If you answer "Yes" to any of these questions by setting the checkbox to the left of the questions, include an
explanation. Your explanation should (1) explain why your answer was "Yes", and (2) provide any additional information
that helps to explain your answer.
1. Have you ever claimed to be a U.S. citizen (in writing or any other way)?
Yes
No
2. Have you ever registered to vote in any Federal, state, or local election in the United States?
Yes
No
3. Have you ever voted in any Federal, State, or local election in the United States?
Yes
No
4. Since becoming a lawful permanent resident, have you ever failed to file a required Federal, State, or local tax return?
Yes
No
5. Do you owe any Federal, State, or local taxes that are overdue?
Yes
No
6. Do you have any title of nobility in any foreign country?
Yes
No
7. Have you ever been declared legally incompetent or been confined to a mental institution within the last five years?
Yes
No
8. Since becoming a Lawful Permanent Resident of the United States have you ever called yourself a "nonresident" on a Federal, State, or local tax return?
Yes
No
9. Since becoming a Lawful Permanent Resident of the United States have you ever failed to file a Federal, State, or local tax return because you considered yourself to be a "nonresident"?
Yes
No
10. Have you ever been a habitual drunkard?
Yes
No
11. Have you ever been a prostitute, or procured anyone for prostitution?
Yes
No
12. Have you ever sold or smuggled controlled substances, illegal drugs or narcotics?
Yes
No
13. Have you ever been married to more than one person at the same time?
Yes
No
14. Have you ever helped anyone enter or try to enter the United States illegally?
Yes
No
15. Have you ever gambled illegally or received income from illegal gambling?
Yes
No
16. Have you ever failed to support your dependents or to pay alimony?
Yes
No
17. Have you ever given false or misleading information to any U.S. Government official while applying for any immigration benefit or to prevent deportation, exclusion, or removal?
Yes
No
18. Have you ever lied to any U.S. Government official to gain entry or admission into the United States?
Yes
No
19. Have you ever been arrested for, charged with, or convicted of a felony or misdemeanor in the United States? Do not include minor traffic violations that only resulted in a fine, unless it was alcohol- or drug-related?
Yes
No
20. Have you ever been arrested for, charged with, or convicted of a crime in any country other than the United States?
Yes
No
21. Have you ever engaged in or do you continue to engage in or plan to engage in terrorist activities?
Yes
No
22. Are you now or have you ever been a member of a gang?
Yes
No
23. Have you ever engaged in, ordered, incited, assisted or otherwise participated in Acts involving torture, genocide, or human trafficking?
Yes
No
24. Have you ever engaged in, ordered, incited, assisted or otherwise participated in Killing any person?
Yes
No
25. Have you ever engaged in, ordered, incited, assisted or otherwise participated in Severely injuring any person?
Yes
No
26. Have you ever engaged in, ordered, incited, assisted or otherwise participated in Any kind of sexual contact or relations with any person who was being forced or threatened?
Yes
No
27. Have you ever been a member of or associated with any organization, association, fund, foundation, party, club, society, or similar group in the United States or in any other place?
Yes
No
28. Have you ever been a member of or in any way associated (either directly or indirectly) with the Communist Party?
Yes
No
29. Have you ever been a member of or in any way associated (either directly or indirectly) with any other totalitarian party?
Yes
No
30. Have you ever been a member of or in any way associated (either directly or indirectly) with a terrorist organization?
Yes
No
31. Have you ever advocated (either directly or indirectly) the overthrow of any government by force or violence?
Yes
No
32. Have you ever persecuted (either directly or indirectly) any person because of race, religion, national origin, membership in a particular social group, or political opinion?
Yes
No
33. Between March 23, 1933, and May 8, 1945, did you work for or associate in any way (either directly or indirectly) with the Nazi government of Germany?
Yes
No
34. Between March 23, 1933, and May 8, 1945, did you work for or associate in any way (either directly or indirectly) with any government in any area (1) occupied by, (2) allied with, or (3) established with the help of the Nazi government of Germany?
Yes
No
35. Between March 23, 1933, and May 8, 1945, did you work for or associate in any way (either directly or indirectly) with any German, Nazi, or S.S. military unit, paramilitary unit, selfdefense unit, vigilante unit, citizen unit, police unit, government agency or office, extermination camp, concentration camp, prisoner of war camp, prison, labor camp, or transit camp?
Yes
No
36. Have you ever committed a crime or offense for which you were not arrested?
Yes
No
37. Have you ever been arrested, cited or detained by any law enforcement officer (including USCIS or former INS and military officers) for any reason?
Yes
No
38. Have you ever been charged with committing any crime or offense?
Yes
No
39. Have you ever been convicted of a crime or offense?
Yes
No
40. Have you ever been placed in an alternative sentencing or a rehabilitative program (for example: diversion, deferred prosecution, withheld adjudication, deferred adjudication)?
Yes
No
41. Have you ever received a suspended sentence, been placed on probation, or been paroled?
Yes
No
42. Have you ever been in jail or prison?
Yes
No