Address Reporting Requirement Form - U.s. Department Of Justice

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UNITED STATES DEPARTMENT OF JUSTICE
EXECUTIVE OFFICE FOR IMMIGRATION REVIEW
IMMIGRATION COURT
(City, State)
Date:
Master Calendar Certification
I certify that, in open court this date, I explained to the respondent, both in English and: _____
Spanish; _________________________, the following legal requirements:
ADDRESS REPORTING REQUIREMENT
The respondent must keep this office informed of his or her correct mailing address and
telephone number. All changes in address or phone number must be reported to this office within
five (5) days of the change. The respondent was given two (blue) Forms EOIR-33/IC “Alien’s
Change of Address Form/Immigration Court.”
CONSEQUENCES OF FAILURE TO APPEAR
The respondent was told that, if he or she does not appear on time for the next scheduled hearing,
it is likely that an order of removal and deportation will be entered against him or her, and he or
she will then become subject to immediate arrest and deportation from this country, without any
further hearing before me or review of the case by a higher court. Furthermore, that he or she
will lose for ten (10) years, all rights to apply for most forms of relief including voluntary
departure, cancellation of removal, adjustment of status, change of status, and registry.

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