Fillable INS-Form-I-751 Petition to Remove Conditions on Residence

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INS-Form-I-751 Petition to Remove Conditions on Residence

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Form I-751 12/23/16 N Page 1 of 11
For
USCIS
Use
Only
Approved under INA 216(c)(4)(C) Battered Spouse/Child
Petition to Remove Conditions on Residence
Department of Homeland Security
U.S. Citizenship and Immigration Services
USCIS
Form I-751
OMB No. 1615-0038
Expires 11/30/2017
Receipt Action Block Remarks
Reloc Sent
Date (mm/dd/yyyy)
/ / /
Reloc Received
Date (mm/dd/yyyy)
/ / /
Date (mm/dd/yyyy)
/ / /
Date (mm/dd/yyyy)
/ / /
Petitioner interviewed on (mm/dd/yyyy) / / /
Select this box if
Form G-28 is
attached.
Attorney State Bar Number
(if applicable)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
To be completed by an
attorney or accredited
representative (if any).
START HERE - Type or print in black ink.►
Part 1. Information About You, the Conditional
Resident
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
Other Names Used
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c.
Middle Name
3.a. Family Name
(Last Name)
3.b. Given Name
(First Name)
3.c.
Middle Name
4. Date of Birth (mm/dd/yyyy)
10.
Marital Status
11. Date of Marriage (mm/dd/yyyy)
12. Place of Marriage
13. If the marriage through which you gained conditional
residence has ended, provide the date it ended (date of
divorce or date of death) (mm/dd/yyyy)
14.
Conditional Residence Expires On (mm/dd/yyyy)
►
U.S. Social Security Number (if any)
8.
Other Information
►
A-
Alien Registration Number (A-Number) (if any)7.
Married WidowedSingle Divorced
Marital Status
USCIS Online Account Number (if any)9.
►
6.
Country of Citizenship or Nationality (provide all that
apply)
List all other names you have ever used, including aliases,
maiden name, and nicknames. If you need extra space to
complete this section, use the space provided in Part 11.
Additional Information.
5. Country of Birth
SMITH
Jane
Joan
DOALLY
Jane
Joan
02/14/1975
06/10/2015
Vail, CO
12/10/2017
1 2 3 4 5 6 7 8 9
Australia
1 2 3 4 5 6 7 8 9
Australia
Form I-751 12/23/16 N Page 2 of 11
Part 1. Information About You, the Conditional
Resident (continued)
Mailing Address
In Care Of Name
15.a.
15.d. City or Town
Street Number
and Name
15.b.
15.c. Flr.Ste.
15.e. State 15.f. ZIP Code
Apt.
Physical Address
16. Is your physical address different than your mailing
address?
NoYes
If you answered “Yes” to Item Number 16., provide your
physical address below.
20. Have you ever been arrested, detained, charged, indicted,
fined, or imprisoned for breaking or violating any law or
ordinance (excluding traffic regulations), or committed
any crime which you were not arrested in the United
States or abroad?
18.
19. Was a fee paid to anyone other than an attorney in
connection with this petition?
Are you in removal, deportation, or rescission
proceedings?
Additional Information About You
Yes
No
Yes No
Yes
No
In Care Of Name
17.a.
17.e. State 17.f. ZIP Code
17.d. City or Town
Street Number
and Name
17.b.
17.c.
Apt. Flr.Ste.
If you answered "Yes" to Item Number 20., provide a detailed
explanation in Part 11. Additional Information or on a
separate sheet of paper, and refer to the What Initial Evidence
Is Required section of the Form I-751 instructions to determine
what criminal history document to include with your petition.
21. If you are married, is this a different marriage than the
one through which you gained conditional resident status?
NoYes
22. Have you resided at any other address since you became a
permanent resident?
NoYes
If you answered “Yes” to Item Number 22., provide a list of all
addresses where you have resided since becoming a permanent
resident and the dates you resided at those locations in the space
provided in Part 11. Additional Information.
