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pdfPetition for Alien Relative
USCIS
Form I-130
Department of Homeland Security
U.S. Citizenship and Immigration Services
For USCIS Use Only
OMB No. 1615-0012
Expires 12/31/2015
Fee Stamp
Action Stamp
A-Number
AInitial Receipt
Resubmitted
Relocated
Received
Sent
Completed
Section of Law/Visa Category
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203(a)(2)(B) Unm. S/D - F2-4
201(b) Spouse - IR-1/CR-1
203(a)(1) Unm. S/D - F1-1
201(b) Child - IR-2/CR-2
203(a)(2)(A) Spouse - F2-1
203(a)(3) Married S/D - F3-1
201(b) Parent - IR-5
203(a)(2)(A) Child - F2-2
203(a)(4) Brother/Sister - F4-1
Petition was filed on (Priority Date mm/dd/yyyy):
Approved
PDR request granted/denied - New priority date (mm/dd/yyyy):
Returned
Remarks
Field Investigation
Personal Interview
204(a)(2)(A) Resolved
Previously Forwarded
Pet. A-File Reviewed
I-485 Filed Simultaneously
203(g) Resolved
Ben. A-File Reviewed
204(g) Resolved
At which USCIS office (e.g., NBC, VSC, LOS, CRO) was Form I-130 adjudicated?
To be completed by an attorney or accredited representative (if any).
Select this box if
Form G-28 is
attached.
Attorney State Bar Number
(if applicable)
Volag Number
(if any)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
► START HERE - Type or print in black ink.
If you need extra space to complete any section of this petition, use the space provided in Part 9. Additional Information.
Complete and submit as many copies of Part 9., as necessary, with your petition.
Part 1. Relationship (You are the Petitioner. Your
relative is the Beneficiary)
1.
1.
Alien Registration Number (A-Number) (if any)
► A-
I am filing this petition for my (Select only one box):
Spouse
2.
Part 2. Information About You (Petitioner)
Parent
Brother/Sister
Child
If you are filing this petition for your child or parent,
select the box that describes your relationship (Select only
one box):
2.
USCIS Online Account Number (if any)
►
3.
U.S. Social Security Number (if any)
►
Child was born to parents who were married to each
other at the time of the child's birth
Stepchild/Stepparent
Your Full Name
Child was born to parents who were not married to
each other at the time of the child's birth
4.a. Family Name
(Last Name)
4.b. Given Name
(First Name)
Child was adopted (not an Orphan or Hague
Convention adoptee)
3.
If the beneficiary is your brother/sister, are you related by
adoption?
Yes
No
4.
Did you gain lawful permanent resident status or
citizenship through adoption?
Yes
Form I-130 12/18/12 N
4.c. Middle Name
No
Page 1 of 12
Part 2. Information About You (Petitioner)
(continued)
Other Names Used (if any)
Provide all other names you have ever used, including aliases,
maiden name, and nicknames.
Address History
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 10.a. - 10.i.
Physical Address 1
5.a. Family Name
(Last Name)
5.b. Given Name
(First Name)
12.a. Street Number
and Name
5.c. Middle Name
12.c. City or Town
12.b.
Apt.
Ste.
Flr.
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12.d. State
Other Information
12.e. ZIP Code
12.f. Province
6.
City/Town/Village of Birth
7.
Country of Birth
8.
Date of Birth (mm/dd/yyyy)
9.
Sex
12.g. Postal Code
Male
12.h. Country
Female
13.a. Date From (mm/dd/yyyy)
13.b. Date To (mm/dd/yyyy)
Mailing Address
Physical Address 2
10.a. In Care Of Name
14.a. Street Number
and Name
14.b.
10.b. Street Number
and Name
10.c.
Apt.
Apt.
Ste.
Flr.
14.c. City or Town
Ste.
Flr.
14.d. State
14.e. ZIP Code
10.d. City or Town
14.f. Province
10.e. State
10.f. ZIP Code
14.g. Postal Code
10.g. Province
14.h. Country
10.h. Postal Code
10.i. Country
11.
Is your current mailing address the same as your physical
address?
Yes
No
If you answered "No" to Item Number 11., provide
information on your physical address in Item Numbers 12.a. 13.b.
15.a. Date From (mm/dd/yyyy)
15.b. Date To (mm/dd/yyyy)
Your Marital Information
16.
How many times have you been married?
17.
