To: U.S. Citizenship and Immigration Services

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CHANGE OF ADDRESS FORM

Please change my address information in my immigration file. The information is as follows:

Name: __________________________________ Alien or File No. _______________

Date of Birth: ______________ Place of Birth: _____________________________

Old Address: ____________________________________________________________

New Address: ___________________________________________________________

I may be contacted at the following telephone number(s): _________________________

I hereby certify that a true copy of this document was mailed / hand delivered to the USCIS office listed above on the date stated below.

Signature:_______________________________ Date:_____________