Form Ar-11 - Alien'S Change Of Address Card - Department Of Homeland Security
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1OMB No. 1615-0007; Exp. 10/31/04
Department of Homeland Security
Alien's Change of Address Card
Bureau of Citizenship and Immigration
I AM IN THE UNITED STATES AS:
(Middle)
NAME (Last in CAPS)
(First)
Visitor
Permanent Resident
(Specify)
Student
Other . . . . . . . .
COUNTRY OF
DATE OF BIRTH
COPY NUMBER FROM ALIEN CARD
CITIZENSHIP
A
PRESENT ADDRESS
(City or Post Office)
(Street or Rural Route)
(State)
(ZIP Code)
(IF ABOVE ADDRESS IS TEMPORARY) I expect to remain there
years
months
(ZIP Code)
LAST ADDRESS
(Street or Rural Route)
(City or Post Office)
(State)
I WORK FOR OR ATTEND SCHOOL AT: (Employer's Name or Name of School)
(City or Post Office)
(State)
(ZIP Code)
(Street Address or Rural Route)
DATE OF ENTRY INTO U.S
IF NOT A PERMANENT
PORT OF ENTRY INTO U.S.
RESIDENT, MY STAY IN
THE U.S. EXPIRES ON:
(Date)
SIGNATURE
DATE
AR-11 (Rev. 06/17/03)Y
ALIEN'S CHANGE OF ADDRESS CARD
This card is to be used by all aliens to report change of address within 10 days of such change.
The collection of this information is required by Section 265 of the I&N Act (8 U.S.C. 1305). The data used by the
Bureau of Citizenship and Immigration Service for statistical and record purposes and may be furnished to
federal, state, local and foreign law enforcement officials. Failure to report is punishable by fine or imprisonment
and/or deportation.
This card is not evidence of identity, age, or status claimed.
Public Reporting Burden. Under the Paperwork Reduction Act, an agency may not conduct or sponsor an
information collection and a person is not required to respond to an information collection unless it displays a
currently valid OMB control number. We try to create forms and instructions that are accurate, can be easily
understood, and which impose the least possible burden on you to provide us with information. Often this is
difficult because some immigration laws are very complex. This collection of information is estimated to
average 5 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including for
reducing this burden to: Bureau of Citizenship and Immigration Services, HQRFS, 425 I Street, N.W., Room 4034,
Washington, DC 20536; OMB No. 1615-0007
.
Do not mail your completed form to this address. MAIL
YOUR FORM TO THE ADDRESSES SHOWN BELOW:
For commercial overnight or fast freight
U.S. DEPARTMENT OF HOMELAND SECURITY
U.S. DEPARTMENT OF HOMELAND SECURITY
Bureau of Citizenship and Immigration Services
Bureau of Citizenship and Immigration Services
Change of Address
Change of Address
1084-I South Laurel Road
P.O. Box 7134
London, KY 40744
London, KY 40742-7134
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