Form I-929 Petition for Qualifying Family Member of a U-1 Nonimmigr

OMB No. 1615-0106; Expires 10/31/2012

Form I-929, Petition for Qualifying Family
Member of a U-1 Nonimmigrant

Department of Homeland Security
U.S. Citizenship and Immigration Services

DO NOT WRITE IN THIS BLOCK-- FOR USCIS USE ONLY
Bene. A-file
reviewed

Yes

U-1 A-file
reviewed

Yes

Action Block

Bar Code (USCIS Use only)

No

No

Bene. filed I-485
Yes

Remarks

No

U-1 adjusted
No

Yes
U-1 I-485 pending

No

Yes

START HERE -- TYPE OR PRINT LEGIBLY USING BLACK INK
I am filing for my: (Check one)
Child:

Spouse

Biological Child

Parent:

Biological Parent

Stepchild

Stepparent

Adopted Child

Parent who adopted me

Part 2. Information About Your Alien Relative

Part 1. Information About You
Last Name (Family Name)

Last Name (Family Name)

First Name (Given Name)

First Name (Given Name)

Middle Name

Middle Name

Current Address

Current Address

Street Number and Name

City

State

Apt. Number

Zip Code

Safe Mailing Address If Other Than Above
Street Number and Name

City

Date of Birth

State

Street Number and Name

Apt. Number

City

State/Province

Country

Postal/Zip Code

Mailing Address If Other Than Above

Apt. Number

Zip Code

A-Number

Date of Birth

A-Number

Form I-929 (10/04/11) Y

Part 1. Information About You (Cont'd)
Country of Birth

Part 2. Information About Your Alien Relative (Cont'd)

Social Security Number

Country of Citizenship/Nationality

Gender: (Check one)

Male

Female

First Name (Given Name)

Middle Name

Last Name (Family Name)

Gender: (Check one)

Male

Female

If alien relative ever used other names, provide them below:
Last Name (Family Name)

First Name (Given Name)

Middle Name

First Name (Given Name)

Middle Name

Last Name (Family Name)

Social Security Number

Country of Citizenship/Nationality

If you ever used other names, provide them below:
Last Name (Family Name)

Country of Birth

Last Name (Family Name)

First Name (Given Name)

Middle Name

First Name (Given Name)

Middle Name

Last Name (Family Name)

First Name (Given Name)

Middle Name

Marital Status: (Check one)

Marital Status: (Check one)

Single (Never Married)

Married

Single (Never Married)

Married

Divorced

Widowed

Divorced

Widowed

Spouse's Name:

Spouse's Name:

Last Name (Family Name)

First Name (Given Name)

Middle Name

Place of Marriage

Last Name (Family Name)

First Name (Given Name)

Middle Name

Place of Marriage

Form I-929 (10/04/11) Y Page 2

Part 1. Information About You (Cont'd)

Part 2. Information About Your Alien Relative (Cont'd)

Number of marriages including current marriage:

Number of marriages including current marriage:

List any previous marriage(s) beginning with the most recent.
If you need more space, attach an additional sheet of paper.
Prior Spouse's Name:

List any previous marriage(s) beginning with the most recent.
If you need more space, attach an additional sheet of paper.
Prior Spouse's Name:

Last Name (Family Name)

First Name (Given Name)

Last Name (Family Name)

First Name (Given Name)

Middle Name

Date of Marriage

Middle Name

Date of Marriage

Place of Marriage

Date of Termination

Place of Termination

Reason for Termination:
Divorce

Death

Place of Marriage

Date of Termination

Place of Termination

Reason for Termination:
Annulment

Other

Divorce

Death

Annulment

Other

Prior Spouse's Name:

Prior Spouse's Name:

Last Name (Family Name)

First Name (Given Name)

Last Name (Family Name)

First Name (Given Name)

Middle Name

Date of Marriage

Middle Name

Date of Marriage

Place of Marriage

Date of Termination

Place of Termination

Reason for Termination:
Divorce
Other

Death

Place of Marriage

Date of Termination

Place of Termination

Reason for Termination:
Annulment

Divorce

Death

Annulment

Other

Form I-929 (10/04/11) Y Page 3

Part 1. Information About You (Cont'd)

Part 2. Information About Your Alien Relative (Cont'd)

Prior Spouse's Name:

Prior Spouse's Name:

Last Name (Family Name)

First Name (Given Name)

Last Name (Family Name)

First Name (Given Name)

Middle Name

Date of Marriage

Middle Name

Date of Marriage

Place of Marriage

Date of Termination

Place of Marriage

Date of Termination

Place of Termination

Reason for Termination:
Divorce

Place of Termination

Reason for Termination:

