Transcription of Sample Form I-539, Application to Extend / Change ...
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Sample Form I-539, Application to Extend / Change ...
Form I-539 02/04/19 Application to Extend / Change Nonimmigrant Status Department of Homeland Security Citizenship and Immigration ServicesUSCISForm I-539 OMB No. 1615-0003 Expires 08/31/2020 Part 1. Information About Name (Last Name) Name (First Name) Mailing or Care Of Name (if any) of Last Arrival Into the United States (mm/dd/yyyy) Date of Birth (mm/dd/yyyy)8. Social Security Number (if any) Numberand :New Class DeniedStill within period of stayS/D to:Place under docket controlFrom / //To / //For USCIS Use OnlyAction BlockSentReceivedRelocatedFee StampResubmittedReturnedApplicant interviewed of Citizenship or NationalityCountry of Information About YouPage 1 of 7 USCIS Online Account Number (if any)3. A-Alien Registration Number (A-Number) (if any) Full Numberand NameZIP or Physical AddressForm I-94 Arrival-Departure Record Number11. Provide Information About Your Most Recent Entry Into theUnited StatesSelect this box if Form G-28 is State Bar Number (if applicable)Attorney or Accredited Representative USCIS Online Account Number (if any)To be completed by an Attorney or Accredited Representative(if any).
application and that all of this information is complete, true, and correct. 6.b. Date of Signature (mm/dd/yyyy) 6.a. Applicant's Signature Applicant's Signature NOTE TO ALL APPLICANTS:If you do not completely fill out this application or fail to submit required documents listed in the Instructions, USCIS may deny your application. Part 6.
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