Current Page Number and Section
|
Current Text
|
Proposed
Text
|
Page 1,
To be completed by an attorney or accredited representative
(if any).
|
[page 1]
To be completed by an attorney or
accredited representative (if any).
[ ] Select this box if Form
G-28 is attached to represent the petitioner.
Attorney State Bar Number (if
applicable)
Attorney or Accredited
Representative
USCIS ELIS Account Number (if
any)
START HERE - Type or print
legibly in black ink.
|
[page 1]
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)
Attorney or Accredited
Representative
USCIS Online
Account Number (if any)
START HERE - Type or print
in black ink.
|
Page 1,
Part 1. Information About
Regional Center
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[page 1]
Part 1. Information About
Regional Center
1. Was the investment by the
entrepreneur associated with an approved regional center?
Yes/No
If you answered “Yes” to
Item Number 1., please complete Item Numbers 2.a. - 2.c.
2.a. Name of Regional Center
2.b. Regional Center
Identification Number
2.c. Receipt number for the
approved Form I-924, Application For Regional Center Under the
Immigrant Investor Program, upon which the related Form I-526,
Immigrant Petition by Alien Entrepreneur, was based
[moved up from Part 2.]
|
[page 1]
Part 1.
Basis for Petition
1. Is
the investment associated with a Regional Center?
Yes/No
If you answered “Yes” to
Item Number 1., complete Item Numbers 2.a. and
2.b.
2.a. What
is the name of the Regional Center?
2.b. Regional Center
Identification Number
3.a. What is the name of the
New Commercial Enterprise (NCE)?
3.b. NCE Identification
Number
Select only one box
4. [ ] I am a
conditional permanent resident based on my investment in a
commercial enterprise.
5. [ ] I am a
conditional permanent resident who is the spouse, former spouse,
or child of an entrepreneur, and I am filing separately from the
entrepreneur's Form I-829.
6. [ ] I am a
conditional permanent resident spouse or child of an entrepreneur
who has died.
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Page 1,
Part 2. Basis for Petition
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[page 1]
Part 2. Basis for Petition
Select only one box.
1. [ ] I am a
conditional permanent resident based on my investment in a
commercial enterprise.
2. [ ] I am a
conditional permanent resident who is the spouse, former spouse,
or child of an entrepreneur, and I am filing separately from the
entrepreneur's Form I-829.
3. [ ] I am a
conditional permanent resident spouse or child of an entrepreneur
who has died.
[moved up from Part 3.]
|
[page 1]
Part 2.
Information About You
1.a. Family Name (Last Name)
1.b. Given Name (First Name)
1.c. Middle Name
2. Alien Registration Number
(A-Number) (if any)
3. USCIS Online
Account Number (if any)
4. U.S. Social Security
Number (if any)
5. Date
of Birth (mm/dd/yyyy)
6. Gender
7. Country
of Birth
8. Country
of Citizenship or Nationality
9.
Date of Admission as a Conditional
Permanent Resident
10.
Form I-526 Receipt Number on Which This Petition is Based
[page 2]
11.
Any additional Form I-526 or Form I-829 Receipt Numbers for other
petitions filed by entrepreneur
Other Names You Have Used
List 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 12.
Additional Information.
12.a.
Family Name (Last Name)
12.b. Given
Name (First Name)
12.c.
Middle Name
13.a.
Family Name (Last Name)
13.b. Given
Name (First Name)
13.c.
Middle Name
Your U.S. Mailing Address
14.a.
In Care Of Name (if any)
14.b.
Street Number and Name
14.c. Apt.
Ste. Flr.
14.d. City
or Town
14.e. State
14.f. ZIP
Code
15. Is
your mailing address the same as your physical address? Yes/No
If you
answered “No” to Item
Number 15., you MUST
provide your current physical address in the Item
Numbers 16.a. - 16.h. If you
need extra space to complete this section, use the space provided
in Part 12. Additional
Information.
Physical Address
Provide your
physical addresses for the last five years. Provide you present
address first. If
you need extra space to complete this section, use the space
provided in Part 12. Additional
Information.
16.a.
Street Number and Name
16.b. Apt.
Ste. Flr.
16.c. City
or Town
16.d. State
16.e. ZIP
Code
16.f.
Province
16.g.
Postal Code
16.h.
Country
Criminal History
17. Since
becoming a conditional permanent resident, have you EVER
been arrested, cited, charged, indicted, convicted, fined, or
imprisoned for violating any law or ordinance (excluding minor
traffic violations)? Yes/No
18. Since
becoming a conditional permanent resident, have you EVER
committed any crime for which you were not arrested? Yes/No
If you answered “Yes” to
Item Number 17., you
must provide certified court dispositions, arrest reports,
statements of charges, indictment information, or any other
charging documents that were issued. If you answered “Yes”
to Item Number 18.,
provide the date and location (town or city/state or
province/country) of the events and provide an explanation in the
space provided in Part 12.
