Form I-129f - Petition For Alien Fiance(E) Page 6

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Part 4. Signature of Petitioner
Penalties
Moreover, I understand that this petition, including any criminal
You may by law be imprisoned for not more than 5 years, or
conviction information that I am required to provide with this
fined $250,000, or both, for entering into a marriage contract for
petition, as well as any related criminal background information
the purpose of evading any provision of the immigration laws,
pertaining to me that U.S. Citizenship and Immigration Services
and you may be fined up to $10,000 or imprisoned upon to five
may discover independently in adjudicating this petition will be
years, or both, for knowingly and willfully falsifying or
disclosed to the beneficiary of this petition.
concealing a material fact or using any false document in
1.a. Signature of Petitioner
submitting this petition.
Your Certification
1.b. Date of Signature (mm/dd/yyyy) ►
I certify that I am legally able to and intend to marry my alien
fiancé(e) within 90 days of his or her arrival in the United
(
)
2.
Daytime Phone Number
-
States. I certify, under penalty of perjury under the laws of the
United States of America, that the foregoing is true and correct.
(
)
3.
Mobile Phone Number
-
Furthermore, I authorize the release of any information from my
records that U.S. Citizenship and Immigration Services needs to
4.
E-mail Address (if any)
determine eligibility for the benefit that I am seeking.
Part 5. Signature of Person Preparing This Petition, If Other Than the Petitioner
NOTE: If you are an attorney or representative, you must submit
Preparer's Mailing Address
a completed Form G-28, Notice of Entry of Appearance as
Attorney or Accredited Representative, along with this Petition.
5.a. Street Number
and Name
Form G-28 submitted with this Petition.
5.b. Apt.
Ste.
Flr.
G-28 ID Number
5.c. City or Town
Preparer's Full Name
5.d. State
5.e. Zip Code
1.a.
Preparer's Family Name (Last Name)
5.f.
Postal Code
1.b.
Preparer's Given Name (First Name)
5.g. Province
5.h. Country
2.
Preparer's Business or Organization Name
Declaration
To be completed by all preparers, including attorneys and
Preparer's Contact Information
authorized representatives: I declare that I prepared this benefit
3.
Preparer's Daytime Phone Number
Extension
request at the request of the Petitioner, that it is based on all the
information of which I have knowledge, and that the information
(
)
-
is true to the best of my knowledge.
6.a. Signature
4.
Preparer's E-mail Address (if any)
of Preparer
6.b. Date of Signature (mm/dd/yyyy) ►
Form I-129F 06/13/13 N
Page 6 of 6

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