Pages 1-2, Part 1.
Information About You
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[Page 1]
3. Alien Registration Number
(A-Number)
10. U.S. Social Security Number (if
any)
1.a. Family Name (Last
Name)
1.b. Given Name (First Name)
1.c. Middle Name
Other Names Used
9.a. Family Name (Last
Name)
9.b. Given Name (First Name)
9.c. Middle Name
Your Mailing Address
2.a. In Care of Name
2.b. Street Number and Name
2.c. Apt. Ste. Flr.
2.d. City or Town
2.e. State
2.f. ZIP Code
2.g. Province
2.h. Postal Code
2.i. Country
7. Gender
6. Date of Birth
8. Marital Status
Married/Widowed/Single/ Divorced
4. City/Town/Village of
Birth
5. Country of Birth
Name of Prior Spouse 1
11.a. Family Name (Last
Name)
11.b. Given Name (First
Name)
11.c. Middle Name
11.d. Date Marriage Ended
(mm/dd/yyyy)
Name of Prior Spouse 2
12.a. Family Name (Last
Name)
12.b. Given Name (First
Name)
[Page 2]
12.c. Middle Name
12.d. Date Marriage Ended
(mm/dd/yyyy)
My
citizenship was acquired through (Select only one box):
13.a. Birth in the United
States
13.b. Naturalization
13.c. Parents
13.d. Have you obtained a
Certificate of Naturalization or a Certificate of Citizenship in
your name? Y/N
If “Yes,” complete the
following:
13.d.1. Certificate Number
13.d.2. Place of Issuance
13.d.3. Date of Issuance
(mm/dd/yyyy)
14.
Have you ever filed for this or any other alien fiancé(e)
or husband/wife before? Y/N
If you
answered "Yes," provide the following for each
alien (attach additional sheets as necessary)
14.a. Alien Registration
Number (A-Number)
14.b. Family Name (Last
Name)
14.c. Given Name (First
Name)
14.d. Middle Name
14.e. Date of Filing
(mm/dd/yyyy)
14.f. City or Town
14.g. State
14.h. Result
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[Page 1]
1.
Alien Registration Number (A-Number)
(if any)
2.
USCIS Online Account Number (if any)
3.
U.S. Social Security Number (if any)
Select one
box below to indicate the classification you are requesting for
your beneficiary:
4.a.
Fiancé(e) (K-1 visa)
4.b.
Spouse (K-3 visa)
5.
If you are filing to classify your spouse as a K-3, have you
filed Form I-130? Y/N
Your Full
Name [section
sub-header]
6.a.
Family Name (Last Name)
6.b.
Given Name (First Name)
6.c.
Middle Name
Other Names
Used [section
sub-header]
Provide all
other names you have ever used, including aliases, maiden name,
and nicknames. If you need extra space to complete this section,
use the space provided in Part 8.
Additional Information.
7.a.
Family Name (Last Name)
7.b.
Given Name (First Name)
7.c.
Middle Name
Your Mailing Address
[section sub-header]
8.a.
In Care Of Name
8.b.
Street Number and Name
8.c.
Apt. Ste. Flr.
8.d.
City or Town
8.e.
State
8.f.
ZIP Code
8.g.
Province
8.h.
Postal Code
8.i.
Country
8.j.
Is your current mailing address the same as your physical address?
Y/N
If you
answered “No,” provide your physical address in Item
Numbers 9.a.-9.h.
[Page 2]
Your Address History [section
sub-header]
Provide your
physical addresses for the last five years, whether inside or
outside the United States. Provide your current address first if
it is different from your mailing address in Item
Numbers 8.a - 8.i. If you need
extra space to complete this section, use the space provided in
Part 8. Additional Information.
Physical
Address 1
9.a.
Street Number and Name
9.b.
Apt. Ste. Flr.
9.c.
City or Town
9.d.
State 9.e.
ZIP Code
9.f.
Province
9.g.
Postal Code
9.h.
Country
10.a. Date
From (mm/dd/yyyy)
10.b. Date
To (mm/dd/yyyy) [PRESENT]
Physical
Address 2
11.a.
Street Number and Name
11.b.
Apt. Ste. Flr.
11.c.
City or Town
11.d.
State 11.e.
ZIP Code
11.f.
Province
11.g.
Postal Code
11.h.
Country
12.a. Date
From (mm/dd/yyyy)
12.b. Date
To (mm/dd/yyyy)
Your
Employment History [section
sub-header]
Provide your
employment history for the last five years, whether inside or
outside the United States. Provide your current employment first.
If you need extra space to complete
this section, use the space provided in
Part 8. Additional Information.
Employer 1
13.
