Application to Register Permanent Residence
or Adjust Status
USCIS
Form I-485
Department of Homeland Security
OMB No. 1615-0023
U.S. Citizenship and Immigration Services
Expires 06/30/2019
For USCIS Use Only
Receipt
Action Block
Preference Category:
Country Chargeable:
Priority Date:
Date Form I-693 Received:
Section of Law
Applicant
Interview
INA 209(a)
INA 249
Interviewed
Waived
INA 209(b)
Sec. 13, Act of 9/11/57
Date of
Initial Interview:
INA 245(a)
Cuban Adjustment Act
INA 245(i)
Other
Lawful Permanent
Resident as of:
INA 245(m)
To be completed by an attorney or accredited representative (if any).
Select this box if
Volag Number
Attorney State Bar Number
Attorney or Accredited Representative
Form G-28 is
(if any)
(if applicable)
USCIS Online Account Number (if any)
attached.
►
►
START HERE - Type or print in black ink.
A-Number
A-
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or fail to submit required documents listed in the
Instructions, U.S. Citizenship and Immigration Services (USCIS) may deny your application.
3.a. Family Name
Part 1. Information About You (Person applying
(Last Name)
for lawful permanent residence)
3.b.
Given Name
(First Name)
Your Current Legal Name (do not provide a
3.c.
Middle Name
nickname)
1.a. Family Name
4.a. Family Name
(Last Name)
(Last Name)
1.b.
Given Name
4.b.
Given Name
(First Name)
(First Name)
1.c.
Middle Name
4.c.
Middle Name
Other Names You Have Used Since Birth (if
Other Information About You
applicable)
5.
Date of Birth (mm/dd/yyyy)
NOTE: Provide all other names you have ever used, including
NOTE: In addition to providing your actual date of birth,
your family name at birth, other legal names, nicknames,
include any other dates of birth you have used in
aliases, and assumed names. If you need extra space to
connection with any legal names or non-legal names in
complete this section, use the space provided in Part 14.
the space provided in Part 14. Additional Information.
Additional Information.
2.a. Family Name
6.
Sex
Male
Female
(Last Name)
2.b.
Given Name
7.
City or Town of Birth
(First Name)
2.c.
Middle Name
Form I-485 06/26/17 N
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