Additional Information.
|
Page 1,
Part 3. Information About You
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[page 1]
Part 3. Information About You
1.a. Family Name (Last Name)
1.b. Given Name (First Name)
1.c. Middle Name
2. Alien Registration Number
(A-Number) (if any)
3. USCIS ELIS Account Number
(if any)
4. U.S. Social Security
Number (if any)
5. Form I-526 Receipt Number
on which this petition is based
Other Names You Have Used
(including maiden name, nicknames, and aliases, if any)
6.a. Family Name (Last Name)
6.b. Given Name (First Name)
6.c. Middle Name
7.a. Family Name (Last Name)
7.b. Given Name (First Name)
7.c. Middle Name
Your U.S. Mailing Address
8.a. In Care Of Name (if
any)
8.b. Street Number and Name
8.c. Apt. Ste. Flr.
8.d. City or Town
8.e. State
8.f. ZIP Code
9. Is your mailing address
the same as your physical address? Yes/No
If your mailing address and the
address where you currently live (physical address) are not the
same, you MUST provide your current physical address in the
Item Numbers 10.a. - 10.h.
Your Physical Address
10.a. Street Number and Name
10.b. Apt. Ste.
Flr.
10.c. City or Town
10.d. State
10.e. ZIP Code
10.f. Province
10.g. Postal Code
10.h. Country
Other Information About You
11. Date of Birth
(mm/dd/yyyy)
12. Gender
13. Country of Birth
14. Country of Citizenship or
Nationality
Criminal History
15. Since becoming a
conditional permanent resident, have you EVER been
arrested, cited, charged, indicted, convicted, fined, or
imprisoned for violating any law or ordinance (excluding minor
traffic violations)? Yes/No
16. Since becoming a
conditional permanent resident, have you EVER committed any
crime for which you were not arrested? Yes/No
If you answered “Yes” to
Item Number 15., you must provide certified court
dispositions, arrest reports, statements of charges, indictment
information, or any other charging documents that were issued. If
you answered “Yes” to Item Number 16., provide
the date and location (town or city/state or province/country) of
the events and provide an explanation in Part 11. Additional
Information.
[moved up from Part 4.]
|
[page 2]
Part 3.
Information About Your Current
or Former Conditional Permanent Resident Spouse
NOTE:
If you have both a current spouse and a former conditional
permanent resident spouse, use the space provided in Part
12. Additional Information to
provide this same information about your current spouse or former
conditional permanent resident spouse who you did not already
include in Part 3.
below.
1.a. Family Name (Last Name)
1.b. Given Name (First Name)
1.c. Middle Name
[page 3]
2. Gender
3. Alien
Registration Number (A-Number) (if any)
4. USCIS Online
Account Number (if any)
5. Date of Birth (mm/dd/yyyy)
Other Names Used
List all other
names your current spouse or former conditional permanent resident
spouse has ever used, including aliases, maiden name, and
nicknames. If you need extra space to complete this section, use
the space provided in Part 12.
Additional Information.
6.a. Family Name (Last Name)
6.b. Given Name (First Name)
6.c. Middle Name
7.a. Family Name (Last Name)
7.b. Given Name (First Name)
7.c. Middle Name
Physical
Address
Provide your
current spouse or former conditional
permanent resident spouse’s physical
addresses for the last five years. Provide the present address
first. If you need extra space to complete this section, use the
space provided in Part 12.
Additional Information.
8.a. Street Number and Name
8.b. Apt. Ste. Flr.
8.c. City or Town
8.d. State
8.e. ZIP Code
8.f. Province
8.g. Postal Code
8.h. Country
Other Information
9. [ ] Current Spouse
[ ] Former Conditional Permanent
Resident Spouse
10. Date of Marriage
(mm/dd/yyyy)
11. Date Marriage Terminated
(mm/dd/yyyy) (if
applicable)
12. Is this spouse currently
living with you? Yes/No
13. Is this spouse applying
with you? Yes/No
14. Current Immigration
Status (for example, conditional permanent
resident, tourist/visitor, entered without inspection)
15. Is the current
immigration status of your spouse or former spouse based on your
current immigration status?
|
Page 2,
Part 4. Information About Your
Current Spouse or Your Former Conditional Permanent Resident
Spouse
|
[page 2]
Part 4. Information About Your
Current Spouse or Your Former Conditional Permanent Resident
Spouse
1.a. Family Name (Last Name)
1.b. Given Name (First Name)
1.c. Middle Name
2. Gender
3. A-Number (if any)
4. USCIS ELIS Account Number
(if any)
5. Date of Birth
(mm/dd/yyyy)
Other Names Used (if
applicable)
6.a. Family Name (Last Name)
6.b. Given Name (First Name)
6.c. Middle Name
7.a. Family Name (Last Name)
7.b. Given Name (First Name)
7.c. Middle Name
Mailing Address
8.a. Street Number and Name
8.b. Apt. Ste. Flr.
