Form I-130 - Petition For Alien Relative Page 2
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12Part 2. Information About You (Petitioner)
Address History
(continued)
Provide your physical addresses for the last five years, whether
inside or outside the United States. Provide your current
Other Names Used (if any)
address first if it is different from your mailing address in Item
Numbers 10.a. - 10.i.
Provide all other names you have ever used, including aliases,
maiden name, and nicknames.
Physical Address 1
5.a. Family Name
12.a.
Street Number
(Last Name)
and Name
5.b. Given Name
12.b.
Apt.
Ste.
Flr.
(First Name)
5.c. Middle Name
12.c.
City or Town
12.d.
State
12.e. ZIP Code
Other Information
12.f.
Province
6.
City/Town/Village of Birth
12.g.
Postal Code
7.
Country of Birth
12.h.
Country
8.
Date of Birth (mm/dd/yyyy)
13.a.
Date From (mm/dd/yyyy)
9.
Sex
Male
Female
13.b.
Date To (mm/dd/yyyy)
Mailing Address
Physical Address 2
10.a.
14.a.
In Care Of Name
Street Number
and Name
14.b.
Apt.
Ste.
Flr.
10.b.
Street Number
and Name
14.c.
City or Town
10.c.
Apt.
Ste.
Flr.
14.d.
State
14.e. ZIP Code
10.d.
City or Town
14.f.
Province
10.e.
10.f.
State
ZIP Code
14.g.
Postal Code
10.g.
Province
14.h.
Country
10.h.
Postal Code
10.i.
Country
15.a.
Date From (mm/dd/yyyy)
15.b.
Date To (mm/dd/yyyy)
11.
Is your current mailing address the same as your physical
address?
Yes
No
Your Marital Information
If you answered "No" to Item Number 11., provide
16.
How many times have you been married?
►
information on your physical address in Item Numbers 12.a. -
13.b.
17.
Current Marital Status
Single, Never Married
Married
Divorced
Widowed
Separated
Annulled
Form I-130 02/27/17 N
Page 2 of 12
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