Uscis Form I 129F – Fill Out and Use This PDF

For USCIS Use Only

Fee Stamp

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

valid for 4 months from the date

Approved

Reason

of action.

Denied

General Waiver

Mandatory Waiver

Approved

Reason

Approved

Reason

Denied

Denied

Initial Receipt

Relocated

Completed

Remarks

Received

Approved

Resubmitted

Sent

Returned

Action Block

AMCON:

Personal Interview		Previously Forwarded
Document Check		Field Investigation
IMBRA	Yes (DOS disclosure to		No
Applies?	the beneficiary required)

1.a Family Name

(Last Name)

1.b. Given Name

(First Name)

1.c. Middle Name

Your Mailing Address

2.a. In Care of Name

2.b.	Street Number
2.c.	and Name
	Apt.
				Ste.		Flr.
2.d.	City or Town
2.e.	State					2.f. Zip Code
2.g.	Postal Code
2.h.	Province
2.i.	Country

3.Alien Registration Number (A-Number)

► A-

4.City/Town/Village of Birth

5.Country of Birth

6.Date of Birth (mm/dd/yyyy) ►

7.

Gender

Male

Female

8.Marital Status

Married

Widowed

Single

Divorced

Other Names Used

9.a. Family Name

(Last Name)

9.b. Given Name

(First Name)

9.c. Middle Name

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

►

Name of Prior Spouse 1

11.a. Family Name

(Last Name)

11.b. Given Name

(First Name)

11.c. Middle Name

11.d. Date Marriage Ended

(mm/dd/yyyy) ►

Name of Prior Spouse 2

12.a. Family Name

(Last Name)

12.b. Given Name

(First Name)

12.c. Middle Name

12.d. Date Marriage Ended

(mm/dd/yyyy) ►

My citizenship was acquired through (Select only one box):

13.a.	Birth in the United States
13.b.	Naturalization
13.c.	Parents

13.d. Have you obtained a Certificate of Naturalization or a
Certificate of Citizenship in your name?
		Yes	No
	If "Yes," complete the following:
13.d.1. Certificate Number
13.d.2. Place of Issuance
13.d.3. Date of Issuance
	(mm/dd/yyyy) ►

14.Have you ever filed for this or any other alien fiancé(e) or husband/wife before?

Yes

No

If you answered "Yes," provide the following for each alien (attach additional sheets as necessary)

14.a. Alien Registration Number (A-Number)

► A-

14.b. Family Name

(Last Name)

14.c. Given Name

(First Name)

14.d. Middle Name

14.e. Date of Filing (mm/dd/yyyy) ►

14.f. City or Town

14.g. State

14.h. Result

2.b. Given Name

(First Name)

2.c. Middle Name

6.Date of Birth (mm/dd/yyyy) ►

7.Country of Citizenship

Alien Fiancé(e)'s Mailing Address

3.a. In Care of Name

3.b.	Street Number
3.c.	and Name
	Apt.
				Ste.		Flr.
3.d.	City or Town
3.e.	State					3.f. Zip Code
3.g.	Postal Code
3.h.	Province
3.i.	Country

8.

Gender

Male

Female

9.Marital Status

Married Widowed Single Divorced

Other Names Used (Including Maiden Name)

10.a. Family Name

(Last Name)

10.b. Given Name

(First Name)

10.c. Middle Name

11.Alien Registration Number (A-Number)

►A-

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

►

Name of Prior Spouse 1

13.a. Family Name

(Last Name)

13.b. Given Name

(First Name)

13.c. Middle Name

13.d. Date Marriage Ended
	(mm/dd/yyyy)	►
Name of Prior Spouse 2
14.a. Family Name
(Last Name)
14.b. Given Name
(First Name)
14.c. Middle Name
14.d. Date Marriage Ended
	(mm/dd/yyyy)	►
15. Has your fiancé(e) ever been in
			Yes	No
the United States?

If your fiancé(e) is currently in the United States, complete the following:

15.a. He or she last arrived as a: (visitor, student, exchange alien, crewman, stowaway, temporary worker, without inspection, etc.)

15.b. I-94 Arrival/Departure Record Number

► 15.c. Date of Arrival (mm/dd/yyyy) ►

15.d. Date authorized stay expired or will expire as shown on

I-94 or I-95.	(mm/dd/yyyy)	►

15.e. Passport Number

15.f. Travel Document Number

15.g. Country of Issuance for Passport or Travel Document

15.h. Expiration Date for Passport or Travel Document

(mm/dd/yyyy) ►

Complete the following for all children of your alien fiancé(e) (if any).

Child 1 of Alien Fiancé(e)

16.a. Family Name

(Last Name)

16.b. Given Name

(First Name)

16.c. Middle Name

17.Country of Birth

18.Date of Birth (mm/dd/yyyy) ►

19.a. Street Number

and Name

19.b.	Apt.		Ste.		Flr.
19.c.	City or Town
19.d.	State				19.e. Zip Code
19.f.	Postal Code
19.g.	Province
19.h.	Country

Child 2 of Alien Fiancé(e)

20.a. Family Name

(Last Name)

20.b. Given Name

(First Name)

20.c. Middle Name

21.Country of Birth

22.Date of Birth (mm/dd/yyyy) ►

23.a. Street Number

and Name

23.b.	Apt.		Ste.		Flr.
23.c.	City or Town
23.d.	State				23.e. Zip Code
23.f.	Postal Code
23.g.	Province
23.h.	Country

Child 3 of Alien Fiancé(e)

24.a. Family Name

(Last Name)

24.b. Given Name

(First Name)

24.c. Middle Name

25.Country of Birth

26. Date of Birth				(mm/dd/yyyy) ►
27.a. Street Number
and Name
27.b. Apt.		Ste.		Flr.
27.c. City or Town
27.d. State				27.e. Zip Code

27.f. Postal Code

27.g. Province

27.h. Country

Address in the United States where your fiancé(e) intends to live.