8.c. City or Town
8.d. State
8.e. ZIP Code
8.f. Province
8.g. Postal Code
8.h. Country
Other Information
9. [ ] Current Spouse
[ ] Former Conditional Permanent
Resident Spouse
10. Date of Marriage
(mm/dd/yyyy)
11. Date Marriage Terminated
(mm/dd/yyyy)
12. Is this spouse currently
living with you? Yes/No
13. Is this spouse applying
with you? Yes/No
14. Current Immigration
Status (for example, conditional resident, tourist/visitor,
entered without inspection)
15. Is the current
immigration status of your spouse or former spouse based on your
current immigration status?
NOTE: If you have both a
current spouse and a former conditional permanent resident spouse,
use Part 11. Additional Information to provide this same
information about your current spouse or former conditional
permanent resident spouse who you did not already include in Part
4. above.
[moved up from Part 5.]
|
[page 3]
Part 4.
Information About Your Children
Provide the
following information about your children.
Child 1
1.a. Family Name (Last Name)
1.b. Given Name (First Name)
1.c. Middle Name
2. Gender
3. Alien
Registration Number (A-Number) (if any)
4. USCIS Online
Account Number (if any)
5. Date of Birth
(mm/dd/yyyy)
Other Names Your
Child Has Used
List all other
names your child has ever used, including aliases, maiden name,
and nicknames. If you need extra space to complete this section,
use the space provided in Part 12.
Additional Information.
6.a. Family Name (Last Name)
6.b. Given Name (First Name)
6.c. Middle Name
[page 4]
Mailing Address
7.a. Street Number and Name
7.b. Apt. Ste. Flr.
7.c. City or Town
7.d. State
7.e. ZIP Code
7.f. Province
7.g. Postal Code
7.h. Country
8. Is this child currently
living with you? Yes/No
9. Is this child applying
with you? Yes/No
10. Current Immigration
Status (for example, conditional permanent
resident, tourist/visitor, entered without inspection)
Child 2
11.a. Family Name (Last Name)
11.b. Given Name (First Name)
11.c. Middle Name
12. Gender
13. Alien
Registration Number (A-Number) (if any)
14. USCIS Online
Account Number (if any)
15. Date of Birth
(mm/dd/yyyy)
Other Names Your
Child Has Used
List all other
names your child has ever used, including aliases, maiden name,
and nicknames. If you need extra space to complete this section,
use the space provided in Part 12.
Additional Information.
16.a. Family Name (Last Name)
16.b. Given Name (First Name)
16.c. Middle Name
Mailing Address
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. Is this child currently
living with you? Yes/No
19. Is this child applying
with you? Yes/No
20. Current Immigration
Status (for example, conditional permanent
resident, tourist/visitor, entered without inspection)
Child 3
21.a. Family Name (Last Name)
21.b. Given Name (First Name)
21.c. Middle Name
22. Gender
23. Alien
Registration Number (A-Number) (if any)
24. USCIS Online
Account Number (if any)
25. Date of Birth
(mm/dd/yyyy)
Other Names Your
Child Has Used
List all other
names your child has ever used, including aliases, maiden name,
and nicknames. If you need extra space to complete this section,
use the space provided in Part 12.
Additional Information
26.a. Family Name (Last Name)
26.b. Given Name (First Name)
26.c. Middle Name
[page 5]
Mailing Address
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. Province
27.g. Postal Code
27.h. Country
28. Is this child currently
living with you? Yes/No
29. Is this child applying
with you? Yes/No
30. Current Immigration
Status (for example, conditional permanent
resident, tourist/visitor, entered without inspection)
Child 4
31.a. Family Name (Last Name)
31.b. Given Name (First Name)
31.c. Middle Name
32. Gender
33. Alien
Registration Number (A-Number) (if any)
34. USCIS Online
Account Number (if any)
35. Date of Birth
(mm/dd/yyyy)
Other Names Your
Child Has Used
List all other
names your child has ever used, including aliases, maiden name,
and nicknames. If you need extra space to complete this section,
use the space provided in Part 12.
Additional Information.
36.a. Family Name (Last Name)
36.b. Given Name (First Name)
36.c. Middle Name
Mailing Address
37.a. Street Number and Name
37.b. Apt. Ste.
Flr.
37.c. City or Town
37.d. State
37.e. ZIP Code
37.f. Province
37.g. Postal Code
37.h. Country
38. Is this child currently
living with you? Yes/No
39. Is this child applying
with you? Yes/No
40. Current Immigration
Status (for example, conditional permanent
resident, tourist/visitor, entered without inspection)
If you need extra space to complete
this section, use the space provided in Part 12.
Additional Information.
|
Page 3,
Part 5. Information About Your
Children
|
[page 3]
Part 5. Information About Your
Children
Provide the following information
about your children.
