I-129F Petition for Alien Fiance(e)

USCIS
Form I-129F

Petition for Alien Fiancé(e)
Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0001
Expires 03/31/2024

Action Block

Fee Stamp

For USCIS Use Only
Case ID Number
A-Number
G-28 Number

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The petition is approved for status
under Section 101(a)(15)(K). It is
valid for 4 months and expires on:

Extraordinary Circumstances Waiver
Approved
Denied

General Waiver
Approved
Denied

Resubmitted
►

Mandatory Waiver

Reason

Approved
Denied

Relocated

Initial Receipt

Reason

Received
Sent

Completed

AMCON:

Reason

Personal Interview
Document Check

Remarks

Previously Forwarded
Field Investigation

IMBRA disclosure to the beneficiary required?
Yes
No

Approved
Returned

START HERE - Type or print in black ink.

Part 1. Information About You

Other Names Used

1.

Provide all other names you have ever used, including aliases,
maiden name, and nicknames. If you need extra space to
complete this section, use the space provided in Part 8.
Additional Information.

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

2.

3.

USCIS Online Account Number (if any)
►
U.S. Social Security Number (if any)
►

Select one box below to indicate the classification you are
requesting for your beneficiary:
4.a.

Fiancé(e) (K-1 visa)

4.b.

Spouse (K-3 visa)

5.

If you are filing to classify your spouse as a K-3, have
you filed Form I-130?
Yes
No

Your Full Name
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 Mailing Address

(USPS ZIP Code Lookup)

8.a. In Care Of Name

8.b. Street Number
and Name
8.c.

Apt.

Ste.

Flr.

8.d. City or Town
8.e. State

8.f.

ZIP Code

8.g. Province
8.h. Postal Code
8.i.

Country

8.j.

Is your current mailing address the same as your physical
address?
Yes
No
If you answered "No," provide your physical address in
Item Numbers 9.a. - 9.h.

Form I-129F Edition 03/21/22

Page 1 of 13

Part 1. Information About You (continued)

Your Employment History

Your Address History

Provide your employment history for the last five years,
whether inside or outside the United States. Provide your
current employment first. If you need extra space to complete
this section, use the space provided in Part 8. Additional
Information.

Provide your physical addresses for the last five years, whether
inside or outside the United States. Provide your current address
first if it is different from your mailing address in Item Numbers
8.a. - 8.i. If you need extra space to complete this section, use the
space provided in Part 8. Additional Information.

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13.

Physical Address 1

9.a. Street Number
and Name
9.b.

Apt.

Employer 1

Ste.

Flr.

Full Name of Employer

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

Apt.

Ste.

Flr.

9.c. City or Town

14.c. City or Town

9.d. State

9.e. ZIP Code

14.d. State

9.f.

14.e. ZIP Code

Province

14.f. Province

9.g. Postal Code

14.g. Postal Code

9.h. Country

14.h. Country

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

15.

Your Occupation (specify)

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

16.a. Employment Start Date (mm/dd/yyyy)

Physical Address 2

11.a. Street Number
and Name
11.b.

Apt.

16.b. Employment End Date (mm/dd/yyyy)

Ste.

Flr.

Employer 2

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

11.e. ZIP Code

11.f. Province
11.g. Postal Code
11.h. Country
12.a. Date From (mm/dd/yyyy)
12.b. Date To (mm/dd/yyyy)

17.

Full Name of Employer

18.a. Street Number
and Name
18.b.

Apt.

Ste.

Flr.

18.c. City or Town
18.d. State

18.e. ZIP Code

18.f. Province
18.g. Postal Code
18.h. Country
19.

Form I-129F Edition 03/21/22

Your Occupation (specify)

Page 2 of 13

Part 1. Information About You (continued)

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

20.a. Employment Start Date
(mm/dd/yyyy)
20.b. Employment End Date
(mm/dd/yyyy)

32.c. Middle Name

Other Information

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21.

Gender

22.

Date of Birth (mm/dd/yyyy)

23.

Marital Status
Single

24.

Parent 2's Information

Male

Female

Married

Divorced

Widowed

33.

Date of Birth (mm/dd/yyyy)

34.

Gender

35.

Country of Birth

Male

Female

36.a. City/Town/Village of Residence

City/Town/Village of Birth

36.b. Country of Residence

25.

Province or State of Birth

37.

26.

Have you ever been previously married?

