Lleno I-589 PDF
Lleno I-589 PDF
Lleno I-589 PDF
START HERE - Type or print in black ink. See the instructions for information about eligibility and how to complete and file this
application. There is NO filing fee for this application.
NOTE: Check this box if you also want to apply for withholding of removal under the Convention Against Torture.
4. First Name
VARGAS PACHON
ALVARO
5. Middle Name
6. What other names have you used (include maiden name and aliases)?
7. Residence in the U.S. (where you physically reside)
Apt. Number
3628 S 59TH CT
City
State
CICERO
IL
Zip Code
Telephone Number
60804
( 708
) 6209722
8. Mailing Address in the U.S. (if different than the address in Item Number 7)
In Care Of (if applicable):
Telephone Number
(
Apt. Number
City
State
9. Gender:
Male
Female
Zip Code
Single
Married
Divorced
Widowed
01/01/1967
BOGOTA, COLOMBIA
COLOMBIAN
COLOMBIAN
HISPANO
CHRISTIAN
c.
I am not now in Immigration Court proceedings, but I have been in the past.
c. List each entry into the U.S. beginning with your most recent entry. List date (mm/dd/yyyy), place, and your status for each entry.
(Attach additional sheets as needed.)
Date
Place
Status
Date
Place
Status
Date
Place
Status
23. Are you fluent in English? 24. What other languages do you speak fluently?
Yes
For
USCIS
use only.
No
N/A
Action:
Interview Date:
Asylum Officer ID#:
Decision:
Approval Date:
Denial Date:
Referral Date:
Form I-589 (Rev. 12/29/14) Y
7. Middle Name
8. Maiden Name
6. First Name
GONZALEZ ESPINOSA
LILIANA
BOGOTA
BOGOTA, COLOMBIA
08/31/1992
12. Nationality (Citizenship)
COLOMBIAN
COLOMBIAN
14. Gender
Male
Female
No (Specify location):
16. Place of last entry into the U.S. 17. Date of last entry into the
U.S. (mm/dd/yyyy)
20. What is your spouse's
current status?
21. What is the expiration date of his/her 22. Is your spouse in Immigration 23. If previously in the U.S., date of
authorized stay, if any? (mm/dd/yyyy)
previous arrival (mm/dd/yyyy)
Court proceedings?
Yes
No
24. If in the U.S., is your spouse to be included in this application? (Check the appropriate box.)
Yes (Attach one photograph of your spouse in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
Your Children. List all of your children, regardless of age, location, or marital status.
I do not have any children. (Skip to Part A.III., Information about your background.)
I have children.
(NOTE: Use Form I-589 Supplement A or attach additional sheets of paper and documentation if you have more than four children.)
1. Alien Registration Number (A-Number) 2. Passport/ID Card Number 3. Marital Status (Married, Single,
(if any)
(if any)
Divorced, Widowed)
6. First Name
7. Middle Name
12. Gender
Male
Female
No (Specify location):
17. Status when last admitted
(Visa type, if any)
No
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
Yes (Attach one photograph of your spouse in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
6. First Name
7. Middle Name
12. Gender
Male
Female
No (Specify location):
17. Status when last admitted
(Visa type, if any)
No
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
Yes (Attach one photograph of your spouse in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
1. Alien Registration Number (A-Number) 2. Passport/ID Card Number 3. Marital Status (Married, Single,
(if any)
(if any)
Divorced, Widowed)
6. First Name
7. Middle Name
12. Gender
Male
Female
No (Specify location):
17. Status when last admitted
(Visa type, if any)
No
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
Yes (Attach one photograph of your spouse in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
1. Alien Registration Number (A-Number) 2. Passport/ID Card Number 3. Marital Status (Married, Single,
(if any)
(if any)
Divorced, Widowed)
6. First Name
7. Middle Name
12. Gender
Male
Female
No (Specify location):
17. Status when last admitted
(Visa type, if any)
No
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
Yes (Attach one photograph of your spouse in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
Form I-589 (Rev. 12/29/14) Y Page 3
City/Town
Country
Dates
From (Mo/Yr) To (Mo/Yr)
2. Provide the following information about your residences during the past 5 years. List your present address first.
(NOTE: Use Form I-589 Supplement B, or additional sheets of paper, if necessary.)
