Form I-140 - Immigrant Petition For Alien Worker Page 2
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3
4
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6Part 3. Information About the Person for Whom You Are Filing
1.a. Family Name
9.
Country of Citizenship
(Last Name)
1.b. Given Name
(First Name)
Country of Nationality
10.
1.c. Middle Name
Alien Registration Number (A-Number)
11.
Mailing Address
A-
In Care of Name
2.a.
12.
U.S. Social Security Number (if any)
must be 9 digits; no dashes
2.b.
Street Number
and Name
2.c. Apt.
Ste.
Flr.
If in the United States, please provide the following
(complete all sections, as applicable):
2.d. City or Town
13.
Date of Arrival (mm/dd/yyyy)
2.e. State
2.f.
Zip Code
I-94 Arrival-Departure Record Number :
14.a.
2.g. Postal Code
2.h. Province
Passport Number
14.b.
Country
2.i.
14.c.
Travel Document Number
Other Information
14.d. Country of Issuance for Passport or Travel Document
E-mail Address (if any)
3.
14.e. Expiration Date for Passport or Travel Document
(
)
(mm/dd/yyyy)
Daytime Phone Number
-
4.
15.
Current Nonimmigrant Status
Date of Birth (mm/dd/yyyy)
5.
City/Town/Village of Birth
6.
Date Status Expires:
16.
(mm/dd/yyyy)
State/Province of Birth
7.
Country of Birth
8.
Part 4. Processing Information
1.b.
Alien is in the United States and will apply for
Complete the following for the person named in Part 3:
adjustment of status to that of lawful permanent
(Check one)
resident.
Alien will apply for a visa abroad at a U.S. Embassy
1.a.
or consulate at:
Alien's country of current residence or, if now in the
City or Town
United States, last country of permanent residence
abroad.
Country
Form I-140 03/05/13 N
Page 2 of 6
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