Full Name of Employer
14.a.
Street Number and Name
14.b.
Apt. Ste. Flr.
14.c.
City or Town
14.d.
State 14.e.
ZIP Code
14.f.
Province
14.g.
Postal Code
14.h.
Country
15.
Your Occupation (specify)
16.a.
Employment Start
Date (mm/dd/yyyy)
16.b. Employment
End Date
(mm/dd/yyyy)
Employer 2
17.
Full Name of Employer
18.a.
Street Number and Name
18.b.
Apt. Ste. Flr.
18.c.
City or Town
18.d.
State 18.e.
ZIP Code
18.f.
Province
18.g.
Postal Code
18.h.
Country
19.
Your Occupation (specify)
20.a.
Employment Start
Date (mm/dd/yyyy)
20.b.
Employment End
Date (mm/dd/yyyy)
Other
Information [section
sub-header]
21.
Gender
22.
Date of Birth (mm/dd/yyyy)
23.
Marital Status
Single/Married/Divorced/ Widowed
24.
City/Town/Village of Birth
25.
Province or State of Birth
26.
Country of Birth
Information
About Your Parents
[subheader]
Parent 1’s
Information
27.a.
Family Name (Last Name)
27.b.
Given Name (First Name)
27.c.
Middle Name
28.
Date of Birth
29.
Gender Male Female
30.
Country of Birth
31.a.
City/Town/Village of Residence
31.b.
Country of Residence
Parent 2’s
Information
Full Name of
Parent 2
32.a.
Family Name (Last Name)
32.b.
Given Name (First Name)
32.c.
Middle Name
33.
Date of Birth
34. Gender
Male Female
35.
Country of Birth
36.a.
City/Town/Village of Residence
36.b.
Country of Residence
37.
Have you ever been previously married? Y/N
If you
answered “Yes” to Item
Number 37.,
provide the names of each spouse and the date that each prior
marriage ended in Item
Numbers 38.a.
- 39. If
you need extra space to complete this section, use the space
provided in Part 8. Additional
Information.
Name of Previous
Spouse
38.a.
Family Name (Last Name)
38.b.
Given Name (First Name)
38.c.
Middle Name
39.
Date Marriage Ended (mm/dd/yyyy)
[Delete.]
Your
Citizenship Information
[subheader]
You
are a U.S. citizen through (select
only one box):
40.a.
Birth in the United States
40.b.
Naturalization
40.c. U.S.
citizen Parents
41.
Have you obtained a Certificate of Naturalization or a
Certificate of Citizenship in your own name?
Y/N
If you
answered "Yes" to Item
Number 41.,
complete Item Numbers 42.a.
- 42.c.
42.a.
Certificate Number
42.b.
Place of Issuance
42.c. Date
of Issuance (mm/dd/yyyy)
Additional
Information [subheader]
43.
Have you ever filed Form I-129F for
any other beneficiary? Y/N
If you
answered "Yes" to
Item Number 43.,
provide the responses to Item
Number 44. - 46.
for each previous beneficiary.
If you need to provide information for more than one beneficiary,
use the space provided in Part 8.
Additional Information.
44.
A-Number (if any)
45.a.
Family Name (Last Name)
45.b.
Given Name (First Name)
45.c.
Middle Name
46.
Date of Filing (mm/dd/yyyy)
[Delete.]
[Delete.]
47.
What action did USCIS take on Form I-129F
(for example, approved, denied, revoked)?
48.
Do you have any children under 18
years of age?
If
you answered “Yes” to Item
Number 48.,
provide the ages for your children under 18 years of age in Item
Numbers 49.a. - 49.b.
[Page
3]
Provide
the ages for your children under 18 years of age. If you need
extra space to complete this section, use the space provided in
Part 8. Additional Information.
49.a.
Age ___________
49.b.
Age ___________
Provide all
U.S. states and foreign countries in which you have resided since
your 18th birthday.
Residence 1
50.a.
State
50.b.
Country
Residence 2
51.a.
State
51.b.
Country
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Pages 2-5, Part 2.
Information About Your Alien Fiancé(e), Item Number 1.
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[Page 2]
Part 2. Information About Your
Alien Fiancé(e)
1. Identify the classification
sought for your beneficiary (select one):
2.a. Family Name (Last Name)
2.b. Given Name (First Name)
2.c. Middle Name
11. Alien Registration Number
(A-Number)
12. U.S. Social Security Number (if
any)
6. Date of Birth (mm/dd/yyyy)
8. Gender M/F
9. Marital Status
Married/Widowed/Single/ Divorced
4. City/Town/Village of Birth
5. Country of Birth
7. Country of Citizenship
Other Names Used (Including
Maiden Name)
10.a. Family Name (Last Name)
10.b. Given Name (First Name)
10.c. Middle Name
Alien Fiance(e)’s
Mailing Address
3.a. In Care of Name
3.b. Street Number and Name
3.c. Apt. Ste. Flr.
