Form I-130 Petition for Alien Relative

Petition 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 07/31/2018

Fee Stamp

Action Stamp

A-Number
AInitial Receipt
Resubmitted
Relocated

Section of Law/Visa Category

Received

201(b) Spouse - IR-1/CR-1

203(a)(1) Unm. S/D - F1-1

Sent

201(b) Child - IR-2/CR-2

203(a)(2)(A) Spouse - F2-1

203(a)(3) Married S/D - F3-1

Completed

201(b) Parent - IR-5

203(a)(2)(A) Child - F2-2

203(a)(4) Brother/Sister - F4-1

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Approved

Petition was filed on (Priority Date mm/dd/yyyy):

Returned

PDR request granted/denied - New priority date (mm/dd/yyyy):

Remarks

203(a)(2)(B) Unm. S/D - F2-4

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.

I am filing this petition for my (Select only one box):
Spouse

2.

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):

Part 2. Information About You (Petitioner)

1.

Alien Registration Number (A-Number) (if any)
► A-

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

Your Full Name

Stepchild/Stepparent
Child was born to parents who were not married to
each other at the time of the child's birth
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 02/27/17 N

4.a. Family Name
(Last Name)
4.b. Given Name
(First Name)
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.

Other Information

Apt.

Ste.

Flr.

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12.d. State

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

Mailing Address

Ste.

10.d. City or Town
10.e. State

Female

13.b. Date To (mm/dd/yyyy)

Physical Address 2

14.a. Street Number
and Name
14.b.

10.b. Street Number
and Name
Apt.

13.a. Date From (mm/dd/yyyy)

(USPS ZIP Code Lookup)

10.a. In Care Of Name

10.c.

12.h. Country

Flr.

10.f. ZIP Code

10.g. Province

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

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 02/27/17 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

Full Name of Parent 2

19.c. Province

30.a. Family Name
(Last Name)
30.b. Given Name
(First Name)
30.c. Middle Name

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19.d. Country

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

34.

City/Town/Village of Residence

35.

Country of Residence

20.a. Family Name
(Last Name)
20.b. Given Name
(First Name)
20.c. Middle Name
21.

Female

Date Marriage Ended (mm/dd/yyyy)

Additional Information About You (Petitioner)

Spouse 2
22.a. Family Name
(Last Name)
22.b. Given Name
(First Name)

36.

I am a (Select only one box):
U.S. Citizen

Lawful Permanent Resident

If you are a U.S. citizen, complete Item Number 37.

22.c. Middle Name
23.

Male

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

Form I-130 02/27/17 N

Female

39.b. Place of Issuance

39.c. Date of Issuance (mm/dd/yyyy)
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.

Apt.

40.b. Date of Admission (mm/dd/yyyy)

47.c. City or Town

Place of Admission

47.d. State

40.c. City or Town

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Did you gain lawful permanent resident status through
marriage to a U.S. citizen or lawful permanent resident?
No

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

Name of Employer/Company

Apt.

Ste.

48.

49.b. Date To (mm/dd/yyyy)

Part 3. Biographic Information

NOTE: Provide the biographic information about you, the
petitioner.

Flr.

44.

Your Occupation

45.a. Date From (mm/dd/yyyy)
45.b. Date To (mm/dd/yyyy)

Form I-130 02/27/17 N

Race (Select all applicable boxes)
White
Asian
Black or African American

American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander

43.g. Postal Code
43.h. Country

Ethnicity (Select only one box)
Hispanic or Latino
Not Hispanic or Latino

43.e. ZIP Code

43.f. Province

Your Occupation

49.a. Date From (mm/dd/yyyy)

2.

43.c. City or Town
43.d. State

47.h. Country

1.

43.a. Street Number
and Name
43.b.

47.e. ZIP Code

47.g. Postal Code

Yes

42.

Flr.

47.f. Province

40.d State
41.

Ste.

3.

Height

4.

Weight

5.

