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I-191, Application For Advance Permission To Return To Unrelinquished Domicile

This document is an I-191 Application for Advance Permission to Return to Unrelinquished Domicile. It collects information such as the applicant's name, citizenship, addresses, entry/exit details from the US, employment history, and family members. The applicant signs to say the statements are true and provides their signature. They also acknowledge the information may be used in legal proceedings including removal cases. It is a form submitted to request permission to return to the US under Section 212(c) of the Immigration and Nationality Act.

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Nestor Lopez
Copyright
© Attribution Non-Commercial (BY-NC)
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79 views0 pages

I-191, Application For Advance Permission To Return To Unrelinquished Domicile

This document is an I-191 Application for Advance Permission to Return to Unrelinquished Domicile. It collects information such as the applicant's name, citizenship, addresses, entry/exit details from the US, employment history, and family members. The applicant signs to say the statements are true and provides their signature. They also acknowledge the information may be used in legal proceedings including removal cases. It is a form submitted to request permission to return to the US under Section 212(c) of the Immigration and Nationality Act.

Uploaded by

Nestor Lopez
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

COMPLETED

(Length of Time)
(Date - mm/dd/yyyy)
Fee Stamp
Action Block
Alien Registration Number
Date
(1) I hereby apply for permission to return to the United States under the authority contained in Section 212(c) of the Immigration and Nationality Act.
MY NAME IS: (Middle) (Last) (First)
I AM A CITIZEN/NATIONAL OF: (Country) PLACE OF BIRTH: (City, Province, Country) DATE OF BIRTH: (mm/dd/yyyy)
PRESENT ADDRESS: (Street and number, apt. no., city, state, country)
(2) I was lawfully admitted to the United States for permanent residence at:
NAME OF VESSEL OR OTHER MEANS OF CONVEYANCE: PORT OF ENTRY/DHS OFFICE: DATE: (mm/dd/yyyy)
(3) Since that admission I have departed from and reentered the United States as follows:
RETURNED TO THE UNITED STATES PURPOSE OF TRIP DEPARTED FROM THE UNITED STATES
Port
Date
Vessel or Other Means
of Conveyance
Port
(4) During the past 7 years I have resided at the following places: (List present address first)
(Complete Address - Include Apt. No.) From - To-
Present time
(5) During the past 7 years I have been employed as follows: (List present employment first)
From - To - Address
Occupation or Type of
Business
(6) My immediate family (spouse, unmarried minor children and parents) consists of the following persons:
Name Relation Date and Country of Birth Citizen of Present Address
(7) I depart(ed) temporarily from the United States on or about
approximately , for the purpose of
(Country)
; and expect to apply for admission at
RECEIVED TRANS. IN RET'D-TRANS. OUT
Department of Homeland Security
U.S. Citizenship and Immigration Services
I-191, Application for Advance Permission
to Return to Unrelinquished Domicile
(mm/dd/yyyy)
Date
(mm/dd/yyyy)
Vessel or Other Means
of Conveyance
Employer's Name
and will remain
FormI-191 (Rev. 04/08/11) Y
OMB No. 1615-0016
(Intend to or have)
in
(Port)
Remarks:
(Signature of Applicant)
(8) I believe I may be inadmissible to the United States for the following reasons:
I understand that the information herein contained may be used in any criminal or civil proceedings, including removal, hereafter instituted against me.

I certify that the statements above are true and correct to the best of my knowledge and belief.
Signature of person preparing form, if other than applicant.
I declare that the document was prepared by me at the request of the applicant and is based on all information of which I have any knowledge.
(Signature) (Address) (Date)
Decision:
Application granted upon the following terms and conditions:
DATE
OF
ACTION
DD
DISTRICT
FormI-191 (Rev. 04/08/11) Y Page 2

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