Form I-90 - Application To Replace Permanent Resident Card Page 2
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7Part 1. Information About You (continued)
Reason for Application (Select only one box)
Section A. (To be used only by a lawful permanent resident or
Additional Information
a permanent resident in commuter status.)
8.
Gender
Male
Female
2.a.
My previous card has been lost, stolen, or destroyed.
9.
Date of Birth
(mm/dd/yyyy)
2.b.
My previous card was issued but never received.
10.
City/Town/Village of Birth
2.c.
My existing card has been mutilated.
My existing card has incorrect data because of
2.d.
Department of Homeland Security (DHS) error.
11.
Country of Birth
(Attach your existing card with incorrect data along
with this application.)
2.e.
My name or other biographic information has been
Mother's Name
legally changed since issuance of my existing card.
12.
Given Name
2.f.
My existing card has already expired or will expire
(First Name)
within six months.
Father's Name
2.g.1.
I have reached my 14th birthday and am registering
as required. My existing card will expire AFTER my
Given Name
13.
16th birthday. (See NOTE below for additional
(First Name)
information.)
14.
Class of Admission
2.g.2.
I have reached my 14th birthday and am registering
as required. My existing card will expire BEFORE
my 16th birthday. (See NOTE below for additional
15.
Date of Admission
information.)
(mm/dd/yyyy)
NOTE: If you are filing this application before your
16.
U.S. Social Security Number (if any)
14th birthday, or more than 30 days after your 14th
►
birthday, you must select reason 2.j. However, if
your card has expired, you must select reason 2.f.
2.h.1.
I am a permanent resident who is taking up commuter
Part 2. Application Type
status.
NOTE: If your conditional permanent resident status (for
My Port-of-Entry (POE) into the United States will be:
2.h.1.a.
example: CR1, CR2, CF1, CF2) is expiring within the next 90
City or Town and State
days, then do not file this application. (See the What is the
Purpose of This Application section of the Form I-90
Instructions for further information.)
2.h.2.
I am a commuter who is taking up actual residence in
My status is (Select only one box):
the United States.
2.i.
1.a.
Lawful Permanent Resident (Proceed to Section A.)
I have been automatically converted to lawful
permanent resident status.
1.b.
Permanent Resident - In Commuter Status
2.j.
(Proceed to Section A.)
I have a prior edition of the Alien Registration Card,
or I am applying to replace my current Permanent
1.c.
Conditional Permanent Resident
Resident Card for a reason that is not specified above.
(Proceed to Section B.)
Form I-90 02/27/17 N
Page 2 of 7
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