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Item Number 4. U.S. Social Security Number (if any). Provide your U.S. Social Security Number, if you have one. If

you have been issued or have previously used more than one Social Security Number, use the space provided in Part 12.

Additional Information to list all the Social Security Numbers that have been issued to you or that you have previously

used.

Item Number 5. Date of Birth. Provide your date of birth in a mm/dd/yyyy format.

Item Number 6. Gender. Indicate whether you are male or female.

Item Number 7. Country of Birth. Provide the name of the country where you were born.

Item Number 8. Country of Citizenship or Nationality. Provide the name of the country where you are a citizen and/

or national. This is not necessarily the country where you were born. If you do not have citizenship in any country, type

or print “stateless” and provide an explanation in Part 12. Additional Information.

Item Number 9. Date of Admission as a Conditional Permanent Resident. Provide the date you first entered the

United States as a conditional permanent resident or the date you adjusted status. Refer to the date listed as “Resident

Since” on your Form I-551, Permanent Resident Card.

Item Number 10. Form I-526 Receipt Number. Provide the receipt number for the approved Form I-526, Immigrant

Petition by Alien Entrepreneur, on which this petition is based.

Item Number 11. Additional Form I-526 or I-829 Receipt Numbers. Provide the receipt numbers for any additional

Form I-526, Immigrant Petition by Alien Entrepreneur, or Form I-829, Petition by Entrepreneur to Remove Conditions to

Permanent Resident Status, filed by the entrepreneur.

Item Numbers 12.a. - 13.c. Other Names You Have Used (including maiden names, nicknames, and aliases, if any).

Provide all the names you have ever used, including maiden names, married names, nicknames and aliases, in the spaces

provided. Use the space provided in Part 12. Additional Information to provide additional names.

Item Numbers 14.a. - 14.f. Your U.S. Mailing Address. Provide the address where you would like to receive printed

notices about your petition. If your petition is approved, this is also the address that USCIS will use to mail your new

Permanent Resident Card.

NOTE: Do not provide a PO Box or the address of your attorney or accredited representative.

Item Number 15. Your Physical Address. Indicate whether your physical address is the same as the mailing address

you provided in Item Numbers 14.a. - 14.f.

Item Numbers 16.a. - 16.h. Your Physical Address. If you answered “No” to Item Number 15., you must provide your

current physical address, the address where you live.

Item Numbers 17. - 18. Criminal History. Indicate whether you have ever been arrested, cited, charged, indicted,

convicted, fined, or imprisoned for violating any law or ordinance. Also, indicate if you have ever committed any crime

for which you were not arrested.

NOTE: If you answered “Yes” to Item Number 17., you must provide certified court dispositions, arrest reports,

statements of charges, indictment information, and any other charging documents that were issued. If you answered “Yes”

to Item Number 18., you must provide the date and location (town or city, state or province, and country) of the events

and provide an explanation in Part 12. Additional Information.

See the What Evidence Must You Submit section of these Instructions for information on required documents.

Form I-829 Instructions 04/21/17 N

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Instructions For Form I-829 - Petition By Entrepreneur To Remove Conditions On Permanent Resident Status Page 4