Child 1
1.a. Family Name (Last Name)
1.b. Given Name (First Name)
1.c. Middle Name
2. Gender
3. A-Number (if any)
4. USCIS ELIS Account Number
(if any)
5. Date of Birth
(mm/dd/yyyy)
Other Names Used (if
applicable)
6.a. Family Name (Last Name)
6.b. Given Name (First Name)
6.c. Middle Name
Mailing Address
7.a. Street Number and Name
7.b. Apt. Ste. Flr.
7.c. City or Town
7.d. State
7.e. ZIP Code
7.f. Province
7.g. Postal Code
7.h. Country
8. Is this child currently
living with you? Yes/No
9. Is this child applying
with you? Yes/No
10. Current Immigration
Status (for example, conditional resident, tourist/visitor,
entered without inspection)
Child 2
11.a. Family Name (Last Name)
11.b. Given Name (First Name)
11.c. Middle Name
12. Gender
13. A-Number (if any)
14. USCIS ELIS Account Number
(if any)
15. Date of Birth
(mm/dd/yyyy)
Other Names Used (if
applicable)
16.a. Family Name (Last Name)
16.b. Given Name (First Name)
16.c. Middle Name
Mailing Address
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. Is this child currently
living with you? Yes/No
19. Is this child applying
with you? Yes/No
20. Current Immigration
Status (for example, conditional resident, tourist/visitor,
entered without inspection)
Child 3
21.a. Family Name (Last Name)
21.b. Given Name (First Name)
21.c. Middle Name
22. Gender
23. A-Number (if any)
24. USCIS ELIS Account Number
(if any)
25. Date of Birth
(mm/dd/yyyy)
Other Names Used (if
applicable)
26.a. Family Name (Last Name)
26.b. Given Name (First Name)
26.c. Middle Name
Mailing Address
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. Province
27.g. Postal Code
27.h. Country
28. Is this child currently
living with you? Yes/No
29. Is this child applying
with you? Yes/No
30. Current Immigration
Status (for example, conditional resident, tourist/visitor,
entered without inspection)
Child 4
31.a. Family Name (Last Name)
31.b. Given Name (First Name)
31.c. Middle Name
32. Gender
33. A-Number (if any)
34. USCIS ELIS Account Number
(if any)
35. Date of Birth
(mm/dd/yyyy)
Other Names Used (if
applicable)
36.a. Family Name (Last Name)
36.b. Given Name (First Name)
36.c. Middle Name
Mailing Address
37.a. Street Number and Name
37.b. Apt. Ste.
Flr.
37.c. City or Town
37.d. State
37.e. ZIP Code
37.f. Province
37.g. Postal Code
37.h. Country
38. Is this child currently
living with you? Yes/No
39. Is this child applying
with you? Yes/No
40. Current Immigration
Status (for example, conditional resident, tourist/visitor,
entered without inspection)
If you need extra space to list
additional children, use the space provided in Part 11.
Additional Information 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.
[moved up from Part 6.]
|
[page 5]
Part 5.
Biographic Information
1. Ethnicity (Select only
one box)
[ ] Hispanic or Latino
[ ] Not Hispanic or Latino
2. Race (Select all
applicable boxes)
[ ] White
[ ] Asian
[ ] Black or African American
[ ] American Indian or Alaska Native
[ ] Hawaiian or Other Pacific
Islander
3. Height Feet
Inches
4. Weight Pounds
5. Eye Color (Select only
one box)
[ ] Black [ ] Blue [ ]
Brown [ ] Gray [ ] Green [ ] Hazel [ ]
Maroon [ ] Pink [ ] Unknown/Other
6. Hair Color (Select only
one box)
[ ] Bald (No hair) [ ] Black
[ ] Blond [ ] Brown [ ] Gray [ ] Red [
] Sandy [ ] White [ ] Unknown/Other
|
Page 5,
Part 6. Your Biographic
Information
|
[page 5]
Part 6. Your Biographic
Information
1. Ethnicity (Select only
one box)
[ ] Hispanic or Latino
[ ]Not Hispanic or Latino
2. Race (Select all
applicable boxes)
[ ] White
[ ] Asian
[ ] Black or African American
[ ] American Indian or Alaska Native
[ ] Hawaiian or Other Pacific
Islander
3. Height Feet
Inches
4. Weight Pounds
5. Eye Color (Select only
one box)
[ ] Black [ ] Blue [ ]
Brown [ ] Gray [ ] Green [ ] Hazel [ ]
Maroon [ ] Pink [ ] Unknown/Other
6. Hair Color (Select only
one box)
[ ] Bald (No hair) [ ] Black
[ ] Blond [ ] Brown [ ] Gray [ ] Red [
] Sandy [ ] White [ ] Unknown/Other
[moved up from Part 7.]
|
[page 6]
Part 6.
