OMB No. 1615-0023 (Expires 05-31-05)
I-485, Application to Register
Permanent Residence or Adjust Status
Department of Homeland Security
U.S. Citizenship and Immigration Services
What Is the Purpose of This Form?
Based on Cuban citizenship or nationality.
You may apply to adjust status if:
You are a native or citizen of Cuba, were admitted or
paroled into the United States after January 1, 1959, and
thereafter have been physically present in the United
States for at least one year; or
This form is used by a person who is in the United States to
apply to the U.S. Citizenship and Immigration Services
(USCIS), to adjust to permanent resident status or register for
permanent residence.
.
This form may also be used by certain Cuban nationals to
request a change in the date that their permanent residence
began.
.
NOTE: USCIS is comprised of offices of the former
Immigration and Naturalization Service (INS).
Who May File?
Based on an immigrant petition.
You may apply to adjust your status if:
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An immigrant visa number is immediately available to you
based on an approved immigrant petition; or
You are filing this application with a completed relative
petition, special immigrant juvenile petition or special
immigrant military petition which if approved would
make an immigrant visa number immediately available
to you.
Based on being the spouse or child (derivative) at the time
another adjustment applicant (principal) files to adjust
status or at the time a person is granted permanent resident
status in an immigrant category that allows derivative status
for spouses and children.
.
.
If the spouse or child is in the United States, the
individual derivatives may file their Form I-485 adjustment
of status applications concurrently with the Form I-485
for the principal applicant, or file the Form I-485 at
anytime after the principal is approved, if a visa number is
available.
If the spouse or child is residing abroad, the person
adjusting status in the United States should file the Form
I-824, Application for Action on an Approved Application
or Petition, concurrently with the principal's adjustment
of status application to allow the derivatives to immigrate
to the United States without delay if the principal's
adjustment of status application is approved. The fee
submitted with the Form I-824 will not be refunded if the
principal's adjustment is not granted.
Based on admission as the fiancé(e) of a U. S. citizen and
subsequent marriage to that citizen.
You may apply to adjust status if you were admitted to the
United States as the K-1 fiancé(e) of a United States citizen
and you married that citizen within 90 days of your entry. If
you were admitted as the K-2 child of such a fiancé(e), you
may apply to adjust status based on your parent's adjustment
application.
Based on asylum status.
You may apply to adjust status after you have been granted
asylum in the United States if you have been physically
present in the United States for one year after the grant of
asylum, provided you still qualify as an asylee or as the
spouse or child of a refugee.
You are the spouse or unmarried child of a Cuban
described above and regardless of your nationality, you
were admitted or paroled after January 1, 1959, and
thereafter have been physically present in the United
States for at least one year.
Applying to change the date on which your permanent
residence began.
If you were granted permanent residence in the United States
prior to November 6, 1966, and are a native or citizen of Cuba,
his or her spouse or unmarried minor child, you may ask to
change the date your lawful permanent residence began to
your date of arrival in the United States or May 2, 1964,
whichever date is later.
Based on continuous residence since before January 1, 1972.
You may apply for permanent residence if you have
continuously resided in the United States since before
January 1, 1972.
Other basis of eligibility.
If you are not included in the above categories, but believe
you may be eligible for adjustment or creation of record of
permanent residence, contact our National Customer Service
Center at 1-800-375-5283 for information on how to use
InfoPass on our internet website (www.uscis.gov). InfoPass
can help you make an appointment at your local USCIS office
concerning your possible eligibiltiy.
Persons Who Are Not Eligible to Adjust Status.
Unless you are applying for creation of record based on
continuous residence since before January 1, 1972, or
adjustment of status under a category in which special rules
apply (such as 245(i) adjustment, asylum adjustment, Cuban
adjustment, special immigrant juvenile adjustment, or special
immigrant military personnel adjustment), you are not eligible
for adjustment of status if any of the following apply to you:
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.
.
.
.
