Fillable Form I-129f - Petition For Alien Fiance(E) (Page 9 of 13) in pdf

Part 3. Other Information (continued)

Multiple Filer Waiver Request Information

2.b.

Homicide, murder, manslaughter, rape, abusive sexual

Refer to Part 3. Types of Waivers in the Specific Instructions

contact, sexual exploitation, incest, torture, trafficking,

section of the Instructions for an explanation of the filing

peonage, holding hostage, involuntary servitude, slave

waivers.

trade, kidnapping, abduction, unlawful criminal restraint,

Indicate which one of the following waivers you are requesting:

false imprisonment, or an attempt to commit any of these

crimes?

Yes

5.a.

Multiple Filer, No Permanent Restraining Orders or

Convictions for a Specified Offense (General

2.c.

Three or more arrests or convictions, not from a single

Waiver)

act, for crimes relating to a controlled substance or

alcohol?

Yes

5.b.

Multiple Filer, Prior Permanent Restraining Orders or

Criminal Conviction for Specified Offense

NOTE: If you were ever arrested or convicted of any of the

(Extraordinary Circumstances Waiver)

specified crimes, you must submit certified copies of all court

Multiple Filer, Prior Permanent Restraining Order or

5.c.

and police records showing the charges and disposition for

Criminal Convictions for Specified Offense Resulting

every arrest or conviction. You must do so even if your records

from Domestic Violence (Mandatory Waiver)

were sealed, expunged, or otherwise cleared, and regardless of

whether anyone, including a judge, law enforcement officer, or

5.d.

Not applicable, beneficiary is my spouse or I am not

attorney, informed you that you no longer have a criminal

a multiple filer

record. If you need extra space to complete this section, use the

space provided in Part 8. Additional Information.

Part 4. Biographic Information

If you have provided information about a conviction for a crime

listed in Item Numbers 2.a. - 2.c. and you were being battered

Ethnicity (Select only one box)

or subjected to extreme cruelty at the time of your conviction,

Hispanic or Latino

select all of the following that apply to you:

Not Hispanic or Latino

3.a.

I was acting in self-defense.

Race (Select all applicable boxes)

3.b.

I violated a protection order issued for my own

White

protection.

Asian

3.c.

I committed, was arrested for, was convicted of, or

Black or African American

pled guilty to a crime that did not result in serious

American Indian or Alaska Native

bodily injury and there was a connection between the

Native Hawaiian or Other Pacific Islander

crime and me having been battered or subjected to

extreme cruelty.

Height

Feet

Inches

Have you ever been arrested, cited, charged, indicted,

4.a.

convicted, fined, or imprisoned for breaking or violating

Weight

Pounds

any law or ordinance in any country, excluding traffic

violations (unless a traffic violation was alcohol- or drug-

Eye Color (Select only one box)

related or involved a fine of $500 or more)?

Black

Blue

Brown

Yes

Gray

Green

Hazel

If the answer to Item Number 4.a. is "Yes," provide

4.b.

Maroon

Pink

Unknown/Other

information about each of those arrests, citations, charges,

Hair Color (Select only one box)

indictments, convictions, fines, or imprisonments in the

space below. If you were the subject of an order of

Bald (No hair)

Black

Blond

protection or restraining order and believe you are the

Brown

Gray

Red

victim, please explain those circumstances and provide

Sandy

White

Unknown/

any evidence to support your claims. Include the dates

Other

and outcomes. If you need extra space to complete this

section, use the space provided in Part 8. Additional

Information.

Form I-129F 04/10/17 N

Page 9 of 13

Form I-129f - Petition For Alien Fiance(E) Page 9

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