Additional Information About the Regional Center and the New
Commercial Enterprise (NCE)
1. Receipt
Number for the Approved Form I-924, Application For Regional
Center Designation Under the Immigrant Investor Program, Upon
Which the Related Form I-526, Immigrant Petition by Alien
Entrepreneur, Was Based
2.
Was the Regional Center associated with the entrepreneur
terminated? Yes/No
Physical Address of
the NCE
3.a. Street
Number and Name
3.b. Apt.
Ste. Flr.
3.c. City
or Town
3.d. State
3.e. ZIP
Code
4.
Telephone Number
5. Internet
Web site Address (if established)
6. Included
Industries (select North American Industry Classification System
(NAICS) code or codes)
7. IRS
Tax Identification Number
8. Date
Business Established (mm/dd/yyyy)
9. Date
of the Entrepreneur’s Initial Investment
(mm/dd/yyyy)
10. Amount
of the Entrepreneur’s Initial Investment
Subsequent Investment in the NCE
Provide the following information
about how much you have invested in the NCE since your initial
investment.
11.a.
Date of Subsequent Investment (mm/dd/yyyy)
11.b.
Amount of Subsequent Investment
11.c. Type
of Subsequent Investment (for example, cash, equipment, inventory,
other tangible property, cash equivalents, or qualifying
indebtedness as described in 8 CFR 204.6(e))
NOTE: If multiple
investments have been made since the entrepreneur's initial
investment in the commercial enterprise, use the space provided in
Part 12. Additional
Information to list the dates, amounts, and type of
investments.
12. Amount
of Capital Investment Sustained in the NCE.
13. Changes
in Assets of the NCE. Has
the commercial enterprise sold any assets, including but not
limited to investment securities and real property, and
distributed the proceeds of the sale to any of its equity holders
or had any other capital distributions or withdrawals since the
date of your initial
investment? Yes/No
If you
answered “Yes” to Item
Number 13., use the space
provided in Part 12. Additional
Information to provide an
explanation.
14.
Provide the total amount of capital invested by EB-5 investors
into the NCE.
15. Provide
the number of EB-5 investors associated with the NCE.
16. Has
the NCE filed for bankruptcy, ceased business operations,
materially changed the nature of the business, or made any changes
in its organization or ownership since the date of your initial
investment, or have any criminal or civil proceedings been filed
against the NCE or any of its owners, officers, directors, general
partners, managers or other persons with a similar interest or in
a similar position of authority for the NCE involving fraud or
other unlawful activity? Yes/No
If you
answered “Yes” to Item
Number 16., use the space
provided in Part 12. Additional
Information to provide an
explanation.
|
Page 5,
Part 7. Information About the
New Commercial Enterprise (NCE)
|
[page 5]
Part 7. Information About the
New Commercial Enterprise (NCE)
Type of Enterprise
1. [ ] NCE formed after
November 29, 1990.
2. [ ] NCE resulting from the
purchase of a business, formed on or before November 29, 1990,
that has been restructured or reorganized.
3. [ ] NCE resulting from
a capital investment in, and substantial expansion of, a
business formed on or before November 29, 1990.
Additional Information About
the NCE
4. Name of the NCE
Physical Address
5.a. Street Number and Name
5.b. Apt. Ste. Flr.
5.c. City or Town
5.d. State
5.e. ZIP Code
6. Telephone Number
7. Internet Web site Address
(if established)
8. Type of Business
Organization (for example, corporation, limited liability company,
partnership)
9. Nature of Business (for
example, furniture manufacturer)
10. Included Industries
(select North American Industry Classification System (NAICS) code
or codes)
11. IRS Tax Identification
Number
12. Date Business Established
(mm/dd/yyyy)
13. Amount of the
Entrepreneur's Initial Investment in the NCE $
14. Date of the
Entrepreneur's Initial Investment (mm/dd/yyyy)
15. What percentage of the
NCE does the entrepreneur own?
16. Is this petition based on
investment in a troubled business? Yes/No
Subsequent Investments in the NCE
Provide the following information
about how much the entrepreneur has invested in the NCE since the
entrepreneur's initial investment.
17.a. Date of Subsequent
Investment (mm/dd/yyyy)
17.b. Amount of Subsequent
Investment $
17.c. Type of Subsequent
Investment (for example, cash, equipment, inventory, other
tangible property, cash equivalents, or qualifying indebtedness as
described in
8 CFR 204.6(e))
NOTE: If multiple
investments have been made since the entrepreneur's initial
investment in the commercial enterprise, use Part 11.
Additional Information to list the dates, amounts, and type of
investments.
Full-time Positions and
Qualifying Employees
Provide the number of full-time
positions for direct and qualifying employees in the NCE in the
United States (excluding you, your spouse, and your children):
18.a. At the time of the
Entrepreneur's Initial Investment
18.b. Currently Employed in
the NCE
Job Creation
19.a. How many new
direct jobs did the entrepreneur's investment create?
19.b. How many new direct
jobs will the entrepreneur's investment create within a
reasonable amount of time after filing this petition?