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You entered the United States in transit without a visa;
You entered the United States as a nonimmigrant crewman;
You were not admitted or paroled following inspection by
an immigration officer;
Your authorized stay expired before you filed this
application;
You were employed in the United States, without USCIS
authorization, prior to filing this application;
You failed to maintain your nonimmigrant status, through
no fault of your own or for technical reasons; unless you
are applying because you are:
-- An immediate relative of a United States citizen (parent,
spouse, widow, widower or unmarried child under 21
years old);
-- A K-1 fiancé(e) or a K-2 fiancé(e) dependent who married
the United States petitioner within 90 days of admission;
or
Form I-485 Instructions (Rev. 04/22/05)N (Prior editions to be used until 09/30/05)
--
--
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.
.
.
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An H or I nonimmigrant or special immigrant (foreign
medical graduates, international organization
employees or their derivative family members);
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You were admitted as a K-1 fiancé(e), but did not marry
the U.S. citizen who filed the petition for you, or you were
admitted as the K-2 child of a fiancé(e) and your parent
did not marry the U.S. citizen who filed the petition;
You are or were a J-1 or J-2 exchange visitor and are
subject to the two-year foreign residence requirement and
you have not complied with or been granted a waiver of
the requirement;
You have A, E or G nonimmigrant status or have an
occupation that would allow you to have this status,
unless you complete Form I-508 (I-508F for French
nationals) to wave diplomatic rights, privileges and
immunities and, if you are an A or G nonimmigrant, unless
you submit a completed Form I-566;
You were admitted to Guam as a visitor under the Guam
visa waiver program;
You were admitted to the United States as a visitor under
the Visa Waiver Program, unless you are applying
because you are an immediate relative of a U.S. citizen
(parent, spouse, widow, widower or unmarried child under
21 years old); or
.
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You are already a conditional permanent resident.
General Filing Instructions.
Please answer all questions by typing or clearly printing in
black ink. Indicate that an item is not applicable with "N/A."
If the answer is "none," write "none." If you need extra space
to answer any item, attach a sheet of paper with your name
and your alien registration number (A#), if any, and indicate
the number of the item to which the answer refers. You must
file your application with the required Initial Evidence
described below. Your application must be properly signed
and filed with the correct fee. If you are under 14 years of age,
your parent or guardian may sign your application.
Translations.
Any foreign language document must be accompanied by a
full English translation that the translator has certified as
complete and correct and by the translator's certification that
he or she is competent to translate the foreign language into
English.
Copies.
If these instructions state that a copy of a document may be
filed with this application, and you choose to send us the
original, we may keep the original for our records.
Initial Evidence.
You must file your application with the following evidence:
Birth certificate.
Submit a copy of your foreign birth certificate or other
record of your birth that meets the provisions of
secondary evidence found in Title 8, Code of Federal
Regulations (CFR), 103.2(b)(2).
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.
Copy of passport page with nonimmigrant visa.
If you have obtained a nonimmigrant visa(s) from an
American embassy or consulate abroad within the last
year, submit a photocopy(ies) of the page(s) of your
passport containing the visa(s).
.
Photos.
Submit two identical natural color passport-style
photographs of yourself, taken within 30 days of the
application. The photos must have a white background,
be unmounted, printed on thin paper, and be glossy and
unretouched. The photos must show your full-frontal
facial position with your head bare. You may wear a
headdress, if required by a religious order of which you
are a member. The photos must be no larger than 2 x 2
inches, with the distance from the top of the head to just
below the chin about 1 and 1/4 inches. Using a pencil,
lightly print your Alien Registration Number (A#), or your
name, if you do not have an A#, on the back of each
photo.
Biometric services.
If you are between the ages of 14 and 79, you must be
fingerprinted as part of the USCIS biometric services
requirement. After you have filed this application, the
USCIS will notify you in writing of the time and location
where you must go to be fingerprinted. If necessary, USCIS
may also take your photograph and signature. Failure to
appear to be fingerprinted or for other biometric services
may result in a denial of your application.
Police clearances.
If you are filing for adjustment of status as a member of a
special class described in an I-485 supplement form,
please read the instructions on the supplement form to
see if you need to obtain and submit police clearances, in
addition to the required fingerprints, with your
application.