3.d. City or Town
3.e. State 3.f. Zip Code
3.g. Postal Code
3. h. Province
3.i. Country
Other Information About Your
Alien Fiance(e)
[Page 3]
Name of Prior Spouse 1
13.a. Family Name (Last Name)
13.b. Given Name (First Name)
13.c. Middle Name
13.d. Date Marriage Ended
(mm/dd/yyyy)
Name of Prior Spouse 2
14.a. Family Name (Last Name)
14.b. Given Name (First Name)
14.c. Middle Name
14.d. Date Marriage Ended
(mm/dd/yyyy)
15. Has your fiancé(e) ever
been in the United States? Y/N
If your
fiancé(e) is currently in the United States, complete the
following:
15.a. He
or she last arrived as a: (visitor, student, exchange alien,
crewman, stowaway, temporary worker, without inspection, etc.)
15.b. 1-94
Arrival/Departure Record Number
15.c. Date of Arrival (mm/dd/yyyy)
15.d. Date authorized stay expired
or will expire as shown on I-94 or I-95 (mm/dd/yyyy)
15.e.
Passport Number
15.f. Travel
Document Number
15.g.
Country of Issuance for Passport or Travel Document
15.h. Expiration Date for Passport
or Travel Document (mm/dd/yyyy)
Complete the following for all
children of your alien fiancé(e) (if any).
Child 1 of
Alien Fiancé(e)
16.a.
Family Name (Last Name)
16.b.
Given Name (First Name)
16.c.
Middle Name
17.
Country of Birth
18. Date of Birth
(mm/dd/yyyy)
19.a. Street Number and Name
19.b. Apt. Ste. Flr.
19.c. City or Town
19.d. State 19.e.
Zip Code
19.f. Postal Code
19.g. Province
19.h. Country
Child 2 of
Alien Fiancé(e)
20.a.
Family Name (Last Name)
20.b.
Given Name (First Name)
20.c.
Middle Name
21.
Country of Birth
22. Date of Birth
(mm/dd/yyyy)
23.a. Street Number and Name
23.b. Apt. Ste. Flr.
23.c. City or Town
23.d. State 23.e.
Zip Code
23.f. Postal Code
23.g. Province
23.h. Country
[Page 4]
Child 3 of
Alien Fiancé(e)
24.a.
Family Name (Last Name)
24.b.
Given Name (First Name)
24.c.
Middle Name
25.
Country of Birth
26. Date of Birth
(mm/dd/yyyy)
27.a. Street Number and Name
27.b. Apt. Ste. Flr.
27.c. City or Town
27.d. State 27.e.
Zip Code
27.f. Postal Code
27.g. Province
27.h. Country
Address in the United States
where your fiancé(e) intends to live.
28.a. Street Number and Name
28.b. Apt. Ste. Flr.
28.c. City or Town
28.d. State 28.e.
Zip Code
Your
fiancé(e)’s address abroad.
29.a. Street Number and Name
29.b. Apt. Ste. Flr.
29.c. City or Town
29.d. Postal Code
29.e. Province
29.f. Country
30. Daytime Phone Number/Extension
If your fiancé(e)’s
native alphabet uses other than Roman letters, write his or her
name and address abroad in the native alphabet.
31.b.
Family Name (Last Name)
31.c.
Given Name (First Name)
31.d.
Middle Name
Your
fiancé(e)’s address abroad. (Native
Alphabet)
32.a. Street Number and Name
32.b. Apt. Ste. Flr.
32.c. City or Town
32.d. Postal Code
32.e. Province
32.f. Country
33. Is your
fiancé(e) related to you? Y/N
33.a. If you
are related, state the nature and degree of relationship, e.g.,
third cousin or maternal uncle, etc.
34. Has your
alien fiancé(e) met and seen you within the 2-year period
immediately preceeding the filing of this petition? Yes/No
34.a.
Describe the circumstances under which you met. If you have not
personally met each other, explain how the relationship was
established. If you met your fiancé(e) or spouse through
an international marriage broker, please explain those
circumstances in number 35.a. Explain in detail any reasons you
may have for requesting that the requirement that you and your
fiancé(e) must have met should not apply to you.
