Record Of Abandonment Of Lawful Permanent Resident Status {I-407}

Form I-407 05/16/19Page 1 of 3 Record of Abandonment of Lawful Permanent Resident Status Department of Homeland Security U.S. Citizenship and Immigration ServicesUSCIS Form I-407 OMB No. 1615-0130 Expires 05/31/2021 Alien Registration Number (A-Number)1.a. Part 1. Information About YouA- USCIS Online Account Number (if any)2. Your Name Exactly As It Appears On Your Permanent Resident Card 1.b.3.a.Family Name (Last Name) 3.b. Given Name (First Name) 3.c. Middle Name 7.Date of Last Departure from the United States (mm/dd/yyyy)4.Date of Birth 5.Country of Birth (mm/dd/yyyy)6.Country of Citizenship or Nationality Your Current Legal Name Other InformationCountry9.g.9.f. Postal Code 9.e.Province or State 9.d. City or Town 9.a. In Care Of Name (if applicable) Street Number and Name9.b. 9.c. Ste. Flr. Apt. Mailing Address Outside of the United States Mailing Address Outside of the United States Written in the Language Where You ResideCountry11.g.11.f. Postal Code 11.e.Province or State 11.d. City or Town 11.a. In Care Of Name (if applicable) Street Number and Name11.b. 11.c. Ste. Flr. Apt.State the reasons for abandoning lawful permanent resident status.8. Email Address (if any)10.NOTE: If you are outside of the United States, we recommend that you provide your email address so we can contact you if needed.START HERE - Type or print in black ink. American LegalNet, Inc. www.FormsWorkFlow.com Form I-407 05/16/19Page 2 of 3 A- A-NumberPermanent Resident Card 12.b.I certify, under penalty of perjury under the laws of the United States of America that I no longer possess my Permanent Resident Card for the reasons stated in this form, which I signed on (mm/dd/yyyy)12.c.12.d.13.a. 13.c. 13.d.I am submitting Form I-407 at a U.S. Port of Entry.I am submitting Form I-407 from inside the United States to document that I abandoned my lawful permanent resident (LPR) status in the past. I already abandoned my prior LPR status by leaving the United States intending to make my permanent home abroad. I did not retain my LPR status. I have since returned to the United States through a port of entry by being admitted as a nonimmigrant or by being paroled. I am submitting Form I-407 outside of the United States by mail.13.b.If you did not return your Permanent Resident Card, select the reason why and select and complete the certification statement. I am submitting Form I-407 outside of the United States in-person.12.a. Documents Returned and Location of Submission No Yes Lost Other Stolen Mutilated List other documents you returned (if any).I knowingly, willingly, and affirmatively declare that I already abandoned my prior lawful permanent resident (LPR) status by leaving the United States intending to make my permanent home abroad and I did not retain my LPR status.240 I have since returned to the United States through a Port of Entry by being admitted as a nonimmigrant or by being paroled.240240I declare that I am submitting this Form I-407 to document that I abandoned my prior LPR status. I have reviewed the form and its instructions, and I have been informed, and I understand, that had I not previously abandoned my LPR status, that I would have a right to seek a hearing before an immigration judge to contest the abandonment of my LPR status. 240By signing and submitting this form, I knowingly, willingly, and affirmatively waive my rights, if any, to such a hearing.AND/OR Consent of Parents Custodial Parent, or Legal Guardian to Submit Form I-407 for Incapacitated Adult or Minors 14 Years of Age and Younger (if applicable)I confirm that I am the parent, custodial parent, or duly appointed legal guardian for the individual identified in Part 1. of this form. As the parent or legal guardian of this individual, I consent to the alien minor's/incapacitated adult's submission of this form.14.a.Your Signature (or signature of the parent, custodial parent, or legal guardian, if applicable) 14.c.Date of Signature (mm/dd/yyyy) 14.b. Your Name (or name of parent, custodial parents, or legal guardian, if applicable)NOTE: Signing this form is voluntary. 240U.S. law does not require you to complete, sign, or submit this form. 240You may request a hearing before an immigration judge if you disagree with a Department of Homeland Security (DHS) allegation that you have abandoned your lawful permanent residence.If signed by a parent, custodial parent, or legal guardian, submit evidence to show parental, custodial parental, or legal guardianship responsibility of the minor or incapacitated adult.I knowingly, willingly, and affirmatively declare that I currently have no intention of residing permanently in the United States, and that by signing and submitting this form, I intend to record the fact that I have knowingly and willingly abandoned my LPR status in the United States. I have reviewed the form and its instructions, and I have been informed of and I understand my rights to a hearing before an immigration judge about whether I have abandoned my LPR status in the United States. By signing and submitting this form, I knowingly, willingly, and affirmatively waive my rights to such a hearing. CertificationOR Part 1. Information About You (continued) American LegalNet, Inc. www.FormsWorkFlow.com Form I-407 05/16/19Page 3 of 3 A- A-Number Part 2. Interpreter's Contact Information, Certification, and Signature Interpreter's Family Name (Last Name)1.a. Interpreter's Full Name Interpreter's Given Name (First Name)1.b. Interpreter's Business or Organization Name (if any)2.Provide the following information about the interpreter. Interpreter's Mailing Address (USPS ZIP Code Lookup)3.c.City or Town3.d.State3.e.ZIP Code3.f.Postal CodeStreet Number and Name3.a.3.b.3.g.3.h.Country Province Flr. Apt. Ste. Interpreter's Contact Information4.Interpreter's Daytime Telephone NumberInterpreter's Email Address (if any) 6. 5.Interpreter's Mobile Telephone Number (if any) Interpreter's Signature7.a. Date of Signature (mm/dd/yyyy)7.b. Interpreter's SignatureInstructions to the U.S. government official: Select Item Number 1. if you interviewed the individual identified in Part 1. If you did not, select Item Number 2. Sign the form and provide other information requested. Part 3. For Government Use Only I certify that I personally interviewed the individual identified in Part 1., who has signed this Form I-407, and that I advised the individual of the hearing rights specified in the Instructions. The individual stated that he or she fully understands the effect of signing this Form I-407. I further certify that, if an interpreter was used, I confirmed that the individual understood the interpreter.1. I certify that I reviewed this Form I-407, which was submitted by mail as indicated in Part 1. Item Number 13.b. Based on the completed information, signature, and any attached documentation, the individual identified in Part 1. has declared that he or she fully understands the effect of submitting this Form I-407.2.A copy of the signed Form I-407 was provided to this individual.3. No Yesand I have read to this respondent in the identified language every question and instruction on this form and his or her answer to every question. The respondent informed me that he or she understands every instruction, question, and answer on the form, including the Certification and the Consent of Parent, Custodial Parent, or Legal Guardian to Submit Form I-407 for Incapacitated Adult or Minors 14 Years of Age and Younger (if applicable), and has verified the accuracy of every answer. Interpreter CertificationI certify, under penalty of perjury, that: I am fluent in English and 4.e. Date of Signature (mm/dd/yyyy) U.S. Government Official Information4.a.Title of U.S. Government Official4.d.Name of DHS Component, if signed by a DHS Official4.c.Name of U.S. Government Official 4.b.Signature of U.S. Government Official (sign in ink or use signature stamp) American LegalNet, Inc. www.FormsWorkFlow.com