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
Moodley
Same as mailing address
(Last Name)
and Name
5.b. Given Name
12.b.
Apt.
Ste.
Flr.
Jacob
N/A
(First Name)
5.c. Middle Name
12.c.
City or Town
N/A
N/A
12.d.
State
12.e. ZIP Code
N/A
N/A
Other Information
12.f.
Province
N/A
6.
City/Town/Village of Birth
Durban
12.g.
Postal Code
N/A
7.
Country of Birth
12.h.
Country
South Africa
N/A
8.
Date of Birth (mm/dd/yyyy)
05/08/1982
13.a.
Date From (mm/dd/yyyy)
09/18/2003
9.
Sex
Male
Female
13.b.
Date To (mm/dd/yyyy)
PRESENT
Mailing Address
Physical Address 2
10.a.
In Care Of Name
14.a.
Street Number
N/A
and Name
14.b.
Apt.
Ste.
Flr.
N/A
10.b.
Street Number
1 Main St
and Name
14.c.
City or Town
N/A
10.c.
Apt.
Ste.
Flr.
N/A
14.d.
State
14.e. ZIP Code
N/A
N/A
10.d.
City or Town
Austin
14.f.
Province
N/A
10.e.
State
10.f.
ZIP Code
TX
78710
14.g.
Postal Code
N/A
10.g.
Province
N/A
14.h.
Country
10.h.
Postal Code
N/A
N/A
10.i.
Country
15.a.
Date From (mm/dd/yyyy)
N/A
United States
15.b.
Date To (mm/dd/yyyy)
N/A
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?
1
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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