Current Marital Status
Single, Never Married
Widowed
Form I-130 12/18/12 N
Separated
►
Married
Divorced
Annulled
Page 2 of 12
Part 2. Information About You (Petitioner)
(continued)
27.
Country of Birth
18.
28.
City/Town/Village of Residence
29.
Country of Residence
Date of Current Marriage (if currently married)
(mm/dd/yyyy)
Place of Your Current Marriage (if married)
19.a. City or Town
Parent 2's Information
19.b. State
19.c. Province
19.d. Country
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Full Name of Parent 2
30.a. Family Name
(Last Name)
30.b. Given Name
(First Name)
30.c. Middle Name
Names of All Your Spouses (if any)
31.
Date of Birth (mm/dd/yyyy)
Provide information on your current spouse (if currently married)
first and then list all your prior spouses (if any).
32.
Sex
Spouse 1
33.
Country of Birth
20.a. Family Name
(Last Name)
20.b. Given Name
(First Name)
34.
City/Town/Village of Residence
20.c. Middle Name
35.
Country of Residence
21.
Female
Date Marriage Ended (mm/dd/yyyy)
Spouse 2
Additional Information About You (Petitioner)
22.a. Family Name
(Last Name)
22.b. Given Name
(First Name)
36.
22.c. Middle Name
37.
23.
Male
I am a (Select only one box):
U.S. Citizen
Lawful Permanent Resident
If you are a U.S. citizen, complete Item Number 37.
Date Marriage Ended (mm/dd/yyyy)
My citizenship was acquired through (Select only one
box):
Birth in the United States
Naturalization
Information About Your Parents
Parents
Parent 1's Information
38.
Full Name of Parent 1
24.a. Family Name
(Last Name)
24.b. Given Name
(First Name)
24.c. Middle Name
Have you obtained a Certificate of Naturalization or a
Certificate of Citizenship?
Yes
No
If you answered "Yes" to Item Number 38., complete the
following:
39.a. Certificate Number
25.
Date of Birth (mm/dd/yyyy)
26.
Sex
Male
39.b. Place of Issuance
Female
39.c. Date of Issuance (mm/dd/yyyy)
Form I-130 12/18/12 N
Page 3 of 12
Employer 2
Part 2. Information About You (Petitioner)
(continued)
46.
If you are a lawful permanent resident, complete Item
Numbers 40.a. - 41.
Name of Employer/Company
47.a. Street Number
and Name
40.a. Class of Admission
47.b.
40.b. Date of Admission (mm/dd/yyyy)
Apt.
Ste.
Flr.
47.c. City or Town
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Place of Admission
47.d. State
47.e. ZIP Code
40.c. City or Town
47.f. Province
40.d State
41.
47.g. Postal Code
Did you gain lawful permanent resident status through
marriage to a U.S. citizen or lawful permanent resident?
Yes
No
47.h. Country
48.
Your Occupation
Employment History
Provide your employment history for the last five years, whether
inside or outside the United States. Provide your current
employment first. If you are currently unemployed, type or print
"Unemployed" in Item Number 42.
Employer 1
42.
49.a. Date From (mm/dd/yyyy)
49.b. Date To (mm/dd/yyyy)
Part 3. Biographic Information
Name of Employer/Company
NOTE: Provide the biographic information about you, the
petitioner.
1.
43.a. Street Number
and Name
43.b.
Apt.
Ste.
Hispanic or Latino
Not Hispanic or Latino
Flr.
2.
43.c. City or Town
43.d. State
43.f. Province
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
43.g. Postal Code
44.
Your Occupation
45.a. Date From (mm/dd/yyyy)
Race (Select all applicable boxes)
White
Asian
Black or African American
43.e. ZIP Code
43.h. Country
Ethnicity (Select only one box)
3.
Height
4.
Weight
5.
Eye Color (Select only one box)
Black
Gray
Maroon
Feet
Inches
Pounds
Blue
Green
Pink
Brown
Hazel
Unknown/Other
45.b. Date To (mm/dd/yyyy)
Form I-130 12/18/12 N
Page 4 of 12
Part 3. Biographic Information (continued)
Beneficiary's Physical Address
6.
If the beneficiary lives outside the United States in a home
without a street number or name, leave Item Numbers 11.a.
and 11.b. blank.
Hair Color (Select only one box)
Bald (No hair)
Brown
Sandy
Black
Gray
White
Blond
Red
Unknown/Other
11.a. Street Number
and Name
11.b.
