Department of Homeland Security U.S. Citizenship and Immigration Services Department of Justice U.S. Executive Office for Immigration Review OMB No. 1615-0072; Exp. 03/31/2019 I-881, Application for Suspension of Deportation or Special Rule Cancellation of Removal (Pursuant to Section 203 of Public Law 105-100, NACARA) For USCIS Use Only Returned Receipt START HERE - Type or print in black ink. If any question does not apply to you, write "None" or "N/A" in the appropriate space. Part 1. Background Information About YOU Alien Registration Number(s), if any (List every A-Number you have been given) Family Name(s) Given Name Middle Name Resubmitted What other names have you used? (include maiden name and aliases) Address - Street Number and Name (or P.O. Box) City Date of Birth (mm/dd/yyyy) U.S. Social Security Number Present Nationality (Citizenship) State Apartment Number Reloc Sent ZIP Code Place of Birth (City or Town and Country) Gender Male Female Home Telephone Number (with area code) Reloc Rec'd Decision Part 2. Application (Check all that apply to you) I am eligible to apply for suspension of deportation or special rule cancellation of removal under the Nicaraguan Adjustment and Central American Relief Act (NACARA) because I have not been convicted of an aggravated felony and: (a) I am a national of El Salvador who first entered the United States on or before September 19, 1990, or a national of Guatemala who first entered the United States on or before October 1, 1990. I also timely registered for benefits under the settlement agreement in American Baptist Churches v. Thornburgh (ABC), 760 F. Supp. 796 (N.D. Cal. 1991), either directly or, if Salvadoran, by applying for Temporary Protected Status (TPS), and I have not been apprehended at time of entry after December 19, 1990. (b) I am a national of Guatemala or El Salvador who filed an application for asylum on or before April 1, 1990. (c) I entered the United States on or before December 31, 1990; filed an application for asylum on or before December 31, 1991; and at the time of filing was a national of the Soviet Union (USSR), Russia, any Republic of the former Soviet Union, Latvia, Estonia, Lithuania, Poland, Czechoslovakia, Romania, Hungary, Bulgaria, Albania, East Germany, Yugoslavia (including Bosnia and Herzegovina, Croatia, Kosovo, Macedonia, Montenegro, Slovenia, and Serbia). (d) I am the spouse, child (unmarried and under 21 years of age), unmarried son or unmarried daughter of someone who has already applied, or is presently filing with me, for suspension of deportation or special rule cancellation of removal under NACARA. If I am an unmarried son or unmarried daughter, I entered the United States on or before October 1, 1990, or my parent was granted suspension of deportation or special rule cancellation of removal when I was less than 21 years of age. Attach proof of relationship and provide the following information about that spouse or parent: Name: A-Number(s): The person who has applied for suspension of deportation or special rule cancellation of removal is your: Spouse Parent (e) I am or was the spouse or child of an individual described in Part 2(a), (b), or (c) on Page 1, and I or my child has been battered or subjected to extreme cruelty by that individual described in Part 2(a), (b), or (c). Suspension of Deportation or Special Rule Cancellation of Removal and Adjustment of Status granted Referred to Immigration Judge in accordance with 8 CFR Section 240.70 (Adjudicating Officer's Signature) (Date of Action) (Office Location) EOIR Actions Attorney or Representative, if any Check Box if G-28 is attached. Attorney State License Number: Form I-881 03/21/17 Y Page 1 American LegalNet, Inc. www.FormsWorkFlow.com Part 3. Information About Your Presence In the United States 1. Provide information about the places where you have resided in the United States during the past 10 years: (List PRESENT ADDRESS FIRST and work back in time. List only places where you resided 60 days or more. Attach additional sheets of paper as needed.) Street Number and Name Apt Number City or Town State ZIP Code Resided From: (Month/Year) Resided To: (Month/Year) Present 2. Provide information about your first entry into the United States: Name used when first entered the United States: (Family Name, First, Middle) Status when you first entered the United States: Place of first entry into the United States: (City and State) Date of first entry into the United States: (mm/dd/yyyy) Period admitted: (mm/dd/yyyy) From: To: Date you first changed status: (mm/dd/yyyy) Last Extension of Stay expired on: (mm/dd/yyyy) If you changed nonimmigrant status after entry, list status you changed to: 3. Provide information about any departure from and return to the United States you have made since your first entry: (List all departures, including brief ones. Attach additional sheets of paper as needed.) If you have not departed the United States since your first date of entry, please mark an "X" in this box: Port of Departure: (Place or Port, City, State) Port of Return: (Place or Port, City, State) Port of Departure: (Place or Port, City, State) Port of Return: (Place or Port, City, State) Departure Date: (mm/dd/yyyy) Purpose of Travel: Return Date: (mm/dd/yyyy) Status at Entry: Destination: Inspected and Admitted: Yes No Destination: Inspected and Admitted: Yes No Departure Date: (mm/dd/yyyy) Purpose of Travel: Return Date: (mm/dd/yyyy) Status at Entry: 4. Have you ever: (a) Been ordered deported or removed? (b) Departed the United States under an order of deportation or removal? (c) Overstayed a grant of voluntary departure from an immigration judge or DHS? (d) Departed the United States under a grant of voluntary departure or voluntary return? (e) Failed to appear for deportation or removal? Yes Yes Yes Yes Yes No No No No No If you responded "Yes" to any of the above, indicate the name and Alien Registration Number (A-Number) you were using at that time, along with the date you left the United States, if applicable: Form I-881 03/21/17 Y Page 2 American LegalNet, Inc. www.FormsWorkFlow.com Part 3. Information About Your Presence in the United States (Continued) If you are unsure about any of your answers to questions 4(a) - (e) in Part 3 on Page 2, indicate which question(s) and explain why you are unsure about the response(s) you have given: (Attach additional sheets of paper as needed.) Part 4. Information About Your Financial Status