OMB#1125-0001; Expires 08/31/05
U.S. Department of Justice
Application for Cancellation of Removal and
Executive Office for Immigration Review
Adjustment of Status for Certain Nonpermanent Residents
ADVICE TO APPLICANT
PLEASE READ CAREFULLY. FEE WILL NOT BE RETURNED.
I.
Aliens Eligible for Cancellation of Removal: You may be eligible to have your removal canceled under section
240A(b) of the Immigration and Nationality Act (INA). To qualify for this benefit, you must establish in a hearing
before an Immigration Judge that:
A.
1.
Prior to the service of the Notice to Appear, you have maintained continuous physical presence in the
United States for 10 years or more, and you have been a person of good moral character as defined in
section 101(f) of the INA during such period;
2.
You have not been convicted of an offense covered under sections 212(a)(2), 237(a)(2), or 237(a)(3) of
the INA; and
3.
Your removal would result in exceptional and extremely unusual hardship to your United States citizen
or lawful permanent resident spouse, parent, or child, and you are deserving of a favorable exercise of
discretion on your application.
OR
B.
1.
You have been battered or subjected to extreme cruelty in the United States by your United States citizen
or lawful permanent resident spouse or parent, or you are the parent of a child of a United States citizen
or lawful permanent resident and the child has been battered or subjected to extreme cruelty in the United
States by such citizen or lawful permanent resident parent;
2.
Prior to the service of the Notice to Appear, you have maintained continuous physical presence in the
United States for 3 years or more and you have been a person of good moral character as defined in section
101(f) of the INA during such period;
3.
You are not inadmissible under sections 212(a)(2) or 212(a)(3) of the INA, you are not deportable under
section 237(a)(1)(G) or sections 237(a)(2)-(4) of the INA, and you have not been convicted of an
aggravated felony as defined under the INA;
4.
a. Y