23. Is your spouse or parent's spouse currently serving with or
employed by the U.S. Government and serving outside
the United States?
Yes No
Part 2. Biographic Information
1.
2.
Height
4. Weight
Feet Inches
3.
Pounds
Not Hispanic or Latino
Hispanic or Latino
Ethnicity (Select only one box)
Race (Select all applicable boxes)
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
White
Asian
Black or African American
Black Brown
Maroon
Pink
HazelGreen
Blue
5.
Eye Color (Select only one box)
Unknown/Other
Gray
White
Hair Color (Select only one box) 6.
Black
Brown Red
Unknown/Other
Sandy
Gray
BlondBald (No hair)
Vail
183 Gore Creek Drive
CO
5
6
1
2
5
Form I-751 12/23/16 N Page 3 of 11
Part 3. Basis for Petition
1.a.
1.b.
My parent's spouse because I am unable to be
included in a joint petition filed by my parent and my
parent's spouse.
My spouse.
Joint Filing
My conditional residence is based on my marriage or my
parent's marriage to a U.S. citizen or lawful permanent resident,
and I am filing this joint petition together with (Select only one
box):
OR (Select all applicable boxes in the next section.)
1.c.
My spouse is deceased.
My conditional residence is based on my marriage or my
parent's marriage to a U.S. citizen or lawful permanent resident,
I am unable to file a joint petition with my spouse or my
parent's spouse, because:
Waiver or Individual Filing Request
1.d.
My marriage was entered in good faith, but the
marriage was terminated through divorce or
annulment.
1.e.
1.f.
1.g.
The termination of my status and removal from the
United States would result in an extreme hardship.
My parent entered the marriage in good faith, and,
during the marriage, I was battered, or was subjected
to extreme cruelty, by my parent's U.S. citizen or
lawful permanent resident spouse or by my
conditional resident parent.
I entered the marriage in good faith, and, during the
marriage, I was battered, or was the subject of
extreme cruelty, by my U.S. citizen or lawful
permanent resident spouse.
1.a.
Relationship
1.b.
Part 4. Information About the U.S. Citizen or
Lawful Permanent Resident Spouse. If Filing as
a Child Separately, Information About the U.S.
Citizen or Lawful Permanent Resident
Stepparent Through Whom You Gained Your
Conditional Residence.
Spouse or Former Spouse
Parent's Spouse or Former Spouse
►
U.S. Social Security Number (if any)4.
Given Name
(First Name)
2.b.
Family Name
(Last Name)
2.a.
Middle Name2.c.
3. Date of Birth (mm/dd/yyyy)
►
A-
A-Number (if any)5.
Other Information
6.d. State 6.e. ZIP Code
6.c. City or Town
Street Number
and Name
6.a.
6.b. Apt. Flr.Ste.
6.f.
Postal Code
6.g.
6.h. Country
Province
Physical Address
Part 5. Information About Your Children
Given Name
(First Name)
1.b.
Family Name
(Last Name)
1.a.
Middle Name
1.c.
2. Date of Birth (mm/dd/yyyy)
Child 1
Provide information on all of your children. If you need extra
space to complete this section, use the space provided in
Part 11. Additional Information.
►
A-
A-Number (if any)3.
4. Is this child living with you?
5. Is this child applying with you?
No
Yes No
Yes
John
SMITH
Jerry
1 2 3 4 5 6 7 8 9
Vail
183 Gore Creek Drive
CO
US
Form I-751 12/23/16 N Page 4 of 11
Part 5. Information About Your Children
(continued)
6.c. City or Town
Street Number
and Name
6.a.
6.b. Apt. Flr.Ste.
6.d. State 6.e. ZIP Code
6.f.
Postal Code
6.g.
6.h. Country
Province
Physical Address
Given Name
(First Name)
7.b.
Family Name
(Last Name)
7.a.
Middle Name
7.c.
