Form I-***F Edition **/**/** Page * of **

Petition for Alien Fiancé(e)

Department of Homeland Security

U.S. Citizenship and Immigration Services

Resubmitted

Initial Receipt

For USCIS Use Only

USCIS

Form I-129F

OMB No. 1615-0001

Expires 03/31/2024

START HERE - Type or print in black ink.

Part 1. Information About You

6.a. Family Name

(Last Name)

6.b. Given Name

(First Name)

6.c. Middle Name

Completed

Sent

Received Approved

Returned

Case ID Number

Personal Interview

Document Check

Previously Forwarded

Field Investigation

A-Number

G-28 Number

The petition is approved for status

under Section 101(a)(15)(K). It is

valid for 4 months and expires on:

AMCON:

General Waiver

Remarks

Action Block

Relocated

Fee Stamp

Approved Reason

Denied

Approved

Denied

Yes

Extraordinary Circumstances Waiver

Reason

Mandatory Waiver

Approved Reason

Denied

No

IMBRA disclosure to the beneficiary required?

A-

1. Alien Registration Number (A-Number) (if any)

3. U.S. Social Security Number (if any)

Your Full Name

Select one box below to indicate the classificationj you are requesting for your beneficiary:

Fiancé(e) (K-1 visa)

Spouse (K-3 visa)

4.a.

4.b.

If you are filing to classify your spouse as a K-3, have you filed Form I-130?

5.

Yes No

2. USCIS Online Account Number (if any)

7.b. Given Name

(First Name)

Your Mailing Address (USPS ZIP Code Lookup)

8.b.

8.d.

8.e.

8.g.

8.i.

8.a.

8.c.

8.h.

7.c. Middle Name

Other Names Used

Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

7.a. Family Name

(Last Name)

8.j. Is your current mailing address the same as your physical address? Yes No

If you answered "No," provide your physical address in Item Numbers 9.a. - 9.h.

City or Town

Province

Country

Postal Code

State 8.f. ZIP Code

Street Number

and Name

Apt. Ste. Flr.

In Care Of Name

N / A

N / A

N/A

N/A

N/A

Form I-129F Edition 03/21/22 Page 2 of 13

Your Address History

9.a.

9.c.

9.d.

9.b.

9.f.

Part 1. Information About You (continued)

9.h.

10.a.

10.b. Date To (mm/dd/yyyy)

9.g.

City or Town

Province

Country

Postal Code

State 9.e. ZIP Code

Street Number

and Name

Provide your physical addresses for the last five years, whether inside or outside the United States. Provide your current address first if it is different from your mailing address in Item Numbers 8.a. - 8.i. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

Physical Address 1

Date From (mm/dd/yyyy)

11.a.

11.c.

11.d.

11.b.

11.f.

11.h.

12.a.

12.b. Date To (mm/dd/yyyy)

11.g.

City or Town

Province

Country

Postal Code

State 11.e. ZIP Code

Street Number

and Name

Apt. Ste. Flr.

Physical Address 2

Date From (mm/dd/yyyy)

Your Employment History

Provide your employment history for the last five years, whether inside or outside the United States. Provide your current employment first. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

13. Full Name of Employer

14.a.

14.c.

14.d.

14.b.

14.f.

14.h.

16.a.

16.b.

14.g.

City or Town

Province

Country

Postal Code

State 14.e. ZIP Code

Street Number

and Name

Apt. Ste. Flr.

Employment Start Date (mm/dd/yyyy)

Employment End Date (mm/dd/yyyy)

Employer 2

15. Your Occupation (specify)

Employer 1

17. Full Name of Employer

18.a.

18.c.

18.d.

18.b.

18.f.

18.h.

18.g.

City or Town

Province

Country

Postal Code

State 18.e. ZIP Code

Street Number

and Name

Apt. Ste. Flr.

19. Your Occupation (specify)

Apt. Ste. Flr.

PRESENT

PRESENT

Form I-129F Edition 03/21/22 Page 3 of 13

Part 1. Information About You (continued)

20.a.

20.b.

Employment Start Date

(mm/dd/yyyy)

Employment End Date

(mm/dd/yyyy)

24. City/Town/Village of Birth

25.