__________________________________
__________________________________
35. Did you
meet your fiancé(e) or spouse through the services of an
international marriage broker? Y/N
35.a. If you
answered “Yes,” provide the Internet and/or Street
Address below. In additional, attach a copy of the signed,
written consent form the IMB obtained from your beneficiary
authorizing the release of your beneficiary’s personal
contact information to you. If additional space is needed, attach
a separate sheet of paper.
[Page 5]
Your
fiancé(e) will apply for a visa abroad at the American
embassy or consulate at:
36.a.
City or Town
36.b. Country
Note: Designation of a U.S.
embassy or consulate outside the country of your fiancé(e)’s
last residence does not guarantee acceptance for processing by
that foreign post. Acceptance is at the discretion of the
designated embassy or consulate.
|
[Page 3]
Part 2. Information About Your
Beneficiary
[Delete.]
1.a.
Family Name (Last Name)
1.b.
Given Name (First Name)
1.c.
Middle Name
2.
A-Number (if any)
3.
U.S. Social Security Number (if any)
4.
Date of Birth (mm/dd/yyyy)
5.
Gender M/F
6.
Marital Status Single/Married/Divorced/
Widowed
7.
City/Town/Village of Birth
8.
Country of Birth
9.
Country of Citizenship or Nationality
Other Names Used [subheader]
Provide all
other names you have ever used, including aliases, maiden name,
and nicknames. If you need extra
space to complete this section, use the space provided in Part
8. Additional Information.
[no change]
[Page 3]
Mailing
Address for
Your Beneficiary
11.a.
In Care Of Name
11.b.
Street Number and Name
11.c.
Apt. Ste. Flr.
11.d.
City or Town
11.e.
State 11.f. ZIP
Code
11.g.
Province
11.h.
Postal Code
11.i.
Country
Your
Beneficiary’s Address History [section
sub-header]
Provide your
beneficiary’s physical addresses for the last five years,
whether inside or outside the United States. Provide your
beneficiary’s current address first if it is different from
the mailing address in Item
Numbers 11.a - 11.i. If you need
extra space to complete this section, use the space provided in
Part 8. Additional Information.
Beneficiary's
Physical Address 1
12.a.
Street Number and Name
12.b.
Apt. Ste. Flr.
12.c.
City or Town
12.d.
State 12.e.
ZIP Code
12.f.
Province
12.g.
Postal Code
12.h.
Country
13.a. Date
From (mm/dd/yyyy)
13.b. Date
To (mm/dd/yyyy) [PRESENT]
Beneficiary's
Physical Address 2
14.a.
Street Number and Name
14.b.
Apt. Ste. Flr.
14.c.
City or Town
14.d.
State 14.e.
ZIP Code
14.f.
Province
14.g.
Postal Code
14.h.
Country
15.a. Date
From (mm/dd/yyyy)
15.b. Date
To (mm/dd/yyyy)
Your
Beneficiary’s Employment History [section
sub-header]
Provide your
beneficiary’s employment history for the last five years,
whether inside or outside the United States. Provide your current
employment first. If you need extra
space to complete this section, use the space provided in
Part 8. Additional Information.
Beneficiary's
Employer 1
16.
Full Name of Employer
17.a.
Street Number and Name
17.b.
Apt. Ste. Flr.
17.c.
City or Town
17.d.
State 17.e.
ZIP Code
17.f.
Province
17.g.
Postal Code
17.h.
Country
18.
Beneficiary’s Occupation (specify)
19.a.
Employment Start
Date (mm/dd/yyyy)
19.b.
Employment End
Date (mm/dd/yyyy)
Beneficiary's
Employer 2
20.
Full Name of Employer
21.a.
Street Number and Name
21.b.
Apt. Ste. Flr.
21.c.
City or Town
21.d.
State 21.e.
ZIP Code
21.f.
Province
21.g.
Postal Code
21.h.
Country
22.
Beneficiary’s Occupation (specify)
23.a.
Employment Start
Date (mm/dd/yyyy)
23.b.
Employment End
Date (mm/dd/yyyy)
Information
About Your Beneficiary’s Parents
[subheader]
Parent 1’s
Information
24.a.
Family Name (Last Name)
24.b.
Given Name (First Name)
24.c.
Middle Name
25.
Date of Birth
26.
Gender Male Female
27.
Country of Birth
28.a.
City/Town/Village of Residence
28.b.
Country of Residence
Parent 2’s
Information
Full Name of
Parent 2
29.a.
Family Name (Last Name)
29.b.
Given Name (First Name)
29.c.
Middle Name
30.
Date of Birth
31. Gender
Male Female
32.
Country of Birth
33.a.
City/Town/Village of Residence
33.b.
Country of Residence
Other Information About Your
Beneficiary
34.
