Fillable INS-Form-I-130 Form I-130

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INS-Form-I-130 Form I-130

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Form I-130 02/27/17 N Page 1 of 12
Petition for Alien Relative
Department of Homeland Security
U.S. Citizenship and Immigration Services
For USCIS Use Only
Did you gain lawful permanent resident status or
citizenship through adoption?
USCIS
Form I-130
OMB No. 1615-0012
Expires 07/31/2018
Attorney State Bar Number
(if applicable)
Select this box if
Form G-28 is
attached.
Volag Number
(if any)
Attorney or Accredited Representative
USCIS Online Account Number (if any)
To be completed by an attorney or accredited representative (if any).
START HERE - Type or print in black ink.►
A-Number
Remarks
Action StampFee Stamp
Petition was filed on (Priority Date mm/dd/yyyy):
PDR request granted/denied - New priority date (mm/dd/yyyy):
Previously Forwarded
I-485 Filed Simultaneously
Ben. A-File Reviewed
204(a)(2)(A) Resolved
203(g) Resolved
204(g) Resolved
Field Investigation
201(b) Spouse - IR-1/CR-1
201(b) Child - IR-2/CR-2
201(b) Parent - IR-5
203(a)(1) Unm. S/D - F1-1
203(a)(2)(A) Spouse - F2-1
203(a)(2)(A) Child - F2-2
203(a)(2)(B) Unm. S/D - F2-4
203(a)(3) Married S/D - F3-1
203(a)(4) Brother/Sister - F4-1
Section of Law/Visa Category
Resubmitted
Initial Receipt
Completed
Sent
Received
Approved
Returned
Relocated
Part 1. Relationship (You are the Petitioner. Your
relative is the Beneficiary)
1. I am filing this petition for my (Select only one box):
Child was adopted (not an Orphan or Hague
Convention adoptee)
Stepchild/Stepparent
3.
4.
If the beneficiary is your brother/sister, are you related by
adoption?
2. If you are filing this petition for your child or parent,
select the box that describes your relationship (Select only
one box):
Child was born to parents who were married to each
other at the time of the child's birth
Child was born to parents who were not married to
each other at the time of the child's birth
A-
Your Full Name
4.a. Family Name
(Last Name)
4.b. Given Name
(First Name)
4.c. Middle Name
3. U.S. Social Security Number (if any)
Personal Interview
Pet. A-File Reviewed
Spouse Brother/SisterParent Child
Yes
NoYes
No
►
Part 2. Information About You (Petitioner)
1. Alien Registration Number (A-Number) (if any)
USCIS Online Account Number (if any)2.
►
A-
►
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.
At which USCIS office (e.g., NBC, VSC, LOS, CRO) was Form I-130 adjudicated?
1 2 3 4 5 6 7 8 9
SMITH
John
Jerry
Form I-130 02/27/17 N Page 2 of 12
Part 2. Information About You (Petitioner)
(continued)
7. Country of Birth
8. Date of Birth (mm/dd/yyyy)
9. Sex Male Female
Mailing Address
10.b.
10.c.
10.d.
10.e.
10.g.
10.i.
10.h.
11. Is your current mailing address the same as your physical
address?
Yes No
10.a.
City or Town
Province
Country
Postal Code
ZIP Code10.f.State
Street Number
and Name
Apt. Ste. Flr.
In Care Of Name
14.c.
14.f.
14.h.
14.g.
14.d.
14.a.
14.b.
Street Number
and Name
Apt. Ste. Flr.
City or Town
State 14.e. ZIP Code
Province
Country
Postal Code
Physical Address 2
If you answered "No" to Item Number 11., provide
information on your physical address in Item Numbers 12.a. -
13.b.
Date From (mm/dd/yyyy)13.a.
Date To (mm/dd/yyyy)13.b.
Date From (mm/dd/yyyy)15.a.
Date To (mm/dd/yyyy)15.b.
12.c.
12.f.
12.h.
12.g.
12.d.
12.a.
12.b.
