Form I-140 - Immigrant Petition For Alien Worker Page 2
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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)
10.
Country of Nationality
1.c. Middle Name
11.
Alien Registration Number (A-Number)
Mailing Address
►
A-
2.a.
In Care of Name
12.
U.S. Social Security Number (if any)
2.b.
Street Number
must be 9 digits; no dashes
►
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
Date of Arrival (mm/dd/yyyy) ►
13.
2.e. State
2.f.
Zip Code
14.a.
I-94 Arrival-Departure Record Number:
2.g. Postal Code
►
2.h. Province
14.b.
Passport Number
2.i.
Country
14.c.
Travel Document Number
Other Information
14.d. Country of Issuance for Passport or Travel Document
3.
E-mail Address (if any)
14.e. Expiration Date for Passport or Travel Document
(mm/dd/yyyy) ►
(
)
4.
Daytime Phone Number
-
15.
Current Nonimmigrant Status
Date of Birth (mm/dd/yyyy) ►
5.
6.
City/Town/Village of Birth
16.
Date Status Expires:
►
(mm/dd/yyyy)
7.
State/Province of Birth
8.
Country of Birth
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.
1.a.
Alien will apply for a visa abroad at a U.S. Embassy
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 01/17/17 N
Page 2 of 6
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