Medical examination (Section 232 of the Immigraton
and Nationality Act (INA) ).
When required, submit a medical examination report on
the form you have obtained from USCIS.
-- A. Individuals applying for adjustment of status
through a USCIS service center.
1) General:
If you are filing your adjustment of status application
with a USCIS service center, include your medical
examination report with the application, unless you are
a refugee or asylee.
2) Refugees:
If you are applying for adjustment of status one year
after you were admitted as a refugee, you only need to
submit a vaccination supplement with your adjustment of
status application, not the entire medical report, unless
there were medical grounds of inadmissibility that arose
during the initial examination that you had overseas.
-- B. Individuals applying for adjustment of status
through a local USCIS office and asylees applying for
adjustment of status through a service center.
If you are filing your adjustment of status application
with a local USCIS office, or if you are an asylee filing
an adjustment of status application with a service
center one year after you were granted asylum, do not
submit a medical report with your adjustment of status
application. Wait for further instructions from USCIS
about how and where to take and submit medical
examination report.
Form I-485 Instructions (Rev. 04/22/05)N (Prior editions may be used until 09/30/05) Page 2
-- Fiancé(e)s.
-- Based on asylum status.
If you are a K-1 fiancé(e) or K-2 dependent who had a
medical examination within the past year as required for
the nonimmigrant fiancé(e) visa, you only need to
submit a vaccination supplement, not the entire medical
report. You may include the vaccination supplement
with your adjustment of status application.
Attach a copy of the letter or Form 1-94 that shows the
date you were granted asylum.
-- Based on continuous residence in the United States
since before January 1, 1972.
Attach copies of evidence that shows continuous
residence since before January 1, 1972.
-- Persons not required to have a medical examination.
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The medical report is not required if you are applying
for creation of a record for admission as a lawful
permanent resident under section 249 of the INA as
someone who has continuously resided in the United
States since January 1, 1972 (registry applicant).
-- Based on Cuban citizenship or nationality.
Attach evidence of your citizenship or nationality, such
as a copy of your passport, birth certificate or travel
document.
Form G-325A, Biographic Information Sheet.
-- Based on derivative status as the spouse or child of
another adjustment applicant or person granted
permanent residence based on issuance of an
immigrant visa.
You must submit a completed Form G-325A if you are
between 14 and 79 years of age.
Evidence of status.
Submit a copy of your Form I-94, Nonimmigrant
Arrival/Departure Record, showing your admission to the
United States and current status, or other evidence of
your status.
File your application with the application of the other
applicant, or with evidence that the application is
pending with USCIS or was approved, or with
evidence that your spouse or parent was granted
permanent residence based on an immigrant visa, and:
Affidavit of Support/Employment Letter.
If you are applying as the spouse of that person,
also attach a copy of your marriage certificate and
copies of documents showing the legal termination
of all other marriages by you and your spouse;
-- Affidavit of Support.
Submit an Affidavit of Support (Form I-864) if your
adjustment of status application is based on your entry
as a fiancé(e), a relative visa petition (Form I-130) filed
by your relative, or an employment based visa petition
(Form I-140) related to a business that is five percent or
more owned by your family.
If you are applying as the child of that person, also
attach a copy of your birth certificate and, if the
other person is not your natural mother, copies of
evidence (such as a marriage certificate and
documents showing the legal termination of all
other marriages and an adoption decree) to
demonstrate that you qualify as his or her child.
-- Employment Letter.
If your adjustment of status application is related to an
employment based visa petition (Form I-140), you must
submit a letter on the letterhead of the petitioning
employer which confirms that the job on which the visa
petition is based is still available to you. The letter
must also state the salary that will be paid.
NOTE: The affidavit of support and/or employment letter are
not required if you applying for creation of record based on
continuous residence since before January 1, 1972, asylum
adjustment, or a Cuban citizen or a spouse or unmarried child
of a Cuban citzen who was admitted after January 1, 1959.)
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Evidence of eligibility.
--Based on an immigrant petition.