26. Country of Birth

Province or State of Birth

23. Marital Status

Single Married Divorced Widowed

22. Date of Birth (mm/dd/yyyy)

21. Gender Male Female

Other Information

Information About Your Parents

27.a. Family Name

(Last Name)

27.b. Given Name

(First Name)

27.c. Middle Name

Parent 1's Information

28. Date of Birth (mm/dd/yyyy)

29. Gender Male Female

31.b. Country of Residence

30. Country of Birth

31.a. City/Town/Village of Residence

32.a. Family Name

(Last Name)

32.b. Given Name

(First Name)

32.c. Middle Name

Parent 2's Information

33. Date of Birth (mm/dd/yyyy)

34. Gender Male Female

36.b. Country of Residence

35. Country of Birth

36.a. City/Town/Village of Residence

If you answered "Yes" to Item Number 37., provide the names of each spouse and the date that each prior marriage ended in Item Numbers 38.a. - 39. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

37. Have you ever been previously married?

Yes No

Name of Previous Spouse

38.a. Family Name

(Last Name)

38.b. Given Name

(First Name)

38.c. Middle Name

39. Date Marriage Ended (mm/dd/yyyy)

Your Citizenship Information

You are a U.S. citizen through (select only one box): 40.a. Birth in the United States

40.b. Naturalization

40.c. U.S. citizen parents

Have you obtained a Certificate of Naturalization or a Certificate of Citizenship in your own name?

41.

Yes No

If you answered "Yes" to Item Number 41., complete Item Numbers 42.a. - 42.c.

Form I-129F Edition 03/21/22 Page 4 of 13

Part 1. Information About You (continued)

Certificate Number

Place of Issuance

42.a.

42.b.

42.c. Date of Issuance (mm/dd/yyyy)

45.a. Family Name

(Last Name)

45.b. Given Name

(First Name)

45.c. Middle Name

46. Date of Filing (mm/dd/yyyy)

What action did USCIS take on Form I-129F (for

example, approved, denied, revoked)?

47.

If you answered "Yes" to Item Number 43., provide the responses to Item Number 44. - 46. for each previous beneficiary. If you need to provide information for more than one beneficiary, use the space provided in Part 8. Additional Information.

44. A-Number (if any) A-

Have you ever filed Form I-129F for any other

beneficiary?

43.

Yes No

Additional Information

If you answered "Yes" to Item Number 48., provide the ages for your children under 18 years of age in Item Numbers 49.a. - 49.b. 48. Do you have any children under 18 years of age? Yes No

Provide the ages for your children under 18 years of age. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

49.a. Age

49.b. Age

Provide all U.S. states and foreign countries in which you have resided since your 18th birthday.

Residence 1

50.b. Country

50.a. State

Residence 2

51.b. Country

51.a. State

Part 2. Information About Your Beneficiary

1.a. Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

A-

2. A-Number (if any)

8. Country of Birth

9. Country of Citizenship or Nationality

7. City/Town/Village of Birth

6. Marital Status

Single Married Divorced Widowed

3. U.S. Social Security Number (if any)

4. Date of Birth (mm/dd/yyyy)

5. Gender Male Female

10.a. Family Name

(Last Name)

10.b. Given Name

(First Name)

10.c. Middle Name

Provide all other names you have ever used, including aliases, maiden name, and nicknames. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

Other Names Used

Form I-129F Edition 03/21/22 Page 5 of 13

Part 2. Information About Your Beneficiary

(continued)

Mailing Address for Your Beneficiary

11.b. Street Number

and Name

11.d. City or Town

11.e. State 11.f. ZIP Code

11.g. Province

11.a. In Care Of Name

11.i. Country

11.c. Apt. Ste. Flr.

11.h. Postal Code

Your Beneficiary's Address History

12.a.

12.c.

12.d.

12.b.

12.f.

12.h.

13.a.

13.b. Date To (mm/dd/yyyy)

12.g.

City or Town

Province

Country

Postal Code

State 12.e. ZIP Code

Street Number

and Name

Apt. Ste. Flr.

Provide your beneficiary's physical addresses for the last five years, whether inside or outside the United States. Provide your beneficiary's current address first if it is different from the mailing address in Item Numbers 11.a. - 11.i. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

Beneficiary's Physical Address 1

Date From (mm/dd/yyyy)

14.a.

14.c.

14.d.

14.b.

14.f.

14.h.

15.a.

15.b. Date To (mm/dd/yyyy)

14.g.

