Department of Homeland Security
U.S. Citizenship and Immigration Services
OMB No. 1615-0007; Expires 09/30/11
AR-11 SR, Alien's Change
of Address Card
Name (Last in CAPS)
(First Name)
(Middle Name)
I am in the United States as a:
Visitor
Student
Permanent Resident
Other
Copy Number From Alien CardDate of Birth (mm/dd/yyyy)
Country of Citizenship
A
(City or Post Office)
Present Address (Street or Rural Route)
(City or Post Office)
Last Address (Street or Rural Route)
(Street Address or Rural Route)
I work for or attend school at: (Employer's Name or Name of School)
(State) (Zip Code)
(If the above address is temporary) I expect to remain there
Years Months
(Zip Code)(State)
(Zip Code)(State)
(City or Post Office)
Date of Entry Into U.S. (mm/dd/yyyy)Port of Entry Into U.S.
Date (mm/dd/yyyy)Signature
If not a Permanent Resident,
my stay in the U.S. expires on:
(Date - mm/dd/yyyy)
Form AR-11 SR (Rev. 10/06/08) Y
Special Registration
AR-11 SR, Alien's Change of Address Card
This card is to be used by all aliens to report a change of address within ten days of such change.
The collection of this information is required by Section 265 of the Immigration and Nationality Act (8 U.S.C. 1305). The data is
used by U.S. Citizenship and Immigration Services for statistical and record purposes and may be furnished to federal, state, local
and foreign law enforcement officials. Failure to report a change of address is punishable by fine or imprisonment and/or removal.
ADVISORY: This card is not evidence of identity, age, or status claimed.
Department of Homeland Security
U.S. Citizenship and Immigration Services
Change of Address
P.O. Box 7134
London, KY 40742-7134
Department of Homeland Security
U.S. Citizenship and Immigration Services
Change of Address
1084-I South Laurel Road
London, KY 40742-7134
For commercial overnight or fast freight
(Specify)
Fingerprint Identification Number (FIN):
Mail Your Form to the Address Shown Below:
Paperwork Reduction Act
An agency may not conduct or sponsor an information collection and a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. The public reporting burden for this collection of information is
estimated at five minutes per response, including the time for reviewing instructions and completing and submitting the form. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to: U.S. Citizenship and Immigration Services, Regulatory Management Division, 111 Massachusetts Avenue, N.W., 3rd
Floor, Suite 3008, Washington, DC 20529. OMB No. 1615-0007. Do not mail your application to this address.
