Fillable INS-Form-I-129F-K3 Petition for Alien Fiancé(e)

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INS-Form-I-129F-K3 Petition for Alien Fiancé(e)

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Form I-129F 04/10/17 N
Page 1 of 13
Petition for Alien Fiancé(e)
Department of Homeland Security
U.S. Citizenship and Immigration Services
Resubmitted
Initial Receipt
For USCIS Use Only
USCIS
Form I-129F
OMB No. 1615-0001
Expires 08/31/2018
START HERE - Type or print in black ink.►
Part 1. Information About You
6.a. Family Name
(Last Name)
6.b. Given Name
(First Name)
6.c.
Middle Name
Completed
Sent
Received Approved
Returned
Case ID Number
Personal Interview
Document Check
Previously Forwarded
Field Investigation
A-Number
G-28 Number
The petition is approved for status
under Section 101(a)(15)(K). It is
valid for 4 months and expires on:
AMCON:
General Waiver
Remarks
Action Block
Relocated
Fee Stamp
Reason
Approved
Denied
Approved
Denied
Yes
Extraordinary Circumstances Waiver
Reason
Mandatory Waiver
Reason
Approved
Denied
No
IMBRA disclosure to the beneficiary required?
►
A-
Alien Registration Number (A-Number) (if any)1.
U.S. Social Security Number (if any)3.
►
Your Full Name
Select one box below to indicate the classification you are
requesting for your beneficiary:
Fiancé(e) (K-1 visa)
Spouse (K-3 visa)
4.a.
4.b.
If you are filing to classify your spouse as a K-3, have
you filed Form I-130?
5.
Yes No
USCIS Online Account Number (if any)2.
►
7.b. Given Name
(First Name)
Your Mailing Address
8.b.
8.d.
8.e.
8.g.
8.i.
8.a.
8.c.
8.h.
7.c. Middle Name
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.
7.a. Family Name
(Last Name)
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.
City or Town
Province
Country
Postal Code
ZIP Code8.f.State
Street Number
and Name
Flr.Apt. Ste.
In Care Of Name
SMITH
JOHN
JERRY
1 2 3 4 5 6 7 8 9
183 Gore Creek Drive
VAIL
81658
CO
USA
Form I-129F 04/10/17 N
Page 2 of 13
Your Address History
9.a.
9.c.
9.d.
9.b.
9.f.
Part 1. Information About You (continued)
9.h.
10.a.
Date To (mm/dd/yyyy)10.b.
9.g.
City or Town
Province
Country
Postal Code
ZIP Code9.e.State
Street Number
and Name
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.
Physical Address 1
Date From (mm/dd/yyyy)
11.a.
11.c.
11.d.
11.b.
11.f.
11.h.
12.a.
Date To (mm/dd/yyyy)12.b.
11.g.
City or Town
Province
Country
Postal Code
ZIP Code11.e.State
Street Number
and Name
Flr.Apt. Ste.
Physical Address 2
Date From (mm/dd/yyyy)
Your 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 need extra space to complete
this section, use the space provided in Part 8. Additional
Information.
Full Name of Employer13.
14.a.
14.c.
14.d.
14.b.
14.f.
14.h.
16.a.
16.b.
14.g.
City or Town
Province
Country
Postal Code
ZIP Code14.e.State
Street Number
and Name
Flr.Apt. Ste.
Employment Start Date (mm/dd/yyyy)
Employment End Date (mm/dd/yyyy)
Employer 2
Your Occupation (specify)15.
Employer 1
Full Name of Employer17.
18.a.
18.c.
18.d.
18.b.
18.f.
18.h.
18.g.
City or Town
Province
Country
Postal Code
ZIP Code18.e.State
Street Number
and Name
Flr.Apt.
Ste.
Your Occupation (specify)19.
Flr.Apt. Ste.
PRESENT
05/13/2016
05/12/2016
Denver
80204
CO
USA
05/13/2004
Acme Engineering
PRESENT
Vail
81658
CO
USA
05/13/2016
ENGINEER
Expert Engineering Services
Denver
80204
CO
USA
Engineer
Form I-129F 04/10/17 N
Page 3 of 13
Part 1. Information About You (continued)
20.a.
20.b.
