Form I-751 - Petition To Remove Conditions On Residence
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11USCIS
Petition to Remove Conditions on Residence
Form I-751
Department of Homeland Security
OMB No. 1615-0038
U.S. Citizenship and Immigration Services
Expires 11/30/2017
Receipt
Action Block
Remarks
For
USCIS
Use
Reloc Sent
Reloc Received
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
Only
/
/
/
/
/
/
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
/
/
/
/
/
/
Petitioner interviewed on (mm/dd/yyyy)
/
/
/
Approved under INA 216(c)(4)(C) Battered Spouse/Child
Attorney State Bar Number
Select this box if
Attorney or Accredited Representative
To be completed by an
(if applicable)
Form G-28 is
USCIS Online Account Number (if any)
attorney or accredited
attached.
representative (if any).
►
START HERE - Type or print in black ink.
5.
Country of Birth
Part 1. Information About You, the Conditional
Resident
1.a. Family Name
6.
Country of Citizenship or Nationality (provide all that
(Last Name)
apply)
1.b. Given Name
(First Name)
7.
Alien Registration Number (A-Number) (if any)
1.c. Middle Name
►
A-
Other Names Used
8.
U.S. Social Security Number (if any)
►
List all other names you have ever used, including aliases,
maiden name, and nicknames. If you need extra space to
9.
USCIS Online Account Number (if any)
complete this section, use the space provided in Part 11.
►
Additional Information.
2.a. Family Name
Marital Status
(Last Name)
2.b. Given Name
10.
Marital Status
(First Name)
Single
Married
Divorced
Widowed
2.c. Middle Name
11.
Date of Marriage (mm/dd/yyyy)
3.a. Family Name
(Last Name)
12.
Place of Marriage
3.b. Given Name
(First Name)
13.
If the marriage through which you gained conditional
3.c. Middle Name
residence has ended, provide the date it ended (date of
divorce or date of death) (mm/dd/yyyy)
Other Information
4.
Date of Birth (mm/dd/yyyy)
14.
Conditional Residence Expires On (mm/dd/yyyy)
Form I-751 12/23/16 N
Page 1 of 11
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