Form I-129f - Petition For Alien Fiance(E)
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6USCIS
Petition for Alien Fiancé(e)
Form I-129F
Department of Homeland Security
OMB No. 1615-0001
U.S. Citizenship and Immigration Services
Expires 06/30/2016
Action Block
Fee Stamp
For USCIS Use Only
Case ID Number
A-Number
G-28 Number
The petition is approved for status
Extraordinary Circumstances Waiver
under Section 101(a)(5)(k). It is
Reason
valid for 4 months from the date
Approved
of action.
Denied
General Waiver
Mandatory Waiver
AMCON:
Reason
Reason
Approved
Approved
Denied
Denied
Personal Interview
Previously Forwarded
Document Check
Field Investigation
Relocated
Completed
Remarks
Initial Receipt
Received
Approved
No
IMBRA
Yes (DOS disclosure to
Resubmitted
Applies?
the beneficiary required)
Sent
Returned
►
START HERE - Type or print in black ink.
Part 1. Information About You
1.a
Family Name
(mm/dd/yyyy) ►
6.
Date of Birth
11/01/1985
Doe
(Last Name)
1.b. Given Name
7.
Gender
Male
Female
John
(First Name)
8.
Marital Status
1.c. Middle Name
Mid
Married
Widowed
Single
Divorced
Your Mailing Address
Other Names Used
2.a.
In Care of Name
9.a. Family Name
(Last Name)
John M Doe
9.b. Given Name
2.b. Street Number
(First Name)
123 Main Lane
and Name
9.c. Middle Name
2.c. Apt.
1E
Ste.
Flr.
10.
U.S. Social Security Number (if any)
2.d. City or Town
Smalltown
►
1 2 3 4 5 6 7 8 9
2.e. State
2.f.
Zip Code
NY
12345
Name of Prior Spouse 1
2.g. Postal Code
11.a. Family Name
Doe
(Last Name)
2.h. Province
11.b. Given Name
Mary
(First Name)
2.i.
Country
USA
11.c. Middle Name
Mid
3.
Alien Registration Number (A-Number)
11.d. Date Marriage Ended
►
(mm/dd/yyyy) ►
A-
12/01/2014
4.
City/Town/Village of Birth
Name of Prior Spouse 2
New York City, NY
12.a. Family Name
(Last Name)
5.
Country of Birth
12.b. Given Name
(First Name)
USA
Form I-129F 06/13/13 N
Page 1 of 6
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