Employment Start Date
(mm/dd/yyyy)
Employment End Date
(mm/dd/yyyy)
24. City/Town/Village
of Birth
25.
Country of Birth26.
Province or State of Birth
23. Marital Status
Widowed
DivorcedSingle Married
22. Date of Birth (mm/dd/yyyy)
21. Gender Male Female
Other Information
Information About Your Parents
27.a. Family Name
(Last Name)
27.b. Given Name
(First Name)
27.c. Middle Name
Parent 1's Information
28. Date of Birth (mm/dd/yyyy)
29. Gender Male Female
31.b. Country of Residence
Country of Birth30.
31.a. City/Town/Village of Residence
32.a. Family Name
(Last Name)
32.b. Given Name
(First Name)
32.c. Middle Name
Parent 2's Information
33. Date of Birth (mm/dd/yyyy)
34. Gender Male Female
36.b. Country of Residence
Country of Birth35.
36.a. City/Town/Village of Residence
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.
Have you ever been previously married? 37.
Yes No
Name of Previous Spouse
38.a. Family Name
(Last Name)
38.b. Given Name
(First Name)
38.c. Middle Name
39. Date Marriage Ended (mm/dd/yyyy)
Your Citizenship Information
You are a U.S. citizen through (select only one box):
40.a. Birth in the United States
40.b.
Naturalization
U.S. citizen parents40.c.
Have you obtained a Certificate of Naturalization or a
Certificate of Citizenship in your own name?
41.
Yes
No
If you answered "Yes" to Item Number 41., complete Item
Numbers 42.a. - 42.c.
05/12/2016
05/13/2006
TAMPA
USA
FLORIDA
11/21/1975
SMITH
ROBERT
EDWARD
04/20/1945
USA
USA
TAMPA
SMITH
JULIA
LAWRENCE
08/21/1949
USA
USA
TAMPA
SMITH
JANE
JOAN
Form I-129F 04/10/17 N
Page 4 of 13
Part 1. Information About You (continued)
Certificate Number
Place of Issuance
42.a.
42.b.
Date of Issuance (mm/dd/yyyy)
42.c.
45.a. Family Name
(Last Name)
45.b. Given Name
(First Name)
45.c.
Middle Name
Date of Filing (mm/dd/yyyy)46.
What action did USCIS take on Form I-129F (for
example, approved, denied, revoked)?
47.
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.
►
A-
A-Number (if any)44.
Have you ever filed Form I-129F for any other
beneficiary?
43.
Yes No
Additional Information
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.
Do you have any children under 18 years of age?48.
Yes No
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.
Residence 1
Country 50.b.
50.a. State
Residence 2
Country 51.b.
51.a. State
Part 2. Information About Your Beneficiary
1.a. Family Name
(Last Name)
1.b. Given Name
(First Name)
1.c.
Middle Name
►
A-
A-Number (if any)2.
Country of Birth8.
9. Country of Citizenship or Nationality
7. City/Town/Village
of Birth
6. Marital Status
WidowedDivorced
Single
Married
U.S. Social Security Number (if any)3.
►
4. Date of Birth (mm/dd/yyyy)
5. Gender Male Female
10.a. Family Name
(Last Name)
10.b. Given Name
(First Name)
10.c.
Middle Name
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.
Other Names Used
USA
FL
USA
CO
SMITH
JANE
JOAN
AUSTRALIA
AUSTRALIA
SYDNEY
02/13/1975
DOALLY
JANE
JOAN
Form I-129F 04/10/17 N
Page 5 of 13
Part 2. Information About Your Beneficiary
(continued)
Mailing Address for Your Beneficiary
11.b. Street Number
and Name
11.d. City or Town
11.e. State
11.f.
ZIP Code
11.g. Province
In Care Of Name
11.a.
Country11.i.
11.c.
Apt.
Flr.Ste.
11.h. Postal Code
Your Beneficiary's Address History
12.a.
12.c.
12.d.
12.b.
12.f.
12.h.
13.a.
Date To (mm/dd/yyyy)13.b.
12.g.
City or Town
Province
Country
Postal Code
ZIP Code12.e.State
Street Number
and Name
Flr.Apt. Ste.
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.
Beneficiary's Physical Address 1
Date From (mm/dd/yyyy)
14.a.
14.c.
14.d.
14.b.
14.f.
14.h.
15.a.
