Form I-485 - Application To Register Permanent Residence Or Adjust Status Page 6
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A-Number
A-
3.
Date of Birth (mm/dd/yyyy)
Part 3. Additional Information About You
(continued)
4.
Sex
Male
Female
Provide your most recent employment outside of the United
5.
City or Town of Birth
States (if not already listed above).
19.
Name of Employer or Company
6.
Country of Birth
Address of Employer or Company
7.
Current City or Town of Residence (if living)
20.a.
Street Number
and Name
20.b.
Apt.
Ste.
Flr.
8.
Current Country of Residence (if living)
20.c.
City or Town
Information About Your Parent 2
20.d.
State
20.e.
ZIP Code
Parent 2's Legal Name
20.f.
Province
9.a. Family Name
20.g. Postal Code
(Last Name)
9.b.
Given Name
20.h.
Country
(First Name)
9.c.
Middle Name
21.
Your Occupation
Parent 2's Name at Birth (if different than above)
10.a. Family Name
(Last Name)
Dates of Employment
10.b.
Given Name
22.a.
From (mm/dd/yyyy)
(First Name)
10.c.
Middle Name
22.b.
To (mm/dd/yyyy)
11.
Date of Birth (mm/dd/yyyy)
Part 4. Information About Your Parents
12.
Sex
Male
Female
Information About Your Parent 1
13.
City or Town of Birth
Parent 1's Legal Name
1.a. Family Name
14.
Country of Birth
(Last Name)
1.b.
Given Name
(First Name)
15.
Current City or Town of Residence (if living)
Middle Name
1.c.
16.
Current Country of Residence (if living)
Parent 1's Name at Birth (if different than above)
2.a. Family Name
(Last Name)
2.b.
Given Name
(First Name)
2.c.
Middle Name
Form I-485 06/26/17 N
Page 6 of 18
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Parent category: Legal