Part 4. Information About Beneficiary
24.
Date Marriage Ended (mm/dd/yyyy)
N/A
(continued)
Information About Beneficiary's Family
15.
Mobile Telephone Number (if any)
N/A
Provide information about the beneficiary's spouse and
children.
16.
Email Address (if any)
Person 1
N/A
25.a. Family Name
N/A
(Last Name)
Beneficiary's Marital Information
25.b. Given Name
N/A
(First Name)
17.
How many times has the beneficiary been married?
►
25.c. Middle Name
1
N/A
18.
Current Marital Status
26.
Relationship
N/A
Single, Never Married
Married
Divorced
27.
Date of Birth (mm/dd/yyyy)
N/A
Widowed
Separated
Annulled
28.
Country of Birth
19.
Date of Current Marriage (if currently married)
N/A
(mm/dd/yyyy)
N/A
Person 2
Place of Beneficiary's Current Marriage
(if married)
29.a. Family Name
N/A
(Last Name)
20.a.
City or Town
N/A
29.b. Given Name
N/A
(First Name)
20.b.
State
N/A
29.c. Middle Name
N/A
20.c.
Province
N/A
30.
Relationship
N/A
20.d.
Country
31.
Date of Birth (mm/dd/yyyy)
N/A
N/A
32.
Country of Birth
Names of Beneficiary's Spouses (if any)
N/A
Provide information on the beneficiary's current spouse (if
currently married) first and then list all the beneficiary's prior
Person 3
spouses (if any).
33.a.
Family Name
N/A
(Last Name)
Spouse 1
33.b.
Given Name
N/A
21.a. Family Name
(First Name)
Moodley
(Last Name)
33.c.
Middle Name
N/A
21.b. Given Name
John
(First Name)
34.
Relationship
N/A
21.c. Middle Name
N/A
35.
Date of Birth (mm/dd/yyyy)
N/A
22.
Date Marriage Ended (mm/dd/yyyy)
04/03/2015
36.
Country of Birth
N/A
Spouse 2
23.a. Family Name
N/A
(Last Name)
23.b. Given Name
N/A
(First Name)
23.c. Middle Name
N/A
Form I-130 02/27/17 N
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