Date To (mm/dd/yyyy)15.b.
14.g.
City or Town
Province
Country
Postal Code
ZIP Code14.e.State
Street Number
and Name
Flr.Apt. Ste.
Beneficiary's Physical Address 2
Date From (mm/dd/yyyy)
Your Beneficiary's 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 need extra space to complete
this section, use the space provided in Part 8. Additional
Information.
Full Name of Employer16.
17.a.
17.c.
17.d.
17.b.
17.f.
17.h.
19.a.
19.b.
17.g.
City or Town
Province
Country
Postal Code
ZIP Code17.e.State
Street Number
and Name
Flr.Apt. Ste.
Employment Start Date (mm/dd/yyyy)
Employment End Date (mm/dd/yyyy)
Beneficiary's Occupation (specify)18.
Beneficiary's Employer 1
SYDNEY
35 Chamberlain Street
AUSTRALIA
NSW
12345
PRESENT
08/12/2009
BETA COMPUTING
PRESENT
SYDNEY
NSW
12345
AUSTRALIA
08/12/2009
ACCOUNTANT
Form I-129F 04/10/17 N
Page 6 of 13
Part 2. Information About Your Beneficiary
(continued)
Full Name of Employer20.
21.a.
21.c.
21.d.
21.b.
21.f.
21.h.
23.a.
23.b.
21.g.
City or Town
Province
Country
Postal Code
ZIP Code21.e.State
Street Number
and Name
Flr.Apt. Ste.
Employment Start Date (mm/dd/yyyy)
Employment End Date (mm/dd/yyyy)
Beneficiary's Occupation (specify)22.
Beneficiary's Employer 2
Information About Your Beneficiary's Parents
24.a. Family Name
(Last Name)
24.b. Given Name
(First Name)
24.c. Middle Name
Parent 1's Information
25. Date of Birth (mm/dd/yyyy)
26. Gender Male Female
28.b. Country of Residence
Country of Birth27.
28.a. City/Town/Village of Residence
29.a. Family Name
(Last Name)
29.b. Given Name
(First Name)
29.c. Middle Name
Parent 2's Information
30. Date of Birth (mm/dd/yyyy)
31. Gender Male Female
33.b. Country of Residence
Country of Birth32.
33.a. City/Town/Village of Residence
Other Information About Your Beneficiary
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.
Has your beneficiary ever been previously married?34.
Yes No
Name of Previous Spouse
35.a. Family Name
(Last Name)
35.b. Given Name
(First Name)
35.c.
Middle Name
36. Date Marriage Ended
(mm/dd/yyyy)
Has your beneficiary ever been in the United States? 37.
Yes No
If your beneficiary is currently in the United States, complete
Item Numbers 38.a. - 38.h.
He or she last entered as a (for example, visitor, student,
exchange alien, crewman, stowaway, temporary worker,
without inspection):
38.a.
38.b. I-94 Arrival-Departure Record Number
►
Date of Arrival (mm/dd/yyyy)38.c.
DOALLY
JACK
JONES
07/07/2045
AUSTRALIA
AUSTRALIA
SYDNEY
DOALLY
EMILY
JANE
09/20/1951
AUSTRALIA
AUSTRALIA
SYDNEY
SMITH
JOHN
JERRY
VISITOR
1 2 3 4 5 6 7 8 9 0 0
04/17/2017
Form I-129F 04/10/17 N
Page 7 of 13
Part 2. Information About Your Beneficiary
(continued)
38.g.
Country of Issuance for Passport or Travel Document
38.h.
Expiration Date for Passport or Travel Document
(mm/dd/yyyy)
Passport Number38.e.
Travel Document Number38.f.
Date authorized stay expired or will expire as shown on
Form I-94 or I-95 (mm/dd/yyyy)
38.d.
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.
Does your beneficiary have any children?39.
Yes No
40.a. Family Name
(Last Name)
40.b. Given Name
(First Name)
Middle Name
40.c.
Children of Beneficiary
Country of Birth 41.
42. Date of Birth (mm/dd/yyyy)
Does this child reside with your beneficiary?43.
Yes No
Address in the United States Where Your
Beneficiary Intends to Live
45.a. Street Number
and Name
45.c. City or Town
45.d.
State
45.e.
ZIP Code
45.b.
Apt.