City or Town

Province

Country

Postal Code

State 14.e. ZIP Code

Street Number

and Name

Apt. Ste. Flr.

Beneficiary's Physical Address 2

Date From (mm/dd/yyyy)

Your Beneficiary's Employment History

Provide your employment history for the last five years, whether inside or outside the United States. Provide your current employment first. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

16. Full Name of Employer

17.a.

17.c.

17.d.

17.b.

17.f.

17.h.

19.a.

19.b.

17.g.

City or Town

Province

Country

Postal Code

State 17.e. ZIP Code

Street Number

and Name

Apt. Ste. Flr.

Employment Start Date (mm/dd/yyyy)

Employment End Date (mm/dd/yyyy)

18. Beneficiary's Occupation (specify)

Beneficiary's Employer 1

PRESENT

PRESENT

#11 10 Street Luke Rd. Luzhu

Dist.

#52 1293 Zhongshan Rd. Luzhu

Dist.

#52 1293 Zhongshan Rd. Luzhu

Dist.

Sumplicio 2nd St. Compound Par City

328 Edang St., Brgy. 149

Simplicio 2nd St. Compound Par City

328 362 Edang Xiaoxinying St., Brgy. Shanhua 149 Dist. Form I-129F Edition 03/21/22 Page 6 of 13

Part 2. Information About Your Beneficiary

(continued)

20. Full Name of Employer

21.a.

21.c.

21.d.

21.b.

21.f.

21.h.

23.a.

23.b.

21.g.

City or Town

Province

Country

Postal Code

State 21.e. ZIP Code

Street Number

and Name

Apt. Ste. Flr.

Employment Start Date (mm/dd/yyyy)

Employment End Date (mm/dd/yyyy)

22. Beneficiary's Occupation (specify)

Beneficiary's Employer 2

Information About Your Beneficiary's Parents

24.a. Family Name

(Last Name)

24.b. Given Name

(First Name)

24.c. Middle Name

Parent 1's Information

25. Date of Birth (mm/dd/yyyy)

26. Gender Male Female

28.b. Country of Residence

27. Country of Birth

28.a. City/Town/Village of Residence

29.a. Family Name

(Last Name)

29.b. Given Name

(First Name)

29.c. Middle Name

Parent 2's Information

30. Date of Birth (mm/dd/yyyy)

31. Gender Male Female

33.b. Country of Residence

32. Country of Birth

33.a. City/Town/Village of Residence

Other Information About Your Beneficiary

If you answered "Yes" to Item Number 34., provide the names of each prior spouse and the date each prior marriage ended in Item Numbers 35.a. - 36. If you need to provide information for more than one spouse, use the space provided in Part 8. Additional Information.

34. Has your beneficiary ever been previously married? Yes No

Name of Previous Spouse

35.a. Family Name

(Last Name)

35.b. Given Name

(First Name)

35.c. Middle Name

36. Date Marriage Ended

(mm/dd/yyyy)

37. Has your beneficiary ever been in the United States? Yes No

If your beneficiary is currently in the United States, complete Item Numbers 38.a. - 38.h.

He or she last entered as a (for example, visitor, student, exchange alien, crewman, stowaway, temporary worker, without inspection):

38.a.

38.b. I-94 Arrival-Departure Record Number

38.c. Date of Arrival (mm/dd/yyyy)

Advance Forces Security and Investigation

Services Inc.

MIA Terminal 3, EU State Tower

#30 Quezon Ave.

2nd

Form I-129F Edition 03/21/22 Page 7 of 13

Part 2. Information About Your Beneficiary

(continued)

38.g. Country of Issuance for Passport or Travel Document 38.h. Expiration Date for Passport or Travel Document

(mm/dd/yyyy)

38.e. Passport Number

38.f. Travel Document Number

Date authorized stay expired or will expire as shown on Form I-94 or I-95 (mm/dd/yyyy)

38.d.

If you answered "Yes" to Item Number 39., provide the following information about each child. If you need to provide information for more than one child, use the space provided in Part 8. Additional Information.

39. Does your beneficiary have any children?

Yes No

40.a. Family Name

(Last Name)

40.b. Given Name

(First Name)

40.c. Middle Name

Children of Beneficiary

41. Country of Birth

42. Date of Birth (mm/dd/yyyy)

43. Does this child reside with your beneficiary?

Yes No

Address in the United States Where Your

Beneficiary Intends to Live

45.a. Street Number

and Name

45.c. City or Town

45.d. State 45.e. ZIP Code

45.b. Apt. Ste. Flr.

