EFTA01263134¶
OMB No. 1115-0053¶
Application to Register Permanent Residence or Adjust Status¶
START HERE - Please Type or Print¶
Part 1. Information about you.¶
| Family Name Maxwell | Given Name Ghislaine | Middle Initial N | |
| Address - C/O The Villard House | |||
| Street Number and Name | |||
| City New York | |||
| State New York | Zip Code 10022 10021 | ||
| Date of Birth(month/day/year) | Country of Birth France | ||
| Social Security # | A #(if any)None | ||
| Date of Last Arrival(month/day/year)9/19/95 | 95#70051451304 | ||
| Current INS StatusH-1B Visa | Expires on(month/day/year)11/4/95 | ||
Part 2. Application Type. (check one)¶
a. $ \Box $ an immigrant petition giving me an immediately available immigrant visa number has been approved (attach a copy of the approval notice), or a relative, special immigrant juvenile, or special immigrant military visa petition filed with this application will give me an immediately available visa number if approved.¶
b. □ My spouse or parent applied for adjustment of status or was granted lawful permanent residence in an immigrant visa category which allows derivative status for spouses and children.¶
c. $ \Box $ I entered as a K-1 fiance(e) of a U.S. citizen whom I married within 90 days of entry, or I am the K-2 child of such a fiance(e) (attach a copy of the fiance(e) petition approval notice and the marriage certificate).¶
d. $ \Box $ I was granted asylum or derivative asylum status as the spouse or child of a person granted asylum and am eligible for adjustment.¶
e. $ \Box $ I am a native or citizen of Cuba admitted or paroled into the U.S. after January 1, 1959, and thereafter have been physically present in the U.S. for at least 1 year.¶
f. □ I am the husband, wife, or minor unmarried child of a Cuban described in (e) and am residing with that person, and was admitted or paroled into the U.S. after January 1, 1959, and thereafter have been physically present in the U.S. for at least 1 year.¶
g. $ \Box $ I have continuously resided in the U.S. since before January 1, 1972.¶
h. Other-explain DV-96 Registration selected (see attached)¶
I am already a permanent resident and am applying to have the date I was granted permanent residence adjusted to the date I originally arrived in the U.S. as a nonimmigrant or parolee, or as of May 2, 1964, whichever is later, and: (Check one)¶
i. $ \Box $ I am a native or citizen of Cuba and meet the description in (e), above.¶
j. □ I am the husband, wife or minor unmarried child of a Cuban, and meet the description in (f), above.¶
Continued on back.¶
| Returned | Receipt RECEIVED INFORMATION OCT 12 1995 Immigration and Naturalization Service New York, N.Y. RECEIVED S2 FLOOR CASHIER OCT 12 1995 Immigration and Naturalization Service New York, N.Y. |
| Resubmitted | |
| Reloc Sent | |
| Reloc Rec'd | |
| Applicant Interviewed | |
| Section of Law ☐ Sec. 209(b), INA ☐ Sec. 13, Act of 9/11/57 ☐ Sec. 245, INA ☐ Sec. 249, INA ☐ Sec. 1 Act of 11/2/66 ☐ Sec. 2 Act of 11/2/66 ☐ Other | |
| Country Chargeable France | |
| Eligibility Under Sec. 245 ☐ Approved Visa Petition ☐ Dependent of Principal Alien ☐ Special Immigrant ☐ Other | |
| Preference | |
| Action Block APPROVED INE DISTRICT DIRECTOR FEB 0 9 1996 Programmed by NYC | 0812 | |
| To Be Completed by Attorney or Representative, if any ☐ Fill in box if G-28 is attached to represent the applicant | |
| VOLAG# | |
| ATTY State License # SDNY_GM_00000729 | |
Form I-485 (09-09-92)N¶
EFTA_00114813¶
EFTA01263135¶
Part 3. Processing Information.¶
A. City/Town/Village of birth Maison Laffitte Your mother’s first name Elizabeth Your father’s first name Robert¶
Give your name exactly how it appears on your Arrival /Departure Record (Form I-94) Maxwell, Ghislaine¶
Place of last entry into the U.S. (City/State) New York, New York¶
Where you inspected by a U.S. Immigration Officer? ☐ Yes □ No¶
Nonimmigrant Visa Number 1/15/93¶
Date Visa was issued (month/day/year)¶
Sex: ☐ Male ☐ Female¶
Marital Status: ☐ Married ☐ Single ☐ Divorced ☐ Widowed¶
Have you ever before applied for permanent resident status in the U.S? ☐ No ☐ Yes (give date and place of filing and final disposition):¶
B. List your present husband/wife, all of your sons and daughters (if you have none, write “none”). If additional space is needed, use separate paper.¶
Family Name NONE Given Name Middle Initial Date of Birth (month/day/year)¶
Country of birth Relationship A # Applying with you? ☐ Yes ☐ No¶
Family Name Given Name Middle Initial Date of Birth (month/day/year)¶
Country of birth Relationship A # Applying with you? ☐ Yes ☐ No¶
Family Name Given Name Middle Initial Date of Birth (month/day/year)¶
Country of birth Relationship A # Applying with you? ☐ Yes ☐ No¶
Family Name Given Name Middle Initial Date of Birth (month/day/year)¶
Country of birth Relationship A # Applying with you? ☐ Yes ☐ No¶
C. List your present and past membership in or affiliation with every political organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other place since your 16th birthday. Include any foreign military service in this part. If none, write “none”. Include the name of organization, location, dates of membership from and to, and the nature of the organization. If additional space is needed, use separate paper.¶
NONE¶
Form I-485 (Rev. 09-09-92) N¶
Continued On Next Page¶
SDNY_GM_00000730¶
EFTA_00114814¶
EFTA01263136¶
Please answer the following questions. (If your answer is “Yes” on any one of these questions, explain on a separate piece of paper. Answering “Yes” does not necessarily mean that you are not entitled to register for permanent residence or adjust status).¶
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Have you ever, in or outside the U.S.: a. knowingly committed any crime of moral turpitude or a drug-related offense for which you have not been arrested? b. been arrested, charged, indicted, fined, or imprisoned for breaking or violating any law or ordinance, excluding traffic violation? c. been the beneficiary of a pardon, amnesty, rehabilitation decree, other act of clemency or similar action? d. exercised diplomatic immunity to avoid prosecution for a criminal offense in the U.S.
