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A-Number (if any)
Living with youIf in U.S., give address/immigration status
Part 3. Additional Information About You
Other Names Used (including maiden name):
Date of Marriage (mm/dd/yyyy)
Are you in removal, deportation, or rescission proceedings
Was a fee paid to anyone other than an attorney in connection with this petition
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
If you are married, is this a different marriage than the one through which conditional residence status was
Have you resided at any other address since you became a permanent resident (If "Yes," attach a list of
all addresses and dates.)
Is your spouse currently serving with or employed by the U.S. Government and serving outside the United States
Part 4. Information About the Spouse or Parent Through Whom You Gained Your Conditional Residence
Family NameFirst NameMiddle Name
Date of Birth (mm/dd/yyyy)Social Security # (if any)A-Number (if any)
Part 5. Information About Your Children-List All Your Children (Attach other sheets if necessary)
Place of Marriage
If your spouse is deceased, give the date of death (mm/dd/yyyy)
Form I-751 (Rev. 01/12/11) Y Page 2
Date of Birth (mm/dd/yyyy)
If you answered "Yes" to any of the above, provide a detailed explanation on a separate sheet of paper and refer to "What Initial Evidence Is
Required" to determine what criminal history documentation to include with your petition. Place your name and A-Number at the top of each sheet
and give the number of the item that refers to your response.
I am requesting an accommodation:
3. For my included child(ren) because of his or her (their) disability(ies) and/or impairment(s).
2. For my spouse because of his or her disability(ies) and/or impairment(s).
1. Because of my disability(ies) and/or impairment(s).
Blind or sight-impaired and request the following accommodation(s):
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):
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)):
Part 6. Accommodations for Individuals With Disabilities and Impairments
(Read the information in the instructions before completing this section.)
If you answered "Yes," check any applicable box. Provide information on the disability(ies) and/or impairment(s) for each person:
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