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APPLICATION TO DETERMINE EXPIRATION Date: …

8. Previous Immigration RecordFirst Name1. Family NameMiddle Name2. Other Names Used, Aliases (If Married Woman, Give Maiden Name)3. Current Home Address and Telephone Number4. Place of Birth (City, Province, Country)5. date of Birth (mm-dd-yyyy)6. Marital StatusMarriedSingle (Never Married)WidowedDivorcedIf married, information about spousea. Name (Last, First, MI)b. Addressc. Place of Birthd. date of Birth (mm-dd-yyyy)e. Residence Status, if any ( Citizen, Legal Permanent Resident, Etc.)f. date of Marriage to You (mm-dd-yyyy)7. List Below All Close Family Members in the United States (Continue on Separate Page if Necessary.)Full NameRelationshipResident StatusPlace of Residencea. DHS "A" Numberb. Immigration Categoryc. Previous Immigrant Visa d. Adjustment of StatusDate of Issue (mm-dd-yyyy) date of Adjustment of Statuswith DHS (IF ANY) (mm-dd-yyyy)Place of Adjustment ofStatus with DHS (IF ANY)Place of Issuee.

EXPIRATION Date: 05/31/2023 ESTIMATED BURDEN: 30 MINUTES* DS-117 10-2019 Page 1 of 3 INSTRUCTIONS This is an application for Special Immigrant Status under Section 101(a)(27)(A) of the Immigration and Nationality Act, for lawfully admitted permanent

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Bureau of Population, Refugees and Migration ESTIMATED ...

eforms.state.gov

Speaking 13. Occupation/Skill 14. Education Level/Field of Study 17. English Speaking Ability (Good, Some, None) 18. Pregnant Yes No 19. Estimated Delivery Date (mm-dd-yyyy) 20. Health Issues (If yes, please explain) 1. Name as it Appears on Passport (Last, First, Middle) Child 2 2. Passport No. 4. Sex 9. Ethnicity 10. Religion 11. Phone Number ...

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FOR INFORMATION AND QUESTIONS …

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CAN I USE THIS FORM? - State

eforms.state.gov

If you are unable to document your name change in this manner, you must apply on the DS-11 application form by making a personal appearance at (1) a passport agency; (2) U.S. Embassy or Consulate, if abroad; (3) any federal or state court of record or any probate court accepting

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USE OF THIS FORM FORM INSTRUCTIONS SPECIAL …

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STATEMENT OF CONSENT To be completed by the non-applying parent or guardian using his/her information when not present at the time the applying parent or guardian submits the minor's application. Statements expire after 90 days .

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I can submit my most recent U.S. passport book and/or U.S. passport card with this application. I was at least 16 years old when my most recent U.S. passport book

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