yes

No

13. Are you now withholding custody of a U.S. citizen child outside the United States from a person granted custody of the child?

Yes

No

Yes

No

Been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action?

d. Exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States?
2. 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), or are you likely to receive public assistance in the
future?
3. Have you ever:
a.

Within the past ten years been a prostitute or procured anyone for prostitution, or intend to engage in such activities
in the future?

DRAFT

4. Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited membership or
funds for, or have you through any means ever assisted or provided any type of material support to any person or
organization that has ever engaged or conspired to engage in sabotage, kidnapping, political assassination, hijacking, or any
other form of terrorist activity?
5. Do you intend to engage in the United States in:
a.

Espionage?

b. Any activity a purpose of which is opposition to, or the control or overthrow of, the Government of the United
States, by force, violence, or other unlawful means?
c.

Any activity to violate or evade any law prohibiting the export from the United States of goods, technology, or
sensitive information?

14. Do you plan to practice polygamy in the United States?

Form I-485 (Rev. 12/05/08) Y Page 3

Part 4. Signature (Read the information on penalties in the instructions before completing this section. You must file this
application while in the United States.)

Your Registration With U.S. Citizenship and Immigration Services
"I understand and acknowledge that, under section 262 of the Immigration and Nationality Act (Act), as an alien who has been or will
be in the United States for more than 30 days, I am required to register with U.S. Citizenship and Immigration Services. I understand
and acknowledge that, under section 265 of the Act, I am required to provide USCIS with my current address and written notice of
any change of address within ten days of the change. I understand and acknowledge that USCIS will use the most recent address that I
provide to USCIS, on any form containing these acknowledgements, for all purposes, including the service of a Notice to Appear
should it be necessary for USCIS to initiate removal proceedings against me. I understand and acknowledge that if I change my
address without providing written notice to USCIS, I will be held responsible for any communications sent to me at the most recent
address that I provided to USCIS. I further understand and acknowledge that, if removal proceedings are initiated against me and I fail
to attend any hearing, including an initial hearing based on service of the Notice to Appear at the most recent address that I provided
to USCIS or as otherwise provided by law, I may be ordered removed in my absence, arrested, and removed from the United States."

Selective Service Registration
The following applies to you if you are a male at least 18 years of age, but not yet 26 years of age, who is required to register
with the Selective Service System: "I understand that my filing Form I-485 with U.S. Citizenship and Immigration Services
authorizes USCIS to provide certain registration information to the Selective Service System in accordance with the Military Selective
Service Act. Upon USCIS acceptance of my application, I authorize USCIS to transmit to the Selective Service System my name,
current address, Social Security Number, date of birth, and the date I filed the application for the purpose of recording my Selective
Service registration as of the filing date. If, however, USCIS does not accept my application, I further understand that, if so required, I
am responsible for registering with the Selective Service by other means, provided I have not yet reached age 26."

Applicant's Certification

DRAFT

I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted
with it is all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration
Services (USCIS) needs to determine eligibility for the benefit I am seeking.

Signature

Print Your Name

Date

Daytime Phone Number

(

)

NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be
found eligible for the requested document and this application may be denied.

Part 5. Signature of Person Preparing Form, If Other Than Above (Sign below)
I declare that I prepared this application at the request of the above person, and it is based on all information of which I have
knowledge.
Signature

Firm Name
and Address

Print Your Full Name

Date

Phone Number
(Include Area Code)

E-Mail Address (if any)

Form I-485 (Rev. 12/05/08) Y Page 4