Applicant's first name: Applicant's middle name: Applicant's last name: Has Applicant used any other names (such as maiden name or aliases)? If yes, what names has Applicant used? Applicant's home address (physical location): Applicant's mailing address: Applicant's date of birth: Applicant's country of birth: Applicant's country of citizenship: Applicant's alien number (this is listed on the permanent resident card): Applicant's social security number: Date when Applicant's current permanent resident card will expire: Applicant's daytime telephone number: Is Applicant still married to the spouse through whom Applicant obtained permanent resident status? If not, what is the date of divorce? Date of marriage: Place of marriage (city, state/province and country): If spouse is deceased, date of death: Is Applicant currently in Removal Proceedings or Immigration Court proceedings? Has Applicant ever been arrested or charged with any crimes? If yes, please list each charge, including year and location: Is Applicant currently married to a different spouse than the one through whom Applicant obtained permanent resident status? Please list ALL addresses at which Applicant has resided SINCE BECOMING A PERMANENT RESIDENT, including street address, city, state, country, and dates Applicant lived there: Is Applicant's spouse currently serving with or employment by the U.S. Government and serving outside of the United States? What is the first name of the spouse through whom Applicant obtained permanent resident status? What is the middle name of the spouse through whom Applicant obtained permanent resident status? What is the last name of the spouse through whom Applicant obtained permanent resident status? What is the date of birth of the spouse through whom Applicant obtained permanent resident status? What is the social security number of the spouse through whom Applicant obtained permanent resident status? What is the alien number (if any) of the spouse through whom Applicant obtained permanent resident status? Please list ALL of Applicant's children (including children of ALL ages who live in the U.S. or anywhere else in the world):
Child's first name:
Child's middle name:
Child's last name:
Child's date of birth:
Child's alien number:
Child's city, state/province, and country of current residence:
Child's immigration status in the U.S.:
Does child live with Applicant? (If Applicant has more than 1 child, please list information for additional children on a separate sheet of paper.) Please return completed questionnaire to: Prepared By: JOHN M. VICKERSTAFF
VICKERSTAFF LAW OFFICE, PSC
4109 Bardstown Road, Suite 106
Louisville, KY 40218
Telephone (502) 491-0197
Facsimile (502) 491-0719
john@vickerstafflaw.com
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