20.a. If the NCE is
associated with an approved regional center, how many indirect
jobs were created?
20.b. If the NCE is
associated with an approved regional center, how many indirect
jobs will the NCE create within a reasonable amount of time after
filing this petition?
21. If the investment was
made into a troubled business, how many jobs were maintained as a
result of the investment?
Gross and Net Incomes
Provide the gross and net incomes
generated annually by the commercial enterprise since the
entrepreneur's initial investment. Include all income
generated in the present year to date.
22.a. Year (yyyy)
22.b. Gross Income $
22.c. Net Income $
23.a. Year (yyyy)
23.b. Gross Income $
23.c. Net Income $
24.a. Year (yyyy)
24.b. Gross Income $
24.c. Net Income $
25. Has the commercial
enterprise filed for bankruptcy, ceased business operations,
materially changed the nature of the business, or made any changes
in its organization or ownership since the date of the
entrepreneur's initial investment? Yes/No
26. Has the commercial
enterprise sold any corporate assets, shares, or property, or had
any capital withdrawn since the date of the entrepreneur's initial
investment? Yes/No
NOTE: If you answered “Yes”
to Item Number 25. or 26., provide an explanation in
Part 11. Additional Information.
27. Provide the total number
of EB-5 investors associated with the NCE.
28. Provide the total amount
of EB-5 capital invested into the NCE.
If you need extra space to provide
additional information for any item in Part 7., use the
space provided in Part 11. Additional Information 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.
[new]
|
[page 7]
Part 7.
Information About the Job Creating Entity (JCE)
JCE 1
1. Name
of the JCE
Physical
Address
2.a. Street
Number and Name
2.b. Apt.
Ste.
Flr.
2.c. City
or Town
2.d. State
2.e. ZIP
Code
JCE 2
3. Name
of the JCE
Physical
Address
4.a. Street
Number and Name
4.b. Apt.
Ste.
Flr.
4.c. City
or Town
4.d. State
4.e. ZIP
Code
JCE 3
5. Name
of the JCE
Physical
Address
6.a. Street
Number and Name
6.b. Apt.
Ste.
Flr.
6.c. City
or Town
6.d. State
6.e. ZIP
Code
If there are
additional JCEs,
use Part 12. Additional
Information to provide the names
and physical addresses of the additional JCEs.
7. Has
any of the JCEs filed for bankruptcy, ceased business operations,
materially changed the nature of the business, or made any changes
in its organization or ownership since the date of your initial
investment, or have any criminal or civil proceedings been filed
against any of the JCEs or any of their owners, officers,
directors, general partners, managers or other persons with a
similar interest or in a similar position of authority for any of
the JCEs involving fraud or other unlawful activity? Yes/No
If you
answered “Yes” to Item
Number 7., use the space provided
in Part 12. Additional Information
to provide an explanation.
|
Page 7,
Part 8. Petitioner's Statement,
Contact Information, Acknowledgement of Appointment at USCIS
Application Support Center, Certification, and Signature
|
[page 7]
Part 8. Petitioner's Statement,
Contact Information, Acknowledgement of Appointment at USCIS
Application Support Center, Certification, and Signature
NOTE: Read the information
on penalties in the Penalties section of the Form I-829
Instructions before completing this part.
Petitioner's Statement
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 have read and understand every question
and instruction on this petition, as well as my answer to every
question. I have read the Acknowledgement of Appointment at
USCIS Application Support Center.
1.b. [ ] The interpreter
named in Part 9. has read every question and instruction on
this petition, as well as my answer to every question, in
[fillable field], a language in which I am fluent. I understand
every question and instruction on this petition as translated to
me by my interpreter, and have provided complete, true, and
correct responses in the language indicated above. The
interpreter named in Part 9. has also read the
Acknowledgement of Appointment at USCIS Application Support
Center to me, in the language in which I am fluent, and I
understand this Application Support Center (ASC) Acknowledgement
as read to me by my interpreter.
2. [ ] I have requested the
services of and consented to [fillable field], who [ ] is [ ] is
not an attorney or accredited representative, in preparing this
petition for me. This person who assisted me in preparing my
petition has reviewed the Acknowledgement of Appointment at
USCIS Application Support Center with me, and I understand the
ASC Acknowledgement.
Petitioner's Contact
Information
3. Petitioner's Daytime
Telephone Number
4. Petitioner's Mobile Phone
Number (if any)
5. Petitioner's Email Address
(if any)
Acknowledgement of Appointment
at USCIS Application Support Center
I, [fillable field], understand
that the purpose of a USCIS ASC appointment is for me to provide
fingerprints, photograph, and/or signature and to re-affirm that
all of the information in my petition is complete, true, and
correct and was provided by me. I understand that I will sign my
name to the following declaration which USCIS will display to me
at the time I provide my fingerprints, photograph, and/or
signature during my ASC appointment.
