17400 Dallas Parkway Suite 216

Dallas, TX 75287
Tel: (972) 241-4698
Fax: (972) 241-4439
www.akulalaw.com

I-539 CHECKLIST

Name of person:
DHAMJEWAR HARSHA
___________________ _______________________ _____________________
LAST FIRST MIDDLE

Date of Birth ( mm/dd/yyyy ) : __11/21/1990______________________

Place of Birth (City, State, Country): __BODHAN _TELANGANA _INDIA___________

____________

Citizen of: ___INDIA________________

Home Telephone Number : ____502.876.3930_________________

Work Telephone Number: ______________________

Cellular Telephone Number: ____________________

Fax Number if any: ___________________________

E-mail address : _jukiran1@gmail.com______________

U.S. Physical Address (Please include the address of your actual residence.): _
1010, LA FONTENAY CT. LOUISVILLE – KY -
40223_____________________________________________________________

Permanent Address Abroad (include city, state, country, and postal code):

H.No 4-2-115/1A, Venkateswara Colony, Bodhan, Nizamabad – 503185, Telangana,

India________________________________________________________________________

Social Security Number :__________________________

Date of Latest Arrival to the U.S.:__12/06/2017_______________

I-94 #: ___74818892685________________

Date current status expires: __12/16/2019______________________

Are you currently employed: No

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 17400 Dallas Parkway Suite 216
Dallas, TX 75287
Tel: (972) 241-4698
Fax: (972) 241-4439
www.akulalaw.com

Date you first entered the U.S. in current status :

_________12/17/2016__________________

Will there be any other dependents needing extension of I-539 status (circle one) Yes
SHREYANVI JHADE.

PROVIDE ONE SET OF THE FOLLOWING DOCUMENTS:

(DO NOT SUBMIT DOCUMENTS PRINTED ON LEGAL OR A-5 SIZE PAPER –
ONLY DOCUMENTS SUBMITTED ON USA A-4 SIZE PAPER WILL BE
ACCEPTED)

1. Copy of all pages of valid foreign passport (Please note that you must submit all
pages of your passport, even blank pages.).
2. Copy of all pages of any previous passport, either cancelled or expired, if the
previous passport contains any visa stamps issued by the U.S. consulate.).
3. Copy of I-94 front and back.
4. Copies of all previous H4/I-797 approval notices, if applicable. (Please submit any
and all approval notices you have received in the past)
5. If currently employed, Three recent paystubs.
6. Copy of Social Security Card, if applicable.
7. Copy of marriage certificate with English translation.
8. Copy of any name change documents, if applicable.
9. Copy of birth certificate with English translation (for dependent children only)
9. List of all entries and exits from the U.S. including immigration status for each.
10. All the I-20’s received till date.

I-539 Documents (please submit separate checks)

USCIS FILING FEE: $370 (payable to U.S Department of Homeland Security)
ATTORNEY FEE: $300+75 copying & mailing ($375 payable to Akula & Associates)

The I-539 application form will be completed based on the information you provide in this
checklist, however, since the form requires an original signature from the applicant, the application
cannot be filed with the USCIS until the applicant signs and dates it. The application will be sent
to you by e-mail for review. You will print, date, and sign and return copies (with original
signatures in blue ink) to us for filing. Instruction regarding this part of the process will be sent to
you by e-mail once the forms are prepared and ready for your review.

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