Form I-821 - Application For Temporary Protected Status Page 5
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13Second Marriage
Part 5. Information About Your Former
Spouses (if any)
11.a. Family Name
(Last Name)
Complete this section only if you are filing a late initial
11.b. Given Name
application for TPS. See the form instructions for information
(First Name)
on requirements for late initial filing for TPS. If you need extra
11.c. Middle Name
space to complete this section on all former spouses or all of
your children, please use the space provided in Part 11.
12.
Nationalities of Former Spouse
Additional Information.
Names of All Your Former Spouses (if any)
13.
A-Number of Former Spouse (if any and if known)
First Marriage
A-
1.a. Family Name
14.
Date of Birth of Former Spouse
(Last Name)
(mm/dd/yyyy)
1.b. Given Name
(First Name)
15.
Date of Death if Former Spouse Deceased
1.c. Middle Name
(mm/dd/yyyy)
2.
Nationalities of Former Spouse
Dates of Marriage to Former Spouse
16.a.
From (mm/dd/yyyy)
3.
A-Number of Former Spouse (if any and if known)
16.b.
To (mm/dd/yyyy)
►
A-
17.
How Marriage Ended (for example, divorce, widowed,
annulled)
4.
Date of Birth of Former Spouse
(mm/dd/yyyy)
5.
Date of Death if Former Spouse Deceased
18.
Did or does this former spouse have TPS (if known)?
(mm/dd/yyyy)
Yes
No
I Do Not Know
Dates of Marriage to Former Spouse
If yes, what dates did he or she have TPS (if known)?
6.a.
From (mm/dd/yyyy)
19.a. From (mm/dd/yyyy)
6.b.
To (mm/dd/yyyy)
19.b.
To (mm/dd/yyyy)
How Marriage Ended (for example, divorce, widowed,
7.
19.c.
Present
annulled)
19.d.
I do not know the dates
20.
Is this former spouse currently applying for or re-
registering for TPS (if known)?
8.
Did or does this former spouse have TPS (if known)?
Yes
No
I Do Not Know
Yes
No
I Do Not Know
If yes, what dates did he or she have TPS (if known)?
9.a. From (mm/dd/yyyy)
9.b.
To (mm/dd/yyyy)
9.c.
Present
9.d.
I do not know the dates
10.
Is this former spouse currently applying for or re-
registering for TPS (if known)?
Yes
No
I Do Not Know
Form I-821 10/19/17 N
Page 5 of 13
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