Street Number
and Name
Apt. Ste. Flr.
City or Town
State 12.e. ZIP Code
Province
Country
Postal Code
Physical Address 1
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.
Other Information
6. City/Town/Village of Birth
Other Names Used (if any)
Provide all other names you have ever used, including aliases,
maiden name, and nicknames.
5.a. Family Name
(Last Name)
5.b. Given Name
(First Name)
5.c. Middle Name
17.
How many times have you been married?16.
Current Marital Status
Your Marital Information
►
Widowed AnnulledSeparated
Single, Never Married Married Divorced
11/21/1975
USA
183 Gore Creek Dr
Vail
82658
CO
USA
3444 Denver Lane
Denver
CO
80204
USA
05/13/2016
05/13/2004
05/12/2016
Norwalk
PRESENT
Form I-130 02/27/17 N Page 3 of 12
20.a. Family Name
(Last Name)
20.b. Given Name
(First Name)
20.c.
Middle Name
Names of All Your Spouses (if any)
Spouse 1
Provide information on your current spouse (if currently married)
first and then list all your prior spouses (if any).
Place of Your Current Marriage (if married)
Part 2. Information About You (Petitioner)
(continued)
Date Marriage Ended (mm/dd/yyyy)23.
24.c.
Middle Name22.c.
Given Name
(First Name)
22.b.
Family Name
(Last Name)
22.a.
Spouse 2
21. Date Marriage Ended (mm/dd/yyyy)
18. Date of Current Marriage (if currently married)
(mm/dd/yyyy)
Parent 1's Information
Information About Your Parents
Given Name
(First Name)
Middle Name
Family Name
(Last Name)
25. Date of Birth (mm/dd/yyyy)
28.
Country of Residence
City/Town/Village of Residence
29.
Country of Birth
30.a.
Parent 2's Information
Given Name
(First Name)
Middle Name
Family Name
(Last Name)
31. Date of Birth (mm/dd/yyyy)
33.
34.
Country of Residence
City/Town/Village of Residence
35.
Country of Birth
Additional Information About You (Petitioner)
36. I am a (Select only one box):
U.S. Citizen Lawful Permanent Resident
If you are a U.S. citizen, complete Item Number 37.
My citizenship was acquired through (Select only one
box):
Birth in the United States
Naturalization
Parents
If you answered "Yes" to Item Number 38., complete the
following:
Certificate Number39.a.
Have you obtained a Certificate of Naturalization or a
Certificate of Citizenship?
38.
Yes No
27.
37.
39.c. Date of Issuance (mm/dd/yyyy)
Place of Issuance39.b.
Full Name of Parent 1
Full Name of Parent 2
24.a.
24.b.
30.b.
30.c.
26. Sex
Male Female
32. Sex
Male Female
19.a. City or Town
19.b. State
19.c. Province
19.d. Country
SMITH
Jane
Joan
06/09/2017
SMITH
Robert
Edward
04/20/1945
Tampa
USA
USA
Julia
Lawrence
SMITH
08/21/1949
Tampa
USA
USA
Vail
CO
USA
Form I-130 02/27/17 N Page 4 of 12
If you are a lawful permanent resident, complete Item
Numbers 40.a. - 41.
40.a. Class of Admission
40.b. Date of Admission (mm/dd/yyyy)
Place of Admission
40.c. City or Town
Did you gain lawful permanent resident status through
marriage to a U.S. citizen or lawful permanent resident?
41.
NoYes
Part 2. Information About You (Petitioner)
(continued)
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.
City or Town43.c.
43.f.
43.h.
Province
Country
43.g. Postal Code
ZIP Code43.e.State43.d.
Street Number
and Name
43.a.
43.b. Apt. Ste. Flr.
Employer 1
42. Name of Employer/Company
City or Town47.c.
47.f.
47.h.
Province
Country
47.g. Postal Code
ZIP Code47.e.State47.d.
Street Number
and Name
47.a.
47.b. Apt. Ste. Flr.
