Upon receiving your questionnaire, we will initiate the process of your application. Send this questionnaire:

Mailing Address: IPS, 10097 Cleary Blvd. No. 312, Plantation, FL 33324

Part #1.-  Information about you:  

1)  Full name: _____________   __________________   ___________________________________

                                 First Name                            Middle Name                                               Last Name          

2) Others name : ________________   __________________   ___________________________________

                                 First Name                            Middle Name                                               Last Name          

3)     Current Address:  __________________________________________________

          _____________________________ ______________________________________________

4) Date of Birth: ___/____/___      5) Place of Birth: ______________________________

                                  Month/ Day/ Year                                                               City, State, Country

6).- Resident Alien: (Starts with a “A”)  ____________________

7) a) Name of your mother:  ________________________________

    b) Name of your father:   ________________________________

8) City of Residence where you applied for an immigrant visa or adjustment ofstatus:_____________

9) Consulate where immigrant Visa was issued or INS office where status was adjusted:__________

10) Date of Admission as an immigrant or Adjustment of  Status. _____________________.

11) If you entered the U.S. with an Immigrant Visa, also complete the following::

     a) Destination in U.S. at time of Admission: ___________________________  

      b) Port of Entry where admitted to U.S.:  ________________________

12)  Are you in deportation or exclusion proceedings?    Yes _____      No: ______

13) 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 judged to have abandoned your status?  

Yes (    )   No:  (       ) If your answer “yes” to any of the above questions, explain in detail on a separate piece of paper.

14)    What is your current status?   Permanent resident   (     )      Conditional Resident  (      )

15)    Please check one only:

           I am a permanent resident or conditional resident and

a)  my card was lost, stolen, or destroyed. I have a copy of an identity document

b)  I never received a card. I have a copy of an identity document.

c)  my card is mutilated. I have the mutilated card.

d)   my card was incorrect when issued. I have the incorrect card and evidence of the correct information.

e)   my name or other biographic information has changed since the  card was issued. I have my present card and evidence of the new information.

          I am a permanent resident and:

f)  my present card has an expiration date on it and is expiring. I have my present card.

g) I have reached my 14^th birthday. I have my present card and a Fingerprint Card.

h) I was a commuter and am now taking up residence in the U.S. I have my present card and evidence of my residence in the U.S.

i)  my status has been automatically converted to permanent resident. I have my Temporary Status   Document.

j)  I have an old edition of the card.

Name and signature of the person replying to this questionnaire:.

Full Name: ___________________________________________________

U.S. Mailing Address:___________________________________________________

E-mail: _______________________   Telephone: _____________

Hours when you can be contacted: From _______    until: _______   on the following days ____________

I, __________________________, authorize Immigration & Passport Service (I.V.C.) to submit the application for my resident card to the USCIS and I agree with the terms and conditions published in the website www.immigrationusinfo.com 

Date: ________________               Signature: __________________________