Has your beneficiary ever been previously married? Y/N
If
you answered “Yes” to Item
Number 34.,
provide the names of each prior spouse and the date each prior
marriage ended in Item Numbers
35.a. - 36.
If you need to provide
information for more than one spouse, use the space provided in
Part 8. Additional Information.
Name of Previous
Spouse
35.a.
Family Name (Last Name)
35.b.
Given Name (First Name)
35.c.
Middle Name
36.
Date Marriage Ended (mm/dd/yyyy)
[Delete.]
37.
Has your beneficiary ever
been in the United States? Y/N
If your
beneficiary is currently in the
United States, complete Item
Numbers 38.a. - 38.h.
[Page 4]
38.a.
He or she last entered as a
(for example, visitor, student,
exchange alien, crewman, stowaway, temporary worker, without
inspection):
38.b.
1-94 Arrival-Departure Record
Number
38.c.
Date of Arrival (mm/dd/yyyy)
38.d.
Date authorized stay expired or will expire as shown on
Form I-94 or I-95 (mm/dd/yyyy)
38.e.
Passport Number
38.f.
Travel Document Number
38.g.
Country of Issuance for Passport or Travel Document
38.h.
Expiration Date for Passport or Travel Document
(mm/dd/yyyy)
39.
Does your beneficiary have any
children? Y/N
If
you answered “Yes” to Item
Number 39.,
provide the following information about each child. If you need
to provide information for more than one child, use the space
provided in Part 8. Additional
Information.
[Delete.]
Children
of Beneficiary
40.a.
Family Name (Last Name)
40.b.
Given Name (First Name)
40.c.
Middle Name
41.
Country of Birth
42.
Date of Birth (mm/dd/yyyy)
43.
Does this child reside with your beneficiary? Y/N
If
the child does not reside with your beneficiary, provide the
child’s physical residence.
44.a.
Street Number and Name
44.b.
Apt. Ste. Flr.
44.c.
City or Town
44.d.
State 44.e. ZIP
Code
44.f.
Province
44.g.
Postal Code
44.h.
Country
[Delete.]
[Delete.]
Address in
the United States Where Your
Beneficiary Intends to Live
[subheader]
45.a.
Street Number and Name
45.b.
Apt. Ste. Flr.
45.c.
City or Town
45.d.
State 45.e. ZIP
Code
46.
Daytime Telephone Number
[Page 4]
Your
Beneficiary’s Physical Address Abroad [subheader]
47.a.
Street Number and Name
47.b.
Apt. Ste. Flr.
47.c.
City or Town
47.d.
Province
47.e.
Postal Code
47.f.
Country
48.
Daytime Telephone Number
[Page 5]
Your
Beneficiary’s Name and Address in His or Her Native Alphabet
49.a.
Family Name (Last Name)
49.b.
Given Name (First Name)
49.c.
Middle Name
50.a.
Street Number and Name
50.b.
Apt. Ste. Flr.
50.c.
City or Town
50.d.
Province
50.e.
Postal Code
50.f.
Country
51.
Is your fiancé(e) related to you? Y/N/
N/A, beneficiary is my spouse
52.
Provide the nature and
degree of relationship (for example, third
cousin or maternal uncle).
53.
Have you and your fiancé(e)
met in person during the two years
immediately before filing this
petition? Yes/No/N/A, beneficiary is my
spouse
If
you answered “Yes” to Item
Number 53.,
describe the circumstances of your in-person meeting in Item
Number 54.
Attach evidence to demonstrate
that you were in each other’s physical presence during the
required two year period.
If
you answered “No,” explain your reasons for requesting
an exemption from the in person meeting requirement in Item
Number 54.
and provide evidence that you should
be exempt from this requirement. Refer to Part
2., Item
Numbers 53. - 54.
of the Specific
Instructions section of the
Instructions for additional information about the requirement to
meet. If you need extra space to complete this section, use the
space provided in Part 8.
Additional Information.
54.
[Lines.]
International
Marriage Broker (IMB) Information
[subheader]
55.
Did you meet your beneficiary through the
services of an IMB? Y/N
If
you answered “Yes” to Item
Number 55.,
provide the IMB’s contact
information and Web
site information below. In addition,
attach a copy of the signed, written consent form the IMB obtained
from your beneficiary authorizing your
beneficiary’s personal contact information to
be released to you.
56.
IMB’s Name (if any)
57.a.
Family Name of IMB (Last Name)
57.b.
Given Name of IMB (First Name)
58.
Organization Name of IMB
59.
Web site of IMB
60.a.
Street Number and Name
60.b.
Apt. Ste. Flr.
60.c.
City or Town
60.d.
Province
60.e.