By signing here, I declare
under penalty of perjury that I have reviewed and understand my
application, petition, or request as identified by the receipt
number displayed on the screen above, and all supporting
documents, applications, petitions, or requests filed with my
application, petition, or request that I (or my attorney or
accredited representative) filed with USCIS, and that all of the
information in these materials is complete, true, and correct.
I also understand that when I sign
my name, provide my fingerprints, and am photographed at the USCIS
ASC, I will be re-affirming that I willingly submit this petition;
I have reviewed the contents of this petition; all of the
information in my petition and all supporting documents submitted
with my petition were provided by me and are complete, true, and
correct; and if I was assisted in completing this petition, the
person assisting me also reviewed this Acknowledgement of
Appointment at USCIS Application Support Center with me.
Petitioner's Certification
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 and all of my records that
USCIS may need to determine my eligibility for the immigration
benefit that I seek.
I furthermore 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 certify, under penalty of perjury,
that the information in my petition and any document submitted
with my petition were provided by me and are complete, true and
correct.
Petitioner's Signature
6.a. Petitioner's
Signature
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, your petition may
be denied.
[new]
|
[page 7]
Part 8.
Information About Job Creation
Information
about direct job creation at the NCE:
1.a.
Number of Full-Time Direct and
Qualifying Employees in the NCE at the Time of Your Initial
Investment
1.b.
Number of Full-Time Direct and Qualifying Employees in the NCE at
the Time of Filing This Petition
1.c.
Difference in Number of Full-Time
Direct and Qualifying Employees
1.d.
Amount of Capital Invested in
the NCE That Was Not Funded by EB-5 Investors
Information
about indirect job creation outside of the NCE (if applicable)
2.a. Number
of Full-Time Economically Direct, Indirect and Induced Jobs
Created as a Result of EB-5 Investment
2.b.
Amount of Capital From EB-5 Investors That Was Transferred to the
JCE
2.c.
Amount of Capital Invested in the JCE That Was Not Funded by
Investors Who Received or are Seeking Classification as Alien
Entrepreneurs
3.
Are you investing in a troubled business? Yes/No
If the
investment was made into a troubled business:
4.a. How
many full-time, qualifying positions were maintained as a result
of the investment?
4.b.
How many full-time, qualifying positions were created as a result
of the investment?
[page 8]
5.
If ten full-time jobs for qualifying employees have not yet been
created, please indicate the number of jobs expected to be created
within a reasonable time.
6.
Changes to Business Plan. Have you made an investment and created
jobs in the United States according to the plan presented in the
Form I-526? Yes/No
If you
answered “No” to Item
Number 6.,
use the space provided in Part
12. Additional Information to
provide an explanation of the changes made to the original
business plan submitted with the approved Form I-526.
|
Page 8,
Part 9. Interpreter's
Certification, Contact Information, and Signature
|
[page 8]
Part 9. Interpreter's
Certification, Contact Information, and Signature
Provide the following information
about the interpreter.
Interpreter's Full Name
1.a. Interpreter's Family
Name (Last Name)
1.b. Interpreter's Given Name
(First Name)
2. Interpreter's Business or
Organization Name (if any)
Interpreter'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
Interpreter's Contact
Information
4. Interpreter's Daytime
Telephone Number
5. Interpreter's Email
Address (if any)
Interpreter's Certification
I certify that:
I am fluent in English and [fillable
field], which is the same language provided in Part
8., Item Number 1.b.;
I have read to this petitioner every
question and instruction on this petition, as well as the answer
to every question, in the language provided in Part 8.,
Item Number 1.b.; and
I have read the Acknowledgement
of Appointment at USCIS Application Support Center to the
petitioner in the same language provided in Part 8., Item
Number 1.b.
The petitioner has informed me that
he or she understands every instruction and question on the
petition, as well as the answer to every question, and the
petitioner verified the accuracy of every answer; and
The petitioner has also informed me
that he or she understands the ASC Acknowledgement and that by
appearing for a USCIS ASC biometric services appointment and
providing his or her fingerprints, photograph, and/or signature,
he or she is re-affirming that the contents of this petition and
all supporting documentation are complete, true, and correct.
Interpreter's Signature
6.a. Interpreter's
Signature
6.b. Date of
Signature (mm/dd/yyyy)
[moved
down from Part
8.]
|
[page 8]
Part
9. Petitioner’s
Statement, Contact Information,
Declaration, Certification, and
Signature
NOTE:
Read the Penalties
section
of the Form I-829 Instructions before completing this part.
Petitioner’s
Statement
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
10.
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
11.,
[Fillable Filed], prepared this
petition
for
me based only upon information I provided or authorized.
Petitioner’s
Contact Information
3.
Petitioner’s Daytime
Telephone Number
4.
Petitioner’s Mobile
Telephone
Number
(if
any)
5.
Petitioner’s Email
Address (if any)
Petitioner’s
Declaration
and Certification
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
and
all 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 law.
