Information Pertaining to the Petitioner

Please respond to every box:

·  If unknown – write “unknown”

·  If not applicable – write “N/A”

·  If none – write “none”

Leaving an answer blank will delay your case

Family History

First Name
Middle Name
Last Name
Any other names used (e.g. names from previous marriages, alternate spellings you have used)
US Social Security Number
Current Address
Current Address Abroad
Father's Full Name
Father's Date of Birth
Father's City and Country of Birth
Father's City and Country of Residence, Please State if Deceased
Mother's Full Name
Mother's Maiden Name
Mother's Date of Birth
Mother's City and Country of Birth
Mother's City and Country of Residence, , Please State if Deceased

Marriage History

Full name of any current and/or former Husband or Wife (if none so state). Please include maiden names if any. / Date of Birth / Date and Place of Marriage / Date and Place of Termination of Marriage

Residence History

Please provide all addresses that you have held in the last five (5) years starting with your current address Please make sure there are no gaps.

Street Name and Number / City / State or Province / Country / Dates of Residency (mm/yyyy – mm/yyyy)

Please provide your most recent foreign address of more than one (1) year

Street Name and Number / City / State or Province / Country / Dates of Residency (mm/yyyy – mm/yyyy)

Please list all employment for the last five (5) years. If none, so state.

Employer Name / Job Title / Employer Address / Dates of Employment (mm/yyyy – mm/yyyy)

Please list your Last Occupation Abroad

Employer Name / Job Title / City / State or Province / Country / Dates of Employment (mm/yyyy – mm/yyyy)

Please list your children

Name / Date of Birth / Country of Birth

Please Answer The Following Questions:

1. If you were not born in the U.S., how did you gain permanent residence (adoption, marriage, employment, etc.)?

2. Have you ever filed an immigration petition for your spouse or any other foreign national (child, parent, etc.)?

3. Are you currently on active duty in the U.S. armed forces?

4. How many dependent children do you have? How many other dependents do you have?

5. What is your current employment situation (name of employer, job title, annual salary or estimated annual income)?

6. What was your total income for each of the last three (3) years, as listed on your Federal Tax Returns?