Child 2
8. Date of Birth (mm/dd/yyyy)
►
A-
A-Number (if any)9.
10.
Is this child living with you?
11. Is this child applying with you?
Yes
NoYes
No
12.a.
12.b.
12.c. City or Town
Street Number
and Name
Apt. Flr.
Ste.
12.d. State 12.e. ZIP Code
12.f.
Postal Code
12.g.
12.h. Country
Province
Physical Address
Given Name
(First Name)
13.b.
Family Name
(Last Name)
13.a.
Middle Name
13.c.
Child 3
14. Date of Birth (mm/dd/yyyy)
►
A-
A-Number (if any)15.
16. Is this child living with you?
17. Is this child applying with you?
Yes
NoYes
No
18.a.
18.b.
18.c. City or Town
Street Number
and Name
Apt. Flr.Ste.
18.d. State 18.e. ZIP Code
18.f.
Postal Code
18.g.
18.h. Country
Province
Physical Address
Given Name
(First Name)
19.b.
Family Name
(Last Name)
19.a.
Middle Name
19.c.
Child 4
20. Date of Birth (mm/dd/yyyy)
►
A-
A-Number (if any)21.
22. Is this child living with you?
23. Is this child applying with you?
Yes
NoYes
No
Form I-751 12/23/16 N Page 5 of 11
Part 5. Information About Your Children
(continued)
24.a.
24.b.
24.c. City or Town
Street Number
and Name
Apt. Flr.Ste.
24.d. State 24.e. ZIP Code
24.f.
Postal Code
24.g.
24.h. Country
Province
Physical Address
Given Name
(First Name)
25.b.
Family Name
(Last Name)
25.a.
Middle Name
25.c.
Child 5
26. Date of Birth (mm/dd/yyyy)
►
A-
A-Number (if any)27.
28. Is this child living with you?
29. Is this child applying with you?
Yes
NoYes
No
30.a.
30.b.
30.c. City or Town
Street Number
and Name
Apt. Flr.Ste.
30.d. State 30.e. ZIP Code
30.f.
Postal Code
30.g.
30.h. Country
Province
Physical Address
Part 6. Accommodations for Individuals With
Disabilities and/or Impairments
Are you requesting an accommodation because of your
included children's disabilities and/or impairments?
3.
1. Are you requesting an accommodation because of your
disabilities and/or impairments?
2. Are you requesting an accommodation because of your
spouse's disabilities and/or impairments?
No
Yes
NoYes
No
Yes
NOTE: Read the information in the Form I-751 Instructions
before completing this part.
4.a. I am deaf or hard of hearing and request the
following accommodation. (If you are requesting a
sign-language interpreter, indicate for which
language (for example, American Sign Language).):
I am blind or have low vision and request the
following accommodation:
4.b.
I have another type of disability and/or impairment.
(Describe the nature of your disability and/or
impairment and the accommodation you are
requesting.):
4.c.
If you answered "Yes" to Item Numbers 1. - 3., select any
applicable box for Item Numbers 4.a. - 4.c. Provide
information on the disabilities and/or impairments for each
person.
Form I-751 12/23/16 N Page 6 of 11
Part 7. Petitioner's Statement, Contact
Information, Acknowledgement of Appointment
at USCIS Application Support Center,
Certification, and Signature
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
1.a.
I can read and understand English, and have read and
understand every question and instruction on this
petition, as well as my answer to every question. I
have read and understand the Acknowledgement of
Appointment at USCIS Application Support
Center.
NOTE: If you selected Box 1.a. in Part 3., your spouse must
also read and sign the petition in Part 8. Signature of a
conditional resident child under 14 years of age is not required;
a parent may sign for a child.
Petitioner's Statement
NOTE: Read the information on penalties in the Penalties
section of the Form I-751 Instructions before completing this
part.
1.b.