Apt.
Ste.
Flr.
Part 4. Information About Beneficiary
1.
► A-
2.
11.d. State
USCIS Online Account Number (if any)
►
3.
11.c. City or Town
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Alien Registration Number (A-Number) (if any)
U.S. Social Security Number (if any)
11.e. ZIP Code
11.f. Province
11.g. Postal Code
11.h. Country
►
Beneficiary's Full Name
Other Address and Contact Information
4.a. Family Name
(Last Name)
4.b. Given Name
(First Name)
Provide the address in the United States where the beneficiary
intends to live, if different from Item Numbers 11.a. - 11.h. If
the address is the same, type or print "SAME" in Item Number
12.a.
4.c. Middle Name
12.a Street Number
and Name
Other Names Used (if any)
12.b.
Provide all other names the beneficiary has ever used, including
aliases, maiden name, and nicknames.
5.a. Family Name
(Last Name)
5.b. Given Name
(First Name)
Apt.
Ste.
Flr.
12.c. City or Town
12.d. State
12.e. ZIP Code
5.c. Middle Name
Provide the beneficiary's address outside the United States, if
different from Item Numbers 11.a. - 11.h. If the address is the
same, type or print "SAME" in Item Number 13.a.
Other Information About Beneficiary
13.a. Street Number
and Name
6.
City/Town/Village of Birth
13.b.
7.
Country of Birth
Apt.
Ste.
Flr.
13.c. City or Town
13.d. Province
8.
Date of Birth (mm/dd/yyyy)
9.
Sex
10.
Has anyone else ever filed a petition for the beneficiary?
Yes
No
Unknown
13.e. Postal Code
13.f. Country
Male
Female
14.
Daytime Telephone Number (if any)
NOTE: Select "Unknown" only if you do not know, and
the beneficiary also does not know, if anyone else has
ever filed a petition for the beneficiary.
Form I-130 12/18/12 N
Page 5 of 12
Part 4. Information About Beneficiary
(continued)
24.
15.
Mobile Telephone Number (if any)
Information About Beneficiary's Family
Email Address (if any)
Provide information about the beneficiary's spouse and
children.
16.
Date Marriage Ended (mm/dd/yyyy)
Person 1
Beneficiary's Marital Information
17.
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How many times has the beneficiary been married?
►
18.
25.c. Middle Name
Current Marital Status
Single, Never Married
Widowed
19.
Married
Separated
Annulled
Place of Beneficiary's Current Marriage
(if married)
20.a. City or Town
20.c. Province
20.d. Country
26.
Relationship
27.
Date of Birth (mm/dd/yyyy)
28.
Country of Birth
Divorced
Date of Current Marriage (if currently married)
(mm/dd/yyyy)
20.b. State
25.a. Family Name
(Last Name)
25.b. Given Name
(First Name)
Person 2
29.a. Family Name
(Last Name)
29.b. Given Name
(First Name)
29.c. Middle Name
30.
Relationship
31.
Date of Birth (mm/dd/yyyy)
32.
Country of Birth
Names of Beneficiary's Spouses (if any)
Provide information on the beneficiary's current spouse (if
currently married) first and then list all the beneficiary's prior
spouses (if any).
Spouse 1
21.a. Family Name
(Last Name)
21.b. Given Name
(First Name)
21.c. Middle Name
22.
Date Marriage Ended (mm/dd/yyyy)
Person 3
33.a. Family Name
(Last Name)
33.b. Given Name
(First Name)
33.c. Middle Name
34.
Relationship
35.
Date of Birth (mm/dd/yyyy)
36.
Country of Birth
Spouse 2
23.a. Family Name
(Last Name)
23.b. Given Name
(First Name)
23.c. Middle Name
Form I-130 12/18/12 N
Page 6 of 12
Part 4. Information About Beneficiary
(continued)
48.
Travel Document Number
Person 4
49.
Country of Issuance for Passport or Travel Document
37.a. Family Name
(Last Name)
37.b. Given Name
(First Name)
50.
Expiration Date for Passport or Travel Document
(mm/dd/yyyy)
37.c. Middle Name
Beneficiary's Employment Information
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38.
Relationship
39.
Date of Birth (mm/dd/yyyy)
40.
Country of Birth
Provide the beneficiary's current employment information (if
applicable), even if they are employed outside of the United
States. If the beneficiary is currently unemployed, type or print
"Unemployed" in Item Number 51.a.
