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G-1145 Form PDF
Personalized Filling Instructions
Cover Letter
Where to File
Application to Replace Permanent Resident Card
Department of Homeland Security
U.S.Citizenship and Immigration Services
USCIS
Form I-90
OMB No. 1615-0082
Expires 02/28/2027
For USCIS Use Only
Applicant Interviewed
Date:_______________
Class of Admission
Receipt
Remarks
Action Block
START HERE - Type or print in black ink.
Part 1. Information About You
1.
Alien Registration Number (A-Number)
A-
2.
USCIS Online Account Number (if any)
Your Full Name
NOTE: Your card will be issued in this name.
3.a.
Family Name (Last Name)
3.b.
Given Name (First Name)
3.c.
Middle Name
4.
Has your name legally changed since the issuance of your Permanent Resident Card?
Yes (Proceed to Item Numbers 5.a. - 5.c.)
Yes (Proceed to Item Numbers 6.a. - 6.i.)
N/A - I never received my previous card.
(Proceed to Item Numbers 6.a. - 6.i.)
Provide your name exactly as it is printed on your current Permanent Resident Card.
NOTE: Attach all evidence of your legal name change with this application
5.a.
Family Name (Last Name)
5.b.
Given Name (First Name)
5.c.
Middle Name
Mailing Address ( USPS ZIP Code Lookup)
6.a.
In Care Of Name
6.b.
Street Number and Name
6.c.
6.d.
City or Town
6.e.
State
6.f.
ZIP Code
6.g.
Province
6.h.
Postal Code
6.i.
Country
Physical Address
Provide this information only if different than mailing address.
7.a.
Street Number and Name
7.b.
7.c.
City or Town
7.d.
State
7.e.
ZIP Code
7.f.
Province
7.g
Postal Code
7.h.
Country
Form I-90 Edition 04/01/24
Page 1 of 7
Part 1. Information About You (continued)
Additional Information
8.
Gender
Male
Female
9.
Date of Birth
(mm/dd/yyyy)
10.
City/Town/Village of Birth
11.
Country of Birth
Mother's Name
12.
Given Name
(First Name)
Father's Name
13.
Given Name
(First Name)
14.
Class of Admission
15.
Date of Admission
(mm/dd/yyyy)
16.
U.S. Social Security Number (if any)
Part 2. Application Type
NOTE: If your conditional permanent resident status (for example: CR1, CR2, CF1, CF2) is expiring within the next 90 days, then do not file this application. (See the What is the
Purpose of This Application section of the Form I-90 Instructions for further information.)
My status is (Select only one box):
1.a.
Lawful Permanent Resident (Proceed to Section A.)
1.b.
Permanent Resident - In Commuter Status (Proceed to Section A.)
1.c.
Conditional Permanent Resident (Proceed to Section B.)
Reason for Application (Select only one box)
Section A. (To be used only by a lawful permanent resident or a permanent resident in commuter status.)
2.a.
My previous card has been lost, stolen, or destroyed.
2.b.
My previous card was issued but never received.
2.c.
My existing card has been mutilated.
2.d.
My existing card has incorrect data because of Department of Homeland Security (DHS) error. (Attach your existing card with incorrect data along with this application.)
2.e.
My name or other biographic information has been legally changed since issuance of my existing card.
2.f.
My existing card has already expired or will expire within six months.
2.g.1.
I have reached my 14th birthday and am registering as required. My existing card will expire AFTER my 16th birthday. (See NOTE below for additional information.)
2.g.2.
I have reached my 14th birthday and am registering as required. My existing card will expire BEFORE my 16th birthday. (See NOTE below for additional information.)
NOTE: If you are filing this application before your 14th birthday, or more than 30 days after your 14th birthday, you must select reason 2.j. However, if your card has expired, you must select reason 2.f.
2.h.1.
I am a permanent resident who is taking up commuter
status.
2.h.1.a.
My Port-of-Entry (POE) into the United States will be: City or Town and State
2.h.2.
I am a commuter who is taking up actual residence in the United States.
2.i.
I have been automatically converted to lawful permanent resident status.
2.j.
I have a prior edition of the Alien Registration Card, or I am applying to replace my current Permanent Resident Card for a reason that is not specified above.
Form I-90 Edition 04/01/24
Page 2 of 7
Part 2. Application Type (continued)
Section B. (To be used only by a conditional permanent resident.)
3.a.
My previous card has been lost, stolen, or destroyed.
3.b.
My previous card was issued but never received.
3.c.
My existing card has been mutilated.
3.d.
My existing card has incorrect data because of DHS error. (Attach your existing permanent resident card with incorrect data along with this application.)
3.e.
My name or other biographic information has legally changed since issuance of my existing card.
Part 3. Processing Information
1.
Location where you applied for an immigrant visa or adjustment of status:
2.
Location where your immigrant visa was issued or USCIS
office where you were granted adjustment of status:
Complete Item Numbers 3.a. and 3.a1. if you entered the United States with an immigrant visa. (If you were granted adjustment of status, proceed to Item Number 4.)
3.a.
Destination in the United States at time of admission
3.a.1.
My Port-of-Entry (POE) into the United States:
City or Town and State
4.
Have you ever been in exclusion, deportation, or removal
proceedings or ordered removed from the United States?
Yes
No
5.
Since you were granted permanent residence, have you ever filed Form I-407, Abandonment by Alien of Status as Lawful Permanent Resident, or otherwise been determined
to have abandoned your status?
Yes
No
NOTE: If you answered "Yes" to Item Numbers 4. or 5.
above, provide a detailed explanation in the space provided in
Part 8. Additional Information.
Biographic Information
6.
Ethnicity (Select only one box)
7.
Race (Select all applicable boxes)
8.
Height
Feet
Inches
9.
