I-751 Petition to Remove Conditions on Residence

USCIS
Form I-751

Petition to Remove Conditions on Residence
Department of Homeland Security
U.S. Citizenship and Immigration Services
Action Block

Receipt

For
USCIS
Use
Only

Reloc Sent
Date
Date

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OMB No. 1615-0038
Expires 01/31/2013
Remarks

Reloc Rec'd
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Date
Date

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Approved under INA
216(c)(4)(C) Battered
Spouse/Child

Petitioner interviewed on

3.a. Family Name
(Last Name)
3.b. Given Name
(First Name)

DRAFT Not For
Production
01/09/2013

3.c. Middle Name

(mm/dd/yyyy) ►

To be completed by an Attorney or
BIA-accredited Representative, if any

Check the box if Form G-28 is attached to represent the petitioner
Attorney State License Number:

►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

7.

Alien Registration Number (A-Number)
► A-

8.

U.S. Social Security Number (if any)
►

Contact Information

Other Names Used (including maiden name)

9.

Daytime Phone Number

2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)

10.

E-Mail Address (if any)

2.c. Middle Name

(

)

-

Marital Status

11.

12.

Marital Status

Married

Single

Divorced

Widowed

Date of Marriage

13.

Place of Marriage

14.

If the marriage through which you gained conditional
residence has ended, give the date it ended (date of
divorce or date of death)
(mm/dd/yyyy) ►

15.

Conditional Residence Expires On

Other Information
4.

Date of Birth (mm/dd/yyyy) ►

5.

Country of Birth

6.

Country of Citizenship

(mm/dd/yyyy) ►

Form I-751 01/09/2013 N

Page 1 of 5

Part 1. Information About You, the Conditional
Resident (continued)

23.

Physical Address

If you answered "Yes" to Item Number 20., provide a detailed
explanation on a separate sheet of paper and refer to the section
entitled "What Initial Evidence Is Required?" to determine
what criminal history document to include with your petition.

16.a. In Care Of Name

16.b. Street Number
and Name
16.c. Apt.

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. Basis for Petition

Ste.

Flr.

Joint Filing
16.d. City or Town
16.e. State

My conditional residence is based on my marriage or my
parent's marriage to a U.S. citizen or permanent resident, and I
am filing this joint petition together with:

16.f. Zip Code

DRAFT Not For
Production
01/09/2013

Mailing Address (If different than Physical Address)
17.a. In Care Of Name

17.b. Street Number
and Name
17.c. Apt.

Ste.

19.

20.

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.

Waiver Request Filing

Flr.

My conditional residence is based on my marriage or my
parent's marriage to a U.S. citizen or permanent resident; I am
unable to file a joint petition with my spouse or my parent's
spouse and I request a hardship waiver because:

17.f. Zip Code

Additional Information About You
18.

My spouse

OR (check all that apply)

17.d. City or Town
17.e. State

1.a.

Are you in removal, deportation, or rescission
proceedings?
Yes

Was a fee paid to anyone other than an attorney in
connection with this petition?
Yes

My spouse or my parent's spouse is deceased.

1.d.

I or my parent entered the marriage in good faith, but
the marriage was terminated through divorce or
annulment.

1.e.

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 permanent
resident spouse.

1.f.

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
permanent resident spouse or by my conditional
resident parent.

1.g.

The termination of my status and removal from the
United States would result in an extreme hardship.

No

No

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?
Yes
No

21.

If you are married, is this a different marriage than the
one through which conditional residence status was
obtained?
Yes
No

22.

Have you resided at any other address since you became a
permanent resident? (If "Yes," attach a list of all
addresses and dates.)
Yes
No

Form I-751 01/09/2013 N

1.c.

Page 2 of 5

Part 3. Information About the Petitioning Spouse
or, If Filing as a Child Separately,
Information About the U.S. Citizen or
LPR Stepparent Through Whom You
Gained Your Conditional Residence

4.a. Street Number
and Name
4.b. Apt.

Ste.

Flr.

4.c. City or Town

1.a.

Spouse or Former Spouse

4.d. State or
Province
4.e. Zip Code or
Postal Code

1.b.

Parent's Spouse or Former Spouse

4.f.

Country

5.

Is child living with you?

Yes

No

6.

Is child applying with you?

Yes

No

Relationship

2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
2.c. Middle Name

DRAFT Not For
Production
01/09/2013
Child 2

3.

Date of Birth (mm/dd/yyyy) ►

4.

U.S. Social Security Number (if any)
►

7.a. Family Name
(Last Name)
7.b. Given Name
(First Name)

7.c. Middle Name

5.

Alien Registration Number (A-Number)
► A-

6.a. Street Number
and Name
6.b. Apt.

8.

Date of Birth (mm/dd/yyyy) ►

9.

Alien Registration Number (A-Number)
► A-

Ste.

Flr.

6.c. City or Town

10.a. Street Number
and Name
10.b. Apt.

6.d. State

Ste.

Flr.

6.e. Zip Code

10.c. City or Town

6.f.