Attach a copy of the approval notice for an immigrant
petition that makes a visa number immediately available
to you, or submit a complete relative, special immigrant
juvenile, or special immigrant military petition which, if
approved, will make a visa number immediately
available to you.
--Based on admission as the K-1 fiancé(e) of a United
States citizen and subsequent marriage to that citizen.
Attach a copy of the fiancé(e) petition approval notice,
a copy of your marriage certificate and your Form 1-94.
.
Other basis for eligibility.
Attach copies of documents proving that you are eligible
for the classification.
Where to File.
File this application at the USCIS Service Center or local office
that has jurisdiction over your place of residence or submit the
form to the USCIS Lockbox Facility. For details on where to file
your application, read the additional instructions that may be
attached to this form, call our National Customer Service Center
at 1-800-375-5283, or visit our website at www.uscis.gov.
Fee.
The fee for this application is $315.00, or $215.00 if you are
less than 14 years old. There is no application fee if you are
filing as a refugee under section 209(a) of the INA.
If you are between the ages of 14 and 79, there is a $70.00
biometric services fee for USCIS to take your fingerprints and,
if necessary, also your photograph and signature. The
biometric services fee is in addition to the application fee.
For example, if your application fee is $315.00 and you are
between the ages of 14 and 79 years and require fingerprints,
the total fee you must pay is $385.00.
Form I-485 Instructions (Rev. 04/22/05)N (Prior editions may be used until 09/30/05) Page 3
You may submit one check or money order for both the
application and biometric services fees, including
fingerprinting fees. Fees must be submitted in the exact
amount. Do not mail cash. Fees cannot be refunded. All
checks and money orders must be drawn on a bank or
other institution located in the United States and must be
payable in United States currency. The check or money
order should be made payable to the Department of
Homeland Security except:
When your signed application is filed and accepted by the
USCIS, we will transmit to the Selective Service System your
name, current address, Social Security number, date of birth
and the date you filed the application. This action will enable
the Selective Service System to record your registration as of
the filing date of your application. If USCIS does not accept
your application and, if still so required, you are responsible
to register with the Selective Service System by using other
means, provided you are under 26 years of age. If you have
already registered, the Selective Service System will check its
records to avoid any duplication.
-- If you live in Guam and are filing this application there,
make your check or money order payable to the
''Treasurer, Guam.''
(NOTE: Men 18 through 25 years old who are applying for
student financial aid, government employment or job training
benefits should register directly with the Selective Service
System or such benefits may be denied. Men can register at
a local post office or on the Internet at http://www.sss.gov).
-- If you live in the U.S. Virgin Islands and are filing this
application freely, make your check or money order
payable to the ''Commissioner of Finance of the Virgin
Islands.''
Travel Outside the United States for Adjustment of Status
Applicants Under Sections 209 and 245 of the Act and
Registry Applicants Under Section 249 of the Act.
Checks are accepted subject to collection. An uncollected
check in payment of an application fee will render the
application and any document issued invalid. A charge of
$30.00 will be imposed if a check for payment of a fee is not
honored by the bank on which it is drawn.
Your departure from the United States (including brief visits to
Canada or Mexico) constitutes an abandonment of your
adjustment of status application, unless you are granted
permission to depart and you are inspected upon your return
to the United States. Such permission to travel is called
''advance parole.'' To request advance parole, you must file
Form I-131, Application for Travel Document, with the
appropriate fee at the USCIS office where you applied for
adjustment of status.
Processing Information.
Acceptance.
Any application that is not signed or is not accompanied by
the correct application fee will be rejected with a notice that
the application is deficient. You may correct the deficiency
and resubmit the application. An application is not
considered properly filed until accepted by USCIS.
Initial Processing.
Once an application has been accepted, it will be checked for
completeness, including submission of the required initial
evidence. If you do not completely fill out the form or file it
without required initial evidence, you will not establish a basis
for eligibility and we may deny your application.
-- Exceptions.
1) H, L, V or K3/K4 nonimmigrants:
If you are an H, L,V, or K3/K4 nonimmigrant who
continues to maintain his or her status, you may travel on
a valid H, L, V or K3/K4 visa without obtaining advance
parole.
