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Form I-751

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Form I-751 Page 2
Form I-751
A-Number (if any)
Living with youIf in U.S., give address/immigration status
Part 3. Additional Information About You
1.
Other Names Used (including maiden name):
2.
Date of Marriage (mm/dd/yyyy)
5.
Are you in removal, deportation, or rescission proceedings
6.
Was a fee paid to anyone other than an attorney in connection with this petition
Yes No
Yes No
7.
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
8.
If you are married, is this a different marriage than the one through which conditional residence status was
obtained
Yes No
Yes No
9.
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
Is your spouse currently serving with or employed by the U.S. Government and serving outside the United States
Yes No
10.
Part 4. Information About the Spouse or Parent Through Whom You Gained Your Conditional Residence
Address
Family Name First Name Middle 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)
Name (First/Middle/Last)
Yes No
Yes No
Yes No
Yes No
Yes No
3.
Place of Marriage
4.
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)):
Yes
No
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:
Yes No
Yes
No
Form I-751

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