Death

Annulment

Divorce

Other

Death

Annulment

Other

(Check One):
I am a Lawful Permanent Resident
I obtained my Lawful
Permanent Residence on:
My Form I-485 is currently pending

Complete if your relative is in the United States
Place of Admission

Date of Admission

Class of Admission

Date Authorized to Stay

Receipt Number

Part 3. Information About Your Alien Relative's Children
Last Name (Family Name)

Date of Birth

First Name (Given Name)

Place of Birth

Middle Name

Biological Child
Gender: (Check one)

Street Number and Name

Country

Apt. Number

Postal/Zip Code

City

A-Number

Stepchild
Male

Adopted Child
Female
State/Province

Country of Birth

Name of Mother
Last Name (Family Name)

First Name (Given Name)

Middle Name

First Name (Given Name)

Middle Name

Name of Father
Last Name (Family Name)

Form I-929 (10/04/11) Y Page 4

Part 3. Information About Your Alien Relative's Children (Cont'd)
Last Name (Family Name)

Date of Birth

First Name (Given Name)

Place of Birth

Middle Name

Biological Child
Gender: (Check one)

Street Number and Name

Country

Apt. Number

Postal/Zip Code

Stepchild
Male

Adopted Child
Female

City

State/Province

A-Number

Country of Birth

Name of Mother
First Name (Given Name)

Middle Name

Last Name (Family Name)

First Name (Given Name)

Middle Name

Last Name (Family Name)

First Name (Given Name)

Middle Name

Last Name (Family Name)

Name of Father

Date of Birth

Place of Birth

Biological Child
Gender: (Check one)

Street Number and Name

Country

Apt. Number

Postal/Zip Code

Stepchild
Male

Adopted Child
Female

City

State/Province

A-Number

Country of Birth

Name of Mother
First Name (Given Name)

Middle Name

Last Name (Family Name)

First Name (Given Name)

Middle Name

Last Name (Family Name)

First Name (Given Name)

Middle Name

Last Name (Family Name)

Name of Father

Date of Birth

Place of Birth

Biological Child
Gender: (Check one)

Stepchild
Male

Adopted Child
Female

Form I-929 (10/04/11) Y Page 5

Part 3. Information About Your Alien Relative's Children (Cont'd)
Street Number and Name

Country

Apt. Number

Postal/Zip Code

City

State/Province

A-Number

Country of Birth

Name of Mother
First Name (Given Name)

Middle Name

Last Name (Family Name)

First Name (Given Name)

Middle Name

Last Name (Family Name)

First Name (Given Name)

Middle Name

Last Name (Family Name)

Name of Father

Date of Birth

Place of Birth

Biological Child
Gender: (Check one)

Street Number and Name

Country

Apt. Number

Postal/Zip Code

City

A-Number

Stepchild
Male

Adopted Child
Female
State/Province

Country of Birth

Name of Mother
Last Name (Family Name)

First Name (Given Name)

Middle Name

First Name (Given Name)

Middle Name

Name of Father
Last Name (Family Name)

Name and address of your alien relative in the language written in the country where he/she currently resides.
Last Name (Family Name)

C/O: (In Care Of)

City/State or Province

First Name (Given Name)

Street Number and Name

Country

Middle Name

Apt. Number

Postal/Zip Code

Form I-929 (10/04/11) Y Page 6

Part 4. Processing Information
1. Check one:
a.

The person named in Part 2 is now in the United States

b.

The person named in Part 2 is now outside the United States. (Indicate below at which U.S. Embassy
or consulate your relative will apply for a visa.)
U.S. Embassy or consulate at:
City and Country

2. Is the person named in Part 2 or has this person ever been in deportation or removal proceedings in the United States?
a.

No

b.

Yes (Indicate when and where):

Part 6. Signature
I certify, or if outside the United States, I swear or affirm, under penalty of perjury under the laws of the United States of America,
that this petition and the evidence submitted with it, is all true and correct. I authorize the release of any information from my record
that U.S. Citizenship and Immigration Services needs to determine eligibility for the benefit I am seeking.
Signature

Print Your Full Name

Date

Part 7. Preparer's Information, If Other Than Person Signing Above
I declare that I prepared this petition at the request of the above person, and it is based on all the information that I have knowledge.
Signature

Firm Name

City/State or Province

Print Your Full Name

Street Number and Name

Postal/Zip Code

Date

Suite Number

Telephone Number

Form I-929 (10/04/11) Y Page 7