(State)
(Zip Code)
*(Zip Code)
Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0007; Expires 12/31/2014
AR-11 SR, Alien's Change of Address Card
*Name (Last in CAPS)
*(First Name) (Middle Name)
I am in the United States as a:
*Date of Birth (mm/dd/yyyy)
Country of Citizenship
*(City or Post Office)
*Present Address (Street or Rural Route)
(City or Post Office)
Last Address (Street or Rural Route)
(Street Address or Rural Route)
I work for or attend school at: (Employer's Name or Name of School)
*(State)
(If the above address is temporary) I expect to remain there
Years
Months
(State)
(City or Post Office)
Date of Entry Into U.S. (mm/dd/yyyy)
Port of Entry Into U.S.
Date (mm/dd/yyyy)
Form AR-11 SR (Rev. 12/11/11) Y
Special Registration
AR-11 SR, Alien's Change of Address Card
This card is to be used by all aliens to report a change of address within 10 days of such change. The collection of this information is required by
Section 265 of the Immigration and Nationality Act (8 U.S.C. 1305). The data is used by U.S. Citizenship and Immigration Services for statistical
and record purposes and may be furnished to federal, state, local and foreign law enforcement officials. Failure to report a change of address is
punishable by fine or imprisonment and/or removal.
ADVISORY: This card is not evidence of identity, age, or status claimed.
Fingerprint Identification Number (FIN):
Mail Your Form AR-11 SR to the Address Below:
Paperwork Reduction Act
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 currently valid OMB control number. The public reporting burden for this collection of information is estimated at 5 minutes per response,
including the time for reviewing instructions and completing and submitting the form. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Citizenship and Immigration Services, Regulatory
Products Division, Office of the Executive Secretariat, 20 Massachusetts Avenue, N.W., Washington, DC 20529-2020. OMB No. 1615-0007. Do
not mail your application to this address.
U. S. Department of Homeland Security
Citizenship and Immigration Services
Attn: Change of Address
1344 Pleasants Drive
Harrisonburg, VA 22801
Visitor
Permanent Resident
Student
Other
(Specify)
A-Number (Copy Number From Alien Card)
*Signature
* Indicates mandatory fields that must be completed.
A-
(Zip Code)
If not a Permanent Resident,
my stay in the U.S. expires on:
(Date - mm/dd/yyyy)
