Form I-694 05/16/18 Page 1 of 6 Notice of Appeal of Decision Under INA Section 210 or 245A of the Immigration and Nationality Act Department of Homeland Security U.S. Citizenship and Immigration ServicesUSCIS Form I-694 OMB No. 1615-0034 Expires: 05/31/2020 START HERE - Type or print in black ink. For USCIS Use Only Action Block Fee StampFamily Name (Last Name)Given Name (First Name)Middle Name1. Part 1.240 Information About You (Appellant)Full Legal NameAny Other Names Used2.Family Name (Last Name)Given Name (First Name)Middle Name Family Name (Last Name)Given Name (First Name)Middle Name B.A.3. In Care Of Name U.S. Mailing Address (USPS ZIP Code Lookup)City or Town State ZIP Code Street Number and Name Flr. Ste. Apt.Is your current U.S. mailing address the same as your U.S. physical address? If you answered "No," provide your U.S. physical address in Item Number 5.4. No YesNumber6.Alien Registration Number (A-Number) (if any)A-U.S. Physical AddressStreet Number and NameCity or Town State ZIP Code Flr. Ste. Apt.5.Number USCIS Online Account Number (if any)7. American LegalNet, Inc. www.FormsWorkFlow.com Form I-694 05/16/18 Page 2 of 6 Part 2.240 Application Information Part 3.240 Reason for Appeal The appeal must include a statement explaining any error or conclusion of law in the decision being appealed or any erroneous statement of fact stated in the decision. Please provide an explanation. If you need additional space to complete this section, use the space provided in Part 7. Additional Information. Is your written brief attached?If you answered "No," select a response in Item Number 2.1. No Yes2. 2.Your appeal is based on an application for which of the following? 1.Receipt Number (if any) Date of Decision (mm/dd/yyyy)3. Permanent Residence (Form I-698)Temporary Residence (Form I-687)Waiver of Grounds of Inadmissibility (Form I-690) I waive the right to submit a written brief or statement.I will submit a brief within 30 calendar days. American LegalNet, Inc. www.FormsWorkFlow.com Form I-694 05/16/18 Page 3 of 6 At my request, the preparer named in Part 6., prepared this form for me based only upon information I provided or authorized. Appellant's Statement Regarding the Preparer2.Appellant's SignatureDate of Signature (mm/dd/yyyy) 6. Appellant's SignatureThe interpreter named in Part 5. read to me every question and instruction on this form and my answer to B. , a language in whichevery question in I am fluent and I understood everything. Appellant's CertificationCopies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any of my records that USCIS may need to determine my eligibility for the immigration benefit I seek.I can read and understand English, and I have read and understand every question and instruction on this form and my answer to every question. Part 4. Appellant's Statement, Contact Information, Certification, and Signature A.Appellant's Statement Regarding the Interpreter1.NOTE: Select the box for either Item A. or B. in Item Number 1.240 If applicable, select the box for Item Number 2. NOTE: Read the Penalties section of the Form I-694 Instructions before completing this part. Appellant's Email Address (if any)5. Appellant's Daytime Telephone Number 3.4. Appellant's Mobile Telephone Number (if any) Appellant's Contact InformationNOTE TO ALL APPELLANTS: If you do not completely fill out this form or fail to submit required documents listed in the Instructions, USCIS may deny your benefit. Appellant's StatementI certify, under penalty of perjury, that I provided or authorized all of the information in this form, I understand all of the information contained in, and submitted with, this form, and that all of this information is complete, true, and correct. Interpreter's Full Name Provide the following information about the interpreter.Interpreter's Family Name (Last Name)Interpreter's Given Name (First Name) 1. Part 5.240 Interpreter's Contact Information, Certification, and SignatureInterpreter's Business or Organization Name (if any) 2. American LegalNet, Inc. www.FormsWorkFlow.com Form I-694 05/16/18 Page 4 of 6 Interpreter's Mailing Address 3.City or Town State ZIP Code Street Number and Name Flr. Ste. Apt.Postal Code CountryProvince Numberin Part 4., Item B. in Item Number 1., and I have read to this appellant in the identified language every question and instruction on this form and his or her answer to every question. The appellant informed me that he or she understands every instruction, question, and answer on the form, including the Appellant's Certification, and has verified the accuracy of every answer. 4.Interpreter's Daytime Telephone Number Interpreter's Email Address (if any) Interpreter's Contact Information Interpreter's Certification I am fluent in English and , which is the same language provided I certify, under penalty of perjury, that:6. Interpreter's SignatureDate of Signature (mm/dd/yyyy) 6. Interpreter's Signature 5.Interpreter's Mobile Telephone Number (if any) Part 6.240 Contact Information, Declaration, and Signature of the Person Preparing This Form, if Other Than the Appellant Provide the following information about the preparer.Preparer's Family Name (Last Name)Preparer's Given Name (First Name)1. Preparer's Full Name Preparer's Business or Organization (if any) 2. Part 5.240 Interpreter's Contact Information, Certification, and Signature (continued) American LegalNet, Inc. www.FormsWorkFlow.com Form I-694 05/16/18 Page 5 of 6 3.City or Town State ZIP Code Street Number and Name Flr. Ste. Apt.Postal Code CountryProvince Preparer's Mailing Address Number Preparer's Daytime Telephone Number 4.Preparer's Email Address (if any)6.5. Preparer's Mobile Telephone Number (if any) Preparer's Contact Information I am an attorney or accredited representative and my representation of the appellant in this case extends does not extend beyond the preparation of this form. Preparer's Certification I am not an attorney or accredited representative but have prepared this form on behalf of the appellant and with the appellant's consent. By my signature, I certify, under penalty of perjury, that I prepared this form at the request of the appellant. The appellant then reviewed this completed form and informed me that he or she understands all of the information contained in, and submitted with, his or her form, including the Appellant's Certification, and that all of this information is complete, true, and correct. I completed this form based only on information that the appellant provided to me or authorized me to obtain or use. 7. Preparer's StatementB.A. Preparer's SignatureDate of Signature (mm/dd/yyyy)8. Preparer's SignatureNOTE: If you are an attorney or accredited representative whose representation extends beyond preparation of this form, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this form. Part 6.240 Contact Information, Declaration, and Signature of the Person Preparing This Form, if Other Than the Appellant (continued) American LegalNet, Inc. www.FormsWorkFlow.com Form I-694 05/16/18 Page 6 of 6 Part 7.240 Additional InformationIf you need extra space to provide any additional information within this form, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this form or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.A-Number (if any)A-Page Number Part Number Item Number D.Family Name (Last Name)Given Name (First Name)Middle Name1. 2.3. D. D. D.B.C.Page Number Part Number Item Number 4.B.C.Page Number Part Number Item Number 5.B.C.Page Number Part Number Item Number 6.B.C. A.A.A.A. American LegalNet, Inc. www.FormsWorkFlow.com