Postal Code

6.g. Province
6.h. Country

10.d. State or
Province
10.e. Zip Code or
Postal Code

10.f. Country

Part 4. Information About Your Children

11.

Is child living with you?

Yes

No

12.

Is child applying with you?

Yes

No

List All Your Children (Attach other sheets if necessary).
Child 1

Child 3

1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)

13.a. Family Name
(Last Name)
13.b. Given Name
(First Name)

1.c. Middle Name

13.c. Middle Name

2.

Date of Birth (mm/dd/yyyy) ►

14.

Date of Birth (mm/dd/yyyy) ►

3.

Alien Registration Number (A-Number)

15.

Alien Registration Number (A-Number)

► AForm I-751 01/09/2013 N

► APage 3 of 5

Part 4. Information About Your Children
(continued)

27.

► A-

16.a. Street Number
and Name
16.b. Apt.

Ste.

Alien Registration Number (A-Number)

28.a. Street Number
and Name
Flr.

28.b. Apt.

16.c. City or Town

Ste.

Flr.

28.c. City or Town

16.d. State or
Province
16.e. Zip Code or
Postal Code

28.d. State or
Province
28.e. Zip Code or
Postal Code

16.f. Country

28.f. Country

17.

Is child living with you?

Yes

No

29.

Is child living with you?

Yes

No

18.

Is child applying with you?

Yes

No

30.

Is child applying with you?

Yes

No

Child 4
19.a. Family Name
(Last Name)
19.b. Given Name
(First Name)
19.c. Middle Name

DRAFT Not For
Production
01/09/2013

Part 5. Accommodations for Individuals With
Disabilities and Impairments (Read the
information in the instructions before
completing this section.)

I am requesting an accommodation:

20.

Date of Birth (mm/dd/yyyy) ►

21.

Alien Registration Number (A-Number)

1.

► A-

22.a. Street Number
and Name
22.b. Apt.

Ste.

22.c. City or Town
22.d. State or
Province
22.e. Zip Code or
Postal Code
22.f. Country

No

For my spouse because of his or her disability(ies) and/or
impairment(s).
Yes
No

3.

For my included child(ren) because of his or her (their)
disability(ies) and/or impairment(s).
Yes
No

If you answered "Yes," check any applicable box. Provide
information on the disability(ies) and/or impairment(s) for each
person:

23.

Is child living with you?

Yes

No

24.

Is child applying with you?

Yes

No

25.a. Family Name
(Last Name)
25.b. Given Name
(First Name)

Yes

2.

Flr.

Child 5

Because of my disability(ies) and/or impairment(s).

4.a.

Deaf or hard of hearing and request the following
accommodation(s) (if requesting a sign-language
interpreter, indicate which language (e.g., American
Sign Language)):

4.b.

Blind or sight-impaired and request the following
accommodation(s):

25.c. Middle Name
26.

Date of Birth (mm/dd/yyyy) ►

Form I-751 01/09/2013 N

Page 4 of 5

Part 5. Accommodations for Individuals With
Disabilities and Impairments (continued)
4.c.

Other type of disability(ies) and/or impairment(s)
(describe the nature of the disability(ies) and/or
impairment(s) and accommodation(s) being
requested):

NOTE: If you do not completely fill out this form or fail to
submit any required documents listed in the instructions, you
may not be found eligible for the requested benefit and this
petition may be denied.

Part 7. Signature and Contact Information of
Person Preparing Form, If Other Than
Above
I declare that I prepared this petition at the request of the above
person, and it is based on all information of which I have
knowledge.

Part 6. Signature (Read the information on
penalties in the instructions before
completing this section. If you checked Block
1.a. in Part 2, your spouse must also sign
below. Signature of a conditional resident
child under the age of 14 is not required; a
parent may sign for the child).

1.

Signature
of Preparer

DRAFT Not For
Production
01/09/2013
2.

Date of Signature (mm/dd/yyyy) ►

Preparer's Full Name

3.a. Preparer's Family Name (Last Name)

I certify, under penalty of perjury under the laws of the United
States of America, that this petition and the evidence submitted
with it is all true and correct. If conditional residence was based
on a marriage, I further certify that the marriage was entered in
accordance with the laws of the place where the marriage took
place and was not for the purpose of procuring an immigration
benefit. I also authorize the release of any information from my
records that U.S. Citizenship and Immigration Services needs to
determine eligibility for the benefit sought.

3.b. Preparer's Given Name (First Name)

Signature of Conditional Resident

5.b. Apt.

1.a. Signature of Conditional Resident

1.b. Printed Name of Conditional Resident

4.

Preparer's Business or Organization Name

Preparer's Mailing Address

5.a. Street Number
and Name

Ste.

Flr.

5.c. City or Town
5.d. State

5.e. Zip Code

Preparer's Contact Information

2.

Date of Signature (mm/dd/yyyy) ►

Signature of Spouse or Individual Listed In Part 3
(if applicable)

6.

Daytime Phone Number

7.

E-mail Address (if any)

(

)

-

3.a. Signature of Spouse

3.b. Printed Name of Spouse

4.

Date of Signature (mm/dd/yyyy) ►

Form I-751 01/09/2013 N

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