Eye Color (Select only one box)
Black
Gray
Maroon

Feet

Inches
Pounds

Blue
Green
Pink

Brown
Hazel
Unknown/Other

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

Part 4. Information About Beneficiary
1.

Alien Registration Number (A-Number) (if any)
► A-

2.

11.b.

Apt.

Ste.

Flr.

11.c. City or Town
11.d. State

11.e. ZIP Code

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USCIS Online Account Number (if any)
►

3.

11.a. Street Number
and Name

U.S. Social Security Number (if any)
►

Beneficiary's Full Name
4.a. Family Name
(Last Name)
4.b. Given Name
(First Name)

11.f. Province

11.g. Postal Code
11.h. Country

Other Address and Contact Information

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)

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)

12.b.

Apt.

Ste.

Flr.

12.c. City or Town
12.d. State

12.e. ZIP Code

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.

5.c. Middle Name

Other Information About Beneficiary

13.a. Street Number
and Name

6.

City/Town/Village of Birth

13.b.

7.

Country of Birth

8.

Date of Birth (mm/dd/yyyy)

9.

Sex

10.

Has anyone else ever filed a petition for the beneficiary?
Yes
No
Unknown

Apt.

Ste.

Flr.

13.c. City or Town

Male

13.d. Province

Female

13.e. Postal Code
13.f. Country
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 02/27/17 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.

Person 1

Beneficiary's Marital Information
17.

How many times has the beneficiary been married?

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Current Marital Status

Single, Never Married
Widowed
19.

Married

Separated

Divorced

Annulled

Date of Current Marriage (if currently married)
(mm/dd/yyyy)

Place of Beneficiary's Current Marriage
(if married)
20.a. City or Town
20.b. State
20.c. Province
20.d. Country

25.a. Family Name
(Last Name)
25.b. Given Name
(First Name)
25.c. Middle Name

►

18.

Date Marriage Ended (mm/dd/yyyy)

26.

Relationship

27.

Date of Birth (mm/dd/yyyy)

28.

Country of Birth

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 02/27/17 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

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.

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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.

Ste.

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

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):

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
47.

Flr.

51.d. City or Town

41.c. Middle Name

45.

Apt.

Passport Number

Form I-130 02/27/17 N

Yes

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
56.

Date (mm/dd/yyyy)

Page 7 of 12

Part 4. Information About Beneficiary
(continued)
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.
57.a. Family Name
(Last Name)
57.b. Given Name
(First Name)
58.a. Street Number
and Name
Apt.

62.a. City or Town
62.b. Province
62.c. Country

57.c. Middle Name

58.b.

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:

Ste.

58.c. City or Town

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.

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Part 5. Other Information

58.d. Province

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.

59.c. City or Town
59.d. State

Flr.

3.a. City or Town
3.b. State

59.e. ZIP Code

59.f. Province
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 02/27/17 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

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.

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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.

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.
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:

Part 6. Petitioner's Statement, Contact
Information, Declaration, and Signature

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.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 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.

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 (sign in ink)

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 02/27/17 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)
1.b. Interpreter's Given Name (First Name)
2.

Interpreter's Mailing Address

3.b.

Apt.

Ste.

3.c. City or Town
3.d. State
3.f.

Flr.

3.e. ZIP Code

Province

3.g. Postal Code
3.h. Country

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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Interpreter's Business or Organization Name (if any)

3.a. Street Number
and Name

Interpreter's Certification

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 Signature

7.a. Interpreter's Signature (sign in ink)

7.b. Date of Signature (mm/dd/yyyy)

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.

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.f.

3.e. ZIP Code

Province

3.g. Postal Code
3.h. Country

Form I-130 02/27/17 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 (sign in ink)

8.b. Date of Signature (mm/dd/yyyy)

Form I-130 02/27/17 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.
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c. Middle Name
2.

5.b. Part Number 5.c. Item Number

5.d.

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A-Number (if any) ► A-

3.a. Page Number

3.b. Part Number

3.d.

4.a. Page 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 02/27/17 N

7.a. Page Number

7.b. Part Number 7.c. Item Number

7.d.

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