Looking for a Form Eoir-42b Templates? Download it for free!

PART 3 - INFORMATION ABOUT YOUR PRESENCE IN THE UNITED STATES

18) I first arrived in the United States under the name of:

19) I first arrived in the United States on:

(Last, First, Middle)

(Month, Day, Year)

20) Place or port of first arrival:

(Place or Port, City, and State)

21) I:

was inspected and admitted.

I entered using my Lawful Permanent Resident card which is valid until

(Month, Day, Year)

I entered using a

visa which is valid until

(Specify Type of Visa)

(Month, Day, Year)

was not inspected and admitted.

I entered without documents. Explain:

I entered without inspection. Explain:

Other. Explain:

22) I applied on

for additional time to stay and it was

granted on

(Month, Day, Year)

and valid until

, or

denied on

(Month, Day, Year)

23) Since the date of my first entry, I departed from and returned to the United States at the following places and on the following dates:

(Please list all departures regardless of how briefly you were absent from the United States.)

If you have never departed from the United States since your original date of entry, please mark an X in this box:

Port of Departure (Place or Port, City and State)

Departure Date (Month, Day, Year)

Purpose of Travel

Destination

Inspected and Admitted?

Port of Return (Place or Port, City and State)

Return Date (Month, Day, Year)

Manner of Return

Yes

Port of Departure (Place or Port, City and State)

Departure Date (Month, Day, Year)

Purpose of Travel

Destination

Inspected and Admitted?

Port of Return (Place or Port, City and State)

Return Date (Month, Day, Year)

Manner of Return

Yes

24) Have you ever departed the United States:

a) under an order of deportation, exclusion, or removal?........................................

Yes

b) pursuant to a grant of voluntary departure?........................................................

Yes

PART 4 - INFORMATION ABOUT YOUR MARITAL STATUS AND SPOUSE

(Continued on page 3)

26) If married, the name of my spouse is:

27) My spouse’s name before marriage was:

(Last, First, Middle)

25) I am not married:

I am married:

28) The marriage took place in:

29) Date of marriage:

(City and Country)

(Month, Day, Year)

31) Place and date of birth of my spouse:

30) My spouse currently resides at:

(City & Country; Month, Day, Year)

Apt. number and/or in care of

32) My spouse is a citizen of:

(Country)

Number and Street

City or Town

State/Country

Zip Code

33) If your spouse is other than a native born United States citizen, answer the following:

He/she arrived in the United States at:

(Place or Port, City and State)

He/she arrived in the United States on:

(Month, Day, Year)

His/her alien registration number(s) is: A#

He/she was naturalized on:

(Month, Day, Year)

(City and State)

34) My spouse

- is

- is not employed. If employed, please give salary and the name and address of the place(s) of employment.

Full Name and Address of Employer

Earnings Per Week

(Approximate)

Please continue answers on a separate sheet as needed.

Form EOIR-42B

Revised July 2014

(2)

Form Eoir-42b - Application For Cancellation Of Removal And Adjustment Of Status For Certain Nonpermanent Residents Page 7

Related Articles

Related Categories