□ Yes No
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Have you received public assistance in the U.S. from any source, including the U.S. government or any state, county, city, or municipality (other than emergency medical treatment), or are you likely to receive public assistance in the future?
□ Yes No
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Have you ever: a. within the past 10 years been a prostitute or procured anyone for prostitution, or intend to engage in such activities in the future? b. engaged in any unlawful commercialized vice, including, but not limited to, illegal gambling? c. knowingly encouraged, induced, assisted, abetted or aided any alien to try to enter the U.S. illegally? d. illicitly trafficked in any controlled substance, or knowingly assisted, abetted or cofused in the illicit trafficking of any controlled substance?
□ Yes No
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Have you ever engaged in, conspired to engage in, or do you intend to engage in, or have you ever solicited membership or funds for, or have you through any means ever assured or provided any type of material support to, any person or organization that has ever engaged or conspired to engage, in sabotage, kidnapping, political assassination, hijacking, or any other form of terrorist activity?
□ Yes No
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Do you intend to engage in the U.S. in: a. espionage? b. any activity a purpose of which is opposition to, or the control or overthrow of, the Government of the United States, by force, violence or other unlawful means? c. any activity to violate or evade any law prohibiting the export from the United States of goods, technology or sensitive information?
□ Yes No
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Have you ever been a member of, or in any way affiliated with, the Communist Party or any other totalitarian party?
□ Yes No
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Did you, during the period March 23, 1933 to May 8, 1945, in association with either the Nazi Government of Germany or any organization or government associated or allied with the Nazi Government of Germany, ever inole, assist or otherwise participate in the persecution of any person because of race, religion, national origin or political opinion?
□ Yes No
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Have you ever engaged in genocide, or otherwise ordered, incited, assisted or otherwise participated in the killing of any person because of race, religion, nationality, ethnic origin, or political opinion?
□ Yes No
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Have you ever been deported from the U.S. or removed from the U.S. at government expense, excluded within the past year, or are you now in exclusion or deportation proceedings?
□ Yes No
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Are you under a final order of civil penalty for violating section 274C of the Immigration Act for use of fraudulent documents, or have you, by fraud or willful misrepresentation of a material fact, ever sought to procure, or procured, a visa, other documentation, entry into the U.S., or any other immigration tribunal?
□ Yes No¶
- Have you ever left the U.S. to avoid being drafted into the U.S. Armed Forces?
□ Yes No¶
- Have you ever been a J nonimmigrant visitor who was subject to the 2 year foreign residence requirement and not yet complied with that requirement or obtained a waiver?
□ Yes No¶
- Are you now withholding custody of a U.S. Citizen child outside the U.S. from a person granted custody of the child?
□ Yes No¶
- Do you plan to practice polygamy in the U.S.?
Form I-485 (Rev. 09-09-92)N¶
Continued on back¶
SDNY_GM_00000731¶
EFTA_00114815¶
EFTA01263137¶
Part 4. Signature. (Read the information on penalties in the instructions before completing this section. You must file this application while in the United States.)¶
I certify under penalty of perjury under the laws of the United States of America that this application, and the evidence submitted with it, is all true and correct. I authorize the release of any information from my records which the Immigration and Naturalization Service needs to determine eligibility for the benefit. I am seeking.¶
Signature¶
Print Your Name¶
Ghislaine Maxwell¶
Date¶
10/6/95¶
Daytime Phone Number¶
Please Note: If you do not completely fill out this form, or fail to submit required documents listed found eligible for the requested document and this application may be denied.¶
Part 5. Signature of person preparing form if other than above. (Sign Below)¶
| Signature | Print Your Name | Date | Day time Phone Number |
| Firm Nameand Address |
Form 1-485 (Rev. 09-09-92) N¶
SDNY_GM_00000732¶
EFTA_00114816¶