[MAILING ADDRESS]

[DATE]
USPS:
United States Department of Homeland Security
U.S. Citizenship Immigration Services
Attn: AOS
PO Box 805887
Chicago, IL 60680-4120

OR

FedEx, UPS y DHL:

United States Department of Homeland Security
U.S. Citizenship Immigration Services
Attn: AOS (Box 805887)
131 South Dearborn - 3rd Floor
Chicago, IL 60603-5517

Re: ORIGINAL SUBMISSION Adjustment of Status

Applicant: [BENEFICIARY’S COMPLETE NAME]
U.S. Citizen Spouse: [PETICIONER’S COMPLETE NAME]

Dear USCIS Officer,

We are writing to inform you of the list of documents included in this document packet. Please find a completed Adjustment of
Status Application (Forms I-485, I-864, [I-693, I-765 & I-131]) for the applicant [BENEFICIARY’S COMPLETE NAME].

Accompanied by this letter, the following documents have been enclosed to support this application:

1. Check for [AMOUNT IN USD] payable to U.S. Department of Homeland Security.

2. Form G-1145 e-Notification of Application/Petition Acceptance.
3. Two (2) Passport size photos (name and A-number in the back).
4. Form I-485 Application to Register Permanent Residence or Adjust Status.
5. Copy of passport biographical page.
6. Copies of passport pages with K-1 visa and entry stamp.
7. Copy of Electronic Form I-94.
8. Copy of both original Birth Certificates and certified translation.
9. Copy of Form I-797 Notice of Action of I-129F approval.
10. Copy of U.S. Department of State's Vaccination Documentation Worksheet DS-3025.
11. Certified copy of Marriage Certificate.
12. [Sworn affidavit by third party having personal knowledge of the validity of the marriage. OPTIONAL]
13. Marriage and relationship evidence.
14. Form I-864 Affidavit of Support and supporting documents.
15. [Form I-693 Report of Medical Examination and Vaccination Record and supporting documents. IF NEEDED]
16. Form I-765 Application for Employment Authorization and supporting documents. OPTIONAL]
17. Form I-131 Application for Travel Document and supporting documents. OPTIONAL]

If you happen to have any concerns at all about this application or any of the documents provided, please do not hesitate to
contact us at [PHONE NUMBER].

Thank you for your time.

Yours sincerely,

[BENEFICIARY’S AND PETITIONER’S SIGNATURES AND COMPLETE NAMES]