Alien's Change of Address Card
Department of Homeland Security USCIS
U.S. Citizenship and Immigration Services Form AR-11
NOTE: An asterisk (*) indicates a mandatory field that must be completed.
Information About You
**Family Name (Last Name) *Given Name (First Name) Middle Name (if applicable)
Villanueva Claudia Julissa
*Date of Birth (mm/dd/yyyy) Alien Registration Number (A-Number) (if any)
03/06/1997 ► A- 246381384 *
Information About Your Address
*Present Physical Address (No PO Boxes)
*Street Number and Name Apt. Ste. Flr. Number
10627 PALOMINO AVE
*City or Town *State *ZIP Code
*HESPERIA CA 92345
Previous Physical Address
* * *
Street Number and Name Apt. Ste. Flr. Number
7220 SW 16 CORAL TERRACE
City or Town State ZIP Code
MIAMI FL 33155
Mailing Address optional)
Street Number and Name Apt. Ste. Flr. Number
10627 PALOMINO AVE
City or Town State ZIP Code
HESPERIA CA 92345
Your Signature
*Your Signature Date of Signature (mm/dd/yyyy)
06/01/2023
*
Your Online Confirmation Number is: COA15223005166
Form AR-11 Edition 09/10/19 Page 1 of 2
Address Change Information and Instructions
All aliens subject to registration requirements must use this form to report a change of address within 10 days of such change. The
collection of this information is required by Immigration and Nationality Act (INA) section 265 (8 U.S.C. 1305). U.S. Citizenship and
Immigration Services (USCIS) uses the data collected on this form for statistical and record-keeping purposes, and may share this
information with other Federal, state, local, and law enforcement officials. Failure to report a change of address is punishable by fine
or imprisonment and/or removal from the United States.
NOTE: This form is not evidence of identity, age, or status claimed.
IMPORTANT: If you are in immigration proceedings, you must separately notify the Immigration Court of any address
changes. Filing Form AR-11 with USCIS does not update your address with the Immigration Court.
Instructions
Complete all fields on this form, sign and date the form, and mail it to:
U.S. Department of Homeland Security
Citizenship and Immigration Services
Attn: Change of Address
1344 Pleasants Drive
Harrisonburg, VA 22801
DHS Privacy Notice
AUTHORITIES: The information requested on this form is collected under the Immigration and Nationality Act (INA) section 265.
PURPOSE: The primary purpose for providing the requested information on this form is to report a change of address. Except for
those exempted, all aliens in the U.S. are required to report any change of address or new address. DHS uses the information you
provide to contact you about the immigration benefit you are seeking.
DISCLOSURE: The information you provide is mandatory. Failure to report a change of address may result in a fine, imprisonment
and/or removal (8 U.S.C. sections 1227(a)(3) and1306). Failure to comply could also jeopardize your ability to obtain a future visa or
other immigration benefits.
ROUTINE USES: DHS may share the information you provide on this form with other Federal, state, local, and foreign government
agencies and authorized organizations. DHS follows approved routine uses described in the associated published system of records
notices [DHS/USCIS-001 - Alien File, Index, and National File Tracking System and DHS/USCIS-007 - Benefits Information
System] and the published privacy impact assessments [DHS/USCIS/PIA-018 Alien Change of Address Card (AR-11)] which you can
find at [Link]/privacy. DHS may also share this information, as appropriate, for law enforcement purposes or in the interest
of national security.
Form AR-11 Edition 10/06/21 Page 2 of 2