2) Refugees and Asylees:
If you are applying for adjustment of status one year after
you were admitted as a refugee or one year after you were
granted asylum, you may travel outside the United States
on your valid refugee travel document, if you have one,
without the need to obtain advance parole.
Requests for More Information.
We may request more information or evidence. We may also
request that you submit the originals of any copy. Originals
may be returned to you, if requested.
Interview.
After you file your application, you may be notified to appear
at a USCIS office to answer questions about the application.
You will be required to answer these questions under oath or
affirmation. You must bring your Arrival-Departure Record
(Form I-94) and any passport you have to the interview.
Decision.
You will be notified in writing of the decision on your
application.
Selective Service Registration.
If you are a male at least 18 years old, but not yet 26 years old,
and required according to the Military Selective Service Act to
register with the Selective Service System, USCIS will help
you register.
-- WARNING:
Travel outside of the United States may trigger the 3-and
10-year bar to admission under section 212(a)(9)(B)(i) of
the Act for adjustment applicants, but not registry
applicants. This ground of inadmissibility is triggered if
you were unlawfully present in the United States (i.e., you
remained in the United States beyond the period of
authorized stay) for more than 180 days before you
applied for adjustment of status and you travel outside of
the United States while your adjustment of status
application is pending.
(NOTE: Only unlawful presence that was accrued on or
after April 1, 1997, counts towards the 3-and 10-year bar
under section 212 (a)(9) (B)(i) of the Act.)
Form I-485 Instructions (Rev. 04/22/05)N (Prior editons may be used until 09/30/05) Page 4
If you become inadmissible under section 212(a)(9)(B)(i)
of the Act while your adjustment of status application is
pending, you will need a waiver of inadmissibility under
section 212(a)(9)(B)(v) of the Act before your adjustment
of status application can be approved. This waiver,
however, is granted on a case-by-case basis and in the
exercise of discretion. It requires a showing of extreme
hardship to your United States citizen or lawful
permanent resident spouse or parent, unless you are a
refugee or asylee. For refugees and asylees, the waiver
may be granted for humanitarian reasons, to assure family
unity or if it is otherwise in the public interest.
Paperwork Reduction Act Notice.
Penalties.
If you knowingly and willfully falsify or conceal a material fact
or submit a false document with this request, we will deny the
benefit you are seeking and may deny any other immigration
benefit. In addition, you will face severe penalties provided
by law and may be subject to criminal prosecution.
Privacy Act Notice.
An agency may not conduct or sponsor an information
collection and a person is not required to respond to a
collection of information unless it displays a current valid
OMB number. We try to create forms and instructions that
are accurate, can be easily understood and that impose the
least possible burden on you to provide us with information.
Often this is difficult because some immigration laws are very
complex. The estimated average time to complete and file this
application is computed as follows: (1) 20 minutes to learn
about the law and form; (2) 25 minutes to complete the form
and (3) 270 minutes to assemble and file the application,
including the required interview and travel time, for a total
estimated average of 5 hours and 15 minutes per application.
If you have comments regarding the accuracy of this estimate
or suggestions to make this form simpler, you should write to
the U.S. Citizenship and Immigration Services, Regulatory
Management Division, 111 Masschuetts Avenue, N.W.,
Washington, DC 20529; OMB No. 1615-0023. Do not mail
your completed application to this address.
We ask for the information on this form and associated
evidence to determine if you have established eligibility for
the immigration benefit you are seeking. Our legal right to ask
for this information is in 8 U.S.C. 1255 and 1259. We may
provide this information to other government agencies,
including the Selective Service System. Your failure to
provide information on this form and any requested evidence
may delay a final decision or result in denial of your
application.
USCIS Forms and Information.
To order USCIS forms call our toll-free forms line at
1-800-870-3676. You can also get USCIS forms and
information on immigration laws, regulations and procedures
by telephoning our National Customer Service Center at
1-800-375-5283 or visiting our internet website at
www.uscis.gov.
