OMB No. 1615-0023; Expires 06/30/15

Form I-485, Application to Register
Permanent Residence or Adjust Status

Department of Homeland Security
U.S. Citizenship and Immigration Services

START HERE - Type or Print (Use black ink)

For USCIS Use Only

Part 1. Information About You
Family Name (Last Name)

Receipt

Returned

Given Name (First Name)

Middle Name

Address - Street Number and Name

Apt. No.

Resubmitted

C/O (in care of)
City

State

Date of Birth (mm/dd/yyyy)

ZIP Code

Country of Birth

Country of Citizenship/Nationality U.S. Social Security No. (if any) A-Number (if any)
Date of Last Arrival (mm/dd/yyyy)

I-94 Number

Current USCIS Status

Expires on (mm/dd/yyyy)

Part 2. Application Type (Check one)
I am applying for an adjustment to permanent resident status because:
a.

An immigrant petition giving me an immediately available immigrant visa number that has been approved. (Attach a copy of the approval notice, or a relative, special immigrant juvenile, or special immigrant military visa petition filed with this application that will give you an immediately available visa number, if approved.)

b.

My spouse or parent applied for adjustment of status or was granted lawful permanent residence in an immigrant visa category that allows derivative status for spouses and children.
I entered as a K-1 fiancé(e) of a U.S. citizen whom I married within 90 days of entry, or I am the K-2 child of such a fiancé(e). (Attach a copy of the fiancé(e) petition approval notice and the marriage certificate.)

c.

d.
e.

Reloc Sent

I was granted asylum or derivative asylum status as the spouse or child of a person granted asylum and am eligible for adjustment.
I am a native or citizen of Cuba admitted or paroled into the United States after
January 1, 1959, and thereafter have been physically present in the United States for at least 1 year.

f.

I am the husband, wife, or minor unmarried child of a Cuban described above in
(e), and I am residing with that person, and was admitted or paroled into the United
States after January 1, 1959, and thereafter have been physically present in the
United States for at least 1 year.

g.

I have continuously resided in the United States since before January 1, 1972.

Reloc Rec'd

Applicant
Interviewed

Section of Law
Sec. 209(a), INA
Sec. 209(b), INA
Sec. 13, Act of 9/11/57
Sec. 245, INA
Sec. 249, INA
Sec. 1 Act of 11/2/66
Sec. 2 Act of 11/2/66
Other

Country Chargeable

Eligibility Under Sec. 245
Approved Visa Petition
Dependent of Principal Alien
Special Immigrant
Other

Preference
Action Block

h.

Other basis of eligibility. Explain (for example, I was admitted as a refugee, my status has not been terminated, and I have been physically present in the United
States for 1 year after admission). If additional space is needed, see Page 3 of the instructions. I am already a permanent resident and am applying to have the date I was granted permanent residence adjusted to the date I originally arrived in the United States as a nonimmigrant or parolee, or as of May 2, 1964, whichever date is later, and:
(Check one)
i.
I am a native or citizen of Cuba and meet the description in (e) above.

VOLAG No

j.

ATTY State License No.

I am the husband, wife, or minor unmarried child of a Cuban and meet the description in (f) above.

To be Completed by
Attorney or Representative, if any
Fill in box if Form G-28 is attached to represent the applicant.

Form I-485 (Rev. 06/20/13) Y

Part 3. Processing Information
A. City/Town/Village of Birth

Current Occupation

Your Mother's First Name

Your Father's First Name

Give your name exactly as it appears on your Form I-94, Arrival-Departure Record
Place of Last Entry Into the United States
(City/State)

In what status did you last enter? (Visitor, student, exchange visitor, crewman, temporary worker, without inspection, etc.)

Were you inspected by a U.S. Immigration Officer?

Yes

Nonimmigrant Visa Number
Date Visa Issued (mm/dd/yyyy)

No
Consulate Where Visa