46. Daytime Telephone Number

Your Beneficiary's Physical Address Abroad

47.a. Street Number

and Name

47.c. City or Town

47.d. Province

47.f. Country

48.

47.b. Apt. Ste. Flr.

Daytime Telephone Number

47.e. Postal Code

44.a. Street Number

and Name

44.c. City or Town

44.d. State 44.e. ZIP Code

44.f.

44.g.

Province

44.h. Country

44.b. Apt. Ste. Flr.

Postal Code

If the child does not reside with your beneficiary, provide the child's physical residence.

Your Beneficiary's Name and Address in His or

Her Native Alphabet

49.a. Family Name

(Last Name)

49.b. Given Name

(First Name)

49.c. Middle Name

50.a. Street Number

and Name

50.e. Postal Code

50.f. Country

50.c. City or Town

50.b. Apt. Ste. Flr.

50.d. Province

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

#52 1293 Zhongshan Rd. Luzhu

Dist.

Form I-129F Edition 03/21/22 Page 8 of 13

Part 2. Information About Your Beneficiary

(continued)

51. Is your fiancé(e) related to you?

Yes No

Provide the nature and degree of relationship (for example, third cousin or maternal uncle).

52.

Have you and your fiancé(e) met in person during the two years immediately before filing this petition?

53.

N/A, beneficiary is my spouse

Yes No N/A, beneficiary is my spouse

If you answered "Yes" to Item Number 53., describe the circumstances of your in-person meeting in Item Number 54. Attach evidence to demonstrate that you were in each other's physical presence during the required two year period. 54.

60.a. Street Number

and Name

60.c. City or Town

60.d.

60.e.

Province

60.f. Country

60.b. Apt. Ste. Flr.

Postal Code

Organization Name of IMB

59. Website of IMB

58.

61. Daytime Telephone Number

City or Town

Your beneficiary will apply for a visa abroad at the U.S. Embassy or U.S. Consulate at:

62.a.

62.b. Country

Consular Processing Information

If you answered "No," explain your reasons for requesting an exemption from the in person meeting requirement in Item Number 54. and provide evidence that you should be exempt from this requirement. Refer to Part 2., Item Numbers 53. - 54. of the Specific Instructions section of the Instructions for additional information about the requirement to meet. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

If you answered "Yes" to Item Number 55., provide the IMB's contact information and Website information below. In addition, attach a copy of the signed, written consent form the IMB obtained from your beneficiary authorizing your beneficiary's personal contact information to be released to you. International Marriage Broker (IMB) Information

Did you meet your beneficiary through the services of an IMB?

55.

Yes No

57.a. Family Name of IMB (Last Name)

57.b. Given Name of IMB (First Name)

56. IMB's Name (if any)

Part 3. Other Information

Have you EVER been subject to a temporary or

permanent protection or restraining order (either civil or criminal)?

1.

Yes No

Criminal Information

NOTE: These criminal information questions must be answered even if your records were sealed, cleared, or if anyone, including a judge, law enforcement officer, or attorney, told you that you no longer have a record. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

Have you EVER been arrested or convicted of any of the following crimes:

Domestic violence, sexual assault, child abuse, child neglect, dating violence, elder abuse, stalking or an attempt to commit any of these crimes? (See Part 3. Other Information, Item Numbers 1. - 3.c. of the

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

2.a.

Yes No

See attached "I-129F Supplement: Part

2, Question 54"

Form I-129F Edition 03/21/22 Page 9 of 13

Part 3. Other Information (continued)

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?

2.b.

Yes No

Three or more arrests or convictions, not from a single act, for crimes relating to a controlled substance or alcohol?

2.c.

Yes No

NOTE: If you were ever arrested or convicted of any of the specified crimes, you must submit certified copies of all court and police records showing the charges and disposition for every arrest or conviction. You must do so even if your records were sealed, expunged, or otherwise cleared, and regardless of whether anyone, including a judge, law enforcement officer, or attorney, informed you that you no longer have a criminal record. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

If you have provided information about a conviction for a crime listed in Item Numbers 2.a. - 2.c. and you were being battered or subjected to extreme cruelty at the time of your conviction, select all of the following that apply to you:

3.a. I was acting in self-defense.