Use InfoPass for Appointments.
As an alternative to waiting in line for assistance at your local
USCIS office, you can now schedule an appointment through
our internet-based system, Infor Pass. To access the system,
visit our website at www.uscis.gov. Use the InfoPass
appointment scheduler and follow the screen prompts to set
up your appointment. InfoPass generates an electronic
appointment notice that appears on the screen. Print the
notice and take it with you to your appointment. The notice
gives the time and date of your appointment, along with the
address of the USCIS office.
Form I-485 Instructions (Rev. 04/22/05)N (Prior editions may be used until 09/30//05) Page 5
OMB No. 1615-0023 (Expires 05-31-05)
I-485, Application to Register
Permanent Residence or Adjust Status
Department of Homeland Security
U.S. Citizenship and Immigration Services
For USCIS Use Only
START HERE - Please type or print in black ink.
Part 1.
Returned
Information about you.
Family Name
Given Name
Receipt
Middle Name
Address- C/O
Apt.
#
Street Number
and Name
Resubmitted
City
State
Zip Code
Reloc Sent
Date of Birth (mm/dd/yyyy) Country of Birth:
Country of Citizenship/Nationality:
A # (if any)
U.S. Social
Security #
Reloc Rec'd
Date of Last Arrival
(mm/dd/yyyy)
Current USCIS
Status
Part 2.
I-94 #
Expires on
(mm/dd/yyyy)
Applicant
Interviewed
Application type. (check one)
I am applying for an adjustment to permanent resident status because:
a.
an immigrant petition giving me an immediately available immigrant visa number has been
approved. (Attach a copy of the approval notice, or a relative, special immigrant juvenile or
special immigrant military visa petition filed with this application that will give you an
immediately available visa number, if approved.)
b.
my spouse or parent applied for adjustment of status or was granted lawful permanent
residence in an immigrant visa category that allows derivative status for spouses and children.
c.
I entered as a K-1 fiancé(e) of a United States citizen whom I married within 90 days of entry,
or I am the K-2 child of such a fiancé(e). (Attach a copy of the fiancé(e) petition approval
notice and the marriage certificate).
Section of Law
Sec. 209(b), INA
Sec. 13, Act of 9/11/57
Sec. 245, INA
Sec. 249, INA
Sec. 2 Act of 11/2/66
Sec. 2 Act of 11/2/66
Other
Country Chargeable
d.
I was granted asylum or derivative asylum status as the spouse or child of a person granted
asylum and am eligible for adjustment.
e.
I am a native or citizen of Cuba admitted or paroled into the United States after January 1,
1959, and thereafter have been physically present in the United States for at least one year.
f.
I am the husband, wife or minor unmarried child of a Cuban described above in (e) and am
residing with that person, and was admitted or paroled into the United States after January 1,
1959, and thereafter have been physically present in the United States for at least one year.
Preference
g.
I have continuously resided in the United States since before January 1, 1972.
Action Block
h.
Other basis of eligibility. Explain. (If additional space is needed, use a separate piece of
paper.)
I am already a permanent resident and am applying to have the date I was granted
permanent residence adjusted to the date I originally arrived in the United States as a
nonimmigrant or parolee, or as of May 2, 1964, whichever date is later, and: (Check one)
i.
I am a native or citizen of Cuba and meet the description in (e) above.
j.
I am the husband, wife or minor unmarried child of a Cuban, and meet the description in
(f) above.
Eligibility Under Sec. 245
Approved Visa Petition
Dependent of Principal Alien
Special Immigrant
Other
To be Completed by
Attorney or Representative, if any
Fill in box if G-28 is attached to represent
the applicant.
VOLAG #
ATTY State License #
Form I-485 (Rev. 04/22/05)N (Prior editions may be used until 9/30/05)
Part 3. Processing information.
A. City/Town/Village of Birth
Current Occupation
Your Mother's First Name
Your Father's First Name
Give your name exactly how it appears on your Arrival/Departure Record (Form I-94)
In what status did you last enter? (Visitor, student, exchange
alien, crewman, temporary worker, without inspection, etc.)
