Immigration I-485 Document

IMMIGRATION FORM I-485 — APPLICATION TO REGISTER PERMANENT RESIDENCE OR ADJUST STATUS

This Application to Register Permanent Residence or Adjust Status is submitted by Applicant Name: who hereby applies for adjustment of status under the authority of immigration laws and regulations of the United States. Alien Registration Number (A-Number): . Current address: .

RECITALS

WHEREAS, Applicant declares that Applicant presently seeks classification and adjustment to lawful permanent resident status based upon the eligibility basis selected below and in accordance with applicable immigration statutes and regulations; and

WHEREAS, Applicant acknowledges that submission of this form constitutes a sworn statement under penalty of perjury and that Applicant is required to disclose material facts, supporting evidence, and any prior immigration or criminal history; and

WHEREAS, Applicant understands that information provided in support of this application may be verified and that false statements or concealment of material facts may result in denial, removal proceedings, civil or criminal penalties, or other adverse consequences.

NOW, THEREFORE, in consideration of the representations and warranties below, Applicant submits this Application and certifies the following:

1. APPLICANT IDENTIFICATION

2. ELIGIBILITY BASIS (Select all that apply)

Family-based (immediate relative or family preference)

Employment-based (adjustment through employment)

Asylee/Refugee adjustment

Registry (continuous residence since specified date)

3. IMMIGRATION HISTORY

Date of Last Entry to the United States: . Port of Entry: . Class of Admission: .

I-94 Number (if any): . Passport Number: . Passport Expiration Date: .

4. CRIMINAL, IMMIGRATION, AND SECURITY DISCLOSURES

Have you ever been arrested, charged, convicted, or placed in pretrial diversion for any criminal offense (including traffic offenses other than minor traffic violations)? Yes No

Have you ever been ordered removed, excluded, deported, or have you ever applied for or received voluntary departure? Yes No

5. SUPPORTING DOCUMENTS AND EVIDENCE

Applicant certifies that the following supporting documents are submitted with this application where applicable: birth certificate, passport pages, Form I-94, prior immigration documents, proof of eligibility (e.g., Form I-130 receipt/approval, labor certification, employment petition), biometric receipt, and two passport-style photographs.

6. DECLARATIONS, AUTHORIZATIONS, AND CERTIFICATIONS

Applicant declares under penalty of perjury under the laws of the United States that all information contained in this application and supporting documentation is true and correct to the best of Applicant's knowledge. Applicant authorizes the release of information to immigration authorities and other federal agencies as necessary to adjudicate this application, including but not limited to verification of criminal history, immigration records, and national security checks.

Applicant acknowledges that the burden of proof rests with Applicant to demonstrate eligibility, admissibility, and that any misrepresentation may render Applicant inadmissible or removable and may constitute a federal crime.

7. NOTICE PROVISIONS

All notices, requests, and correspondence regarding this application shall be sent to the U.S. mailing address provided herein. Applicant must notify immigration authorities of any change of address within the time period required by statute. Failure to receive a notice because of an incorrect address provided by Applicant does not waive any rights of the Government to proceed on this application.

8. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This application and any determinations thereon are governed by the immigration laws and regulations of the United States. These terms, together with all attachments and declarations, constitute the complete submission of Applicant and supersede any prior oral or written statements regarding the subject matter of this application.

If any provision of this application is held invalid or unenforceable, such provision shall be severed and the remaining provisions shall remain in full force and effect.

9. AMENDMENTS; WAIVER; COUNTERPARTS

No amendment to this application will be effective unless in writing and signed by Applicant. Waiver of any provision or right must be explicit and in writing. This application may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one instrument for all purposes.

10. AFFIRMATION

By signing below, Applicant affirms under penalty of perjury that the information supplied in this Application to Register Permanent Residence or Adjust Status (Form I-485) and any accompanying exhibits is true, complete, and correct, and that Applicant understands the legal consequences of willful false statements.

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