Form I-192 - Application For Advance Permission To Enter As A Nonimmigrant Page 2

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Part 2. Information About You (continued)
7.
Physical Address
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
ZIP Code
Province
Postal Code
Country
Provide the addresses where you have resided during the past five years, starting with the last place you lived prior to your
8.
current physical address listed under Item Number 7. If you need extra space to complete this section, use the space provided
in Part 7. Additional Information.
A.
Residence Number 1
Date of Residence From (mm/dd/yyyy)
To (mm/dd/yyyy)
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
ZIP Code
Province
Postal Code
Country
B.
Residence Number 2
Date of Residence From (mm/dd/yyyy)
To (mm/dd/yyyy)
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
Province
Postal Code
Country
C.
Residence Number 3
Date of Residence From (mm/dd/yyyy)
To (mm/dd/yyyy)
Street Number and Name
Apt.
Ste.
Flr. Number
City or Town
State
ZIP Code
Province
Postal Code
Country
Form I-192 12/23/16 N
Page 2 of 8

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