Application – Tim Farmer Law

Form Progress 1 28

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English

Spanish

Part 1 – Information About You

1. | Alien Registration Number (A-Number)

Please enter a number from 0 to 999999999.

2. | USCIS Online Account Number (if any)

Part 1 – Information About You

3.a | Family Name (Last Name)

3.b | Given Name (First Name)

3.c | Middle Name

Part 1 – Information About You

4. | Has your name legally changed since the issuance of your Permanent Resident Card?

Yes (Proceed to Item Numbers 5.a. – 5.c.)

No (Proceed to Item Numbers 6.a. – 6.i.)

N/A – I never received my previous card. (Proceed to Item Numbers 6.a. – 6.i.)

Part 1 – Information About You

Provide your name exactly as it is printed on your current Permanent Resident Card.

NOTE: at a later point in the form, you will be prompted to upload evidence of your legal name change (marriage certificate, divorce decree, court order, etc)

5.a | Family Name (Last Name)

5.b | Given Name (First Name)

5.c | Middle Name

Part 1 – Information About You

Please provide your mailing address

6.a | In Care Of Name

6.b | Street Number and Name

6.c | Is this a:

Apartment

Suite

Floor

Apartment/Suite/Floor Number

6.d | City or Town

6.e | State

6.f | ZIP Code

6.g | Province

6.h | Postal Code

6.i | Country

Is Physical Address the same as Mailing Address?

Yes

Part 1 – Information About You

Please provide your physical address

7.a | Street Number and Name

7.b | Is this a:

Apartment

Suite

Floor

Apartment/Suite/Floor Number

7.c | City or Town

7.d | State

7.e | ZIP Code

7.f | Province

7.g | Postal Code

7.h | Country

Part 1 – Information About You

8. | Gender

Male

Female

Part 1 – Information About You

9. | Date of Birth (mm/dd/yyyy)

Month

Day

Year

10. | City/Town/Village of Birth

11. | Country of Birth

Part 1 – Information About You

12. | Mother's Given Name (First Name)

13. | Father's Given Name (First Name)

Part 1 – Information About You

14. | Class of Admission

Part 1 – Information About You

15. | Date of Admission (mm/dd/yyyy)

Month

Day

Year

Part 1 – Information About You

16. | U.S. Social Security Number (if any)

Part 2 – Application Type

1. | What is your current status?

1.a | Lawful Permanent Resident (Proceed to Section A.)

1.b | Permanent Resident – In Commuter Status (Proceed to Section A.)

1.c | Conditional Permanent Resident (Proceed to Section B.)

What is the expiration date of your current card?

MM slash DD slash YYYY

Unfortunately you are not eligible to renew your Permanent Resident Card at this time. Please contact us for assistance.

Part 2 – Application Type

Reason for Application (Select only one box)

Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.)

2.a | My previous card has been lost, stolen, or destroyed.

2.b | My previous card was issued but never received.

2.c | My existing card has been mutilated.

2.d | My existing card has incorrect data because of Department of Homeland Security (DHS) error. (Attach your existing card with incorrect data along with this application.)

2.e | My name or other biographic information has been legally changed since issuance of my existing card.

2.f | My existing card has already expired or will expire within six months.

2.g.1 | I have reached my 14th birthday and am registering as required. My existing card will expire AFTER my 16th birthday. (See NOTE below for additional information.)

2.g.2 | I have reached my 14th birthday and am registering as required. My existing card will expire BEFORE my 16th birthday. (See NOTE below for additional information.) NOTE: If you are filing this application before your 14th birthday, or more than 30 days after your 14th birthday, you must select reason 2.j. However, if your card has expired, you must select reason 2.f.

2.h.1 | I am a permanent resident who is taking up commuter status.

2.h.2 | I am a commuter who is taking up actual residence in the United States.

2.i | I have been automatically converted to lawful permanent resident status.

2.j | I have a prior edition of the Alien Registration Card, or I am applying to replace my current Permanent Resident Card for a reason that is not specified above.

2.h.1.a | My Port-of-Entry (POE) into the United States will be:

City State / Province / Region

Part 2 – Application Type

Section B. (To be used only by a conditional permanent resident.)

3.a | My previous card has been lost, stolen, or destroyed.

3.b | My previous card was issued but never received.

3.c | My existing card has been mutilated.

3.d | My existing card has incorrect data because of DHS error. (Attach your existing permanent resident card with incorrect data along with this application.)

3.e | My name or other biographic information has legally changed since the issuance of my existing card.