3.b. I violated a protection order issued for my own protection.

3.c. I committed, was arrested for, was convicted of, or pled guilty to a crime that did not result in serious bodily injury and there was a connection between the crime and me having been battered or subjected to

extreme cruelty.

Multiple Filer Waiver Request Information

Refer to Part 3. Types of Waivers in the Specific Instructions section of the Instructions for an explanation of the filing waivers.

Multiple Filer, No Permanent Restraining Orders or Convictions for a Specified Offense (General

Waiver)

Indicate which one of the following waivers you are requesting: Multiple Filer, Prior Permanent Restraining Orders or Criminal Conviction for Specified Offense

(Extraordinary Circumstances Waiver)

Multiple Filer, Prior Permanent Restraining Order or Criminal Convictions for Specified Offense Resulting from Domestic Violence (Mandatory Waiver)

Not applicable, beneficiary is my spouse or I am not a multiple filer

5.a.

5.b.

5.c.

5.d.

Part 4. Biographic Information

1.

2.

Not Hispanic or Latino

Hispanic or Latino

Ethnicity (Select only one box)

Race (Select all applicable boxes)

Native Hawaiian or Other Pacific Islander

American Indian or Alaska Native

White

Asian

Black or African American

3. Height Feet Inches

Have you ever been arrested, cited, charged, indicted, convicted, fined, or imprisoned for breaking or violating any law or ordinance in any country, excluding traffic violations (unless a traffic violation was alcohol- or drug- related or involved a fine of $500 or more)?

4.a.

Yes No

If the answer to Item Number 4.a. is "Yes," provide information about each of those arrests, citations, charges, indictments, convictions, fines, or imprisonments in the space below. If you were the subject of an order of protection or restraining order and believe you are the victim, please explain those circumstances and provide any evidence to support your claims. Include the dates and outcomes. If you need extra space to complete this section, use the space provided in Part 8. Additional Information.

4.b.

4. Weight Pounds

Black Brown

Green

Maroon Pink

Gray Hazel

Blue

5. Eye Color (Select only one box)

Unknown/Other

6. Hair Color (Select only one box)

Black

Brown Red

White Unknown/

Other

Sandy

Gray

Bald (No hair) Blond

Form I-129F Edition 03/21/22 Page 10 of 13

I can read and understand English, and I have read and understand every question and instruction on this petition and my answer to every question.

1.a.

NOTE: Select the box for either Item Number 1.a. or 1.b. If applicable, select the box for Item Number 2.

Part 5. Petitioner's Statement, Contact

Information, Declaration, Certification, and

Signature

1.b. The interpreter named in Part 6. read to me every question and instruction on this petition and my

answer to every question in

,

a language in which I am fluent, and I understood

everything.

NOTE: Read the Penalties section of the Form I-129F Instructions before completing this part.

Petitioner's Statement

At my request, the preparer named in Part 7.,

,

2.

prepared this petition for me based only upon

information I provided or authorized.

Petitioner's Contact Information

4. Petitioner's Mobile Telephone Number (if any)

5. Petitioner's Email Address (if any)

3. Petitioner's Daytime Telephone Number

Petitioner's Signature

6.a. Petitioner's Signature

6.b. Date of Signature (mm/dd/yyyy)

NOTE TO ALL PETITIONERS: If you do not completely

fill out this petition or fail to submit required documents listed in the Instructions, USCIS may deny your petition. 2) All of this information was complete, true, and correct at the time of filing.

I certify, under penalty of perjury, that all of the information in my petition and any document submitted with it were provided or authorized by me, that I reviewed and understand all of the information contained in, and submitted with my petition, and that all of this information is complete, true, and correct. Part 6. Interpreter's Contact Information,

Certification, and Signature

1.b. Interpreter's Given Name (First Name)

1.a. Interpreter's Family Name (Last Name)

2. Interpreter's Business or Organization Name (if any) Interpreter's Full Name

Provide the following information about the interpreter. Petitioner's Declaration and Certification

Copies of any documents I have submitted are exact photocopies of unaltered, original documents, and I understand that USCIS may require that I submit original documents to USCIS at a later date. Furthermore, I authorize the release of any information from any and all of my records that USCIS may need to determine my eligibility for the immigration benefit that I seek. I furthermore authorize release of information contained in this petition, in supporting documents, and in my USCIS records, to other entities and persons where necessary for the administration and enforcement of U.S. immigration law.