48. Your Occupation
Date From (mm/dd/yyyy)49.a.
Date To (mm/dd/yyyy)49.b.
1.
Not Hispanic or Latino
Hispanic or Latino
Ethnicity (Select only one box)
Race (Select all applicable boxes)
Native Hawaiian or Other Pacific Islander
Black or African American
American Indian or Alaska Native
2.
Asian
White
Height3. Feet Inches
Weight Pounds4.
Part 3. Biographic Information
NOTE: Provide the biographic information about you, the
petitioner.
Employer 2
46. Name of Employer/Company
44. Your Occupation
Date From (mm/dd/yyyy)45.a.
Date To (mm/dd/yyyy)45.b.
Black
Gray Green
Maroon Pink
Hazel
BrownBlue
Eye Color (Select only one box)5.
Unknown/Other
40.d State
223 Hilly Way
Vail
81658
CO
USA
Acme Engineering
1234 Milo Lane
Denver
80204
CO
USA
Engineer
05/13/2006
05/12/2016
6
0
1
8
0
Expert Engineering Services
Engineer
05/13/2016
PRESENT
Form I-130 02/27/17 N Page 5 of 12
Part 4. Information About Beneficiary
1. Alien Registration Number (A-Number) (if any)
►
A-
USCIS Online Account Number (if any)2.
►
3. U.S. Social Security Number (if any)
►
Beneficiary's Full Name
4.a. Family Name
(Last Name)
4.b. Given Name
(First Name)
4.c. Middle Name
5.a. Family Name
(Last Name)
5.b. Given Name
(First Name)
5.c. Middle Name
Other Names Used (if any)
Provide all other names the beneficiary has ever used, including
aliases, maiden name, and nicknames.
Other Information About Beneficiary
6. City/Town/Village
of Birth
7. Country of Birth
11.f.
11.h.
11.g.
Province
Country
Postal Code
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.
12.c.
12.d.
City or Town
State 12.e. ZIP Code
Street Number
and Name
12.a
12.b. Apt. Ste. Flr.
Other Address and Contact Information
13.c. City or Town
13.e. Postal Code
13.f. Country
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.
Street Number
and Name
13.a.
Apt. Ste. Flr.13.b.
13.d. Province
Beneficiary's Physical Address
11.a.
11.b.
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.
Street Number
and Name
Apt. Ste. Flr.
11.c.
11.d.
City or Town
ZIP Code11.e.State
8. Date of Birth (mm/dd/yyyy)
9. Sex Male Female
Hair Color (Select only one box)
Black
Brown Red
White
Unknown/OtherSandy
Gray
BlondBald (No hair)
6.
Part 3. Biographic Information (continued)
Has anyone else ever filed a petition for the beneficiary?10.
Yes No Unknown
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.
SMITH
Jane
Joan
DOALLY
Jane
Joan
Sydney
Australia
NSW
12345
Australia
183 Gore Creek
Vail
82658
CO
SAME
35 Chamberlain street
Sydney
02/13/1975
Form I-130 02/27/17 N Page 6 of 12
18.
17.
Current Marital Status
►
Widowed AnnulledSeparated
Single, Never Married Married Divorced
How many times has the beneficiary been married?
Part 4. Information About Beneficiary
(continued)
16. Email Address (if any)
Mobile Telephone Number (if any)15.
Beneficiary's Marital Information
20.a.
20.b.
20.c.
20.d.
Place of Beneficiary's Current Marriage
(if married)
19. Date of Current Marriage (if currently married)
(mm/dd/yyyy)
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).
23.a. Family Name
(Last Name)
23.b. Given Name
(First Name)
23.c. Middle Name
Spouse 2
21.a. Family Name
(Last Name)
21.b. Given Name
(First Name)
21.c. Middle Name
22. Date Marriage Ended (mm/dd/yyyy)
Spouse 1
Date Marriage Ended (mm/dd/yyyy)24.
Provide information about the beneficiary's spouse and
children.
Relationship26.
