Form I-485 - Application To Register Permanent Residence Or Adjust Status Page 3
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6Part 3. Processing Information (Continued)
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 military service in this part. If none,
write "None." Include the name of each organization, location, nature, and dates of membership. If additional space is needed,
attach a separate sheet of paper. Continuation pages must be submitted according to the guidelines provided on Page 2 of the
instructions under "What Are the General Filing Instructions?"
Date of Membership
Date of Membership
Name of Organization
Location and Nature
From
To
Answer the following questions. (If your answer is "Yes" to any question, explain on a separate piece of paper. Continuation pages
must be submitted according to the guidelines provided on Page 2 of the instructions under "What Are the General Filing
Instructions?" Information about documentation that must be include with your application is also provide in this section.) 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
Yes
No
arrested?
b. Been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law
Yes
No
or ordinance, excluding traffic violations?
c. Been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency, or similar action?
Yes
No
d. Exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States?
Yes
No
2. Have you received public assistance in the United States from any source, including the U.S. Government or
Yes
No
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 10 years been a prostitute or procured anyone for prostitution, or intend to engage in such
Yes
No
activities in the future?
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
Yes
No
illegally?
d. Illicitly trafficked in any controlled substance, or knowingly assisted, abetted, or colluded in the illicit
Yes
No
trafficking of any controlled substance?
4. Have you EVER engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited
Yes
No
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?
Form I-485 (Rev. 07/15/10) Y Page 3
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