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1345 Avenue of the Americas, 2nd Floor
New York, NY 10105
keN garcia
attorney at law
_________________________________
Immigration & Nationality Law
FREE CONSULTATION
GREEN CARD REPLACEMENT QUESTIONNAIRE
Please answer all questions completely and truthfully.
If a required field is not applicable, please write N/A or NA.
The information collected will be used to prepare the applicable petition/application, will be kept entirely confidential and will not be disclosed to anyone without the client’s consent.
INFORMATION ABOUT THE APPLICANT
1. Complete Name (LAST, First, Middle):
*
2. Complete Name as Appearing on Current Permanent Resident Card (LAST, First, MIddle):
*
3. Alien Registration Number (A-Number):
*
Write "N/A" if not applicable.
4. Date of Issuance of Green Card (mm/dd/yyyy):
*
5. List the location of the US Embassy, US Consulate or USCIS Office where you filed your immigrant visa or granted lawful permanent resident status:
*
6. List the location of the US Embassy, US Consulate or USCIS Office where you were issued your immigrant visa application or adjustment of status:
*
7. If you entered the United States using an immigrant visa, list the city and port-of-entry where you were admitted to the United States:
*
8. Present Address:
*
Line 1
Line 2
City
State
Zip Code
Country
9. Mobile Phone Number:
*
10. Email:
*
11. Date of Birth (mm/dd/yyyy):
*
12. City/Town/Village of Birth:
*
13. Country of Birth:
*
14. Mother's Given Name (First Name):
*
15. Father's Given Name (First Name):
*
16. Gender:
*
Male
Female
17. Ethnicity:
*
Hispanic or Latino
Not Hispanic or Latino
18. Race:
*
White
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
19. U.S. Social Security Number, if any:
*
20. Height:
*
21. Weight:
*
22. Eye Color:
*
Black
Gray
Maroon
Blue
Green
Pink
Brown
Hazel
Unknown/Other
23. Hair Color:
*
Bald (No Hair)
Brown
Sandy
Black
Gray
White
Blond
Red
Unknown/Other
24. I am requesting an accommodation because of my disabilities/impairments:
*
Yes
No
Not Applicable
25. My Status is:
*
Lawful Permanent Resident
Permanent Resident - In Commuter Status
Conditional Permanent Resident
26. Reason for Application:
*
Previous card has been lost, stolen , or destroyed
Previous card was issued but never received
Existing card has been mutilated
Name or other biographic information has been legally changed since issuance of existing card
Existing care has already expired or will expire within 6 months
I have reached my 14th birthday and am registering as required (my existing card will expire AFTER my 16th birthday)
I have reached my 14th birthday and am registering as required (my existing card will expire BEFORE my 16th birthday)
Replacement of current Permanent Resident Card for a reason that specified above
Submit