Person 1
25.a. Family Name
(Last Name)
25.b. Given Name
(First Name)
25.c. Middle Name
Information About Beneficiary's Family
Date of Birth (mm/dd/yyyy)27.
Country of Birth28.
Relationship
Date of Birth (mm/dd/yyyy)
Country of Birth
30.
31.
32.
Person 2
29.a. Family Name
(Last Name)
29.b. Given Name
(First Name)
29.c. Middle Name
Country of Birth
Middle Name33.c.
Given Name
(First Name)
33.b.
Family Name
(Last Name)
33.a.
Person 3
36.
35.
34.
Date of Birth (mm/dd/yyyy)
Relationship
City or Town
State
Country
Province
6155543354
email@gmail.com
06/09/2017
SMITH
John
Jerry
Spouse
SMITH
John
Jerry
11/21/1975
USA
Vail
CO
USA
Form I-130 02/27/17 N Page 7 of 12
Middle Name37.c.
Given Name
(First Name)
37.b.
Family Name
(Last Name)
37.a.
Person 4
40.
39.
38.
Country of Birth
Date of Birth (mm/dd/yyyy)
Relationship
Person 5
41.a. Family Name
(Last Name)
41.b. Given Name
(First Name)
41.c. Middle Name
Relationship42.
Part 4. Information About Beneficiary
(continued)
Country of Birth44.
Date of Birth (mm/dd/yyyy)43.
Beneficiary's Entry Information
Was the beneficiary EVER in the United States?45.
Yes No
If the beneficiary is currently in the United States, complete
Items Numbers 46.a. - 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
46.d.
He or she arrived as a (Class of Admission):46.a.
46.b. Form I-94 Arrival-Departure Record Number
►
Date of Arrival (mm/dd/yyyy)46.c.
Passport Number47.
Travel Document Number48.
49. Country of Issuance for Passport or Travel Document
50. Expiration Date for Passport or Travel Document
(mm/dd/yyyy)
Beneficiary's Employment Information
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.c.
City or Town
51.e. State 51.f. ZIP Code
Name of Current Employer (if applicable)
51.d.
Street Number
and Name
51.a.
51.b.
Apt. Ste. Flr.
51.g. Province
Date Employment Began (mm/dd/yyyy)52.
Was the beneficiary EVER in immigration proceedings?53.
NoYes
City or Town
Removal Exclusion/Deportation
Rescission Other Judicial Proceedings
If you answered "Yes," select the type of proceedings and
provide the location and date of the proceedings.
54.
55.a.
51.h. Postal Code
51.i. Country
Additional Information About Beneficiary
55.b. State
Date (mm/dd/yyyy)56.
10/17/2017
WT - VISITOR FOR PLEASURE - VWPP
1 2 3 4 5 6 7 8 9 0 0
04/17/2017
1234567890
Australia
09/14/2022
Beta Computing
555 West Way Drive
Sydney
NSW
08/12/2009
12345
Australia
Form I-130 02/27/17 N Page 8 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.c. Middle Name
57.a.
57.b.
Family Name
(Last Name)
Given Name
(First Name)
58.c. City or Town
58.f. Country
Province58.d.
Street Number
and Name
58.a.
58.b.
Apt. Ste. Flr.
58.e. Postal Code
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.
59.c. City or Town
59.d. State 59.e. ZIP Code
Street Number
and Name
59.a.
Apt. Ste. Flr.59.b.
Country59.h.
Province59.f.
Date From (mm/dd/yyyy)60.a.
Date To (mm/dd/yyyy)60.b.
59.g. Postal Code
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:
City or Town
Country
Province
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.
62.a.
62.b.
62.c.
Part 5. Other Information
Have you EVER previously filed a petition for this
beneficiary or any other alien?
1.
Yes No
If you answered "Yes," provide the name, place, date of filing,
and the result.
2.a.
2.b.
2.c.
Family Name
(Last Name)
Given Name
(First Name)
Middle Name
Date Filed (mm/dd/yyyy)4.
