Form I-90 - Application To Replace Permanent Resident Card - Department Of Homeland Security

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Application to Replace Permanent Resident Card
USCIS
Form I-90
Department of Homeland Security
OMB No. 1615-0082
U.S. Citizenship and Immigration Services
Expires 07/31/2019
Applicant Interviewed
Receipt
Action Block
Date:
Class of Admission
For
USCIS
Use
Only
Remarks
►
START HERE - Type or print in black ink.
Mailing Address
Part 1. Information About You
1.
Alien Registration Number (A-Number)
6.a. In Care Of Name
A-
6.b.
Street Number
2.
USCIS Online Account Number (if any)
and Name
►
6.c.
Apt.
Ste.
Flr.
Your Full Name
6.d. City or Town
NOTE: Your card will be issued in this name.
6.e. State
6.f.
ZIP Code
3.a. Family Name
(Last Name)
6.g. Province
3.b. Given Name
(First Name)
6.h. Postal Code
3.c.
Middle Name
6.i.
Country
4.
Has your name legally changed since the issuance of your
Permanent Resident Card?
Yes (Proceed to Item Numbers 5.a. - 5.c.)
Physical Address
No (Proceed to Item Numbers 6.a. - 6.i.)
Provide this information only if different than mailing address.
7.a. Street Number
N/A - I never received my previous card.
and Name
(Proceed to Item Numbers 6.a. - 6.i.)
7.b.
Apt.
Ste.
Flr.
Provide your name exactly as it is printed on your current
Permanent Resident Card.
7.c. City or Town
NOTE: Attach all evidence of your legal name change with
7.d. State
7.e. ZIP Code
this application.
5.a. Family Name
7.f.
Province
(Last Name)
5.b. Given Name
7.g.
Postal Code
(First Name)
7.h.
Country
5.c. Middle Name
Form I-90 02/27/17 N
Page 1 of 7

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