Fillable Uscic Form 1-130 - Petition For Alien Relative (Page 2 of 2) in pdf

C. Information about your relative (continued)

17. List spouse and all children of your relative.

(Name)

(Relationship)

(Date of Birth)

(Country of Birth)

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

(Town or City)

(State)

(Street Address)

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 foreign address in the native alphabet.

Address (Include street, city, province and country):

(Name)

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

From:

To:

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:

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)

(State)

(City)

(Country

NOTE: Designation of a U.S. embassy or consulate outside the country of your relative's last residence does not guarantee acceptance for

processing by that post. Acceptance is at the discretion of the designated embassy or consulate.

D. 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

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 U.S. Citizenship and Immigration Services needs to determine eligiblity for

the benefit that I am seeking.

E. Signature of petitioner

(

)

Date

Phone Number

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

I declare that I prepared this document at the request of the person above and that it is based on all information of which I have any knowledge.

Signature

Print Name

Date

Address