Flr.Ste.
Daytime Telephone Number46.
Your Beneficiary's Physical Address Abroad
47.a. Street Number
and Name
47.c. City or Town
47.d. Province
47.f. Country
48.
Ste. Flr.
Apt.
47.b.
Daytime Telephone Number
47.e. Postal Code
44.a. Street Number
and Name
44.c. City or Town
44.d. State 44.e. ZIP Code
44.f.
44.g.
Province
44.h. Country
44.b.
Apt.
Flr.Ste.
Postal Code
If the child does not reside with your beneficiary, provide the
child's physical residence.
Your Beneficiary's Name and Address in His or
Her Native Alphabet
49.a. Family Name
(Last Name)
49.b. Given Name
(First Name)
49.c.
Middle Name
50.a. Street Number
and Name
50.e. Postal Code
50.f. Country
City or Town50.c.
50.b.
Apt.
Flr.
Ste.
50.d. Province
Australia
09/05/2022
123456789
10/17/2017
81658
VAIL
183 Gore Creek Drive
CO
2223334444
AUSTRALIA
NSW
35 Chamberlain Street
SYDNEY
61292597000
12345
Form I-129F 04/10/17 N
Page 8 of 13
Part 2. Information About Your Beneficiary
(continued)
Is your fiancé(e) related to you?
51.
Yes
No
Provide the nature and degree of relationship (for example,
third cousin or maternal uncle).
52.
Have you and your fiancé(e) met in person during the two
years immediately before filing this petition?
53.
N/A, beneficiary is my spouse
N/A, beneficiary is my spouseNoYes
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.
54.
60.a. Street Number
and Name
60.c. City or Town
60.d.
60.e.
Province
60.f. Country
60.b.
Apt.
Flr.Ste.
Postal Code
Organization Name of IMB
59.
Website of IMB
58.
61. Daytime Telephone Number
City or Town
Your beneficiary will apply for a visa abroad at the U.S.
Embassy or U.S. Consulate at:
62.a.
62.b. Country
Consular Processing Information
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.
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.
International Marriage Broker (IMB) Information
Did you meet your beneficiary through the services of an
IMB?
55.
Yes No
57.a. Family Name of IMB (Last Name)
Given Name of IMB (First Name)57.b.
IMB's Name (if any)56.
Part 3. Other Information
Have you EVER been subject to a temporary or
permanent protection or restraining order (either civil or
criminal)?
1.
Yes No
Criminal Information
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.
Have you EVER been arrested or convicted of any of the
following crimes:
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.")
2.a.
Yes No
N/A, beneficiary is my spouse.
SYDNEY
AUSTRALIA
Form I-129F 04/10/17 N
Page 9 of 13
Part 3. Other Information (continued)
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?
2.b.
Yes No
Three or more arrests or convictions, not from a single
act, for crimes relating to a controlled substance or
alcohol?
2.c.
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.
Multiple Filer Waiver Request Information
Refer to Part 3. Types of Waivers in the Specific Instructions
section of the Instructions for an explanation of the filing
waivers.
Multiple Filer, No Permanent Restraining Orders or
Convictions for a Specified Offense (General
Waiver)
Indicate which one of the following waivers you are requesting:
Multiple Filer, Prior Permanent Restraining Orders or
Criminal Conviction for Specified Offense
(Extraordinary Circumstances Waiver)
Multiple Filer, Prior Permanent Restraining Order or
Criminal Convictions for Specified Offense Resulting
from Domestic Violence (Mandatory Waiver)
Not applicable, beneficiary is my spouse or I am not
a multiple filer
5.a.
5.b.
5.c.
5.d.
Part 4. Biographic Information
1.
2.
Not Hispanic or Latino
Hispanic or Latino
Ethnicity (Select only one box)
Race (Select all applicable boxes)
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
White
Asian
Black or African American
Height Feet Inches3.
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 drug-
related or involved a fine of $500 or more)?
4.a.
NoYes
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.
4.b.
4. Weight Pounds
Black Brown
Green
Maroon
Pink
HazelGray
Blue
5. Eye Color (Select only one box)
Unknown/Other
Hair Color (Select only one box) 6.
Black
Brown Red
White
Unknown/
Other
Sandy
Gray
BlondBald (No hair)
6
0
1
8
0
Form I-129F 04/10/17 N
Page 10 of 13
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.a.
