Form I-140 - Immigrant Petition For Alien Worker Page 3

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Part 7. Information on Spouse and All Children of the Person for Whom You Are Filing
List husband/wife and all children related to the individual for whom the petition is being filed. Provide an attachment of additional family
members, if needed.
Name (First/Middle/Last)
Date of Birth (mm/dd/yyyy)
Country of Birth
Relationship
Read the information on penalties in the instructions before completing this section. If someone helped you prepare this
Part 8.
Signature.
petition, he or she must complete Part 9.
I certify, under penalty of perjury under the laws of the United States of America, that this petition and the evidence submitted with it are all true and
correct. I authorize U.S. Citizenship and Immigration Services to release to other government agencies any information from my USCIS records, if
USCIS determines that such action is necessary to determine eligibility for the benefit sought.
Petitioner's Signature
Daytime Phone Number (Area/Country Codes)
E-Mail Address
Print Name
Date (mm/dd/yyyy)
NOTE: If you do not fully complete this form or fail to submit the required documents listed in the instructions, a final decision on your petition
may be delayed or the petition may be denied.
Part 9.
Signature of Person Preparing Form, If Other Than Above
(Sign below)
I declare that I prepared this petition at the request of the above person and it is based on all information of which I have knowledge.
Attorney or Representative: In the event of a Request for Evidence (RFE), may USCIS contact you by Fax or E-mail
Yes
No
?
Signature
Date (mm/dd/yyyy)
Print Name
Firm Name and Address
Daytime Phone Number (Area/Country Codes)
Fax Number (Area/Country Codes)
E-Mail Address
Form I-140 (Rev. 06/12/09) Y Page 3

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