Form I-751 Petition to Remove the Conditions on Residence

USCIS
Form I-751

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

For
USCIS
Use
Only

OMB No. 1615-0038
Expires 11/30/2017

Action Block

Reloc Sent
Reloc Received
Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
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Date (mm/dd/yyyy)
Date (mm/dd/yyyy)
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Petitioner interviewed on (mm/dd/yyyy)

Remarks

DRAFT
Not for
Productions
10/10/2017
(EXT + PN)

To be completed by an
attorney or accredited
representative (if any).

Select this box if
Form G-28 is
attached.

/

/

/

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

Attorney State Bar Number
(if applicable)

Attorney or Accredited Representative
USCIS Online Account Number (if any)

►START HERE - Type or print in black ink.

Part 1. Information About You, the Conditional
Resident

5.

Country of Birth

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

6.

Country of Citizenship or Nationality (provide all that
apply)

7.

Alien Registration Number (A-Number) (if any)
► A-

Other Names Used

8.

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.

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

9.

USCIS Online Account Number (if any)

1.c. Middle Name

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

►

Marital Status

10.

Marital Status
Single

Married

Divorced

Widowed

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)

Other Information
4.

Date of Birth (mm/dd/yyyy)

Form I-751 12/23/16 N

Page 1 of 11

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

21.

Yes
22.

15.a. In Care Of Name

Apt.

15.d. City or Town
15.e. State
16.

Ste.

Flr.

23.

Part 2. Biographic Information

No

Physical Address

1.

Ethnicity (Select only one box)
Hispanic or Latino
Not Hispanic or Latino

2.

Race (Select all applicable boxes)
White
Asian

17.a. In Care Of Name

17.c.

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

Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander

Ste.

Flr.

17.f. ZIP Code

3.

Height

4.

Weight

5.

Eye Color (Select only one box)

Additional Information About You
18.

19.

20.

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

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If you answered “Yes” to Item Number 16., provide your
physical address below.

Apt.

Have you resided at any other address since you became a
permanent resident?
Yes
No

15.f. ZIP Code

Is your physical address different than your mailing
address?
Yes

17.b. Street Number
and Name

No

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.

15.b. Street Number
and Name
15.c.

If you are married, is this a different marriage than the
one through which you gained conditional resident status?

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

No

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

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

6.

Feet

Inches
Pounds

Black
Gray

Blue

Brown

Green

Hazel

Maroon

Pink

Unknown/Other

Hair Color (Select only one box)
Bald (No hair)
Brown
Sandy

Black
Gray
White

Blond
Red
Unknown/Other

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.

Form I-751 12/23/16 N

Page 2 of 11

Part 3. Basis for Petition

Other Information

Joint Filing

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

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):

2.c. Middle Name

1.a.

My spouse.

3.

Date of Birth (mm/dd/yyyy)

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.

4.

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

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OR (Select all applicable boxes in the next section.)

5.

A-Number (if any)

► A-

Waiver or Individual Filing Request

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:
1.c.

My spouse is deceased.

1.d.

My marriage was entered in good faith, but the
marriage was terminated through divorce or
annulment.

1.e.

1.f.

1.g.

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.

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

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.

Physical Address

6.a. Street Number
and Name

6.b.

Apt.

Ste.

Flr.

6.c. City or Town
6.d. State
6.f.

6.e. ZIP Code

Province

6.g. Postal Code
6.h. Country

Part 5. Information About Your Children

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.
Child 1

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

1.c. Middle Name
2.

Date of Birth (mm/dd/yyyy)

3.

A-Number (if any)

Relationship
1.a.

Spouse or Former Spouse

1.b.

Parent's Spouse or Former Spouse

Form I-751 12/23/16 N

► A4.

Is this child living with you?

Yes

No

5.

Is this child applying with you?

Yes

No

Page 3 of 11

Child 3

Part 5. Information About Your Children
(continued)

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

Physical Address
6.a. Street Number
and Name
6.b.

Apt.

13.c. Middle Name
Ste.

Flr.

6.c. City or Town
6.d. State
6.f.

Province

6.g. Postal Code
6.h. Country

14.

Date of Birth (mm/dd/yyyy)

15.

A-Number (if any)
► A-

6.e. ZIP Code

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16.

Is this child living with you?

Yes

No

17.

Is this child applying with you?

Yes

No

Physical Address

18.a. Street Number
and Name

Child 2

7.c. Middle Name

18.d. State

9.

A-Number (if any)

18.h. Country

10.

Is this child living with you?

Yes

No

11.

Is this child applying with you?

Yes

No

Physical Address

12.c. City or Town
12.d. State

18.e. ZIP Code

18.g. Postal Code

► A-

Apt.

Flr.

18.f. Province

Date of Birth (mm/dd/yyyy)

12.a. Street Number
and Name

Ste.

18.c. City or Town

8.

12.b.

Apt.

18.b.

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

Child 4

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

19.c. Middle Name

Ste.

Flr.

20.

Date of Birth (mm/dd/yyyy)

21.

A-Number (if any)

► A-

12.e. ZIP Code
22.

Is this child living with you?

Yes

No

23.

Is this child applying with you?

Yes

No

12.f. Province
12.g. Postal Code
12.h. Country

Form I-751 12/23/16 N

Page 4 of 11

Part 5. Information About Your Children
(continued)

Part 6. Accommodations for Individuals With
Disabilities and/or Impairments

Physical Address

NOTE: Read the information in the Form I-751 Instructions
before completing this part.

24.a. Street Number
and Name
Apt.