28.a. Street Number

and Name

28.b.	Apt.	Ste.		Flr.
28.c.	City or Town
28.d.	State			28.e. Zip Code

Your fiancé(e)'s address abroad.

29.a. Street Number

and Name

29.b.

Apt.

Ste.

Flr.

29.c.

City or Town

29.d.

Postal Code

29.e.

Province

29.f.

Country

30.

Daytime Phone Number

Extension

(

)

-

If your fiancé(e)'s native alphabet uses other than Roman letters, write his or her name and address abroad in the native alphabet.

31.a. Family Name

(Last Name)

31.b. Given Name

(First Name)

31.c. Middle Name

Your fiancé(e)'s address abroad. (Native Alphabet)

32.a. Street Number

and Name

32.b. Apt.

Ste.

Flr.

32.c. City or Town

32.d. Postal Code

32.e. Province

32.f. Country

33. Is your fiancé(e) related to you?

Yes

No

33.a. If you are related, state the nature and degree of relationship, e.g., third cousin or maternal uncle, etc.

34.Has your fiancé(e) met and seen you within the 2-year period immediately preceding the filing of this petition?

Yes

No

34.a. Describe the circumstances under which you met. If you have not personally met each other, explain how the relationship was established. If you met your fiancé(e) or spouse though an international marriage broker, please explain those circumstances in number 35.a. Explain in detail any reasons you may have for requesting that the requirement that you and your fiancé(e) must have met should not apply to you.

35.Did you meet your fiancé(e) or spouse through the services of an international marriage broker?

Yes

No

35.a. If you answered “Yes,” provide the Internet and/or Street Address below. In additional, attach a copy of the signed, written consent form the IMB obtained from your beneficiary authorizing the release of your beneficiary's personal contact information to you. If additional space is needed, attach a separate sheet of paper.

Your fiancé(e) will apply for a visa abroad at the American embassy or consulate at:

36.a. City or Town

36.b. Country

NOTE: Designation of a U.S. embassy or consulate outside the country of your fiancé(e)'s last residence does not guarantee acceptance for processing by that foreign post. Acceptance is at the discretion of the designated embassy or consulate.

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:

1.a.	Street Number
1.b.	and Name
	Apt.
				Ste.		Flr.
1.c.	City or Town
1.d.	State					1.e. Zip Code
1.f.	Postal Code
1.g.	Province
1.h.	Country

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:

2.a.	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").	Yes	No
2.b.	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?	Yes	No

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

Yes

No

These questions must be answered 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, provide 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:

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
	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.

If your beneficiary is your fiancé(e) and: (a) this is the third (or more) Form I-129F petition that you have filed; or (b) this is the third (or more) Form I-129F petition you have filed and your first Form I-129F petition was approved within the last 2 years, then your petition cannot be approved unless a waiver of the multiple filing restriction is granted. Attach a signed and dated letter, requesting the waiver and explaining why a waiver is appropriate under your circumstances, together with any evidence in support of the waiver request.

4.Indicate which waiver applies:

Multiple Filer, No Disqualifying Convictions

(General Waiver)

Multiple Filer, Prior Criminal Conviction for Specified Offenses (Extraordinary Circumstances

Waiver)

Multiple Filer, Prior Criminal Convictions Resulting from Domestic Violence (Mandatory Waiver)

Not applicable, beneficiary is my spouse

NOTE: See Page 3, question 3.b. of the filing instructions.

Penalties

You may by law be imprisoned for not more than 5 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 upon 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 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 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.

1.a. Signature of Petitioner

1.b. Date of Signature (mm/dd/yyyy) ►

2. Daytime Phone Number ( ) -

3. Mobile Phone Number ( ) -

4.E-mail Address (if any)

NOTE: If you are an attorney or representative, you must submit a completed Form G-28, Notice of Entry of Appearance as Attorney or Accredited Representative, along with this Petition.

Form G-28 submitted with this Petition.

G-28 ID Number

Preparer's Full Name

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

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

2.Preparer's Business or Organization Name

Preparer's Contact Information

3.

Preparer's Daytime Phone Number

Extension

( ) -

4.Preparer's E-mail Address (if any)

Preparer's Mailing Address

5.a.	Street Number
5.b.	and Name
	Apt.
				Ste.		Flr.
5.c.	City or Town
5.d.	State					5.e. Zip Code
5.f.	Postal Code
5.g.	Province
5.h.	Country

Declaration

To be completed by all preparers, including attorneys and authorized representatives: I declare that I prepared this benefit 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

of Preparer

6.b. Date of Signature (mm/dd/yyyy) ►