Weight
Pounds
10.
Eye color (Select only one box)
11.
Hair Color(Select only one box)
Part 4. Accommodations for Individuals with Disabilities and/or Impairments (Read the information in the Form I-90 Instructions before completing this part.)
NOTE: If you need extra space to complete this section, use
the space provided in Part 8. Additional Information.
1.
Are you requesting an accommodation because of your disabilities and/or impairments?
Yes
No
If you answered "Yes," select any applicable boxes:
1.a.
I am deaf or hard of hearing and request the following accommodation (If you are requesting a sign-language interpreter, indicate for which language (for example, American Sign Language)):
Form I-90 Edition 04/01/24
Page 3 of 7
Part 4. Accommodations for Individuals with
Disabilities and/or Impairments (continued)
1.b.
I am blind or have low vision and request the following accommodation:
1.c.
I have another type of disability and/or impairment (Describe the nature of your disability and/or impairment and the accommodation you are requesting):
Part 5. Applicant's Statement, Contact Information, Certification, and Signature
NOTE: Read the Penalties section of the Form I-90 Instructions before completing this part
Applicant's Statement
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
1.a.
I can read and understand English, and I have read and understand every question and
instruction on this application and my answer to every question.
1.b.
The interpreter named in Part 6. read to me every question and instruction on
this application and my answer to every question in
,
a language in which I am fluent, and I understood
everything.
2.
At my request, the preparer named in Part 7.,
,
prepared this application for me based only upon
information I provided or authorized
Applicant's Contact Information
3.
Applicant's Daytime Telephone Number
4.
Applicant's Mobile Telephone Number (if any)
5.
Applicant's Email Address (if any)
Applicant's Certification
Copies 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 further authorize release of information contained in this application, in supporting documents, and in my USCIS records to other entities and persons where necessary for the administration and enforcement of U.S. immigration laws.
I understand that USCIS may require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, I will be required to sign an oath reaffirming that:
1) I reviewed and provided or authorized all of the information in my application;
2) I understood all of the information contained in, and submitted with, my application; and
3) All of this information was complete, true, and correct at the time of filing.
I certify, under penalty of perjury, that I provided or authorized all of the information in my application, I understand all of the information contained in, and submitted with, my application, and that all of this information is complete, true, and correct.
Applicant's Signature
6.a.
Applicant's Signature (sign in ink)
6.b.
Date of Signature (mm/dd/yyyy)
NOTE TO ALL APPLICANTS: If you do not completely fill out this application or
fail to submit required documents listed in the Instructions, USCIS may deny your
application.
Form I-90 Edition 04/01/24
Page 4 of 7
Part 6. Interpreter's Contact Information,
Certification, and Signature
Provide the following information about the interpreter.
Interpreter's Full Name
1.a.
Interpreter's Family Name (Last Name)
1.b.
Interpreter's Given Name (First Name)
2.
Interpreter's Business or Organization Name (if any)
Interpreter's Mailing Address
3.a.
Street Number and Name
3.b.
3.c.
City or Town
3.d.
State
3.e.
ZIP Code
3.f.
Province
3.g.
Postal Code
3.h.
Country
Interpreter's Contact Information
4.
Interpreter's Daytime Telephone Number
5.
Interpreter's Mobile Telephone Number (if any)
6.
Interpreter's Email Address (if any)
Interpreter's Certification
I certify, under penalty of perjury, that:
I am fluent in English and
,
which is the same language specified in Part 5., Item Number
1.b., and I have read to this applicant in the identified language
every question and instruction on this application and his or her
answer to every question. The applicant informed me that he or
she understands every instruction, question, and answer on the
application, including the Applicant's Certification, and has verified the accuracy of every answer.
Interpreter's Signature
7.a.
Interpreter's Signature (sign in link)
7.b.
Date of Signature (mm/dd/yyyy)
Part 7. Contact Information, Declaration, and
Signature of the Person Preparing this Application, If Other Than the Applicant
Provide the following information about the preparer.
Preparer's Full Name
1.a.
Preparer's Family Name (Last Name)
1.b.
Preparer's Given Name (First Name)
2.
Preparer's Business or Organization Name (if any)
Preparer's Mailing Address
3.a.
Street Number and Name
3.b.
3.c.
City or Town
3.d.
State
3.e.
ZIP Code
3.f.
Province
3.g.
Postal Code
3.h.
Country
Preparer's Contact Information
4.
Preparer's Daytime Telephone Number
5.
Preparer's Mobile Telephone Number (if any)
6.
Preparer's Email Address (if any)
Form I-90 Edition 04/01/24
Page 5 of 7
Part 7. Contact Information, Declaration, and Signature of the Person Preparing this Application, If Other Than the Applicant (continued)
Preparer's Statement
7.a.
I am not an attorney or accredited representative but have prepared this application on behalf of the applicant and with the applicant's consent.
7.b.
I am an attorney or accredited representative and my representation of the applicant in this case
extends
does not extend beyond the preparation of this application.
NOTE:
If you are an attorney or accredited representative whose representation extends beyond preparation of this application, you may be obliged to submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, with this application.
Preparer's Certification
By my signature, I certify, under penalty of perjury, that I prepared this application at the request of the applicant. The applicant then reviewed this completed application and informed me that he or she understands all of the information contained in, and submitted with, his or her application, including the Applicant's Certification,, and that all of this information is complete, true, and correct. I completed this application based only on information that the applicant provided to me or authorized me to obtain or use
Preparer's Signature
8.a.
Preparer's Signature (sign in link)
8.b.
Date of Signature (mm/dd/yyyy)
Form I-90 Edition 04/01/24
Page 6 of 7
Part 8. Additional Information
If you need extra space to provide any additional information
within this application, 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 application 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.