Postal Code
60.f.
Country
61.
Daytime Telephone Number
Consular
Processing Information
[subheader]
Your
beneficiary will apply
for a visa abroad at the U.S. Embassy
or U.S. Consulate at:
62.a.
City or Town
62.b.
Country
[Delete.]
|
Page 5, Part 3. Other
Information
|
[Page 5]
Part 3. Other Information
1. If you are serving overseas in
the Armed Forces of the United States, please answer the
following:
I presently reside or am stationed
overseas and my current mailing address is:
1.a. In Care of Name
1.b. Street Number and Name
1.c. Apt. Ste. Flr.
1.d. City or Town
1.e. State 1.f.
ZIP Code
1.g. Province
1.h. Postal Code
1.i. Country
2. Have you ever been convicted
by a court of law (civil or criminal) or court martialed by a
military tribunal for any of the following crimes:
2.a. Domestic violence,
sexual assault, child abuse and neglect, dating violence, elder
abuse or stalking? (Please refer to Page 3 of the instructions
for the full definition of the term “domestic violence”).
Y/N
2.b. Homicide, murder,
manslaughter, rape, abusive sexual contact, sexual exploitation,
incest, torture, trafficking, peonage, holding hostage,
involuntary servitude, slave trade, kidnapping, abduction,
unlawful criminal restraint, false imprisonment or an attempt to
commit any of these crimes?
2.c. Three or more convictions for
crimes relating to a controlled substance or alcohol not arising
from a single act? Y/N
These questions must be answered
even if your records were sealed or otherwise cleared; or if
anyone, including a judge, law enforcement officer, or attorney,
told you that you no longer have a record. Using a separate
sheet(s) of paper, provide information relating to the
conviction(s), such as crime involved, date of conviction and
sentence.
3. If you have provided information
about a conviction for a crime listed above and you were being
battered or subjected to extreme cruelty by your spouse, parent,
or adult child at the time of your conviction, check all of the
following that apply to you:
3.a. [ ] I was acting in
self-defense.
3.b. [ ] I violated a protection
order issued for my own protection.
3.c. [ ] I committed, was arrested
for, was convicted of, or plead guilty to committing a crime that
did not result in serious bodily injury, and there was a
connection between the crime committed and my having been battered
or subjected to extreme cruelty.
If your beneficiary s your fiancé(e)
and: (a) this is the third (or more) Form I-129F petition that you
have filed; or (b) this is the third (or more) Form I-129F
petition you have filed and your first Form I-129F petition was
approved within the last 2 years, then your petition cannot be
approved unless a waiver of the multiple filing restriction is
granted. Attach a signed and dated letter, requesting the
waiver and explaining why a waiver is appropriate under your
circumstances, together with any evidence in support of the waiver
request.
4. Indicate which waiver applies:
[ ] Multiple Filer, No Disqualifying
Convictions (General Waiver)
[ ] Multiple Filer, Prior Criminal
Conviction for Specified Offenses (Extraordinary Circumstances
Waiver)
[ ] Multiple Filer, Prior Criminal
Convictions Resulting from Domestic Violence (Mandatory Waiver)
[ ] Not applicable, beneficiary is
my spouse
NOTE: See Page 3, question
3.b. of the filing instructions.
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[Page 6]
Part 3. Other Information
Criminal
Information [subheader]
NOTE:
These criminal information questions must be answered even if
your records were sealed, cleared, or if anyone, including a
judge, law enforcement officer, or attorney, told you that you no
longer have a record. If you need extra space to complete this
section, use the space provided in Part
8. Additional Information.
1. Have you
EVER
been subject to a temporary or permanent protection or restraining
order (either civil or criminal)? Y/N
[Delete]
Have
you EVER
been arrested or
convicted of any of the
following crimes:
2.a. Domestic violence,
sexual assault, child abuse, child neglect,
dating violence, elder abuse, stalking, or
an attempt to commit any of these crimes? (See
Part 3. Other Information,
Item Numbers 1. - 3.c.
of the Instructions for the full definition of the term “domestic
violence.”)
2.b. Homicide, murder,
manslaughter, rape, abusive sexual contact, sexual exploitation,
incest, torture, trafficking, peonage, holding hostage,
involuntary servitude, slave trade, kidnapping, abduction,
unlawful criminal restraint, false imprisonment,
or an attempt to commit any of these crimes?