Country of Birth

Information About Your Parents
Parent 1's Information

Yes

No

If you answered "Yes" to Item Number 37., provide the names
of each spouse and the date that each prior marriage ended in
Item Numbers 38.a. - 39. If you need extra space to complete
this section, use the space provided in Part 8. Additional
Information.
Name of Previous Spouse

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

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

27.c. Middle Name

38.c. Middle Name

28.

Date of Birth (mm/dd/yyyy)

29.

Gender

30.

Country of Birth

39.
Male

Date Marriage Ended (mm/dd/yyyy)

Female

Your Citizenship Information
You are a U.S. citizen through (select only one box):

31.a. City/Town/Village of Residence

31.b. Country of Residence

40.a.

Birth in the United States

40.b.

Naturalization

40.c.

U.S. citizen parents

41.

Have you obtained a Certificate of Naturalization or a
Certificate of Citizenship in your own name?
Yes

No

If you answered "Yes" to Item Number 41., complete Item
Numbers 42.a. - 42.c.

Form I-129F Edition 03/21/22

Page 3 of 13

Part 1. Information About You (continued)

Residence 2

42.a. Certificate Number

51.a. State
51.b. Country

42.b. Place of Issuance

Part 2. Information About Your Beneficiary

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

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

Additional Information
43.

Have you ever filed Form I-129F for any other
beneficiary?
Yes

No

If you answered "Yes" to Item Number 43., provide the
responses to Item Number 44. - 46. for each previous
beneficiary. If you need to provide information for more than
one beneficiary, use the space provided in Part 8. Additional
Information.
44.

2.

A-Number (if any)

► A-

3.

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

A-Number (if any) ► A-

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

45.c. Middle Name

4.

Date of Birth (mm/dd/yyyy)

5.

Gender

6.

Marital Status
Single

46.

Date of Filing (mm/dd/yyyy)

47.

What action did USCIS take on Form I-129F (for
example, approved, denied, revoked)?

48.

1.c. Middle Name

Do you have any children under 18 years of age?
Yes

Male

Married

Female

Divorced

7.

City/Town/Village of Birth

8.

Country of Birth

9.

Country of Citizenship or Nationality

Widowed

No

If you answered "Yes" to Item Number 48., provide the ages for
your children under 18 years of age in Item Numbers 49.a. - 49.b.
Provide the ages for your children under 18 years of age. If you
need extra space to complete this section, use the space
provided in Part 8. Additional Information.
49.a. Age
49.b. Age
Provide all U.S. states and foreign countries in which you have
resided since your 18th birthday.

Other Names Used
Provide all other names you have ever used, including aliases,
maiden name, and nicknames. If you need extra space to
complete this section, use the space provided in Part 8.
Additional Information.
10.a. Family Name
(Last Name)
10.b. Given Name
(First Name)
10.c. Middle Name

Residence 1
50.a. State
50.b. Country

Form I-129F Edition 03/21/22

Page 4 of 13

Part 2. Information About Your Beneficiary
(continued)
Mailing Address for Your Beneficiary
11.a. In Care Of Name

Apt.

Ste.

14.d. State

Ste.

Flr.

Flr.

14.e. ZIP Code

14.f. Province

14.g. Postal Code

11.d. City or Town

11.f. ZIP Code

14.h. Country

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

11.g. Province

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

11.h. Postal Code
11.i. Country

14.b.

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Apt.

11.e. State

14.a. Street Number
and Name

14.c. City or Town

11.b. Street Number
and Name
11.c.

Beneficiary's Physical Address 2

Your Beneficiary's Employment History

Your Beneficiary's Address History

Provide your beneficiary's physical addresses for the last five
years, whether inside or outside the United States. Provide your
beneficiary's current address first if it is different from the
mailing address in Item Numbers 11.a. - 11.i. If you need
extra space to complete this section, use the space provided in
Part 8. Additional Information.

Provide your employment history for the last five years,
whether inside or outside the United States. Provide your
current employment first. If you need extra space to complete
this section, use the space provided in Part 8. Additional
Information.

Beneficiary's Employer 1
16.

Full Name of Employer

Beneficiary's Physical Address 1

17.a. Street Number
and Name

12.a. Street Number
and Name
12.b.

Apt.

Ste.

Flr.

Apt.

Ste.

Flr.

17.c. City or Town

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

17.b.

12.e. ZIP Code

12.f. Province
12.g. Postal Code
12.h. Country
13.a. Date From (mm/dd/yyyy)
13.b. Date To (mm/dd/yyyy)

17.d. State

17.e. ZIP Code

17.f. Province
17.g. Postal Code
17.h. Country
18.

