This questionnaire is NOT the application form from the US immigration & Naturalization Service, this is for our internal application typing service. We will extract information from this questionnaire to type the Application Form. This form is usually filed in conjunction with other forms, not on it's own.

INFORMATION ABOUT THE ALIEN

1.  Family Name    First Name  
     Middle Name

2.  Address:

3.  Place of Birth:   City   State   
     Country 
4.  Date Of Birth:   Day:  Month:    Year: 
5.  Social Security Number:   
6. Alien Registration number:

1. My Status is:  Permanent Resident    Conditional Resident.

2. I am a permanent resident or conditional resident and:

    My card was lost, stolen, or destroyed.  
         I have attached a copy of an identity document.

    I never received a card. I have attached a copy of an identity document.

    My card was incorrect when issued.

    My name/information has changed.

3.  I am a permanent resident and:

    My present card has an expiration date on it and is expiring.

    I have reached my 14th birthday. (attach card and fingerprints).

   I was a commuter and am now taking up residence in the U.S.

    My status has been automatically converted to permanent resident.

    My card is an old edition.

4. Your Mother's first Name:   

5.  Your Fathers first Name: 

6. City of Residence where you applied for an Immigrant Visa or Adjustment of Status:

7. Consulate where Immigrant Visa was issued or INS office where status was adjusted:

8.  City/Town/Village of Birth: 

9.  Date of admission as an immigrant or Adjustment of Status: 

10. If you entered the U.S. with an Immigrant Visa give:

     Destination in U.S. when admitted: 
     Port of entry where Admitted to U.S.: 

11. Are you in Deportation/exclusion proceedings?  Yes   No