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Legal Forms | Application for Replacement I-94 | Adam Edward Rothwell, Immigration Lawyer - JDSupra
The I-94 document is a the small card that foreign citizens without green cards receive upon legally entering the United States. It shows lawful admission into the US and is therefore an extremely important document. This Form is completed and filed by foreign citizens who lose their I-94 document in order to have a duplicate I-94 issued.
OMB No. 1615-0079; Expires 08/31/09 I-102, Application for Replacement/Initial Department of Homeland Security U.S. Citizenship and Immigration Services Nonimmigrant Arrival -Departure Document START HERE -Please type or print in black ink. For USCIS Use Only Part 1. Information About You Returned Receipt Family Name Given Name Middle Name Date Date Address -In care of -Resubmitted Street Number and Name Apt./Suite # Date In care of -Date Reloc Sent City State Date Zip/Postal Code Country Date of Birth (mm/dd/yyyy) Date Reloc Rec'd Country of Birth Country of Citizenship/Nationality Date A # (If any) U.S. Social Security # (If any) DateApplicant Interviewed Date (mm/dd/yyyy) and Place of Last Admission Current Nonimmigrant Status on New I-94 # Status Expires on (mm/dd/yyyy) I-94, I-94W, or I-95 Arrival/Departure Document # Remarks Part 2. Reason for Application Check the box that best describes your reason for requesting a replacement document (Check one box). a. I am applying to replace my lost or stolen Form I-94 (or I-94W). b. I am applying to replace my lost or stolen Form I-95. Action Block c. I am applying to replace Form I-94 (or I-94W) because it is mutilated. I have attached my original I-94 (or I-94W). d. I am applying to replace Form I-95 because it is mutilated. I have attached my original Form I-95. e. I was not issued Form I-94 when I entered as a nonimmigrant, and I am filing this application together with an application for an extension of stay/change of status. f. I was issued Form I-94, I-94W, or I-95 with incorrect information, and I am To Be Completed by requesting USCIS to correct the document. I have attached my original Form Attorney or Representative, if any. I-94, I-94W, or I-95. Fill in box if G-28 is attached to represent the applicant. g. I was not issued Form I-94 when I entered as a nonimmigrant member of the military, and I am filing this application for an initial Form I-94. ATTY State License # Form I-102 Form (Rev. 08/21/08)Y Document hosted at http://www.jdsupra.com/post/documentViewer.aspx?fid=88c23798-ed18-4e2a-aef9-3698d354af87Part 3. Processing Information 1. Are you filing this application with any other petition or application? No Yes -Form # 2. Are you now in removal proceedings? No Yes (Give detailed information regarding the proceedings. If you need more space to complete the answer, use a separate sheet(s) of paper. Write your name and A #, if any, and "Part 3, Number 2" at the top of each sheet.) 3. If you are unable to provide the original of your Form I-94, I-94W, or I-95, give the following information: Your name exactly as it appears on Form I-94, I-94W, or I-95, if known (Print clearly) Class of Admission Place of Admission Part 4. Signature (Read the information on penalties in the instructions before completing this section. You maupspt lifcilaet iothni swhile in the United States.) I certify, under penalty of perjury under the laws of the United States of America, that this application and the evidence submitted with it is all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking. Signature Daytime Telephone Number (With area code) Date (mm/dd/yyyy) ( ) Part 5. Signature of Person Preparing Form, if Other Than Above (Sign below) I declare that I prepared this application at the request of the above person, and it is based on all information of which I have knowledge. Signature Print or Type Your Name Firm Name Firm Address (Street Number and Name or P.O. Box, City, State, Zip Code) Daytime Telephone Number (With area code) E-Mail Address (If any) Date (mm/dd/yyyy) ( ) Form I-102 Form (Rev. 08/21/08)Y Page 2 Document hosted at http://www.jdsupra.com/post/documentViewer.aspx?fid=88c23798-ed18-4e2a-aef9-3698d354af87
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Application to Extend / Change NonImmigrant Status