My OLD address was:
("In care of" other person, if any)
(Number
, Street, Apartment)
(City, State and ZIP Code)
(Country, if other than U.S.)
My NEW
address is:
("In care of" other person, if any)
(Number
, Street, Apartment)
(City, State and ZIP Code)
(Country, if other than U.S.)
(New Telephone Number)
Name: Alien Number: A
OMB# 1125-0004
Alien's Change of Address Form/
Immigration Court
U.S. Department of Justice
Executive Of
fice for Immigration Review
Immigration Court
You are required under 8 C.F.R. 1003.15(d)(2) to notify the Immigration Court of any change of address and any change of telephone
number within five (5) working days of moving or changing your address or phone number. You will receive notification as to the time,
date, and place of hearing or other official correspondence only at the address which you provide.
Failur
e to appear at any hearing before an Immigration Judge, when notice of that hearing or other official correspondence
was served on you or sent to the address you provided, may result in one or more of the following actions:
●
If you are not already detained, you may be taken into custody by the Department of Homeland Security (DHS) and held for further action; and
If you are in removal proceedings:
Your hearing may be held in your
absence under Section 240 of the
Immigration and Nationality Act (INA),
and an order of removal may be entered
against you. Furthermore, you may
become ineligible for the following
forms of relief from removal for a period
of 10 years after the date of the entry of
the final order:
1. Voluntary Departure as provided
for in Section 240B of the INA;
2. Cancellation of Removal as provided
for in Section 240A of the INA;
3. Adjustment of Status or Change of
Status as provided for in Section(s)
245, 248, or 249 of the INA.
If you are in deportation proceedings:
Your hearing may be held in your
absence under Section 242B of the
Immigration and Nationality Act (INA)
(1995), and an order of deportation may
be entered against you. Furthermore, you
may become ineligible for the following
forms of relief from deportation for a
period of 5 years after the date of the
entry of the final order:
1. Voluntary Departure as provided
for in Section 242(b) of the INA
(1995);
2. Suspension of Deportation or Vol-
untary Departure as provided for
in Section 244 of the INA (1995);
3. Adjustment of Status or Change of
Status as provided for in Section(s)
245, 248, or 249 of the INA (1995).
If you are in exclusion proceedings:
Your application for admission to the
United States may be considered
withdrawn, and your hearing may be
held in your absence and an order of
exclusion and deportation entered
against you.
PROOF OF SERVICE (You Must Complete This)
I mailed or delivered a copy of this Change of Address Form on to the
Office of the Chief Counsel for the DHS (U.S. Immigration and Customs Enforcement-ICE) at
.
✍ SIGN HERE
➜
➜
Signature Date
X
✍ SIGN HERE
➜
➜
Signature
X
(Name)
(Date)
(Number and Street, City, State, Zip Code)
Form EOIR - 33/IC
Revised March 2009