When Paying Adjustment of Status Fees Include:

1. All information completed below.
2. A cashier’s check or postal money order for the correct Diversity Visa Lottery fee amount, with the DV case number noted on the cashier’s check or money order.  You, the selectee in the United States, must pay the diversity visa fee for yourself and for each member of your immediate family also in the United States who plans to adjust status with you here.
3. A self-addressed stamped envelope.

U.S. Department of State
Diversity Visa Program
P.O. Box 979079
St. Louis, Missouri 63197-9000

DV Program Case Number: _____________________________________

Selectee Surname _____________________________________________

Selectee Given Name __________________________________________

Address ______________________________________________________

City: State: Zip Code: __________________________________________

Payment for ____________ persons adjusting status in the U.S. (Number of Persons)

Total Amount enclosed ____________________ (Fee amount times the number of persons adjusting status in the U.S.)