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Application To Replace Permanent Resident Card I-90 - Official Federal Forms
| Application To Replace Permanent Resident Card Form. This is a national form and can be used in US Citizenship And Immigration Services . |
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Application to Replace Permanent Resident Card Department of Homeland Security U.S. Citizenship and Immigration Services Applicant Interviewed Date: For USCIS Class of Admission Use Only Remarks Receipt USCIS Form I-90 OMB No. 1615-0082 Expires 12/31/2015 Action Block START HERE - Type or print in black ink. Part 1. Information About You 1. Alien Registration Number (A-Number) Mailing Address 5.a. In Care of Name A- Your Full Name NOTE: Your card will be issued in this name. 2.a. Family Name (Last Name) 2.b. Given Name (First Name) 2.c. Middle Name 3. Has your name legally changed since the issuance of your Permanent Resident Card? Yes (Proceed to number 4.a. - number 4.c.) No (Proceed to number 5.a. - number 5.f.) N/A - I never received my previous card. (Proceed to number 5.a. - number 5.f.) Your name exactly as reflected on your Permanent Resident Card NOTE: Attach all evidence of your legal name change with this application. 4.a. Family Name (Last Name) 4.b. Given Name (First Name) 4.c. Middle Name 5.b. Street Number and Name 5.c. Apt. Ste. Flr. 5.d. City or Town 5.e. State 5.g. Postal Code 5.h. Province 5.i. Country 5.f. Zip Code U.S. Physical Address 6.a. Street Number and Name 6.b. Apt. Ste. Flr. 6.c. City or Town 6.d. State 6.e. Zip Code Form I-90 03/11/13 Y Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Part 1. Information About You (continued) 7. 8. 9. Gender Date of Birth Male Female 11. Class of Admission (mm/dd/yyyy) 12. City/Town/Village of Birth 13. Date of Admission (mm/dd/yyyy) U.S. Social Security Number (if any) 10. Country of Birth Part 2. Application Type NOTE: If your conditional status is expiring within the next 90 days, then do not file this application. (See Form I-90 instructions for further information.) My status is (Select only one box): 1.a. 1.b. 1.c. Permanent Resident (Proceed to Section A) Permanent Resident - In Commuter Status (Proceed to Section A) Conditional Permanent Resident (Proceed to Section B) 2.h1.1. 2.h1. 2.g2. I have reached my 14th birthday and am registering as required. My existing card will expire before my 16th birthday. (If you are filing this form before your 14th birthday, or more than 30 days after your 14th birthday, do not select 2.g.2. You must select 2.j.) I am a permanent resident who is taking up commuter status. My port of entry (POE) into the United States will be: City and State Reason for Application (select only one box) Section A. (To be used only by a permanent resident or a permanent resident in commuter status.) 2.a. 2.b. 2.c. 2.d. My previous card has been lost, stolen, or destroyed. My previous card was issued but never received. My existing card has been mutilated. My existing card has incorrect data because of USCIS error. (Attach existing card with incorrect data along with this application.) My name or other biographic information has been legally changed since issuance of my existing card. My existing card will expire in 6 months or has already expired. I have reached my 14th birthday and am registering as required. My existing card will expire after my 16th birthday. (If you are filing this form before your 14th birthday, or more than 30 days after your 14th birthday, do not select 2.g1. You must select 2.j.) 2.h2. 2.i. 2.j. I am a commuter who is taking up actual residence in the United States. I have been automatically converted to permanent resident status. I have a prior edition of the Alien Registration Card, or I am applying to replace my current Permanent Resident Card for a reason that is not specified above. Section B. (To be used only by a conditional permanent resident.) 3.a. 3.b. 3.c. 3.d. My previous card has been lost, stolen, or destroyed. My previous card was issued but never received. My existing card has been mutilated. My existing card has incorrect data because of USCIS error. (Attach existing permanent resident card with incorrect data along with this application.) My name or other biographical information has been legally changed since the issuance of my existing card. 2.e. 2.f. 2.g1. 3.e. Form I-90 03/11/13 Y Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Part 3. Processing Information Mother's Name 1. Given Name (First Name) Port of entry where admitted to United States: Father's Name 2. Given Name (First Name) 6. Have you ever been ordered removed from the United States? Yes No Since you were granted permanent residence, have you ever filed Form I-407, Abandonment by Alien of Status as Lawful Permanent Resident, or otherwise been judged to have abandoned your status? Yes No 5.a1. City and State 5.a. Destination in United States at time of admission Additional Information 3. Location where you applied for an immigrant visa or adjustment of status: 7. 4. Location where immigrant visa was issued or USCIS office where adjustment of status was granted: Did you enter the United States with an immigrant visa? Complete number 5.a. and number 5.a1. (If you were granted adjustment of status, proceed to number 6.) NOTE: If you answered "Yes" to number 6 or number 7 above, provide a detailed explanation on a separate sheet of paper. You must include your Name and A-Number on the top of each sheet. Part 4. Accommodations for Individuals With Disabilities and Impairments (Read the information in Form I-90 instructions before completing this Part.) 1. Are you requesting an accommodation because of a disability and/or impairment? Yes No 1.b. I am blind or sight-impaired and request the following accommodation: If you answered "Yes," check any applicable boxes: 1.a. I am deaf or hard of hearing and request the following accommodation (if requesting a signlanguage interpreter, indicate for which language (e.g., American Sign Language)): 1.c. I have another type of disability and/or impairment (describe the nature of the disability and/or impairment and accommodation you are requesting): Form I-90 03/11/13 Y Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Part 5. Signature of Applicant (Read the information on penalties in the Form I-90 instructions before completing this part. You must file Form I-90 while in the United States.) I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted with it is all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking. 1.
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