51.a. Name of Current Employer (if applicable)
Person 5
51.b. Street Number
and Name
41.a. Family Name
(Last Name)
41.b. Given Name
(First Name)
51.c.
Apt.
Ste.
Flr.
51.d. City or Town
41.c. Middle Name
51.e. State
42.
Relationship
43.
Date of Birth (mm/dd/yyyy)
44.
Country of Birth
51.f. ZIP Code
51.g. Province
51.h. Postal Code
51.i. Country
Beneficiary's Entry Information
45.
52.
Date Employment Began (mm/dd/yyyy)
Was the beneficiary EVER in the United States?
Yes
No
If the beneficiary is currently in the United States, complete
Items Numbers 46.a. - 46.d.
Additional Information About Beneficiary
53.
Was the beneficiary EVER in immigration proceedings?
46.a. He or she arrived as a (Class of Admission):
Yes
54.
46.b. Form I-94 Arrival-Departure Record Number
►
46.c. Date of Arrival (mm/dd/yyyy)
46.d. Date authorized stay expired, or will expire, as shown on
Form I-94 or Form I-95 (mm/dd/yyyy) or type or print
"D/S" for Duration of Status
No
If you answered "Yes," select the type of proceedings and
provide the location and date of the proceedings.
Removal
Exclusion/Deportation
Rescission
Other Judicial Proceedings
55.a. City or Town
55.b. State
47.
Passport Number
Form I-130 12/18/12 N
56.
Date (mm/dd/yyyy)
Page 7 of 12
Part 4. Information About Beneficiary
(continued)
The beneficiary will not apply for adjustment of status in
the United States, but he or she will apply for an immigrant
visa abroad at the U.S. Embassy or U.S. Consulate in:
If the beneficiary's native written language does not use
Roman letters, type or print his or her name and foreign
address in their native written language.
63.a. City or Town
57.a. Family Name
(Last Name)
57.b. Given Name
(First Name)
63.c. Country
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57.c. Middle Name
58.a. Street Number
and Name
58.b.
Apt.
63.b. Province
Ste.
Flr.
NOTE: Choosing a U.S. Embassy or U.S. Consulate outside
the country of the beneficiary's last residence does not
guarantee that it will accept the beneficiary's case for
processing. In these situations, the designated U.S. Embassy or
U.S. Consulate has discretion over whether or not to accept the
beneficiary's case.
58.c. City or Town
58.d. Province
Part 5. Other Information
1.
58.e. Postal Code
58.f. Country
Have you EVER previously filed a petition for this
beneficiary or any other alien?
Yes
No
If you answered "Yes," provide the name, place, date of filing,
and the result.
If filing for your spouse, provide the last address at which
you physically lived together. If you never lived together,
type or print, "Never lived together" in Item Number 59.a.
2.a. Family Name
(Last Name)
2.b. Given Name
(First Name)
59.a. Street Number
and Name
2.c. Middle Name
59.b.
Apt.
Ste.
Flr.
59.c. City or Town
59.d. State
59.f. Province
3.a. City or Town
3.b. State
59.e. ZIP Code
59.g. Postal Code
59.h. Country
4.
Date Filed (mm/dd/yyyy)
5.
Result (for example, approved, denied, withdrawn)
If you are also submitting separate petitions for other relatives,
provide the names of and your relationship to each relative.
Relative 1
60.a. Date From (mm/dd/yyyy)
60.b. Date To (mm/dd/yyyy)
The beneficiary is in the United States and will apply for
adjustment of status to that of a lawful permanent resident
at the U.S. Citizenship and Immigration Services (USCIS)
office in:
6.a. Family Name
(Last Name)
6.b. Given Name
(First Name)
6.c. Middle Name
7.
Relationship
61.a. City or Town
61.b. State
Form I-130 12/18/12 N
Page 8 of 12
Part 5. Other Information (continued)
Petitioner's Contact Information
Relative 2
3.
Petitioner's Daytime Telephone Number
8.a. Family Name
(Last Name)
8.b. Given Name
(First Name)
4.
Petitioner's Mobile Telephone Number (if any)
8.c. Middle Name
5.
Petitioner's Email Address (if any)
9.
Relationship
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WARNING: USCIS investigates the claimed relationships and
verifies the validity of documents you submit. If you falsify a
family relationship to obtain a visa, USCIS may seek to have
you criminally prosecuted.