The interpreter named in Part 9. has also read to me
every question and instruction on this petition, as well
as my answer to every question, in
a language in which I am fluent. I understand every
question and instruction on this petition as translated
to me by my interpreter, and have provided complete,
true, and correct responses in the language indicated
above. The interpreter named in Part 9. has also
read the Acknowledgement of Appointment at
USCIS Application Support Center to me, in the
language in which I am fluent, and I understand this
Application Support Center (ASC)
Acknowledgement as read to me by my interpreter.
,
2. I have requested the services of and consented to
is is not an attorney or accredited
representative, preparing this petition for me. This
person who assisted me in preparing my petition has
reviewed the Acknowledgement of Appointment at
USCIS Application Support Center with me, and I
understand the ASC Acknowledgement.
,
who
Petitioner's Contact Information
Petitioner's Daytime Telephone Number3.
Petitioner's Email Address (if any)5.
Petitioner's Mobile Telephone Number (if any)4.
Acknowledgement of Appointment at USCIS
Application Support Center
I, ,
understand that the purpose of a USCIS ASC appointment is for
me to provide fingerprints, photograph, and/or signature and to
re-affirm that all of the information in my petition is complete,
true, and correct and was provided by me. I understand that I
will sign my name to the following declaration which USCIS
will display to me at the time I provide my fingerprints,
photograph, and/or signature during my ASC appointment.
I also understand that when I sign my name, provide my
fingerprints, and am photographed at the USCIS ASC, I will be
re-affirming that I willingly submit this petition; I have reviewed
the contents of this petition; all of the information in my petition
and all supporting documents submitted with my petition were
provided by me and are complete, true, and correct; and if I was
assisted in completing this petition, the person assisting me also
reviewed this Acknowledgement of Appointment at USCIS
Application Support Center with me.
By signing here, I declare under penalty of perjury
that I have reviewed and understand my application,
petition, or request as identified by the receipt
number displayed on the screen above, and all
supporting documents, applications, petitions, or
requests filed with my application, petition, or request
that I (or my attorney or accredited representative)
filed with USCIS, and that all of the information in
these materials is complete, true, and correct.
If conditional residence was based on a marriage, I further
certify that the marriage was entered into in accordance with the
laws of the place where the marriage took place and was not for
the purpose of procuring an immigration benefit.
email@gmail.com
2223334444
2223334444
J.J.SMITH
Form I-751 12/23/16 N Page 7 of 11
Part 7. Petitioner's Statement, Contact
Information, Acknowledgement of Appointment
at USCIS Application Support Center,
Certification, and Signature (continued)
Petitioner'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 and all of my records that USCIS may need to determine my
eligibility for the immigration benefit that I seek.
I certify under penalty of perjury, that the information in my
petition, my responses to each question, and any document
submitted with my petition were provided by me and are
complete, true, and correct.
I furthermore authorize release of information contained in this
petition, 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.
Date of Signature (mm/dd/yyyy)6.b.
Petitioner's Signature
NOTE TO ALL PETITIONERS: If you do not completely
fill out this petition or fail to submit required documents listed
in the Instructions, USCIS may deny your petition.
6.a.
Petitioner's Signature
NOTE: If you are filing based on claims of having been
battered or subjected to extreme cruelty waiver or individual
filing, you are not required to have the spouse's or individual
listed in Part 4's signature.
Part 8. Spouse's or Individual Listed in Part 4.'s
Statement, Contact Information,
Acknowledgement of Appointment USCIS
Application Support Center, Certification, and
Signature (if applicable)
Provide the following information about the spouse or
individual listed in Part 4.
NOTE: Read the information on penalties in the Penalties
section of the Form I-751 Instructions before completing this
part.
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
1.a.
I can read and understand English, and have read and
understand every question and instruction on this
petition, as well as the petitioner's answer to every
question. I have read and understand the
Acknowledgement of Appointment at USCIS
Application Support Center.
Spouse's or Individual's Statement
1.b.
