Form I-129 - Petition For A Nonimmigrant Worker - Department Of Homeland Security Page 4
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26Part 5. Basic information about the proposed employment and employer (
Attach the supplement relating to the
classification you are requesting.) (Continued)
9. Type of Petitioner - Check one:
Organization
Other - explain on separate paper
U.S. citizen or permanent resident
10. Type of Business
11. Year Established
12. Current Number of Employees
13. Gross Annual Income
14. Net Annual Income
Part 6. Signature
Read the information on penalties in the instructions before completing this section.
I certify, under penalty of perjury under the laws of the United States of America, that this petition and the evidence submitted with it
is all true and correct. If filing this on behalf of an organization, I certify that I am empowered to do so by that organization. If this
petition is to extend a prior petition, I certify that the proposed employment is under the same terms and conditions as stated in the
prior approved petition. I authorize the release of any information from my records, or from the petitioning organization's records that
U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit being sought.
Signature
Daytime Phone Number (Area/Country Code)
(
)
Print Name
Date (mm/dd/yyyy)
NOTE: If you do not completely fill out this form and the required supplement, or fail to submit required documents listed in the
instructions, the person(s) filed for may not be found eligible for the requested benefit and this petition may be denied.
Part 7. Signature of person preparing form, if other than above
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 any
knowledge.
Signature
Daytime Phone Number (Area/Country Code)
(
)
Print Name
Date (mm/dd/yyyy)
Firm Name and Address
Form I-129 (Rev. 06/12/09)Y Page 4
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