I understand that USCIS may require me to appear for an appointment to take my biometrics (fingerprints, photograph, and/or signature) and, at that time, if I am required to provide biometrics, I will be required to sign an oath reaffirming that: 1)

Interpreter's Mailing Address

3.c. City or Town

3.d. State 3.e. ZIP Code

3.f.

Postal Code

Street Number

and Name

3.a.

3.b. Apt. Ste. Flr.

3.g.

3.h. Country

Province

I reviewed and understood all of the information

contained in, and submitted with, my petition; and N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Form I-129F Edition 03/21/22 Page 11 of 13

4. Interpreter's Daytime Telephone Number

6. Interpreter's Email Address (if any)

Interpreter's Contact Information

Interpreter's Certification

I certify, under penalty of perjury, that:

which is the same language specified in Part 5., Item Number 1.b., and I have read to this petitioner in the identified language every question and instruction on this petition and his or her answer to every question. The petitioner informed me that he or she understands every instruction, question, and answer on the petition, including the Petitioner's Declaration and Certification, and has verified the accuracy of every answer. I am fluent in English and,

7.b. Date of Signature (mm/dd/yyyy)

7.a. Interpreter's Signature

Interpreter's Signature

Part 6. Interpreter's Contact Information,

Certification, and Signature (continued)

5. Interpreter's Mobile Telephone Number (if any)

Preparer's Mailing Address

3.c. City or Town

3.d. State 3.e. ZIP Code

3.f.

Postal Code

Street Number

and Name

3.a.

3.b. Apt. Ste. Flr.

3.g.

3.h. Country

Province

Preparer's Contact Information

5. Preparer's Mobile Telephone Number (if any)

4. Preparer's Daytime Telephone Number

6. Preparer's Email Address (if any)

Part 7. Contact Information, Declaration, and

Signature of the Person Preparing this Petition, if Other Than the Petitioner

Preparer's Full Name

Provide the following information about the preparer. 1.a. Preparer's Family Name (Last Name)

1.b. Preparer's Given Name (First Name)

2. Preparer's Business or Organization Name (if any) Preparer's Statement

I am not an attorney or accredited representative but have prepared this petition on behalf of the petitioner and with the petitioner's consent.

I am an attorney or accredited representative and my representation of the petitioner in this case

does not extend beyond the

7.a.

7.b.

preparation of this petition.

extends

NOTE: If you are an attorney or accredited

representative, you may need to submit a completed Form G-28, Notice of Entry of Appearance as

Attorney or Accredited Representative, or Form

G-28I, Notice of Entry of Appearance as Attorney In Matters Outside the Geographical Confines of the

United States, with this petition.

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Form I-129F Edition 03/21/22 Page 12 of 13

Part 7. Contact Information, Declaration, and

Signature of the Person Preparing this Petition, if Other Than the Petitioner (continued)

8.a. Preparer's Signature

8.b. Date of Signature (mm/dd/yyyy)

Preparer's Certification

Preparer's Signature

By my signature, I certify, under penalty of perjury, that I prepared this petition at the request of the petitioner. The petitioner then reviewed this completed petition and informed me that he or she understands all of the information contained in, and submitted with, his or her petition, including the Petitioner's Declaration and Certification, and that all of this information is complete, true, and correct. I completed this petition based only on information that the petitioner provided to me or authorized me to obtain or use.

N/A

Form I-129F Edition 03/21/22 Page 13 of 13

Part 8. Additional Information

3.d.

If you need extra space to provide any additional information within this petition, use the space below. If you need more space than what is provided, you may make copies of this page to complete and file with this petition or attach a separate sheet of paper. Type or print your name and A-Number (if any) at the top of each sheet; indicate the Page Number, Part Number, and Item Number to which your answer refers; and sign and date each sheet.

1.a Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

3.a. Page Number 3.b. Part Number 3.c. Item Number 2. A-Number (if any) A-

4.d.

4.a. Page Number 4.b. Part Number 4.c. Item Number 5.d.

5.a. Page Number 5.b. Part Number 5.c. Item Number 6.d.

6.a. Page Number 6.b. Part Number 6.c. Item Number 7.d.

7.a. Page Number 7.b. Part Number 7.c. Item Number

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