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New York Criminal lawyer & NY, NJ Family Attorney, Law Office of Bukh & Assoc., PLLC

Free Phone Consultation with US immigration attorney

Part 1. Information about you.

If the employer is an individual, use the top name line. Organizations should use the second line.

Family Name
Given Name
Middle Initial
E-mail
Phone

Address - In care of:
Street Number and Name:
Apt. #:
City:
State:
Zip Code:
Daytime Phone #:
Country of Birth:
Country of Citizenship:
Date of Birth (MM/DD/YYYY):
Social Security # (if any):
A # (if any):
Date of Last Arrival Into the U.S.:
I-94 #:
Current Nonimmigrant Status:
Expires on (MM/DD/YYYY):

Part 2. Application type. (See instructions for fee)

1. I am applying for: (Check one)
a.	An extension of stay in my current status.
b.	A change of status. The new status I am requesting is:
c.	A change of status. The new status I am requesting is:
2. Number of people included in this application: (Check one)
a.	I am the only applicant.
b.	Members of my family are filing this application with me. The total number of people (including me) in the application is: (Complete the supplement for each co-applicant):

Part 3. Processing information.

1. I/We request that my/our current or requested status be extended until (MM/DD/YYYY):

2. Is this application based on an extension or change of status already granted to your spouse, child or parent?

No Yes, Receipt #

3. Is this application based on a separate petition or application to give your spouse, child or parent an extension or change of status?

No Yes, filed with this I-539.
Yes, filed previously and pending with USCIS. USCIS receipt number:

4. If you answered "Yes" to Question 3, give the name of the petitioner or applicant:

If the petition or application is pending with USCIS, also give the following information:
Office filed at Filed on (MM/DD/YYYY)

Part 4. Additional information.

1. For applicant #1, provide passport information:
Country of Issuance		Valid to: (MM/DD/YYYY)
2. Foreign Address.
Street Number and Name:		Apt. #:
City or Town:		State or Province:
Country:		Zip/Postal Code:

3. Answer the following questions. If you answer "Yes" to any question, explain on separate sheet of paper.
a.	Are you, or any other person included on the application, an applicant for an immigrant visa?	Yes	No
b.	Has an immigrant petition ever been filed for you or for any other person included in this application?	Yes	No
c.	Has a Form I-485, Application to Register Permanent Residence or Adjust Status, ever been filed by you or by any other person included in this application?	Yes	No
d.	Have you, or any other person included in this application, ever been arrested or convicted of any criminal offense since last entering the U.S.?	Yes	No
e.	Have you, or any other person included in this application, done anything that violated the terms of the nonimmigrant status you now hold?	Yes	No
f.	Are you, or any other person included in this application, now in removal proceedings?	Yes	No
g.	Have you, or any other person included in this application, been employed in the U.S. since last admitted or granted an extension or change of status?	Yes	No

If you answered "Yes" to Question 3f, give the following information concerning the removal proceedings on the attached page entitled "Part 4. Additional information. Page for answers to 3f and 3g." Include the name of the person in removal proceedings and information on jurisdiction, date proceedings began and status of proceedings.
If you answered "No" to Question 3g, fully describe how you are supporting yourself on the attached page entitled "Part 4. Additional information. Page for answers to 3f and 3g." Include the source, amount and basis for any income.
If you answered "Yes" to Question 3g, fully describe the employment on the attached page entitled "Part 4. Additional information. Page for answers to 3f and 3g." Include the name of the person employed, name and address of the employer, weekly income and whether the employment was specifically authorized by USCIS.

Page for answers to 3f and 3g.

If you answered "Yes" to Question 3f in Part 4 on page 3 of this form, give the following information concerning the removal proceedings. Include the name of the person in removal proceedings and information on jurisdiction, date proceedings began and status of procedings.

If you answered "No" to Question 3g in Part 4 on page 3 of this form, fully describe how you are supporting yourself. Include the source, amount and basis for any income.

If you answered "Yes" to Question 3g in Part 4 on page 3 of this form, fully describe the employment. Include the name of the person employed, name and address of the employer, weekly income and whether the employment was specifically authorized by USCIS.

Supplement -1
Attach to Form I-539 when more than one person is included in the petition or application.
(List each person separately. Do not include the person named in the form)

Family Name:
Given Name:
Middle Name:
Date of Birth (MM/DD/YYYY):
Country of Birth:
Country of Citizenship:
Social Security # (if any):
A # (if any):
Date of Arrival (MM/DD/YYYY):
I-94 #:
Current Nonimmigrant Status:
Expires On (MM/DD/YYYY):
Country Where Passport Issued:
Expiration Date (MM/DD/YYYY):

Family Name:
Given Name:
Middle Name:
Date of Birth (MM/DD/YYYY):
Country of Birth:
Country of Citizenship:
Social Security # (if any):
A # (if any):
Date of Arrival (MM/DD/YYYY):
I-94 #:
Current Nonimmigrant Status:
Expires On (MM/DD/YYYY):
Country Where Passport Issued:
Expiration Date (MM/DD/YYYY):

Family Name:
Given Name:
Middle Name:
Date of Birth (MM/DD/YYYY):
Country of Birth:
Country of Citizenship:
Social Security # (if any):
A # (if any):
Date of Arrival (MM/DD/YYYY):
I-94 #:
Current Nonimmigrant Status:
Expires On (MM/DD/YYYY):
Country Where Passport Issued:
Expiration Date (MM/DD/YYYY):

Family Name:
Given Name:
Middle Name:
Date of Birth (MM/DD/YYYY):
Country of Birth:
Country of Citizenship:
Social Security # (if any):
A # (if any):
Date of Arrival (MM/DD/YYYY):
I-94 #:
Current Nonimmigrant Status:
Expires On (MM/DD/YYYY):
Country Where Passport Issued:
Expiration Date (MM/DD/YYYY):

Family Name:
Given Name:
Middle Name:
Date of Birth (MM/DD/YYYY):
Country of Birth:
Country of Citizenship:
Social Security # (if any):
A # (if any):
Date of Arrival (MM/DD/YYYY):
I-94 #:
Current Nonimmigrant Status:
Expires On (MM/DD/YYYY):
Country Where Passport Issued:
Expiration Date (MM/DD/YYYY):

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