Official Federal Forms > US Citizenship And Immigration Services
Sponsors Notice Of Change Of Address I-865 - Official Federal Forms
| Sponsors Notice Of Change Of Address Form. This is a national form and can be used in US Citizenship And Immigration Services . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
OMB No. 1615-0076; Expires 01/31/2015 Department of Homeland Security U.S. Citizenship and Immigration Services Form I-865, Sponsor's Notice of Change of Address For USCIS Use Only Returned Middle Name Date Date Resubmitted Receipt START HERE-Type or print in black ink Part 1. Information About You, the Sponsor Family Name Given Name Date of Birth (mm/dd/yyyy) Place of Birth (City, State/Province /Country) A-Number (if any) U.S. Social Security Number Date Your current status (Check one) I am a U.S. Citizen Lawful Permanent Resident Date Action Block 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. Your New Home Address - Street Number and Name (Include Apt. # if applicable) City State or Province Zip/Postal Code Country Effective Date of Change of Address Daytime Telephone (Area/Country Code) E-Mail Address (if any) Remarks 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) C/O (in care of): City State or Province Zip/Postal Code Effective Date of Change of Address Daytime Telephone (Area/Country Code) E-Mail Address (if any) Part 2. Information on Sponsored Immigrant(s) (If more than one person, attach a separate sheet(s) of paper) Provide the requested information on the person(s) your are sponsoring:. Family Name Given Name Middle Name A-Number Form I-865 01/03/13 Y Page 1 American LegalNet, Inc. www.FormsWorkFlow.com 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. Signature Date (mm/dd/yyyy) 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. Preparer's Signature Preparer's Printed Name Date (mm/dd/yyyy) Preparer's Firm Name (if applicable) Preparer's Address Daytime Phone Number (with area code) Fax Number (if any) E-Mail Address (if any) Form I-865 01/03/13 Y Page 2 American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
