Fillable Ins Form I-865 (Visa Pro)

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Ins Form I-865 (Visa Pro)

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The Ins Form I-865 (Visa Pro) form is 2 pages long and contains:

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  • 2 check-boxes
  • 35 other fields

Country of origin: US
File type: PDF

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Form I-865 01/03/13 Y Page
Returned
Resubmitted
Form I-865, Sponsor's Notice
of Change of Address
Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0076; Expires 01/31/2015
Family Name
Given Name
Middle Name
Date
Receipt
Provide the requested information on the person(s) your are sponsoring:.
C/O (in care of):
Your New Home Address - Street Number and Name (Include Apt. # if applicable)
Zip/Postal Code
State or Province
Country
City
A-Number (if any)
Place of Birth (City, State/Province /Country)
U.S. Social Security Number
Date of Birth (mm/dd/yyyy)
Effective Date of Change of Address
Family Name
Given Name
Middle Name
A-Number
City
State or Province
Zip/Postal Code
Daytime Telephone (Area/Country Code)
NOTE: If you became a U.S. citizen following the filing of your Form I-864, Affidavit
of Support, or submission of a prior Form I-865 address change, include a copy of proof
of your U.S. citizenship (example: naturalization certificate, certificate of citizenship,
U.S. passport) with this notice.
Part 2. Information on Sponsored Immigrant(s) (If more than one person, attach a separate sheet(s) of paper)
E-Mail Address (if any)
Effective Date of Change of Address
Daytime Telephone (Area/Country Code)
E-Mail Address (if any)
Remarks
Part 1. Information About You, the Sponsor
START HERE-Type or print in black ink
Your current status (Check one)
I am a
Your New Mailing Address - NOTE: You do not need to complete this section if your
new mailing address is the same as your new home address above.
Street Number and Name (Include Apt.#, if applicable)
U.S. Citizen
Lawful Permanent Resident
Date
Date
Date
Form I-865 01/03/13 Y Page
Part 4. Signature of Person Preparing Form, If Other Than Above (Sign below)
I declare that I prepared this request at the request of the above person, and it is based on all information of which I have knowledge.
Date (mm/dd/yyyy)
Preparer's Printed Name
Daytime Phone Number (with area code)
Fax Number (if any)
E-Mail Address (if any)
Preparer's Firm Name (if applicable)
Preparer's Address
Signature
Date (mm/dd/yyyy)
Part 3. Sponsor's Signature (Read the information on penalties in the instructions before completing this part)
I certify, under penalty of perjury under the laws of the United States of America, that all the information provided on this notice is
true and correct.
Preparer's Signature
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Ins Form I-865 (Visa Pro)

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Completed 18 July 2020

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