Form I-130 Information Intake

Form I-130 Information Intake
I am filing this petition for my
Relationship type
Related by adoption?
Did you gain status through adoption?
Petitioner Identification and Personal Information
Petitioner A-Number
USCIS Online Account Number
U.S. Taxpayer Identification Number
Petitioner Full Name

First NameMiddle NameLast Name
Other Name 1

First NameMiddle NameLast Name
City of Birth
Country of Birth
Date of Birth

MonthDayYear
Date
Gender
Petitioner Last Name
Petitioner First Name
Petitioner Mailing and Physical Addresses
In Care Of
Street Address
Apt / Suite / Unit
City
State
ZIP Code
Country
Is your mailing address the same as your physical address?
Physical Address History 1 - Street Address
Physical Address History 1 - City
Physical Address History 1 - State
Physical Address History 1 - ZIP Code
Physical Address History 1 - Country
Physical Address History 1 - From Date

MonthDayYear
Date
Physical Address History 1 - To Date

MonthDayYear
Date
Physical Address History 2 - Street Address
Physical Address History 2 - City
Petitioner Marital History and Parent Information
Current marital status
Number of marriages
Spouse 1 full name

First NameMiddle NameLast Name
Date marriage ended for spouse 1

MonthDayYear
Date
Spouse 2 full name

First NameMiddle NameLast Name
Date marriage ended for spouse 2

MonthDayYear
Date
Current marriage date

MonthDayYear
Date
Place of current marriage
Parent 1 full name

First NameMiddle NameLast Name
Parent 1 date of birth

MonthDayYear
Date
Parent 1 country of birth
Parent 1 city of birth
Parent 2 full name

First NameMiddle NameLast Name
Parent 2 date of birth

MonthDayYear
Date
Parent 2 country of birth
Parent 2 city of birth
Petitioner Immigration Status and Work History
Petitioner immigration status
If U.S. Citizen, basis of citizenship
Naturalization or citizenship certificate number
Place of issuance
Date of issuance

MonthDayYear
Date
Class of admission
Date of admission

MonthDayYear
Date
Place of admission
Did you obtain your permanent resident status through marriage?
Employer 1 name
Employer 1 address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer 1 occupation
Employer 1 from date

MonthDayYear
Date
Employer 1 to date

MonthDayYear
Date
Employer 2 name
Employer 2 address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer 2 occupation
Employer 2 from date

MonthDayYear
Date
Employer 2 to date

MonthDayYear
Date
Petitioner Demographics and Physical Description
Ethnicity
Race

Other
Height
Weight
Eye Color
Hair Color
Beneficiary Identification and Personal Information
Beneficiary A-Number
USCIS Online Account Number
Beneficiary Taxpayer Identification Number
Beneficiary Name

First NameMiddle NameLast Name
Other Name 1

First NameMiddle NameLast Name
Other Name 1 Type
City of Birth
Country of Birth
Date of Birth

MonthDayYear
Date
Gender
Beneficiary Alien Registration Number
Should be Empty:

Form I-130 Information Intake

Petitioner Identification and Personal Information

Petitioner Mailing and Physical Addresses

Petitioner Marital History and Parent Information

Petitioner Immigration Status and Work History

Petitioner Demographics and Physical Description

Beneficiary Identification and Personal Information