2.c. Three or more arrests
or convictions, not from a single
act, for crimes relating to a controlled substance or
alcohol? Y/N
NOTE:
If you were ever arrested or convicted of any of the specified
crimes, you must submit certified copies of all court and police
records showing the charges and disposition for every arrest or
conviction. You must do so even if your records were sealed,
expunged, or otherwise cleared, and regardless of whether anyone,
including a judge, law enforcement officer, or attorney, informed
you that you no longer have a criminal record. If you need extra
space to complete this section, use the space provided in Part
8. Additional Information.
If you
have provided information about a conviction for a crime listed in
Item Numbers 2.a. - 2.c.
and you were being battered or subjected to extreme cruelty
at the time of your conviction, select
all of the following that apply to you:
[no change]
[no change]
3.c.
[ ] I committed, was arrested for, was convicted of, or pled
guilty to a crime that did not result in serious bodily injury and
there was a connection between the crime and me having been
battered or subjected to extreme cruelty.
4.a.
Have you ever been arrested, cited, charged, indicted, convicted,
fined, or imprisoned for breaking or violating any law or
ordinance in any country, excluding traffic violations (unless a
traffic violation was alcohol- or drug-related or involved a fine
of $500 or more)? Y/N
4.b.
If the answer to Item Number 4.a.
is “Yes,” provide information about each of those
arrests, citations, charges, indictments, convictions, fines, or
imprisonments in the space below. If you were the subject of an
order of protection or restraining order and believe you are the
victim, please explain those circumstances and provide any
evidence to support your claims. Include the dates and outcomes.
If you need extra space to complete this section, use the space
provided in Part 8. Additional
Information.
[Delete.]
__________
Multiple
Filer Waiver Request Information
[subheader]
Refer to Part
3. Types of Waivers in the
Specific Instructions section
of the Instructions for an explanation of the filing waivers.
Indicate
which one of the following waivers
you are requesting:
5.a.
Multiple Filer, No Permanent Restraining
Orders or Convictions for a Specified
Offense (General Waiver)
5.b.
Multiple Filer, Prior Permanent Restraining
Orders or Criminal Conviction for Specified Offense
(Extraordinary Circumstances Waiver)
5.c.
Multiple Filer, Prior Permanent Restraining
Order or Criminal Convictions for
Specified Offense Resulting from Domestic Violence
(Mandatory Waiver)
5.d.
Not applicable, beneficiary is my spouse or
I am not a multiple filer
[Delete]
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Page 6, Part 4.
Signature of Petitioner
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[Page 6]
Part 4. Signature of Petitioner
Penalties
You may by law be imprisoned for not
more than 5 years, or fined $250,000, or both, for entering into a
marriage contract for the purpose of evading any provision of the
immigration laws, and you may be fined up to $10,000 or imprisoned
upon to five years, or both, for knowingly and willfully
falsifying or concealing a material fact or using any false
document in submitting this petition.
Your Certification
I certify that I am legally able to
and intend to marry my alien fiancé(e) within 90 days of
his or her arrival in the United States. I certify, under penalty
of perjury under the laws of the United States of America, that
the foregoing is true and correct. Furthermore, I authorize the
release of any information from my records that U.S. Citizenship
and Immigration Services needs to determine eligibility for the
benefit that I am seeking.
Moreover, I understand that this
petition, including any criminal conviction information that I am
required to provide with this petition, as well as any related
criminal background information pertaining to me that U.S.
Citizenship and Immigration Services may discover independently in
adjudicating this petition will be disclosed to the beneficiary of
this petition.
1.a. Signature of Petitioner
1.b. Date of Signature (mm/dd/yyyy)
2. Daytime Phone Number
3. Mobile Phone Number
4. E-mail Address (if any)
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[Page 7]
Part 5.
Petitioner’s Statement, Contact Information, Declaration,
and Signature
NOTE:
Read the Penalties
section of the Form I-129F Instructions before completing this
part.
[delete]
Petitioner’s
Statement [subheader]
NOTE:
Select the box for either Item
Number 1.a. or
1.b. If applicable, select the
box for Item Number 2.
1.a.
I can read and understand English, and I have read and understand
every question and instruction on this petition and my answer to
every question.
1.b.
The interpreter named in Part 6.
read to me every question and instruction on this petition and my
answer to every question in [Fillable Field], a language in which
I am fluent, and I understood everything.
2.
At my request, the preparer named in
Part 7.,
[Fillable Filed], prepared this petition
for me based only upon information I provided or authorized.
Petitioner’s
Contact Information [sub
header]
3.
Petitioner’s Daytime Telephone Number
4.
Petitioner’s Mobile Telephone Number (if any)
5.
Petitioner’s Email Address (if any)
[Page 8]
Petitioner’s
Declaration and Certification
[subheader]
Copies of any
documents I have submitted are exact photocopies of unaltered,
original documents, and I understand that USCIS may require that I
submit original documents to USCIS at a later date. Furthermore,
I authorize the release of any information from any
of my records that USCIS may need to
determine my eligibility for the immigration
benefit that I seek.
