Physical Address
Part 2. Information About You (continued)
Provide your physical addresses for the last five years. Provide
11.
Any Additional Form I-526 or Form I-829 Receipt
your present address first. If you need extra space to complete
Numbers for Other Petitions Filed by Entrepreneur
this section, use the space provided in Part 12. Additional
►
Information.
16.a. Street Number
Other Names You Have Used
and Name
List all other names you have ever used, including aliases,
16.b.
Apt.
Ste.
Flr.
maiden name, and nicknames. If you need extra space to
complete this section, use the space provided in Part 12.
16.c. City or Town
Additional Information.
16.d. State
16.e. ZIP Code
12.a. Family Name
(Last Name)
16.f.
Province
12.b. Given Name
(First Name)
16.g.
Postal Code
12.c. Middle Name
16.h.
Country
13.a. Family Name
(Last Name)
13.b. Given Name
Criminal History
(First Name)
17.
Since becoming a conditional permanent resident, have
13.c. Middle Name
you EVER been arrested, cited, charged, indicted,
convicted, fined, or imprisoned for violating any law or
Your U.S. Mailing Address
ordinance (excluding minor traffic violations)?
14.a. In Care Of Name (if any)
Yes
No
18.
Since becoming a conditional permanent resident, have
14.b.
Street Number
you EVER committed any crime for which you were not
and Name
arrested?
Yes
No
14.c.
Apt.
Ste.
Flr.
If you answered “Yes” to Item Number 17., you must provide
certified court dispositions, arrest reports, statements of charges,
14.d. City or Town
indictment information, or any other charging documents that
were issued. If you answered “Yes” to Item Number 18.,
14.e. State
14.f. ZIP Code
provide the date and location (town or city/state or province/
country) of the events and provide an explanation in the space
15.
Is your mailing address the same as your physical address?
provided in Part 12. Additional Information.
Yes
No
If you answered “No” to Item Number 15., you MUST
Part 3. Information About Your Current or
provide your current physical address in the Item Numbers
16.a. - 16.h. If you need extra space to complete this section,
Former Conditional Permanent Resident Spouse
use the space provided in Part 12. Additional Information.
NOTE: If you have both a current spouse and a former
conditional permanent resident spouse, use the space provided
in Part 12. Additional Information to provide this same
information about your current spouse or former conditional
permanent resident spouse who you did not already include in
Part 3. below.
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
Form I-829 04/21/17 N
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Instructions For Form I-829 - Petition By Entrepreneur To Remove Conditions On Permanent Resident Status
Legal
Uscis Form I-407 - Instructions For Record Of Abandonment Of Lawful Permanent Residential Status
Legal
