Escolar Documentos
Profissional Documentos
Cultura Documentos
USCIS
Form I-90
OMB No. 1615-0082
Expires 10/31/2017
Receipt
Action Block
Date:
Class of Admission
For
USCIS
Use
Only Remarks
A2.
Mailing Address
6.a. In Care Of Name
Apt.
Ste.
Flr.
6.f.
ZIP Code
6.g. Province
6.h. Postal Code
6.i.
Country
Page 1 of 8
Physical Address
Apt.
Ste.
Flr.
1.b.
1.c.
Province
7.h. Country
Additional Information
8.
Gender
Male
Female
9.
Date of Birth
(mm/dd/yyyy)
10.
City/Town/Village of Birth
11.
Country of Birth
2.a.
2.b.
2.c.
2.d.
2.e.
2.f.
2.g1.
2.g2.
Mother's Name
Given Name
(First Name)
Father's Name
12.
13.
14.
15.
16.
Given Name
(First Name)
Class of Admission
Date of Admission
(mm/dd/yyyy)
U.S. Social Security Number (if any)
Page 2 of 8
2.h1.1.
4.
2.h2.
2.i.
2.j.
3.b.
3.c.
3.d.
3.e.
5.
No
Biographic Information
6.
7.
2.
8.
Height
9.
Weight
10.
11.
Feet
Inches
Pounds
Black
Gray
Blue
Brown
Green
Hazel
Maroon
Pink
Unknown/Other
Black
Gray
White
Blond
Red
Unknown/Other
Page 3 of 8
1.b.
1.c.
Applicant's Statement
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
1.a.
1.b.
2.
Page 4 of 8
4.
5.
Applicant's Certification
Copies of any documents I have submitted are exact photocopies
of unaltered, original documents, and I understand that USCIS
may require that I submit original documents to USCIS at a later
date. Furthermore, I authorize the release of any information
from any and all of my records that USCIS may need to
determine my eligibility for the immigration benefit I seek.
I furthermore authorize release of information contained in this
application, in supporting documents, and in my USCIS records
to other entities and persons where necessary for the
administration of U.S. immigration laws.
I certify, under penalty of perjury, that the information in my
application and any document submitted with my application
were provided by me and are complete, true, and correct.
Applicant's Signature
6.a. Applicant's Signature
2.
Page 5 of 8
Apt.
Ste.
Flr.
Province
5.
Interpreter's Signature
6.a. Interpreter's Signature
Interpreter's Certification
I certify that:
I am fluent in English and
which
is the same language provided in Part 5., Item Number 1.b.;
2.
Page 6 of 8
7.a.
7.b.
Apt.
Ste.
Flr.
Preparer's Statement
Province
Preparer's Certification
3.g. Postal Code
3.h. Country
5.
6.
Preparer's Signature
8.a. Preparer's Signature
Page 7 of 8
4.d.
5.d.
3.d.
Page 8 of 8