I further
authorize release of information contained in this petition,
in supporting documents, and in my USCIS records to other entities
and persons where necessary for the administration and enforcement
of U.S. immigration laws.
I understand
that USCIS may require me to appear for an appointment to take my
biometrics (fingerprints, photograph, and/or signature) and, at
that time, if I am required to provide biometrics, I will be
required to sign an oath reaffirming that:
1)
I provided or authorized all of the information contained in, and
submitted with, my petition;
2)
I reviewed and understood all of the information in, and
submitted with, my petition; and
3)
All of this information was complete, true, and correct at the
time of filing.
I certify,
under penalty of perjury, that all of the information in my
petition
and any document submitted with it were provided or authorized by
me, that I reviewed and understand
all of the information contained in, and submitted with, my
petition, and that all of this information is
complete, true, and correct.
[delete]
Petitioner’s
Signature [sub header]
6.a.
Petitioner’s Signature
6.b.
Date of Signature (mm/dd/yyyy)
[Delete]
[Delete]
[Delete]
NOTE TO ALL
PETITIONERS: If you do not
completely fill out this petition or fail to submit required
documents listed in the Instructions, USCIS may deny your
petition.
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Page 6, Part 5.
Signature of Person Preparing This Petition, If Other Than the
Petitioner
|
Part 5. Signature of Person
Preparing This Petition, If Other Than the Petitioner
NOTE: If you are an attorney or
representative, you must submit a completed Form G-28, Notice of
Entry of Appearance as Attorney or Accredited Representative,
along with this Petition.
[ ] Form G-28 submitted with this
Petition.
G-28 ID Number
Preparer’s Full Name
1.a. Preparer’s Family Name
(Last Name)
1.b. Preparer’s Given Name
(First Name)
2. Preparer’s Business or
Organization Name
Preparer’s Mailing Address
5.a. Street Number and Name
5.b. Apt. Ste. Flr.
5.c. City or Town
5.d. State
5.e. ZIP Code
5.f. Province
5.g. Postal Code
5.h. Country
Preparer’s Contact
Information [sub-header]
3. Preparer’s Daytime
Telephone Number
4. Preparer’s Email Address
(if any)
Declaration
To be completed by all preparers,
including attorneys and authorized representatives: I declare that
I prepared this benefit request at the request of the Petitioner,
that it is based on all the information of which I have knowledge,
and that the information is true to the best of my knowledge.
6.a. Signature of Preparer
6.b. Date of Signature (mm/dd/yyyy)
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[Page 9]
Part 7.
Contact Information, Declaration, and Signature of the Person
Preparing this Petition, if Other Than the Petitioner
Provide the
following information about the preparer.
[delete]
Preparer’s Full Name
1.a. Preparer’s Family
Name (Last Name)
1.b. Preparer’s Given
Name (First Name)
2. Preparer’s Business
or Organization Name (if any)
Preparer’s Mailing
Address
3.a.
Street Number and Name
3.b.
Apt. Ste. Flr.
3.c.
City or Town
3.d.
State
3.e.
ZIP Code
3.f.
Province
3.g.
Postal Code
3.h.
Country
[Page 8]
Preparer’s Contact
Information [sub-header]
4.
Preparer’s Daytime Telephone Number
5.
Preparer’s Mobile Telephone Number (if any)
6.
Preparer’s Email Address (if any)
Preparer’s
Statement [sub-header]
7.a.
I am not an attorney or accredited representative but have
prepared this petition on behalf of the petitioner and with the
petitioner’s consent.
7.b.
I am an attorney or accredited representative and my
representation of the petitioner in this case extends/does not
extend beyond the preparation of this petition.
NOTE: If
you are an attorney or accredited representative whose
representation extends beyond preparation of this petition, you
may be obliged to submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Representative, or G-28I,
Notice of Entry of Appearance as Attorney In Matters Outside the
Geographical Confines of the United States, with this petition.
Preparer’s
Certification [sub-header]
By my
signature, I certify, under penalty of perjury, that I prepared
this petition at the request of the petitioner. The
petitioner then reviewed this completed petition
and informed me that he or she
understands all of the information contained in, and submitted
with, his or her petition,
including the Petitioner’s
Declaration and Certification,
and that all of this information is complete, true, and correct.
I completed this petition based
only on information that the petitioner provided to me or
authorized me to obtain or use.
Preparer’s
Signature [sub-header]
8.a.
Preparer's Signature
8.b.
Date of Signature (mm/dd/yyyy)
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