Form I-130 - Petition For Alien Relative Page 5
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12Part 3. Biographic Information (continued)
Beneficiary's Physical Address
6.
Hair Color (Select only one box)
If the beneficiary lives outside the United States in a home
without a street number or name, leave Item Numbers 11.a.
Bald (No hair)
Black
Blond
and 11.b. blank.
Brown
Gray
Red
11.a.
Street Number
Sandy
White
Unknown/Other
and Name
11.b.
Apt.
Ste.
Flr.
Part 4. Information About Beneficiary
11.c.
City or Town
1.
Alien Registration Number (A-Number) (if any)
A-
►
11.d.
State
11.e.
ZIP Code
2.
USCIS Online Account Number (if any)
11.f.
Province
►
11.g.
Postal Code
3.
U.S. Social Security Number (if any)
11.h.
Country
►
Beneficiary's Full Name
Other Address and Contact Information
4.a. Family Name
(Last Name)
Provide the address in the United States where the beneficiary
4.b. Given Name
intends to live, if different from Item Numbers 11.a. - 11.h. If
(First Name)
the address is the same, type or print "SAME" in Item Number
12.a.
4.c. Middle Name
12.a
Street Number
and Name
Other Names Used (if any)
12.b.
Apt.
Ste.
Flr.
Provide all other names the beneficiary has ever used, including
aliases, maiden name, and nicknames.
12.c.
City or Town
5.a. Family Name
(Last Name)
12.d.
State
12.e. ZIP Code
5.b. Given Name
Provide the beneficiary's address outside the United States, if
(First Name)
different from Item Numbers 11.a. - 11.h. If the address is the
5.c. Middle Name
same, type or print "SAME" in Item Number 13.a.
13.a.
Street Number
Other Information About Beneficiary
and Name
13.b.
Apt.
Ste.
Flr.
6.
City/Town/Village of Birth
13.c. City or Town
7.
Country of Birth
13.d. Province
13.e. Postal Code
8.
Date of Birth (mm/dd/yyyy)
13.f. Country
9.
Sex
Male
Female
10.
Has anyone else ever filed a petition for the beneficiary?
14.
Daytime Telephone Number (if any)
Yes
No
Unknown
NOTE: Select "Unknown" only if you do not know, and
the beneficiary also does not know, if anyone else has
ever filed a petition for the beneficiary.
Form I-130 02/27/17 N
Page 5 of 12
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