Form I-130 - Petition For Alien Relative Page 8
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12The beneficiary will not apply for adjustment of status in
Part 4. Information About Beneficiary
the United States, but he or she will apply for an immigrant
(continued)
visa abroad at the U.S. Embassy or U.S. Consulate in:
If the beneficiary's native written language does not use
62.a.
City or Town
Roman letters, type or print his or her name and foreign
address in their native written language.
62.b.
Province
57.a.
Family Name
(Last Name)
62.c.
Country
57.b.
Given Name
(First Name)
57.c. Middle Name
NOTE: Choosing a U.S. Embassy or U.S. Consulate outside
the country of the beneficiary's last residence does not
58.a.
Street Number
guarantee that it will accept the beneficiary's case for
and Name
processing. In these situations, the designated U.S. Embassy or
58.b.
Apt.
Ste.
Flr.
U.S. Consulate has discretion over whether or not to accept the
beneficiary's case.
58.c. City or Town
Part 5. Other Information
58.d.
Province
1.
Have you EVER previously filed a petition for this
58.e. Postal Code
beneficiary or any other alien?
Yes
No
58.f. Country
If you answered "Yes," provide the name, place, date of filing,
and the result.
2.a.
Family Name
If filing for your spouse, provide the last address at which
(Last Name)
you physically lived together. If you never lived together,
2.b.
Given Name
type or print, "Never lived together" in Item Number 59.a.
(First Name)
59.a.
Street Number
2.c.
Middle Name
and Name
59.b.
Apt.
Ste.
Flr.
3.a. City or Town
59.c. City or Town
3.b. State
59.d. State
59.e. ZIP Code
4.
Date Filed (mm/dd/yyyy)
5.
Result (for example, approved, denied, withdrawn)
59.f.
Province
59.g. Postal Code
If you are also submitting separate petitions for other relatives,
59.h.
Country
provide the names of and your relationship to each relative.
Relative 1
6.a.
Family Name
60.a.
Date From (mm/dd/yyyy)
(Last Name)
6.b.
Given Name
60.b.
Date To (mm/dd/yyyy)
(First Name)
6.c.
Middle Name
The beneficiary is in the United States and will apply for
adjustment of status to that of a lawful permanent resident
7.
Relationship
at the U.S. Citizenship and Immigration Services (USCIS)
office in:
61.a.
City or Town
61.b.
State
Form I-130 02/27/17 N
Page 8 of 12
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