Form I-485 - Application To Register Permanent Residence Or Adjust Status Page 2
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6Part 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 Form I-94, Arrival-Departure Record
Place of Last Entry Into the United States
In what status did you last enter? (Visitor, student, exchange
(City/State)
visitor, crewman, temporary worker, without inspection, etc.)
Yes
No
Were you inspected by a U.S. Immigration Officer?
Nonimmigrant Visa Number
Consulate Where Visa Was Issued
Date Visa Issued (mm/dd/yyyy)
Gender
Marital Status
Married
Single
Divorced
Widowed
Male
Female
Have you ever applied for permanent resident status in the U.S.?
Yes (If "Yes" give date and place of
No
filing and final disposition.)
B. List your present spouse and all of your children (include adult sons and daughters). (If you have none, write "None." If additional
space is needed, see Page 2 of the instructions.)
Family Name (Last Name)
Given Name (First Name)
Middle Initial Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A # (if any)
Applying with you?
Yes
No
Family Name (Last Name)
Given Name (First Name)
Middle Initial Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A # (if any)
Applying with you?
Yes
No
Family Name (Last Name)
Given Name (First Name)
Middle Initial Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A # (if any)
Applying with you?
Yes
No
Family Name (Last Name)
Given Name (First Name)
Middle Initial Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A # (if any)
Applying with you?
Yes
No
Family Name (Last Name)
Given Name (First Name)
Middle Initial Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
A # (if any)
Applying with you?
Yes
No
Form I-485 (Rev. 07/15/10) Y Page 2
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