Information & Request Form - Dekalb County Page 2
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1
2DeKalb Family Law Information Center
R
S
V
— F
N
-C
O
ESIDENT
TATUS
ERIFICATION
OR
ON
ITIZENS
NLY
If you are not a U.S. Citizen, please check the boxes that apply to your resident status in this chart. Then,
sign your name on the line below the chart. We must also make copies of your INS or CIS documents
showing your residency status. If you are a U.S. Citizen, please skip this chart.
Usual INS/CIS Forms
Non-Citizen Resident Status in U.S.
(Other forms may also be acceptable.)
I-551 or I-151 (“green card”)
G I am a permanent resident
I-94 stamped admitted for permanent residence
G I am a refugee
I-94 or passport stamped "refugee" or "§207"
G I have been granted asylum
I-94 or passport stamped "asylee" or "§208"
I am: G married to a US citizen OR
G the parent of a US citizen OR
Proof of relationship to US citizen, such as
G unmarried, under age 21, child of US citizen
marriage certificate or birth certificate
AND
AND
G I have applied for permanent residency
I-485 or I-360 (application for adjustment of
status) + proof of filing
AND
G I have not been rejected or turned down
G The US government has granted me withholding from a
I-94 stamped "§243(h)" or "§241(b)"
I-94 o r passp ort stam ped "conditional entrant"
deportation order
I-571 refugee travel document
(because my life or freedom would be threatened in my home
country because of my race, religion, nationality, membership in a
)
social group, or my political opinion
G I am a special agricultural worker (SAW) with temporary
I-688, or I-766 showing issuance under §210
resident status
G I am a foreign national asking for help under the Hague
Convention about custody of my child
G I am a victim (or my child is a victim) of:
No immigration documents required.
G battery or extreme cruelty in the U.S., OR
But, we need copies of any do cuments
G sexual assault or human trafficking in the U.S., OR
available about the abuse or other crime against
you (such as police repo rts, hospital records,
G other criminal activity in the U.S., and qualify for a
court orders).
“U” visa
G None of these apply to me . . . . . . . . . . . Not eligible for legal consultation. Refer to Fulton County FLIC.
(Client Signature)
Print client’s name:
DeKalb FLIC Atty consult request.wpd
Rev. 1/07
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