Beneficiary's Occupation (specify)

19.a. Employment Start Date (mm/dd/yyyy)

19.b. Employment End Date (mm/dd/yyyy)

Form I-129F Edition 03/21/22

Page 5 of 13

Part 2. Information About Your Beneficiary
(continued)
Beneficiary's Employer 2
20.

Full Name of Employer

Parent 2's Information
29.a. Family Name
(Last Name)
29.b. Given Name
(First Name)
29.c. Middle Name

21.a. Street Number
and Name
21.b.

Apt.

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Ste.

Flr.

21.c. City or Town
21.d. State

30.

Date of Birth (mm/dd/yyyy)

31.

Gender

32.

Country of Birth

Male

Female

21.e. ZIP Code

33.a. City/Town/Village of Residence

21.f. Province

33.b. Country of Residence

21.g. Postal Code
21.h. Country
22.

Beneficiary's Occupation (specify)

Other Information About Your Beneficiary

34.

Has your beneficiary ever been previously married?

23.a. Employment Start Date (mm/dd/yyyy)

23.b. Employment End Date (mm/dd/yyyy)

Information About Your Beneficiary's Parents

Yes

No

If you answered "Yes" to Item Number 34., provide the names
of each prior spouse and the date each prior marriage ended in
Item Numbers 35.a. - 36. If you need to provide information
for more than one spouse, use the space provided in Part 8.
Additional Information.

Name of Previous Spouse
35.a. Family Name
(Last Name)
35.b. Given Name
(First Name)

Parent 1's Information
24.a. Family Name
(Last Name)
24.b. Given Name
(First Name)

35.c. Middle Name

24.c. Middle Name
25.

Date of Birth (mm/dd/yyyy)

26.

Gender

27.

Country of Birth

Male

36.

Date Marriage Ended
(mm/dd/yyyy)

37.

Has your beneficiary ever been in the United States?

Female

28.a. City/Town/Village of Residence

Yes

No

If your beneficiary is currently in the United States, complete
Item Numbers 38.a. - 38.h.
38.a. He or she last entered as a (for example, visitor, student,
exchange alien, crewman, stowaway, temporary worker,
without inspection):

28.b. Country of Residence
38.b. I-94 Arrival-Departure Record Number
►
38.c. Date of Arrival (mm/dd/yyyy)
Form I-129F Edition 03/21/22

Page 6 of 13

Part 2. Information About Your Beneficiary
(continued)

Address in the United States Where Your
Beneficiary Intends to Live

38.d. Date authorized stay expired or will expire as shown on
Form I-94 or I-95 (mm/dd/yyyy)

45.a. Street Number
and Name
45.b.

38.e. Passport Number

Apt.

Ste.

Flr.

45.c. City or Town

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38.f. Travel Document Number

45.d. State

46.

45.e. ZIP Code

Daytime Telephone Number

38.g. Country of Issuance for Passport or Travel Document

Your Beneficiary's Physical Address Abroad

38.h. Expiration Date for Passport or Travel Document
(mm/dd/yyyy)
39.

47.a. Street Number
and Name

Does your beneficiary have any children?

Yes

No

If you answered "Yes" to Item Number 39., provide the
following information about each child. If you need to provide
information for more than one child, use the space provided in
Part 8. Additional Information.

47.b.

Apt.

Ste.

Flr.

47.c. City or Town
47.d. Province

47.e. Postal Code

Children of Beneficiary

47.f. Country

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

48.

Daytime Telephone Number

40.c. Middle Name

Country of Birth

Your Beneficiary's Name and Address in His or
Her Native Alphabet

42.

Date of Birth (mm/dd/yyyy)

43.

Does this child reside with your beneficiary?

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

41.

Yes

No

49.c. Middle Name

If the child does not reside with your beneficiary, provide the
child's physical residence.

50.a. Street Number
and Name

44.a. Street Number
and Name

50.b.

44.b.

Apt.

Ste.

Flr.

Ste.

Flr.

50.c. City or Town
50.d. Province

44.c. City or Town
44.d. State

Apt.

44.e. ZIP Code

44.f. Province

50.e. Postal Code
50.f. Country

44.g. Postal Code
44.h. Country

Form I-129F Edition 03/21/22

Page 7 of 13

Part 2. Information About Your Beneficiary
(continued)

58.

Organization Name of IMB

51.

Is your fiancé(e) related to you?
Yes
No
N/A, beneficiary is my spouse

59.

Website of IMB

52.

Provide the nature and degree of relationship (for example,
third cousin or maternal uncle).

