Form I-694 - Notice Of Appeal Of Decision

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OMB No. 1615-0034; Expires 09/30/2012
I-694, Notice of Appeal of
Department of Homeland Security
Decision Under Section 210 or 245A
U.S. Citizenship and Immigration Services
For USCIS use Only
Action Block
Fee Stamp
APPELLANT - START HERE: Please type or print in black ink.
In the Matter of:
File Number: A-
Application for one of the following:
Permanent Residence (I-698)
Temporary Residence (I-687)
Waiver of Grounds of Inadmissibility
in the above entitled case.
I hereby appeal to the USCIS Director from the decision, dated
My written brief or statement is attached.
I waive the right to submit a written brief or statement.
I will submit a brief within 30 calendar days.
Summarize the reasons for this appeal.
The appeal must include a statement explaining any error or conclusion of law in the
decision being appealed or any erroneous statement of fact stated in the decision.
Appellant (or Attorney or Representative): Please complete the following.
Name (Last Name, First Name, Full Middle Name)
Address ( Street Name and Number)
Telephone Number With Area Code
(City or Town)
(Zip Code)
(State)
Title or Relationship to Appellant, If Other Than Appellant
Date (mm/dd/yyyy)
Signature
Form I-694 (09/23/11) Y

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