PENALTIES: By law, you may be imprisoned for up to 5
years or fined $250,000, or both, for entering into a marriage
contract in order to evade any U.S. immigration law. In
addition, you may be fined up to $10,000 and imprisoned for
up to 5 years, or both, for knowingly and willfully falsifying
or concealing a material fact or using any false document in
submitting this petition.
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:
NOTE: Read the Penalties section of the Form I-130
Instructions before completing this part.
1) I provided or authorized all of the information
contained in, and submitted with, my petition;
Petitioner's Statement
2) I reviewed and understood all of the information in,
and submitted with, my petition; and
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
1.b.
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.
The interpreter named in Part 7. read to me every
question and instruction on this petition and my
answer to every question in
,
a language in which I am fluent. I understood all of
this information as interpreted.
2.
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 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.
Part 6. Petitioner's Statement, Contact
Information, Declaration, and Signature
1.a.
Petitioner's Declaration and Certification
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.
Petitioner's Signature
6.a. Petitioner's Signature
At my request, the preparer named in Part 8.,
,
prepared this petition for me based only upon
information I provided or authorized.
Form I-130 12/18/12 N
6.b. Date of Signature (mm/dd/yyyy)
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.
Page 9 of 12
Part 7. Interpreter's Contact Information,
Certification, and Signature
Provide the following information about the interpreter if you
used one.
Interpreter's Full Name
1.a. Interpreter's Family Name (Last Name)
I certify, under penalty of perjury, that:
I am fluent in English and
,
which is the same language provided in Part 6., Item Number
1.b., and I have read to this petitioner in the identified language
every question and instruction on this petition and his or her
answer to every question. The petitioner informed me that he or
she understands every instruction, question, and answer on the
petition, including the Petitioner's Declaration and
Certification, and has verified the accuracy of every answer.
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1.b. Interpreter's Given Name (First Name)
2.
Interpreter's Certification
Interpreter's Business or Organization Name (if any)
Interpreter's Signature
7.a. Interpreter's Signature
Interpreter's Mailing Address
7.b. Date of Signature (mm/dd/yyyy)
3.a. Street Number
and Name
3.b.
Apt.
Ste.
Flr.
3.c. City or Town
Part 8. Contact Information, Declaration, and
Signature of the Person Preparing this Petition, if
Other Than the Petitioner
Provide the following information about the preparer.
3.d. State
3.f.
Province
3.e. ZIP Code
Preparer's Full Name
1.a. Preparer's Family Name (Last Name)
3.g. Postal Code
3.h. Country
Interpreter's Contact Information
4.
Interpreter's Daytime Telephone Number
5.
Interpreter's Mobile Telephone Number (if any)
6.
Interpreter's Email Address (if any)
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.f.
3.e. ZIP Code
Province
3.g. Postal Code
3.h. Country
Form I-130 12/18/12 N
Page 10 of 12
Part 8. Contact Information, Declaration, and
Signature of the Person Preparing this Petition, if
Other Than the Petitioner (continued)
Preparer's Contact Information
4.
Preparer's Daytime Telephone Number
5.
Preparer's Mobile Telephone Number (if any)
6.
Preparer's Email Address (if any)
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Preparer's Statement
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, with this petition.
Preparer's Certification
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
8.a. Preparer's Signature
8.b. Date of Signature (mm/dd/yyyy)
Form I-130 12/18/12 N
Page 11 of 12
5.a. Page Number
Part 9. Additional Information
If you need extra space to provide any additional information
within this petition, use the space below. If you need more
space than what is provided, you may make copies of this page
to complete and file with this petition or attach a separate sheet
of paper. Type or print your name and A-Number (if any) at the
top of each sheet; indicate the Page Number, Part Number,
and Item Number to which your answer refers; and sign and
date each sheet.
5.b. Part Number 5.c. Item Number
5.d.
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1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
2.
A-Number (if any) ► A-
3.a. Page Number
3.d.
4.a. Page Number
3.b. Part Number
3.c. Item Number
6.a. Page Number
6.b. Part Number 6.c. Item Number
6.d.
4.b. Part Number 4.c. Item Number
4.d.
Form I-130 12/18/12 N
7.a. Page Number
7.b. Part Number 7.c. Item Number
7.d.
Page 12 of 12
| File Type | application/pdf |
| File Title | Petition for Alien Relative |
| Author | USCIS |
| File Modified | 2016-05-12 |
| File Created | 2016-05-12 |