60.a. Street Number
and Name

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60.b.

53.

Have you and your fiancé(e) met in person during the two
years immediately before filing this petition?
Yes

No

N/A, beneficiary is my spouse

If you answered "Yes" to Item Number 53., describe the
circumstances of your in-person meeting in Item Number 54.
Attach evidence to demonstrate that you were in each other's
physical presence during the required two year period.

If you answered "No," explain your reasons for requesting an
exemption from the in person meeting requirement in Item
Number 54. and provide evidence that you should be exempt
from this requirement. Refer to Part 2., Item Numbers 53. - 54.
of the Specific Instructions section of the Instructions for
additional information about the requirement to meet. If you
need extra space to complete this section, use the space
provided in Part 8. Additional Information.
54.

Apt.

Ste.

Flr.

60.c. City or Town
60.d. Province

60.e. Postal Code
60.f. Country

61.

Daytime Telephone Number

Consular Processing Information

Your beneficiary will apply for a visa abroad at the U.S.
Embassy or U.S. Consulate at:
62.a. City or Town

62.b. Country

Part 3. Other Information
Criminal Information

International Marriage Broker (IMB) Information
55.

Did you meet your beneficiary through the services of an
IMB?
Yes
No

If you answered "Yes" to Item Number 55., provide the IMB's
contact information and Website information below. In
addition, attach a copy of the signed, written consent form the
IMB obtained from your beneficiary authorizing your
beneficiary's personal contact information to be released to you.
56.

IMB's Name (if any)

57.a. Family Name of IMB (Last Name)

57.b. Given Name of IMB (First Name)

Form I-129F Edition 03/21/22

NOTE: These criminal information questions must be
answered even if your records were sealed, cleared, or if
anyone, including a judge, law enforcement officer, or attorney,
told you that you no longer have a record. If you need extra
space to complete this section, use the space provided in Part 8.
Additional Information.
1.

Have you EVER been subject to a temporary or
permanent protection or restraining order (either civil or
criminal)?
Yes
No

Have you EVER been arrested or convicted of any of the
following crimes:
2.a. Domestic violence, sexual assault, child abuse, child
neglect, dating violence, elder abuse, stalking or an
attempt to commit any of these crimes? (See Part 3.
Other Information, Item Numbers 1. - 3.c. of the
Instructions for the full definition of the term "domestic
violence.")
Yes
No

Page 8 of 13

Part 3. Other Information (continued)

Multiple Filer Waiver Request Information

2.b. Homicide, murder, manslaughter, rape, abusive sexual
contact, sexual exploitation, incest, torture, trafficking,
peonage, holding hostage, involuntary servitude, slave
trade, kidnapping, abduction, unlawful criminal restraint,
false imprisonment, or an attempt to commit any of these
crimes?
Yes
No

Refer to Part 3. Types of Waivers in the Specific Instructions
section of the Instructions for an explanation of the filing
waivers.
Indicate which one of the following waivers you are requesting:
5.a.

Multiple Filer, No Permanent Restraining Orders or
Convictions for a Specified Offense (General
Waiver)

5.b.

Multiple Filer, Prior Permanent Restraining Orders or
Criminal Conviction for Specified Offense
(Extraordinary Circumstances Waiver)

5.c.

Multiple Filer, Prior Permanent Restraining Order or
Criminal Convictions for Specified Offense Resulting
from Domestic Violence (Mandatory Waiver)

5.d.

Not applicable, beneficiary is my spouse or I am not
a multiple filer

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2.c. Three or more arrests or convictions, not from a single
act, for crimes relating to a controlled substance or
alcohol?
Yes
No

NOTE: If you were ever arrested or convicted of any of the
specified crimes, you must submit certified copies of all court
and police records showing the charges and disposition for
every arrest or conviction. You must do so even if your records
were sealed, expunged, or otherwise cleared, and regardless of
whether anyone, including a judge, law enforcement officer, or
attorney, informed you that you no longer have a criminal
record. If you need extra space to complete this section, use the
space provided in Part 8. Additional Information.

If you have provided information about a conviction for a crime
listed in Item Numbers 2.a. - 2.c. and you were being battered
or subjected to extreme cruelty at the time of your conviction,
select all of the following that apply to you:
3.a.

I was acting in self-defense.

3.b.

I violated a protection order issued for my own
protection.

3.c.

I committed, was arrested for, was convicted of, or
pled guilty to a crime that did not result in serious
bodily injury and there was a connection between the
crime and me having been battered or subjected to
extreme cruelty.

1.

Yes

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

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

3.