NOTE: Select the box for either Item Number 1.a. or 1.b. If
applicable, select the box for Item Number 2.
Part 5. Petitioner's Statement, Contact
Information, Declaration, and Signature
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
,
a language in which I am fluent, and I understood
everything.
NOTE: Read the Penalties section of the Form I-129F
Instructions before completing this part.
Petitioner's Statement
At my request, the preparer named in Part 7.,
,
2.
prepared this petition for me based only upon
information I provided or authorized.
Petitioner's Contact Information
Petitioner's Mobile Telephone Number (if any)4.
Petitioner's Email Address (if any)5.
Petitioner's Daytime Telephone Number3.
Petitioner's Signature
6.a. Petitioner's Signature (sign in ink)
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.
2)
3)
I reviewed and understood all of the information in,
and submitted with, my petition; and
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.
Part 6. Interpreter's Contact Information,
Certification, and Signature
Interpreter's Given Name (First Name)1.b.
Interpreter's Family Name (Last Name)1.a.
Interpreter's Business or Organization Name (if any)2.
Interpreter's Full Name
Provide the following information about the interpreter.
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 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:
1) I provided or authorized all of the information
contained in, and submitted with, my petition;
Interpreter's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
Postal Code
Street Number
and Name
3.a.
3.b.
Apt.
Flr.Ste.
3.g.
3.h. Country
Province
MYEMAIL@GMAIL.COM
2223334444
2223334444
Don't forget to sign!
09/17/2017
Form I-129F 04/10/17 N
Page 11 of 13
Interpreter's Daytime Telephone Number4.
Interpreter's Email Address (if any)6.
Interpreter's Contact Information
Interpreter's Certification
I certify, under penalty of perjury, that:
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.
I am fluent in English and
,
Date of Signature (mm/dd/yyyy)7.b.
Interpreter's Signature (sign in ink)7.a.
Interpreter's Signature
Part 6. Interpreter's Contact Information,
Certification, and Signature (continued)
Interpreter's Mobile Telephone Number (if any)5.
Preparer's Mailing Address
3.c. City or Town
3.d. State 3.e. ZIP Code
3.f.
Postal Code
Street Number
and Name
3.a.
3.b.
Apt.
Flr.Ste.
3.g.
3.h. Country
Province
Preparer's Contact Information
Preparer's Mobile Telephone Number (if any)5.
Preparer's Daytime Telephone Number4.
Preparer's Email Address (if any)6.
Part 7. Contact Information, Declaration, and
Signature of the Person Preparing this Petition, if
Other Than the Petitioner
Preparer's Full Name
Provide the following information about the preparer.
1.a. Preparer's Family Name (Last Name)
Preparer's Given Name (First Name)1.b.
Preparer's Business or Organization Name (if any)2.
Preparer's Statement
I am not an attorney or accredited representative but
have prepared this petition on behalf of the petitioner
and with the petitioner's consent.
I am an attorney or accredited representative and my
representation of the petitioner in this case
does not extend beyond the
7.a.
7.b.
preparation of this petition.
extends
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,
or G-28I, Notice of Entry of Appearance as Attorney
In Matters Outside the Geographical Confines of the
United States, with this petition.
Form I-129F 04/10/17 N
Page 12 of 13
Part 7. Contact Information, Declaration, and
Signature of the Person Preparing this Petition, if
Other Than the Petitioner (continued)
8.a. Preparer's Signature (sign in ink)
8.b. Date of Signature (mm/dd/yyyy)
Preparer's Certification
Preparer's Signature
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.
Form I-129F 04/10/17 N
Page 13 of 13
Part 8. Additional Information
3.d.
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
3.a. 3.b. 3.c.Page Number
Part Number
Item Number
A-Number (if any) ►
A-
2.
4.d.
4.a. 4.b. 4.c.Page Number Part Number Item Number
5.d.
5.a. 5.b. 5.c.Page Number Part Number Item Number
6.d.
6.a. 6.b. 6.c.Page Number Part Number
Item Number
7.d.
7.a. 7.b. 7.c.Page Number Part Number
Item Number
SMITH
JOHN
JERRY
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INS-Form-I-129F-K3 Petition for Alien Fianc(e)

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Completed 3 July 2020

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