Form I-526 Immigrant Petition by Alien Entrepreneur

OMB No. 1615-0026; Exp. 05/31/2013

Form I-526, Immigrant Petition
by Alien Entrepreneur

Department of Homeland Security
U.S. Citizenship and Immigration Services

Do Not Write in This Block - For USCIS Use Only (Except G-28 Block Below)
Action Block

Classification

Fee Receipt

Priority Date

DRAFT
NOT FOR
PRODUCTION
12/10/2012

To be completed by Attorney or Representative, if any

G-28 is attached
Attorney's State License No.

Remarks:

START HERE - Type or print in black ink.

Part 1.

Information About You

Family Name

Given Name

Middle Name

Address - In Care of Name, if applicable
Street Number and Name
City

Date of Birth (mm/dd/yyyy)

Apt. Number

State or Province

Country

Country of Birth

Social Security Number (if any)

If you are in the United States, provide the following information:
Date of Arrival (mm/dd/yyyy)
I-94 Number

Zip/Postal Code

A-Number (if any)

Passport Number

Travel Document Number

Expiration Date for Passport or Travel Document Country of Issuance for Passport or Travel Document

Current Nonimmigrant Status

Date Current Status Expires (mm/dd/yyyy)

Part 2.
a.
b.
c.

Part 3.

Daytime Telephone Number (with Area Code)

Application Type (Check one)

This petition is based on an investment in a commercial enterprise in a targeted employment area for which the required
amount of capital invested has been adjusted downward.
This petition is based on an investment in a commercial enterprise in an area for which the required amount of capital invested
has been adjusted upward.
This petition is based on an investment in a commercial enterprise that is not in either a targeted area or in an upward
adjustment area.

Information About Your Investment

Name of commercial enterprise in which funds are invested (Required Field - Do Not Leave Blank)
Street Address
Phone Number with Area Code

Business organized as (corporation, partnership, etc.)

RECEIVED: ________________ RESUBMITTED: ____________ RELOCATED: SENT ________________ REC'D ____________
Form I-526 (12/10/12) N

Part 3.

Information About Your Investment (Continued)

Kind of business
(e.g. furniture manufacturer)

Date established
(mm/dd/yyyy)
Amount of your
initial investment

Date of your initial
investment (mm/dd/yyyy)
Your total capital investment
in the enterprise to date

IRS Tax #
$

Percentage of the
enterprise you own

$

DRAFT
NOT FOR
PRODUCTION
12/10/2012

If you are not the sole investor in the new commercial enterprise, list on separate paper the names of all other parties (natural and nonnatural) who hold a percentage share of ownership of the new enterprise and indicate whether any of these parties is seeking classification
as an alien entrepreneur. Include the name, percentage of ownership, and whether or not the person is seeking classification under section
203(b)(5). NOTE: A "natural" party would be an individual person, and a "non-natural" party would be an entity such as a corporation,
consortium, investment group, partnership, etc.
If you indicated in Part 2 that the enterprise is in a targeted employment
area or in an upward adjustment area, name the county and State:

Part 4.

County

State

Additional Information About the Enterprise

Type of Enterprise (check one):

New commercial enterprise resulting from the creation of a new business.

New commercial enterprise resulting from the purchase of an existing business.

New commercial enterprise resulting from a capital investment in an existing business.

Composition of the Petitioner's Investment:

Total amount in U.S. bank account ......................................................................................

$

Total value of all assets purchased for use in the enterprise.................................................

$

Total value of all property transferred from abroad to the new enterprise...........................

$

Total of all debt financing....................................................................................................

$

Total stock purchases...........................................................................................................

$

Other (explain on separate paper)........................................................................................

$

Total

$

Income:
When you made the investment.........

Gross

$

Net

$

Now....................................................

Gross

$

Net

$

Gross

$

Now

$

Net worth:
When you made investment...............

Form I-526 (12/10/12) N Page 2

Part 5.

Employment Creation Information

Number of full-time employees in the enterprise in U.S. (excluding you, your spouse, sons, and daughters)
When you made your initial investment?

Now

Difference

How many of these new jobs were
created by your investment?

How many additional new jobs will be
created by your additional investment?

What is your position, office, or title with the new commercial enterprise?

DRAFT
NOT FOR
PRODUCTION
12/10/2012

Briefly describe your duties, activities, and responsibilities.

What is your salary?

Part 6.

What is the cost of your benefits?

$

$

Processing Information

Check One:

The person named in Part 1 is now in the United States, and an application to adjust status to permanent resident will be filed if this
petition is approved.
If the petition is approved and the person named in Part 1 wishes to apply for an immigrant visa abroad, complete the following for
that person:
Country of nationality:

Country of current residence or, if now in the United States, last permanent residence abroad:

If you provided a United States address in Part 1, print the person's foreign address:

If the person's native alphabet is other than Roman letters, write the foreign address in the native alphabet:

Are you in deportation or removal proceedings?

Yes (Explain on separate paper)

No

Have you ever worked in the United States without permission?

Yes (Explain on separate paper)

No

Part 7. Signature Read the information on penalties in the instructions before completing this section.
I certify, under penalty of perjury under the laws of the United States of America, that this petition and the evidence submitted with it is
all true and correct. I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs to
determine eligibility for the benefit I am seeking.
Signature

Date

Mobile Phone Number

(

)

-

E-Mail Address

NOTE: If you do not completely fill out this form or fail to the submit the required documents listed in the instructions, you may not be
found eligible for the immigration benefit you are seeking and this petition may be denied.

Part 8.

Signature of Person Preparing Form, If Other Than Above (Sign below)

I declare that I prepared this application at the request of the above person, and it is based on all information of which I have knowledge.
Print Your
Signature
Date
Name
Daytime phone #
Firm Name
with area code
Address
Form I-526 (12/10/12) N Page 3