Height

Feet

4.

Weight

Pounds

5.

Eye Color (Select only one box)

No

4.b. If the answer to Item Number 4.a. is "Yes," provide
information about each of those arrests, citations, charges,
indictments, convictions, fines, or imprisonments in the
space below. If you were the subject of an order of
protection or restraining order and believe you are the
victim, please explain those circumstances and provide
any evidence to support your claims. Include the dates
and outcomes. If you need extra space to complete this
section, use the space provided in Part 8. Additional
Information.

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

2.

4.a. Have you ever been arrested, cited, charged, indicted,
convicted, fined, or imprisoned for breaking or violating
any law or ordinance in any country, excluding traffic
violations (unless a traffic violation was alcohol- or drugrelated or involved a fine of $500 or more)?

Form I-129F Edition 03/21/22

Part 4. Biographic Information

6.

Inches

Black

Blue

Brown

Gray

Green

Maroon

Pink

Hazel
Unknown/Other

Hair Color (Select only one box)
Bald (No hair)
Brown
Sandy

Black
Gray
White

Blond
Red
Unknown/
Other

Page 9 of 13

2)

Part 5. Petitioner's Statement, Contact
Information, Declaration, Certification, and
Signature

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.

NOTE: Read the Penalties section of the Form I-129F
Instructions before completing this part.

Petitioner's Statement

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NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.

Petitioner's Signature

1.a.

I can read and understand English, and I have read
and understand every question and instruction on this
petition and my answer to every question.

1.b.

The interpreter named in Part 6. read to me every
question and instruction on this petition and my
answer to every question in

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.

,

a language in which I am fluent, and I understood
everything.
2.

Part 6. Interpreter's Contact Information,
Certification, and Signature

At my request, the preparer named in Part 7.,

,

prepared this petition for me based only upon
information I provided or authorized.

Provide the following information about the interpreter.

Interpreter's Full Name

1.a. Interpreter's Family Name (Last Name)

Petitioner's Contact Information
3.

Petitioner's Daytime Telephone Number

1.b. Interpreter's Given Name (First Name)

4.

Petitioner's Mobile Telephone Number (if any)

2.

5.

Petitioner's Email Address (if any)

Interpreter's Business or Organization Name (if any)

Interpreter's Mailing Address

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 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 law.

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

I understand that USCIS may require me to appear for an
appointment to take my biometrics (fingerprints, photograph,
and/or signature) and, at that time, if I am required to provide
biometrics, I will be required to sign an oath reaffirming that:
1)

I reviewed and understood all of the information
contained in, and submitted with, my petition; and

Form I-129F Edition 03/21/22

Page 10 of 13

Part 6. Interpreter's Contact Information,
Certification, and Signature (continued)
Interpreter's Contact Information
4.

Interpreter's Daytime Telephone Number

Preparer's Mailing Address
3.a. Street Number
and Name
3.b.

Apt.

Ste.

Flr.

3.c. City or Town

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5.

Interpreter's Mobile Telephone Number (if any)

6.

Interpreter's Email Address (if any)

3.d. State
3.f.

3.e. ZIP Code

Province

3.g. Postal Code

Interpreter's Certification

3.h. Country

I certify, under penalty of perjury, that:

I am fluent in English and
,
which is the same language specified in Part 5., 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.

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)

Interpreter's Signature
7.a. Interpreter's Signature

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.

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

Part 7. Contact Information, Declaration, and
Signature of the Person Preparing this Petition, if
Other Than the Petitioner
Provide the following information about the preparer.

Preparer's Full Name
1.a. Preparer's Family Name (Last Name)

NOTE: If you are an attorney or accredited
representative, you may need 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.

1.b. Preparer's Given Name (First Name)

2.

Preparer's Business or Organization Name (if any)

Form I-129F Edition 03/21/22

Page 11 of 13

Part 7. Contact Information, Declaration, and
Signature of the Person Preparing this Petition, if
Other Than the Petitioner (continued)
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.

DRAFT
NOT FOR
PRODUCTION
07/07/2022

Preparer's Signature
8.a. Preparer's Signature

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

Form I-129F Edition 03/21/22

Page 12 of 13

5.a. Page Number

Part 8. 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

5.b. Part Number

5.c. Item Number

5.d.

DRAFT
NOT FOR
PRODUCTION
07/07/2022

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

7.b. Part Number

7.c. Item Number

6.d.

4.b. Part Number

4.d.

Form I-129F Edition 03/21/22

4.c. Item Number

7.a. Page Number

7.d.

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