Part 3 – Processing Information

How did you get your permanent residency?

Immigration VISA

Adjustment Of Status

1. Country where you applied for an immigrant visa or adjustment of status:

2. US City and State where you applied for adjustment of status.

3.a | Destination in the United States at time of admission

3.a.1 | Port-of-Entry where admitted to the United States:

City State

Part 3 – Processing Information

4. | Have you ever been in exclusion, deportation, or removal proceedings or ordered removed from the United States?

Yes

4. | Additional Information

NOTE: If you answered “Yes” to Item Number 4. above, provide a detailed explanation in the space provided.

Part 3 – Processing Information

5. | Since you were granted permanent residence, have you ever filed Form I-407, Abandonment by Alien of Status as Lawful Permanent Resident, or otherwise been determined to have abandoned your status?

Yes

5. | Additional Information

NOTE: If you answered “Yes” to Item Number 5. above, provide a detailed explanation in the space provided.

Part 3 – Processing Information

6. | Ethnicity (Select only one box)

Hispanic or Latino

Not Hispanic or Latino

Part 3 – Processing Information

7. | Race (Select all applicable boxes)

White

Asian

Black or African American

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Part 3 – Processing Information

8. | Height

Feet

Inches

9. Weight

Please enter a number from 0 to 999.

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9. Weight 1

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9. Weight 2

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9. Weight 3

Part 3 – Processing Information

10. | Eye Color (Select only one box)

Black

Gray

Maroon

Blue

Green

Pink

Brown

Hazel

Unknown/Other

Part 3 – Processing Information

11. | Hair Color (Select only one box)

Bald (No hair)

Brown

Sandy

Black

Gray

White

Blond

Red

Unkown/Other

Part 4 – Accommodations for Individuals with Disabilities and/or Impairments

(Read the information in the Form I-90 Instructions before completing this part.)

1. | Are you requesting an accommodation because of your disabilities and/or impairments?

Yes

If you answered “Yes,” select any applicable boxes:

1.a | I am deaf or hard of hearing and request the following accommodation:

Yes

1.a | Paragraph

(If you are requesting a sign-language interpreter, indicate for which language (for example, American Sign Language)):

1.b | I am blind or have low vision and request the following accommodation:

Yes

1.b | Paragraph

Add accommodation request below.

1.c | I have another type of disability and/or impairment:

(Describe the nature of your disability and/or impairment and the accommodation you are requesting)

Yes

1.c | Paragraph

(Describe the nature of your disability and/or impairment and the accommodation you are requesting)

Part 5 – Applicant’s Statement, Contact Information, Certification, and Signature

3. | Applicant's Daytime Telephone Number

4. | Applicant's Mobile Telephone Number (if any)

5. | Applicant's Email Address (if any)

Part 5 – Applicant’s Statement, Contact Information, Certification, and Signature

Applicant's Certification

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of my records that USCIS may need to determine my eligibility for the immigration benefit I seek.

I further authorize release of information contained in this application, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws.

I understand that USCIS will require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, I will be required to sign an
oath reaffirming that:

1) I reviewed and provided or authorized all of the information in my application;
2) I understood all of the information contained in, and submitted with, my application; and
3) All of this information was complete, true, and correct at the time of filing.

I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the information contained in, and submitted with, my application, and that all of this information is complete, true, and correct.

I agree to the terms and conditions.

6.a. | Applicant's Signature

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1.a. | Interpreter's Family Name (Last Name)

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1.b. | Interpreter's Given Name (First Name)

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2. Interpreter's Business or Organization Name (if any)

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3.a. | Street Number and Name

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3.c. | City or Town

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3.d | State

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3.e. | ZIP Code

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3.f. | Province

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3.g. | Postal Code

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3.h. | Country

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4. | Interpreter's Daytime Telephone Number

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5. | Interpreter's Mobile Telephone Number (if any)

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6. | Interpreter's Email Address (if any)

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Spanish

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Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Application, if Other Than the Applicant

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1.a. | Preparer's Family Name (Last Name)

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1.b. | Preparer's Given Name (First Name)

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2. Preparer's Business or Organization Name (if any)

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3.a. | Street Number and Name

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3.c. | City or Town

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3.d | State

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3.e. | ZIP Code

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3.f. | Province

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3.g. | Postal Code

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3.h. | Country

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4. | Preparer's Daytime Telephone Number

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5. | Preparer's Mobile Telephone Number (if any)

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6. | Preparer's Email Address (if any)

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Signature

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