The interpreter named in Part 9. has also read to me
every question and instruction on this petition, as
well as the petitioner's answer to every question, in
a language in which I am fluent. I understand every
question and instruction on this petition as translated
to me by my interpreter, and have provided complete,
true, and correct responses in the language indicated
above. The interpreter named in Part 9. has also
read the Acknowledgement of Appointment at
USCIS Application Support Center to me, in the
language in which I am fluent, and I understand this
Application Support Center (ASC)
Acknowledgement as read to me by my interpreter.
,
2. I have requested the services of and consented to
is is not an attorney or accredited
representative, preparing this petition for me. This
person who assisted me in preparing my petition has
reviewed the Acknowledgement of Appointment at
USCIS Application Support Center with me, and I
understand the ASC Acknowledgement.
,
who
Spouse's or Individual's Email Address (if any)5.
Spouse's or Individual's Mobile Telephone Number (if any)
4.
Spouse's or Individual's Contact Information
Spouse's or Individual's Daytime Telephone Number3.
09/17/2017
email@gmail.com
2223334444
2223334444
Form I-751 12/23/16 N Page 8 of 11
Part 8. Spouse's or Individual Listed in Part 4.'s
Statement, Contact Information,
Acknowledgement of Appointment USCIS
Application Support Center, Certification, and
Signature (if applicable) (continued)
Acknowledgement of Appointment at USCIS
Application Support Center
I, ,
understand that the purpose of a USCIS ASC appointment is
for me to provide my fingerprints, photograph, and/or
signature and to re-affirm that all of the information in my
petition is complete, true, and correct and was provided by me.
I understand that I will sign my name to the following
declaration which USCIS will display to me at the time I
provide my fingerprints, photograph, and/or signature during
my ASC appointment.
I also understand that when I sign my name, provide my
fingerprints, and am photographed at the USCIS ASC, I will be
re-affirming that I willingly submit this petition; I have reviewed
the contents of this petition; all of the information in my petition
and all supporting documents submitted with my petition were
provided by me and are complete, true, and correct; and if I was
assisted in completing this petition, the person assisting me also
reviewed this Acknowledgement of Appointment at USCIS
Application Support Center with me.
By signing here, I declare under penalty of perjury
that I have reviewed and understand my application,
petition, or request as identified by the receipt
number displayed on the screen above, and all
supporting documents, applications, petitions, or
requests filed with my application, petition, or request
that I (or my attorney or accredited representative)
filed with USCIS, and that all of the information in
these materials is complete, true, and correct.
Spouse's or Individual'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 and all of my records that USCIS may need to determine my
eligibility for the immigration benefit that I seek.
I furthermore authorize release of information contained in this
petition, 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 certify under penalty of perjury, that the information in my
petition, my responses to each question, and any document
submitted with my petition were provided by me and are
complete, true, and correct.
Interpreter's Given Name (First Name)1.b.
Interpreter's Family Name (Last Name)1.a.
Interpreter's Business or Organization Name (if any)2.
Interpreter's Full Name
Part 9. Interpreter's Contact Information,
Certification, and Signature
Provide the following information about the interpreter.
3.h.
Interpreter's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f. Province
Street Number
and Name
3.a.
Country
3.b. Apt. Flr.Ste.
3.g. Postal Code
Date of Signature (mm/dd/yyyy)6.b.
Spouse's or Individual's Signature
NOTE TO ALL SPOUSES OR INDIVIDUALS: If you do
not completely fill out this petition or fail to submit required
documents listed in the instructions, USCIS may deny your
petition.
6.a.
Spouse's or Individual's Signature
Interpreter's Contact Information
4. Interpreter's Daytime Telephone Number
Interpreter's Email Address (if any)5.
J.J.SMITH
09/17/2017
Form I-751 12/23/16 N Page 9 of 11
Part 9. Interpreter's Contact Information,
Certification, and Signature (continued)
I have read the Acknowledgement of Appointment at USCIS
Application Support Center to the petitioner in the same
language provided in Part 7., Item Number 1.b.