Place of Last Entry Into the United States (City/State)
Yes
Were you inspected by a U.S. Immigration Officer?
No
Nonimmigrant Visa Number
Date Visa Was Issued
(mm/dd/yyyy)
Consulate Where Visa Was Issued
Gender:
Male
Have you ever before applied for permanent resident status in the U.S.?
Female
Marital Status:
No
Married
Single
Divorced
Widowed
Yes. If you checked "Yes," give date and place of filing
and final disposition.
B. List your present husband/wife, all of your sons and daughters (If you have none, write "none." If additional space is needed, use separate paper).
Family Name
Given Name
Middle Initial
Date of Birth
(mm/dd/yyyy)
Country of Birth
Relationship
A
#
Applying with you?
Yes
No
Family Name
Given Name
Middle Initial
Date of Birth
(mm/dd/yyyy)
Country of Birth
Relationship
A
#
Applying with you?
Yes
No
Family Name
Given Name
Middle Initial
Date of Birth
(mm/dd/yyyy)
Country of Birth
Relationship
A
#
Applying with you?
Yes
No
Family Name
Given Name
Middle Initial
Date of Birth
(mm/dd/yyyy)
Country of Birth
Relationship
A
#
Applying with you?
Yes
No
Family Name
Given Name
Middle Initial
Date of Birth
(mm/dd/yyyy)
Country of Birth
Relationship
A
#
Applying with you?
Yes
No
C. List your present and past membership in or affiliation with every political organization, association, fund, foundation, party, club, society or similar
group in the United States or in other places since your 16th birthday. Include any foreign military service in this part. If none, write "none." Include
the name(s) of organization(s), location(s), dates of membership from and to, and the nature of the organization(s). If additional space is needed, use a
separate piece of paper.
Form I-485 (Rev. 04/22/05)N (Prior editons may be used 9/30/05) Page 2
Part 3. Processing information. (Continued)
Please answer the following questions. (If your answer is "Yes" on any one of these questions, explain on a separate piece of paper. Answering "Yes" does
not necessarily mean that you are not entitled to adjust status or register for permanent residence.)
1. Have you ever, in or outside the United States:
a. knowingly committed any crime of moral turpitude or a drug-related offense for which you have not been arrested?
Yes
No
b. been arrested, cited, charged, indicted, fined or imprisoned for breaking or violating any law or ordinance, excluding
traffic violations?
Yes
No
c. been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency or similar action?
Yes
No
Yes
No
Yes
No
Yes
No
b. engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling?
Yes
No
c. knowingly encouraged, induced, assisted, abetted or aided any alien to try to enter the United States illegally?
Yes
No
d. illicitly trafficked in any controlled substance, or knowingly assisted, abetted or colluded in the illicit trafficking of
any controlled substance?
Yes
No
4. Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited membership or
Yes
No
a. espionage?
Yes
No
b. any activity a purpose of which is opposition to, or the control or overthrow of, the government of the United
States, by force, violence or other unlawful means?
Yes
No
c. any activity to violate or evade any law prohibiting the export from the United States of goods, technology or
sensitive information?
Yes
No
6. Have you ever been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party?
Yes
No
7. Did you, during the period from March 23, 1933 to May 8, 1945, in association with either the Nazi Government of
Germany or any organization or government associated or allied with the Nazi Government of Germany, ever order, incite,
assist or otherwise participate in the persecution of any person because of race, religion, national orgin or political opinion?
Yes
No
8. Have you ever engaged in genocide, or otherwise ordered, incited, assisted or otherwise participated in the killing of any
person because of race, religion, nationality, ethnic origin or political opinion?
Yes
No
9. Have you ever been deported from the United States, or removed from the United States at government expense,
excluded within the past year, or are you now in exclusion, deportation, removal or recission proceedings?
Yes
No
10. Are you under a final order of civil penalty for violating section 274C of the Immigration and Nationality Act for use of
Yes
No
11. Have you ever left the United States to avoid being drafted into the U.S. Armed Forces?
Yes
No
12. Have you ever been a J nonimmigrant exchange visitor who was subject to the two-year foreign residence requirement and have
Yes
No
13. Are you now withholding custody of a U.S. citizen child outside the United States from a person granted custody of the child?