Number and Street
City/Town
Country
Dates
From (Mo/Yr) To (Mo/Yr)
3. Provide the following information about your education, beginning with the most recent.
(NOTE: Use Form I-589 Supplement B, or additional sheets of paper, if necessary.)
Name of School
Type of School
Location (Address)
Attended
From (Mo/Yr) To (Mo/Yr)
4. Provide the following information about your employment during the past 5 years. List your present employment first.
(NOTE: Use Form I-589 Supplement B, or additional sheets of paper, if necessary.)
Name and Address of Employer
Your Occupation
Dates
From (Mo/Yr) To (Mo/Yr)
5. Provide the following information about your parents and siblings (brothers and sisters). Check the box if the person is deceased.
(NOTE: Use Form I-589 Supplement B, or additional sheets of paper, if necessary.)
Full Name
Current Location
Mother
Deceased
Father
Deceased
Sibling
Deceased
Sibling
Deceased
Sibling
Deceased
Sibling
Deceased
Political opinion
Religion
Nationality
Torture Convention
A. Have you, your family, or close friends or colleagues ever experienced harm or mistreatment or threats in the past by anyone?
No
Yes
Yes
Yes
3.A. Have you or your family members ever belonged to or been associated with any organizations or groups in your home country, such as, but not
limited to, a political party, student group, labor union, religious organization, military or paramilitary group, civil patrol, guerrilla organization,
ethnic group, human rights group, or the press or media?
No
Yes
If "Yes," describe for each person the level of participation, any leadership or other positions held, and the length of time you or your family
members were involved in each organization or activity.
3.B. Do you or your family members continue to participate in any way in these organizations or groups?
No
Yes
If "Yes," describe for each person your or your family members' current level of participation, any leadership or other positions currently held,
and the length of time you or your family members have been involved in each organization or group.
4. Are you afraid of being subjected to torture in your home country or any other country to which you may be returned?
No
Yes
If "Yes," explain why you are afraid and describe the nature of torture you fear, by whom, and why it would be inflicted.
Yes
If "Yes," explain the decision and what happened to any status you, your spouse, your child(ren), your parents, or your siblings received as a
result of that decision. Indicate whether or not you were included in a parent or spouse's application. If so, include your parent or spouse's
A-number in your response. If you have been denied asylum by an immigration judge or the Board of Immigration Appeals, describe any
change(s) in conditions in your country or your own personal circumstances since the date of the denial that may affect your eligibility for
asylum.
2.A. After leaving the country from which you are claiming asylum, did you or your spouse or child(ren) who are now in the United States travel
through or reside in any other country before entering the United States?
No
Yes
2.B. Have you, your spouse, your child(ren), or other family members, such as your parents or siblings, ever applied for or received any lawful status
in any country other than the one from which you are now claiming asylum?
No
Yes
If "Yes" to either or both questions (2A and/or 2B), provide for each person the following: the name of each country and the length of stay, the
person's status while there, the reasons for leaving, whether or not the person is entitled to return for lawful residence purposes, and whether the
person applied for refugee status or for asylum while there, and if not, why he or she did not do so.
3. Have you, your spouse or your child(ren) ever ordered, incited, assisted or otherwise participated in causing harm or suffering to any person
because of his or her race, religion, nationality, membership in a particular social group or belief in a particular political opinion?
No
Yes
If "Yes," describe in detail each such incident and your own, your spouse's, or your child(ren)'s involvement.
Yes
If "Yes," describe in detail the circumstances of your visit(s) (for example, the date(s) of the trip(s), the purpose(s) of the trip(s), and the length
of time you remained in that country for the visit(s).)