I
understand that USCIS will require me to appear for an appointment
to take my biometrics (fingerprints,
photograph, and/or signature)
and, at that time, I will be required to sign an oath reaffirming
that:
1)
I reviewed and understood all of the information in, and
submitted with, my petition; and
2)
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
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,
Part 10. Contact
Information, Statement, Certification, and Signature of the Person
Preparing this Petition, If Other Than the Petitioner
|
[page 9]
Part 10. Contact
Information, Statement, Certification, and Signature of the Person
Preparing this Petition, If Other Than the Petitioner
Provide the following information
about the preparer.
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
Preparer's Contact Information
4. Preparer's
Daytime Telephone Number
5. Preparer's
Fax Number (if any)
6. Preparer's
Email Address (if any)
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 must submit a completed Form
G-28, Notice of Attorney or Accredited Representative, with this
petition.
Preparer's Certification
By my signature, I certify, swear,
or affirm, under penalty of perjury, that I prepared this petition
on behalf of, at the request of, and with the express consent of
the petitioner. I completed this petition based only on responses
the petitioner provided to me. After completing the petition, I
reviewed it and all of the petitioner's responses with the
petitioner, who agreed with every answer on the petition. If the
petitioner supplied additional information concerning a question
on the petition, I recorded it on the petition. I have also read
the Acknowledgement of Appointment at USCIS Application Support
Center to the petitioner and the petitioner has informed me
that he or she understands the ASC Acknowledgement.
Preparer's Signature
8.a. Preparer's
Signature
8.b. Date of
Signature (mm/dd/yyyy)
[moved
down from Part
9.]
|
[page 8]
Part
10.
Interpreter’s
Contact
Information,
Certification,
and
Signature
Provide
the following information about the interpreter.
Interpreter’s
Full Name
1.a.
Interpreter’s Family Name (Last Name)
1.b.
Interpreter’s Given Name (First Name)
2.
Interpreter’s
Business or Organization Name (if any)
[page 9]
Interpreter’s
Mailing Address
3.a.
Street Number and Name
3.b.
[ ] Apt. [ ] Ste. [ ] Flr. [fillable field]
3.c.
City or Town
3.d.
State
3.e.
ZIP Code
3.f.
Province
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)
Interpreter’s
Certification
I
certify, under penalty of perjury, that:
I
am fluent in English and [Fillable
Field],
which
is the same language specified
in
Part
9.,
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.
Interpreter’s
Signature
7.a.
Interpreter’s
Signature
7.b.
Date
of Signature (mm/dd/yyyy)
|
Page 11,
Part 11. Additional Information
|
[page 11]
Part 11. 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. Include 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.
1.a. Family Name (Last Name)
1.b. Given Name (First Name)
1.c. Middle Name
2. A-Number (if any)
3.a. Page Number
3.b. Part Number
3.c. Item Number
3.d. [fillable lines]
4.a. Page Number
4.b. Part Number
4.c. Item Number
4.d. [fillable lines]
5.a. Page Number
5.b. Part Number
5.c. Item Number
5.d. [fillable lines]
6.a. Page Number
6.b. Part Number
6.c. Item Number
6.d. [fillable lines]
[moved
down from Part
10.]
|
[page 9]
Part
11.
Contact
Information, Declaration,
and
Signature of the Person Preparing this Petition,
if Other
Than the Petitioner
Provide
the following information about the preparer.
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. [fillable field]
3.c.
City or Town
3.d.
State
3.e.
ZIP Code
3.f.
Province
3.g.
Postal Code
3.h.
Country
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)
Preparer’s
Statement
7.a.
I am not an attorney or accredited representative but have
prepared this form
on behalf of
the authorized
individual and
with the authorized
individual's consent.
7.b.
I am an attorney or accredited representative and have
prepared this form on behalf of the authorized individual and with
the authorized individual’s consent.
[page 10]
NOTE:
If you are an attorney or accredited representative, you may be
obliged to submit a completed Form G-28, Notice of Entry of
Appearance as Attorney or Accredited Representative, or Form
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
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)
|
|
[moved down from Part 11.]
|
[page 11]
Part
12.
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.
1.a.
Family Name (Last Name) [Auto-populated field]
1.b.
Given Name (First Name) [Auto-populated field]
1.c.
Middle Name [Auto-populated field]
2.
A-Number (if any) [Auto-populated field]
3.a.
Page Number
3.b.
Part Number
3.c.
Item Number
3.d.
[Fillable field]
4.a.
Page Number
4.b.
Part Number
4.c.
Item Number
4.d.
[Fillable field]
5.a.
Page Number
5.b.
Part Number
5.c.
Item Number
5.d.
[Fillable field]
6.a.
Page Number
6.b.
Part Number
6.c.
Item Number
6.d.
[Fillable field]
7.a.
Page Number
7.b.
Part Number
7.c.
Item Number
7.d.
[Fillable field]
|