Yes
No
14. Do you plan to practice polygamy in the United States?
Yes
No
d.
exercised diplomatic immunity to avoid prosecution for a criminal offense in the United States?
2. Have you received public assistance in the United States from any source, including the United States government or any
state, county, city or municipality (other than emergency medical treatment), or are you likely to receive public assistance in
the future?
3. Have you ever:
a. within the past ten years been a prostitute or procured anyone for prostitution, or intend to engage in such
activities in the future?
funds for, or have you through any means ever assisted or provided any type of material support to any person or
organization that has ever engaged or conspired to engage in sabotage, kidnapping, political assassination, hijacking or any
other form of terrorist activity?
5. Do you intend to engage in the United States in:
fraudulent documents or have you, by fraud or willful misrepresentation of a material fact, ever sought to procure, or
procured, a visa, other documentation, entry into the United States or any immigration benefit?
not yet complied with that requirement or obtained a waiver?
Form I-485 (Rev. 04/22/05)N (Prior editions may be used until 09/30/05) Page 3
Part 4. Signature.
(Read the information on penalties in the instructions before completing this section. You must file this application while in
the United States.)
YOUR REGISTRATION WITH THE U.S. CITIZENSHIP AND IMMIGRATION SERVICES. "I understand and acknowledge that,
under section 262 of the Immigration and Nationality Act (Act), as an alien who has been or will be in the United States for more than 30
days, I am required to register with the U.S. Citizenship and Immigration Services. I understand and acknowledge that, under section
265 of the Act, I am required to provide USCIS with my current address and written notice of any change of address within ten days of
the change. I understand and acknowledge that USCIS will use the most recent address that I provide to USCIS, on any form
containing these acknowledgements, for all purposes, including the service of a Notice to Appear should it be necessary for USCIS to
initiate removal proceedings against me. I understand and acknowledge that if I change my address without providing written notice to
USCIS, I will be held responsible for any communications sent to me at the most recent address that I provided to USCIS. I further
understand and acknowledge that, if removal proceedings are initiated against me and I fail to attend any hearing, including an initial
hearing based on service of the Notice to Appear at the most recent address that I provided to USCIS or as otherwise provided by law, I
may be ordered removed in my absence, arrested by USCIS and removed from the United States."
SELECTIVE SERVICE REGISTRATION. The following applies to you if you are a male at least 18 years old, but not yet 26 years old,
who is required to register with the Selective Service System: "I understand that my filing this adjustment of status application with the
U.S. Citizenship and Immigration Services authorizes USCIS to provide certain registration information to the Selective Service System in
accordance with the Military Selective Service Act. Upon USCIS acceptance of my application, I authorize USCIS to transmit to the
Selective Service System my name, current address, Social Security Number, date of birth and the date I filed the application for the
purpose of recording my Selective Service registration as of the filing date. If, however, USCIS does not accept my application, I further
understand that, if so required, I am responsible for registering with the Selective Service by other means, provided I have not yet reached
age 26."
APPLICANT'S CERTIFICATION. I certify, under penalty of perjury under the laws of the United States of America, that this application
and the evidence submitted with it is all true and correct. I authorize the release of any information from my records that the U.S.
Citizenship and Immigration Services (USCIS) needs to determine eligibility for the benefit I am seeking.
Signature
Print Your Name
Date
Daytime Phone Number
(
)
NOTE: If you do not completely fill out this form or fail to submit required documents listed in the instructions, you may not be found eligible for the
requested document and this application may be denied.
Part 5. Signature of person preparing form, if other than above. (sign below)
I declare that I prepared this application at the request of the above person and it is based on all information of which I have knowledge.
Signature
Print Your Name
Date
Daytime Phone Number
(
Firm Name
and Address
)
E-mail Address (if any)
Form I-485 (Rev. 04/22/05)N (Prior editions may be used until 09/30/05) Page 4
