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I-130, Petition for Alien Relative (United States)

This form is a petition for a nonimmigrant worker's relative to work in the United States. The form provided here is simply a sample of what the actual Form I-130 looks like.

Department of Homeland Security
U.S. Citizenship and Immigration Services

I-130, Petition for Alien Relative

A. Relationship You are the petitioner. Your relative is the beneficiary.

1. I am filing this petition for my: ____ Husband/Wife ____ Parent ____ Brother/Sister ____ Child

1. Name (Family name in CAPS) _______________________________

2. Are you related by adoption? ____ Yes ____ No

3. Did you gain permanent residence through adoption? ____ Yes ____ No

B. Information about you

1. Name (Family name in CAPS) (First) _______________________________

(Middle) _______________________________

2. Address: (Number and Street) _______________________________

(Apt. No.) _______________________________

(Town or City) _______________________________

(State/Country) _______________________________

(Zip/Postal Code) _______________________________

3. Place of Birth (Town or City) _______________________________

(State/Country) _______________________________

4. Date of Birth (mm/dd/yyyy) _______________________________

5. Gender ____ Male ____ Female

6. Marital Status

____ Married ____ Single ____ widowed ____ Divorced

7. Other Names Used (including maiden name) _______________________________

8. Date and Place of Present Marriage (if married) _______________________________

9. U.S. Social Security Number (if any) _______________________________

10. Alien Registration Number _______________________________

11. Name(s) of Prior Husband(s)/Wive(s) _______________________________

12. Date(s) Marriage(s) Ended _______________________________

13. If you are a U.S. citizen, complete the following:

My citizenship was acquired through (check one)

____ Birth in the U.S.

____ Naturalization Give certificate number and date and place of issuance. _______________________________

____ Parents Have you obtained a certificate of citizenship in your name?

____ Yes. Give certificate number, date and place of issuance. ____ No

Have you obtained a certificate of citizenship in your name?

____ Yes ____ No

14a. If you are a lawful permanent resident alien, complete the following: Date and place of admission for or adjustment to lawful permanent residence and class of admission.

______________________

14b. Did you gain permanent resident status through marriage to a U.S. citizen or lawful permanent resident? ____ Yes ____No

Part B. Information about your alien relative

1. Name (Family name in CAPS) _______________________________

(First) _______________________________

(Middle) _______________________________

2. Address: (Number and Street) _______________________________

(Apt. No.) _______________________________

(Town or City) _______________________________

(State/Country) _______________________________

(Zip/Postal Code) _______________________________

3. Place of Birth (Town or City) _______________________________

(State/Country) _______________________________

4. Date of Birth (mm/dd/yyyy) _______________________________

5. Gender ____ Male ____ Female

6. Marital Status

____ Married ____ Single ____ Widowed ____ Divorced

7. Other Names Used (including maiden name) _______________________________

8. Date and Place of Present Marriage (if married) _______________________________

9. U.S. Social Security Number (if any) _______________________________

10. Alien Registration Number _______________________________

11. Name(s) of Prior Husband(s)/Wive(s) _______________________________

12. Date(s) Marriage(s) Ended _______________________________

13. Has your relative ever been in the U.S.?

____ Yes ____ No

14. If your relative is currently in the U.S., complete the following:

He or she last arrived as a:
(visitor, student, stowaway, without inspection, etc.). _______________________________

Arrival/Departure Record (I-94) Number ______________________

Date of Arrival (mm/dd/yyyy) ______________________

Date authorized stay expired, or will expire as shown on I-94 or I-95 ______________________

15. Name and address of present employer (if any) ______________________

Date this employment began (mm/dd/yyyy) ______________________

List all children of your alien fiancé(e) (if any) ______________________

16. Has your relative ever been under immigration proceedings?

____ No ____ Yes Where _______________________________ When _______________________________

____ Removal ____ Exclusion/Deportation ____ Rescission ____ Judicial Proceedings

17. List husband/wife and all children of your relative.

(Name) _______________________________

(Relationship) _______________________________

(Date of Birth) _______________________________

(Country of Birth) _______________________________


(Name) _______________________________

(Relationship) _______________________________

(Date of Birth) _______________________________

(Country of Birth) _______________________________


(Name) _______________________________

(Relationship) _______________________________

(Date of Birth) _______________________________

(Country of Birth) _______________________________

18. Address in the United States where your relative intends to live.

(Street Address) _______________________________

(Town or City) _______________________________

(State) _______________________________

19. Your relative's address abroad.

(Include street, city, province and country) _______________________________

Phone Number (if any) _______________________________

20. If your relative's native alphabet is other than Roman letters, write his or her name and address abroad in the native alphabet.

(Name) _______________________________

Address (Include street, city, province and Country) _______________________________

21. If filing for your husband/wife, give last address at which you lived together. (Include street, city, province, if any, and country):

_______________________________

From: (Month) (Year) to: (Month) (Year)

22. Complete the information below if your relative is in the United States and will apply for adjustment of status. Your relative is in the United States and will apply for adjustment of status to that of a lawful permanent resident at the USCIS office in:

(City) _________________________

(State) _________________________.

If your relative is not eligible for adjustment of status, he or she will apply for a visa abroad at the American consular post in

(City) _________________________

(Country) _________________________.

NOTE: Designation of a U.S. embassy or consulate outside the country of your fiancé(e)'s last residence does not guarantee acceptance for processing by that foreign post. Acceptance is at the discretion of the designated embassy or consulate.)

C. Other information.

1. If separate petitions are also being submitted for other relatives, give names of each and relationship.

_______________________________

2. Have you ever before filed a petition for this or any other alien? ___ Yes ___ No

If "Yes," give name, place and date of filing and result. _______________________________

WARNING: USCIS investigates claimed relationships and verifies the validity of documents. USCIS seeks criminal prosecutions when family relationships are falsified to obtain visas.

PENALTIES: By law, you may be imprisoned for not more than five years or fined $250,000, or both, for entering into a marriage contract for the purpose of evading any provision of the immigration laws. In addition, you may be fined up to $10,000 and imprisoned for up to five years, or both, for knowingly and willfully falsifying or concealing a material fact or using any false document in submitting this petition.

YOUR CERTIFICATION: I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true and correct. Furthermore, I authorize the release of any information from my records that the U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit that I am seeking.

E. Signature of petitioner.

Signature _______________________________

Date (mm/dd/yyyy) _______________________________

Daytime Telephone Number (with area code) _______________________________

F. Signature of person preparing form, if other than the petitioner.

I declare that I prepared this application at the request of the applicant and it is based on all information of which I have knowledge.

Print Name _______________________________

Signature _______________________________

Date (mm/dd/yyyy): _______________________________

Address _______________________________

G-28 ID or VOLAG Number, if any, _______________________________

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