24.b.

Ste.

1.

Are you requesting an accommodation because of your
disabilities and/or impairments?
Yes
No

2.

Are you requesting an accommodation because of your
spouse's disabilities and/or impairments?

Flr.

24.c. City or Town
24.d. State

Yes

24.e. ZIP Code

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3.

24.f. Province
24.g. Postal Code
24.h. Country

Child 5
25.a. Family Name
(Last Name)
25.b. Given Name
(First Name)
25.c. Middle Name

Date of Birth (mm/dd/yyyy)

27.

A-Number (if any)

28.

Is this child living with you?

Yes

No

29.

Is this child applying with you?

Yes

No

Physical Address

Apt.

30.c. City or Town
30.d. State

Yes

No

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).):

4.b.

I am blind or have low vision and request the
following accommodation:

4.c.

I have another type of disability and/or impairment.
(Describe the nature of your disability and/or
impairment and the accommodation you are
requesting.):

► A-

30.b.

Are you requesting an accommodation because of your
included children's disabilities and/or impairments?

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.

26.

30.a. Street Number
and Name

No

Ste.

Flr.

30.e. ZIP Code

30.f. Province
30.g. Postal Code
30.h. Country

Form I-751 12/23/16 N

Page 5 of 11

Petitioner's Contact Information

Part 7. Petitioner's Statement, Contact
Information, Acknowledgement of Appointment
at USCIS Application Support Center,
Certification, and Signature
NOTE: Read the information on penalties in the Penalties
section of the Form I-751 Instructions before completing this
part.
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.

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.

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.

4.

Petitioner's Mobile Telephone Number (if any)

5.

Petitioner's Email Address (if any)

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NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.

1.b.

Petitioner's Daytime Telephone Number

Acknowledgement of Appointment at USCIS
Application Support Center

Petitioner's Statement

1.a.

3.

I have requested the services of and consented to

,

who
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.

Form I-751 12/23/16 N

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.
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.
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.

Page 6 of 11

Part 7. Petitioner's Statement, Contact
Information, Acknowledgement of Appointment
at USCIS Application Support Center,
Certification, and Signature (continued)

Spouse's or Individual's Statement
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.

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

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.

DRAFT
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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.

,
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.

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.

Petitioner's Signature
6.a. Petitioner's Signature

2.

,
is
is not an attorney or accredited
who
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.

6.b. Date of Signature (mm/dd/yyyy)

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.
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)

I have requested the services of and consented to

Spouse's or Individual's Contact Information

3.

Spouse's or Individual's Daytime Telephone Number

4.

Spouse's or Individual's Mobile Telephone Number (if any)

5.

Spouse's or Individual's Email Address (if any)

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.

Form I-751 12/23/16 N

Page 7 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.

Spouse's or Individual's Signature
6.a. Spouse's or Individual's Signature

6.b. Date of Signature (mm/dd/yyyy)
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.

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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.

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.

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.

Part 9. Interpreter's Contact Information,
Certification, and Signature

Provide the following information about the interpreter.

Interpreter's Full Name

1.a. Interpreter's Family Name (Last Name)

1.b. Interpreter's Given Name (First Name)

2.

Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address

3.a. Street Number
and Name
3.b.

Apt.

Ste.

Flr.

3.c. City or Town
3.d. State
3.f.

3.e. ZIP Code

Province

3.g. Postal Code
3.h. Country

Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

5.

Interpreter's Email Address (if any)

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.

Form I-751 12/23/16 N

Page 8 of 11

Part 9. Interpreter's Contact Information,
Certification, and Signature (continued)
Interpreter's Certification

Preparer's Mailing Address
3.a. Street Number
and Name
3.b.

Apt.

Ste.

Flr.

I certify that:
3.c. City or Town
I am fluent in English and
, which
is the same language provided in Part 7., Item Number 1.b.;

3.d. State

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

3.f.

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.

3.h. Country

3.e. ZIP Code

Province

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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.

3.g. Postal Code

Preparer's Contact Information

4.

Preparer's Daytime Telephone Number

5.

Preparer's Fax Number

6.

Preparer's Email Address (if any)

Interpreter's Signature
6.a. Interpreter's Signature

Preparer's Statement

7.a.

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.b.

I am an attorney or accredited representative and
my representation of the petitioner in this case
extends
does not extend beyond the
preparation of this petition.

6.b. Date of Signature (mm/dd/yyyy)

Part 10. Contact Information, Statement,
Certification, and Signature of the Person
Preparing this Petition, If Other Than the
Petitioner
Provide the following information about the preparer.

Preparer's Full Name

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.

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

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

2.

Preparer's Business or Organization Name (if any)

Form I-751 12/23/16 N

Page 9 of 11

Part 10. Contact Information, Statement,
Certification, and Signature of the Person
Preparing this Petition, If Other Than the
Petitioner (continued)
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

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Preparer's Signature
8.a. Preparer's Signature

8.b. Date of Signature (mm/dd/yyyy)

Form I-751 12/23/16 N

Page 10 of 11

5.a. Page Number

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.

5.b. Part Number

5.c. Item Number

5.d.

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6.a. Page Number

6.b. Part Number

6.c. Item Number

7.b. Part Number

7.c. Item Number

A-Number (if any)

A-

3.a. Page Number

3.d.

3.b. Part Number

6.d.

3.c. Item Number

7.a. Page Number

7.d.

4.a. Page Number

4.d.

4.b. Part Number

Form I-751 12/23/16 N

4.c. Item Number

Page 11 of 11