The petitioner has informed me that he or she understands every
instruction and question on the petition, as well as the answer to
every question, and the petitioner verified the accuracy of every
answer; and
The petitioner has also informed me that he or she understands
the ASC Acknowledgement and that by appearing for a USCIS
ASC biometric services appointment and providing his or her
fingerprints, photograph, and/or signature, he or she is
re-affirming that the contents of this petition and all supporting
documentation are complete, true, and correct.
Date of Signature (mm/dd/yyyy)6.b.
Interpreter's Signature6.a.
Interpreter's Signature
Interpreter's Certification
I certify that:
is the same language provided in Part 7., Item Number 1.b.;
I am fluent in English and
, which
I have read to this petitioner every question and instruction on
this petition, as well as the answer to every question, in the
language provided in Part 7., Item Number 1.b.; and
Part 10. Contact Information, Statement,
Certification, and Signature of the Person
Preparing this Petition, If Other Than the
Petitioner
Preparer's Full Name
1.a.
Preparer's Family Name (Last Name)
Preparer's Given Name (First Name)
1.b.
Preparer's Business or Organization Name (if any)2.
Provide the following information about the preparer.
Preparer's Contact Information
4. Preparer's Daytime Telephone Number
6. Preparer's Email Address (if any)
5. Preparer's Fax Number
Preparer's Mailing Address
3.h.
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
Province
Street Number
and Name
3.a.
Country
3.b. Apt. Flr.Ste.
3.g. Postal Code
I am not an attorney or accredited representative
but have prepared this petition on behalf of the
petitioner and with the petitioner's consent.
7.a.
7.b.
preparation of this petition.
I am an attorney or accredited representative and
my representation of the petitioner in this case
extends
does not extend beyond the
Preparer's Statement
NOTE: If you are an attorney or accredited
representative whose representation extends
beyond preparation of this petition, you must
submit a completed Form G-28, Notice of Entry
of Appearance as Attorney or Accredited
Representative, with this petition.
Form I-751 12/23/16 N Page 10 of 11
Part 10. Contact Information, Statement,
Certification, and Signature of the Person
Preparing this Petition, If Other Than the
Petitioner (continued)
8.a. Preparer's Signature
8.b.
Date of Signature (mm/dd/yyyy)
Preparer's Certification
By my signature, I certify, swear, or affirm, under penalty of
perjury, that I prepared this petition on behalf of, at the request
of, and with the express consent of the petitioner. I completed
this petition based only on responses the petitioner provided to
me. After completing the petition, I reviewed it and all of the
petitioner's responses with the petitioner, who agreed with every
answer on the petition. If the petitioner supplied additional
information concerning a question on the petition, I recorded it
on the petition. I have also read the Acknowledgement of
Appointment at USCIS Application Support Center to the
petitioner and the petitioner has informed me that he or she
understands the ASC Acknowledgement
Preparer's Signature
Form I-751 12/23/16 N Page 11 of 11
3.d.
Part 11. Additional Information
If you need extra space to provide any additional information
within this petition, use the space below. If you need more
space than what is provided, you may make copies of this page
to complete and file with this petition or attach a separate sheet
of paper. Type or print your name and A-Number (if any) at the
top of each sheet; indicate the Page Number, Part Number,
and Item Number to which your answer refers; and sign and
date each sheet.
Your Full Name
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
2. A-Number (if any)
3.a. Page Number 3.b. Part Number 3.c. Item Number
A-
4.d.
4.a. Page Number 4.b. Part Number 4.c. Item Number
7.a.
Page Number 7.b. Part Number 7.c. Item Number
7.d.
5.d.
5.a.
Page Number
5.b. Part Number 5.c. Item Number
6.d.
6.a.
Page Number 6.b. Part Number 6.c. Item Number
SMITH
Jane
Joan
1 2 3 4 5 6 7 8 9
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INS-Form-I-751 Petition to Remove Conditions on Residence

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Completed 3 July 2020

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