Joao e o pé de feijão

U.S. Department of State

APPLICATION TO DETERMINE RETURNING RESIDENT STATUS

OMB APPROVAL NO. 1405-0091
EXPIRATION DATE 11/30/2013
ESTIMATED BURDEN: 30 MINUTES*

INSTRUCTIONS
This is an application for Special Immigrant Status under Section 101(a)(27)(A) of the Immigration and Nationality Act, for lawfully admitted permanent residents who are returning from a temporary visit abroad. To qualify you must submit with this application evidence that:
(1) You had the status of an alien lawfully admitted for permanent residence at the time of departure from the United States;
(2) You departed from the United States with the intention of returning and you have not abandoned this intention; and
(3) You are returning to the United States from a temporary visit abroad and, if the stay abroad was protracted, this was caused by reasons beyond your control and for which you are not responsible.
Applicants must submit evidence with this application to support the above requirements, including proof of lawful permanent residence
(Examples: Form I-151, I-551, Reentry Permit, etc.), dates of travel outside of the United States (Examples: airline tickets, passport stamps, etc.), proof of ties to the United States and intention to return (Examples: tax returns, and evidence of economic, family and social ties to the United States), and proof a protracted stay was for reasons beyond the applicant's control (Examples: medical incapacitation, employment with a U.S. company, accompanying a U.S. citizen spouse, etc.) All documents will be returned to you.
1. Family Name

First Name

Middle Name

DOS SANTOS

ALBERTO

CARLOS

2. Other Names Used, Aliases (If Married Woman, Give Maiden Name)

3. Current Home Address and Telephone Number

IN BRAZIL - AVENIDA WASHINGTON LUIZ 978, BAIRRO SANTA RITA, GOVERNADOR VALADARES, MG
IN USA - 33 MAPLE AVE, BETHEL, CT
5. Date of Birth (mm-dd-yyyy)

4. Place of Birth (City, Province, Country)

GOVERNADOR VALADARES,