Form I 130 H30S
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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 Approved Petition was filed on (Priority Date mm/dd/yyyy): Returned PDR request granted/denied - New priority date (mm/dd/yyyy): 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 Remarks 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 Other Information 12.d. State 6. City/Town/Village of Birth 12.f. Province 7. Country of Birth 8. Date of Birth (mm/dd/yyyy) 9. Sex 12.b. Apt. Ste. Flr. 12.e. ZIP Code 12.g. Postal Code Male 12.h. Country 13.a. Date From (mm/dd/yyyy) Female Mailing Address 13.b. Date To (mm/dd/yyyy) (USPS ZIP Code Lookup) 10.a. In Care Of Name 14.a. Street Number and Name 14.b. 10.b. Street Number and Name 10.c. Apt. Ste. Flr. 10.d. City or Town 10.e. State Physical Address 2 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 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 20.a. Family Name (Last Name) 20.b. Given Name (First Name) 34. City/Town/Village of Residence 20.c. Middle Name 35. Country of Residence 21. Male Female Date Marriage Ended (mm/dd/yyyy) Spouse 2 Additional Information About You (Petitioner) 22.a. Family Name (Last Name) 22.b. Given Name (First Name) 36. 22.c. Middle Name 37. 23. I am a (Select only one box): U.S. Citizen Lawful Permanent Resident If you are a U.S. citizen, complete Item Number 37. Date Marriage Ended (mm/dd/yyyy) My citizenship was acquired through (Select only one box): Birth in the United States Naturalization Information About Your Parents Parents Parent 1's Information 38. Full Name of Parent 1 24.a. Family Name (Last Name) 24.b. Given Name (First Name) 24.c. Middle Name Have you obtained a Certificate of Naturalization or a Certificate of Citizenship? Yes No If you answered "Yes" to Item Number 38., complete the following: 39.a. Certificate Number 25. Date of Birth (mm/dd/yyyy) 26. Sex Male 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 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. American Indian or Alaska Native Native Hawaiian or Other Pacific Islander 43.g. Postal Code 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 43.e. ZIP Code 43.f. Province 44. Ethnicity (Select only one box) Hispanic or Latino Not Hispanic or Latino 2. 43.h. Country Your Occupation 49.a. Date From (mm/dd/yyyy) Flr. 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. USCIS Online Account Number (if any) U.S. Social Security Number (if any) ► Beneficiary's Full Name Flr. 11.c. City or Town 11.d. State ► 3. 11.a. Street Number and Name 11.e. ZIP Code 11.f. Province 11.g. Postal Code 11.h. Country Other Address and Contact Information 4.a. Family Name (Last Name) 4.b. Given Name (First Name) Provide the address in the United States where the beneficiary intends to live, if different from Item Numbers 11.a. - 11.h. If the address is the same, type or print "SAME" in Item Number 12.a. 4.c. Middle Name 12.a Street Number and Name Other Names Used (if any) 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 5.c. Middle Name Provide the beneficiary's address outside the United States, if different from Item Numbers 11.a. - 11.h. If the address is the same, type or print "SAME" in Item Number 13.a. Other Information About Beneficiary 13.a. Street Number and Name 6. City/Town/Village of Birth 13.b. 7. Country of Birth 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? Current Marital Status Single, Never Married Widowed 19. Married Separated 25.a. Family Name (Last Name) 25.b. Given Name (First Name) 25.c. Middle Name ► 18. Date Marriage Ended (mm/dd/yyyy) 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 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. 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): Yes 54. 46.b. Form I-94 Arrival-Departure Record Number ► 46.c. Date of Arrival (mm/dd/yyyy) 46.d. Date authorized stay expired, or will expire, as shown on Form I-94 or Form I-95 (mm/dd/yyyy) or type or print "D/S" for Duration of Status 47. Flr. 51.d. City or Town 41.c. Middle Name 45. Apt. Passport Number Form I-130 02/27/17 N 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. Flr. 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. 58.d. Province Part 5. Other Information 58.e. Postal Code 1. 58.f. Country Have you EVER previously filed a petition for this beneficiary or any other alien? Yes No If you answered "Yes," provide the name, place, date of filing, and the result. If filing for your spouse, provide the last address at which you physically lived together. If you never lived together, type or print, "Never lived together" in Item Number 59.a. 2.a. Family Name (Last Name) 2.b. Given Name (First Name) 59.a. Street Number and Name 2.c. Middle Name 59.b. Apt. Ste. Flr. 59.c. City or Town 59.d. State 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. 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 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.f. 3.e. ZIP Code 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 , 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. 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) 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. 5.b. Part Number 5.c. Item Number 5.d. 1.a. Family Name (Last Name) 1.b. Given Name (First Name) 1.c. Middle Name 2. A-Number (if any) ► A- 3.a. Page Number 3.b. Part Number 3.c. Item Number 3.d. 4.a. Page 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. Page 12 of 12
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