5. Are you filing this application more than 1 year after your last arrival in the United States?
No
Yes
If "Yes," explain why you did not file within the first year after you arrived. You must be prepared to explain at your interview or hearing why
you did not file your asylum application within the first year after you arrived. For guidance in answering this question, see Instructions, Part 1:
Filing Instructions, Section V. "Completing the Form," Part C.
6. Have you or any member of your family included in the application ever committed any crime and/or been arrested, charged, convicted, or
sentenced for any crimes in the United States?
No
Yes
If "Yes," for each instance, specify in your response: what occurred and the circumstances, dates, length of sentence received, location, the
duration of the detention or imprisonment, reason(s) for the detention or conviction, any formal charges that were lodged against you or your
relatives included in your application, and the reason(s) for release. Attach documents referring to these incidents, if they are available, or an
explanation of why documents are not available.
WARNING: Applicants who are in the United States illegally are subject to removal if their asylum or withholding claims are not granted by
an asylum officer or an immigration judge. Any information provided in completing this application may be used as a basis for the
institution of, or as evidence in, removal proceedings even if the application is later withdrawn. Applicants determined to have knowingly
made a frivolous application for asylum will be permanently ineligible for any benefits under the Immigration and Nationality Act. You may
not avoid a frivolous finding simply because someone advised you to provide false information in your asylum application. If filing with
USCIS, unexcused failure to appear for an appointment to provide biometrics (such as fingerprints) and your biographical information
within the time allowed may result in an asylum officer dismissing your asylum application or referring it to an immigration judge. Failure
without good cause to provide DHS with biometrics or other biographical information while in removal proceedings may result in your
application being found abandoned by the immigration judge. See sections 208(d)(5)(A) and 208(d)(6) of the INA and 8 CFR sections
208.10, 1208.10, 208.20, 1003.47(d) and 1208.20.
Print your complete name.
Did your spouse, parent, or child(ren) assist you in completing this application?
(Name)
No
(Relationship)
(Name)
(Relationship)
Did someone other than your spouse, parent, or child(ren) prepare this application?
No
Asylum applicants may be represented by counsel. Have you been provided with a list of
persons who may be available to assist you, at little or no cost, with your asylum claim?
No
Yes
Date (mm/dd/yyyy)
Part E. Declaration of Person Preparing Form, if Other Than Applicant, Spouse, Parent, or Child
I declare that I have prepared this application at the request of the person named in Part D, that the responses provided are based on all information of
which I have knowledge, or which was provided to me by the applicant, and that the completed application was read to the applicant in his or her
native language or a language he or she understands for verification before he or she signed the application in my presence. I am aware that the
knowing placement of false information on the Form I-589 may also subject me to civil penalties under 8 U.S.C. 1324c and/or criminal penalties
under 18 U.S.C. 1546(a).
Signature of Preparer
Apt. Number
City
State
Zip Code
Signature of Applicant
Date (mm/dd/yyyy)
Signature of Applicant
Date (mm/dd/yyyy)
Date
Applicant's Name
Applicant's Signature
6. First Name
7. Middle Name
12. Gender
Male
Female
No (Specify location):
17. Status when last admitted
(Visa type, if any)
No
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
Yes (Attach one photograph of your spouse in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
1. Alien Registration Number (A-Number) 2. Passport/ID Card Number 3. Marital Status (Married, Single,
(if any)
(if any)
Divorced, Widowed)
6. First Name
7. Middle Name
12. Gender
Male
Female
No (Specify location):
17. Status when last admitted
(Visa type, if any)
No
21. If in the U.S., is this child to be included in this application? (Check the appropriate box.)
Yes (Attach one photograph of your spouse in the upper right corner of Page 9 on the extra copy of the application submitted for this person.)
No
Date
Applicant's Name
Applicant's Signature
NOTE: Use this as a continuation page for any additional information requested. Copy and complete as needed.
Part
Question