Form I-129 - Petition For A Nonimmigrant Worker - Department Of Homeland Security Page 34
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36Section 1. Complete This Section If You Are Filing For An R-1 Religious Worker (continued)
Employer or Organization Address (do not use a post office or private mail box)
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
Employer or Organization's Contact Information
Daytime Telephone Number
Fax Number
Email Address (if any)
Section 2. This Section Is Required For Petitioners Affiliated With The Religious Denomination
Religious Denomination Certification
I certify, under penalty of perjury, that:
Name of Employing Organization
is affiliated with:
Name of Religious Denomination
and that the attesting organization within the religious denomination is tax-exempt as described in section 501(c)(3) of the Internal
Revenue Code of 1986 (codified at 26 U.S.C. 501(c)(3)), any subsequent amendment(s), subsequent amendment, or equivalent
sections of prior enactments of the Internal Revenue Code. The contents of this certification are true and correct to the best of my
knowledge.
Title
Name of Authorized Representative of Attesting Organization
Signature of Authorized Representative of Attesting Organization
Date (mm/dd/yyyy)
Attesting Organization Name and Address (do not use a post office or private mail box)
Attesting Organization Name
Street Number and Name
Apt.
Ste.
Flr.
Number
City or Town
State
ZIP Code
Attesting Organization's Contact Information
Daytime Telephone Number
Fax Number
Email Address (if any)
Form I-129 08/13/15 Y
R-1 Classification Supplement
Page 34 of 36
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