Previously Forwarded
Naturalization. Give certificate number and date and place of issuance.
DO NOT WRITE IN THIS BLOCK - FOR USCIS OFFICE ONLY
Personal Interview
Action Stamp Fee Stamp
Section of Law/Visa Category
(priority date)
201(b) Spouse - IR-1/CR-1
Remarks:
1. I am filing this petition for my:
Brother/Sister Yes
No
Spouse
Child
C. Information about your relative
B. Information about you
(First)
1. Name (Family name in CAPS)
(Middle)
(Town or City)
(State/Country)
(State/Country)
4. Date of Birth
4. Date of Birth
5. Gender
5. Gender
Male
Female
Married
Widowed
Single
Divorced
7. Other Names Used (including maiden name)
8. Date and Place of Present Marriage (if married)
Yes
Yes. Give certificate number, date and place of issuance.
16. Has your relative ever been under immigration proceedings?
Removal
14b. Did you gain permanent resident status through marriage to a
U.S. citizen or lawful permanent resident?
Yes
Rescission
Judicial Proceedings
Married
Widowed
Single
Divorced
Date arrived
Date and place of admission for or adjustment to lawful permanent
residence and class of admission.
Petition was filed on:
A. Relationship
Parent
2. Are you related by adoption?
Yes No
RESUBMITTED
RELOCATED: Rec'd
Sent
COMPLETED: Appv'd
Denied
INITIAL RECEIPT
Yes Where
When
Exclusion/Deportation
13. Has your relative ever been in the U.S.?
(Town or City)
(State/Country) (Zip/Postal Code)
1. Name (Family name in CAPS)
(First)
(Middle)
3. Did you gain permanent residence through adoption?
My citizenship was acquired through (check one):
You are the petitioner. Your relative is the beneficiary.
12. Date(s) Marriage(s) Ended
203(a)(1) Unm. S or D - F1-1
203(a)(2)(A)Spouse - F2-1
203(a)(2)(A) Child - F2-2
203(a)(2)(B) Unm. S or D - F2-4
203(a)(3) Married S or D - F3-1
203(a)(4) Brother/Sister - F4-1
201(b) Child - IR-2/CR-2
201(b) Parent - IR-5
I-485 Filed Simultaneously
204(g) Resolved
203(g) Resolved
Pet.
Field Investigation
203(a)(2)(A) Resolved
Ben. " A" File Reviewed
Male
Female
He or she arrived as a:
(visitor, student, stowaway, without inspection, etc.)
Birth in the U.S.
Parents. Have you obtained a certificate of citizenship in your own name?
No
Ret'd
No
I-130, Petition for Alien Relative
OMB No. 1615-0012; Expires 07/31/2018
A#
Form I-130 (12/23/16) N
2. Address (Number and Street)
3. Place of Birth (Town or City)
3. Place of Birth (Town or City)
11. Name(s) of Prior Spouse(s)
11. Name(s) of Prior Spouse(s)
13. If you are a U.S. citizen, complete the following:
14. If you are a lawful permanent resident alien, complete the following:
Date authorized stay expired, or will expire, as
shown on Form I-94 or I-95
15. Name and address of present employer (if any)
Date this employment began
12. Date(s) Marriage(s) Ended
2. Address (Number and Street) (Apt. No.)
(Apt. No.)
(Zip/Postal Code)
(State/Country)
6. Marital Status
7. Other Names Used (including maiden name)
8. Date and Place of Present Marriage (if married)
No
Arrival/Departure Record (I-94)
No
Department of Homeland Security
U.S. Citizenship and Immigration Services
6. Marital Status
14. If your relative is currently in the U.S., complete the following:
9. U.S. Social Security Number (If any) 9. U.S. Social Security Number (If any)
10. Alien Registration Number
10. Alien Registration Number