Result (for example, approved, denied, withdrawn)5.
3.b. State
3.a. City or Town
State
City or Town61.a.
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:
61.b.
If you are also submitting separate petitions for other relatives,
provide the names of and your relationship to each relative.
6.a.
6.b.
6.c.
Relationship7.
Family Name
(Last Name)
Given Name
(First Name)
Middle Name
Relative 1
NEVER LIVED TOGETHER
Sydney
NSW
Australia
Form I-130 02/27/17 N Page 9 of 12
Part 5. Other Information (continued)
Petitioner's Daytime Telephone Number3.
Petitioner's Contact Information
Petitioner's Email Address (if any)5.
Petitioner's Mobile Telephone Number (if any)4.
Middle Name
Given Name
(First Name)
Family Name
(Last Name)
9. Relationship
8.c.
8.b.
8.a.
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.
Relative 2
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.
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 6. Petitioner's Statement, Contact
Information, Declaration, and Signature
Petitioner's Statement
NOTE: Read the Penalties section of the Form I-130
Instructions before completing this part.
The interpreter named in Part 7. read to me every
question and instruction on this petition and my
answer to every question in
1.b.
a language in which I am fluent. I understood all of
this information as interpreted.
,
2. At my request, the preparer named in Part 8.,
,
prepared this petition for me based only upon
information I provided or authorized.
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;
2) I reviewed and understood all of the information in,
and submitted with, my petition; and
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
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.
Date of Signature (mm/dd/yyyy)
6.b.
Petitioner's Signature (sign in ink)6.a.
2223334444
email@gmail.com
2223334444
09/17/2017
Don't forget to sign in ink!
Form I-130 02/27/17 N Page 10 of 12
Interpreter's Given Name (First Name)1.b.
Interpreter's Family Name (Last Name)1.a.
Interpreter's Full Name
Part 7. Interpreter's Contact Information,
Certification, and Signature
Provide the following information about the interpreter if you
used one.
Interpreter's Business or Organization Name (if any)2.
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. Ste. Flr.
3.g.
3.h. Country
Province
Interpreter's Certification
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.
I certify, under penalty of perjury, that:
,
Interpreter's Signature
Date of Signature (mm/dd/yyyy)7.b.
Interpreter's Signature (sign in ink)7.a.
Preparer's Given Name (First Name)1.b.
2. Preparer's Business or Organization Name (if any)
Preparer's Full Name
Provide the following information about the preparer.
1.a. Preparer's Family Name (Last Name)
Part 8. Contact Information, Declaration, and
Signature of the Person Preparing this Petition, if
Other Than the Petitioner
Interpreter's Contact Information
Interpreter's Daytime Telephone Number4.
Interpreter's Email Address (if any)6.
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. Ste. Flr.
3.g.
3.h. Country
Province
Form I-130 02/27/17 N Page 11 of 12
Preparer's Contact Information
Preparer's Mobile Telephone Number (if any)5.
Preparer's Daytime Telephone Number4.
Part 8. Contact Information, Declaration, and
Signature of the Person Preparing this Petition, if
Other Than the Petitioner (continued)
Preparer's Email Address (if any)6.
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.
7.a.
I am an attorney or accredited representative and my
representation of the petitioner in this case
7.b.
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.
extends does not extend beyond the preparation
of this petition.
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 Certification
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 12 of 12
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.
A-Number (if any) ►
A-
3.a.
2.
Page Number 3.b. Part Number 3.c. Item Number
3.d.
Page Number
Part Number Item Number
Page Number Part Number Item Number5.a.
Page Number
5.b.
Part Number
5.c.
Item Number
5.d.
1.b.
1.c.
1.a. Family Name
(Last Name)
Given Name
(First Name)
Middle Name
4.c.4.b.
4.d.
4.a.
6.d.
6.c.6.b.6.a.
Page Number Part Number Item Number
7.d.
7.c.7.b.7.a.
SMITH
John
Jerry
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INS-Form-I-130 Form I-130

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Completed 3 July 2020

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