Form I-865 - Sponsor'S Notice Of Change Of Address
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5Sponsor's Notice of Change of Address
USCIS
Department of Homeland Security
Form I-865
U.S. Citizenship and Immigration Services
Returned
Resubmitted
Remarks
Action Block
For
USCIS
Date
Date
(mm/dd/yyyy)
(mm/dd/yyyy)
Use
Only
Date
(mm/dd/yyyy)
Date
(mm/dd/yyyy)
CSID Number:
►
START HERE - Type or print in black ink.
Part 1. Information About You (Sponsor)
Your New Mailing Address
6.a.
In Care Of Name (if any)
Your Full Name
1.a. Family Name
(Last Name)
6.b.
Street Number
and Name
1.b.
Given Name
(First Name)
6.c.
Apt.
Ste.
Flr.
1.c.
Middle Name
6.d.
City or Town
Other Information
6.e.
State
6.f.
ZIP Code
2.
Date of Birth (mm/dd/yyyy)
6.g.
Province
Your New Physical Address
6.h. Postal Code
3.a.
Street Number
6.i.
Country
and Name
3.b.
Apt.
Ste.
Flr.
7.
Effective Date of Change of Address (mm/dd/yyyy)
3.c.
City or Town
3.d.
State
3.e.
ZIP Code
Part 2. Information About the Sponsored
3.f.
Province
Immigrants
3.g. Postal Code
Provide the requested information on the persons you are
sponsoring.
3.h.
Country
Sponsored Immigrant 1
1.a. Family Name
4.
Effective Date of Change of Address (mm/dd/yyyy)
(Last Name)
1.b.
Given Name
(First Name)
5.
Is your new physical address the same as your new
1.c.
Middle Name
mailing address?
Yes
No
2.
Alien Registration Number (A-Number) (if any)
If you answered "No" to Item Number 5., provide your
►
A-
new mailing address in Item Numbers 6.a. - 7.
Form I-865 07/17/15 N
Page 1 of 5
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