Fillable Form I-129f - Petition For Alien Fiance(E) (Page 3 of 3) in pdf

Part C. Other information.

1. If you are serving overseas in the Armed Forces of the United States, please answer the following:

I presently reside or am stationed overseas and my current mailing address is:

2. Have you ever been convicted by a court of law (civil or criminal) or court martialed by a military tribunal for any of the

following crimes:

Domestic violence, sexual assault, child abuse and neglect, dating violence, elder abuse or stalking. (Please refer to page 3 of

the instructions for the full definition of the term "domestic violence.)

Homicide, murder, manslaughter, rape, abusive sexual contact, sexual exploitation, incest, torture, trafficking, peonage,

holding hostage, involuntary servitude, slave trade, kidnapping, abduction, unlawful criminal restraint, false imprisonment or

an attempt to commit any of these crimes, or

Three or more convictions for crimes relating to a controlled substance or alcohol not arising from a single act.

Yes

Answering this question is required even if your records were sealed or otherwise cleared or if anyone, including a judge, law

enforcement officer, or attorney, told you that you no longer have a record. Using a separate sheet(s) of paper, attach information

relating to the conviction(s), such as crime involved, date of conviction and sentence.

3. If you have provided information about a conviction for a crime listed above and you were being battered or subjected to

extreme cruelty by your spouse, parent, or adult child at the time of your conviction, check all of the following that apply to

you:

I was acting in self-defense.

I violated a protection order issued for my own protection.

I committed, was arrested for, was convicted of, or plead guilty to committing a crime that did not result in serious bodily

injury, and there was a connection between the crime committed and my having been battered or subjected to extreme cruelty.

Part D. Penalties, certification and petitioner's signature.

PENALTIES:

You may by law be imprisoned for not more than five years, or fined $250,000, or both, for entering into a marriage

contract for the purpose of evading any provision of the immigration laws, and you may be fined up to $10,000 or imprisoned up to five

years, or both, for knowingly and willfully falsifying or concealing a material fact or using any false document in submitting this petition.

YOUR CERTIFICATION:

I am legally able to and intend to marry my alien fiancé(e) within 90 days of his or her arrival in the United

States. I certify, under penalty of perjury under the laws of the United States of America, that the foregoing is true and correct.

Furthermore, I authorize the release of any information from my records that U.S. Citizenship and Immigration Services needs to

determine eligibility for the benefit that I am seeking.

Moreover, I understand that this petition, including any criminal conviction information that I am required to provide with this petition, as

well as any related criminal background information pertaining to me that U.S. Citizenship and Immigration Services may discover

independently in adjudicating this petition will be disclosed to the beneficiary of this petition.

Signature

Date (mm/dd/yyyy)

Daytime Telephone Number (with area code)

E-Mail Address (if any)

Part E. Signature of person preparing form, if other than above.

(Sign below.)

I declare that I prepared this application at the request of the petitioner and it is based on all information of which I have knowledge.

Print or Type Your Name

G-28 ID Number

Date (mm/dd/yyyy)

Signature

Firm Name and Address

Daytime Telephone Number (with area code)

E-Mail Address (if any)

Form I-129F (Rev. 11/23/10) Y Page 3

Form I-129f - Petition For Alien Fiance(E) Page 3

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