I 129 Sample k3 Visa Petition

OMB No. 1615-0001; Expires 01/31/2010 Department of Homeland Security U.S.
Citizenship and Immigration Services
I-129F, Petition for Alien Fianc(e)

For USCIS Use Only
Fee Stamp
Do not write in these blocks.

Case ID # A# G-28 # The petition is approved for status under Section 101(a)(5)(k). It is valid for four months from the date of action. Remarks: Action Block
AMCON:
Personal Interview Document Check
Previously Forwarded Field Investigation
Part A.
Start Here. Information 1. Name (Family name in CAPS) (First) GUPTA Rahul 2. Address (Number and Street) 123 Park Avenue (Town or City) Edison (State or Country) NJ
about you.
(Middle) Ram Apt. # 45 (Zip/Postal Code) 08837 (State/Country) NJ
Part B.
Information about your alien fianc(e).

(Middle) Devi Apt. # 78 (Zip/Postal Code) 400 001 (State/Country) India
1. Name (Family name in CAPS) (First) AGRAWAL Manisha 2. Address (Number and Street) 456 Laurel St (Town or City) (State or Country) Mumbai India 3a. Place of Birth (Town or City)
Mumbai 3b. Country of Citizenship India
3. Place of Birth (Town or City) Budd Lake 4. Date of Birth (mm/dd/yyyy)
5. Gender Male Widowed Female
12/22/1974
6. Marital Status Married Single
None
4. Date of Birth (mm/dd/yyyy)

11/20/1975
5. Gender
Divorced
7. Other Names Used (including maiden name) 8a. U.S. Social Security Number 8b. A# (if any) 123-45-6789 None 9. Names of Prior Spouses Date(s) Marriage(s) Ended
Male Female 6. Marital Status Married Single Widowed Divorced 7. Other Names Used (including maiden name) None 8. U.S. Social Security # None 10. Names of Prior Spouses
Ramesh Singhal
9. A# (if any) None Date(s) Marriage(s) Ended

06/20/2004
None
10. My citizenship was acquired through (check one) Birth in the U.S. Naturalization Give number of certificate, date and place it was issued. Parents Have you obtained a certificate of citizenship in your name? Yes No If "Yes," give certificate number, date and place it was issued. 11. Have you ever filed for this or any other alien fianc(e) or husband/wife before? Yes No If "Yes," give name of all aliens, place and date of filing, A# and result. (Attached additional sheets as necessary.)
INITIAL RECEIPT RESUBMITTED RELOCATED: Rec'd. Sent
11. Has your fianc(e) ever been in the U.S.? Yes No 12. If your fianc(e) is currently in the U.S., complete the following: He or she last arrived as a:(visitor, student, exchange alien, crewman, stowaway, temporary worker, without inspection, etc.)
visitor
Arrival/Departure Record (I-94) Number 0 0 6 1 2 3 4 5 Date of Arrival (mm/dd/yy)
04/23/04 07/22/04
COMPLETED: Appv'd. Denied Ret'd.
Form I-129F (Rev. 07/30/07) N
Part B.
Information about your alien fianc(e).
(Continued.)
Present Address
13. List all children of your alien fianc(e) (if any)

Name (First/Middle/Last) Date of Birth (mm/dd/yyyy) Country of Birth
Jay Agrawal
05/01/2003
India
456 Laurel St, #78, Mumbai, 400001 India
14. Address in the United States where your fianc(e) intends to live. (Number and Street) (Town or City) 123 Park Avenue, Apt 45 Edison 15. Your fianc(e)'s address abroad. (Number and Street) 456 Laurel St, Apt 78 (Country) India
(State) NJ 08837
(Town or City) Mumbai
(State or Province) Maharashtra 400 001
(Phone Number; Include Country, City and Area Codes) +91-22-3456 7890
16. If your fianc(e)'s native alphabet uses other than Roman letters, write his or her name and address abroad in the native alphabet. (Name) (Number and Street) N/A (Town or City) 17. Is your fianc(e) related to you? (State or Province) (Country)
Yes
No
If you are related, state the nature and degree of relationship, e.g., third cousin or maternal uncle, etc. Not a blood relation - we are married, and she will apply for a K-3 visa 18. Has your fianc(e) met and seen you within the two-year period immediately receding the filing of this petition? Yes No 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 fianc(e) or spouse though an international marriage broker, please explain those circumstances in Question 19 below. Explain also in detail any reasons you may have for requesting that the requirement that you and your fianc(e) must have met should not apply to you.
We initially met at a common friend's place and got married in December 2004.
19. Did you meet your fianc(e) or spouse through the services of an international marriage broker? Yes No If you answered yes, please provide the name and any contact information you may have (including internet or street address) of the international marriage broker and where the international marriage broker is located. Attach additional sheets of paper if necessary.
20. Your fianc(e) will apply for a visa abroad at the American embassy or consulate at: (City) (Country)
Mumbai
India
NOTE: (Designation of a U.S. embassy or consulate outside the country of your fianc(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.)
Form I-129F (Rev. 07/30/07) N Page 2
Part C. Other information.

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:
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: 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.) 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, or Three or more convictions for crimes relating to a controlled substance or alcohol not arising from a single act. Yes No Answering this question is required 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, attach 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: I was acting in self-defense. I violated a protection order issued for my own protection. 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.
Part D. Penalties, certification and petitioner's signature.

PENALTIES: You may by law be imprisoned for not more than five 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 up 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 am legally able to and intend to marry my alien fianc(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. Signature Date (mm/dd/yyyy) Daytime Telephone Number (with area code)
11/12/2005
E-Mail Address (if any)
732-481-3053
rahul_gupta@yahoo.com
Part E. Signature of person preparing form, if other than above. (Sign below.)
I declare that I prepared this application at the request of the petitioner and it is based on all information of which I have knowledge.
Signature Print or Type Your Name G-28 ID Number Date (mm/dd/yyyy)
Firm Name and Address
Daytime Telephone Number (with area code)
E-Mail Address (if any)
Form I-129F (Rev. 07/30/07) N Page 3

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OMB No. 1615-0001; Expires 01/31/2010 Department of Homeland Security U.S.

Citizenship and Immigration Services

I-129F, Petition for Alien Fianc(e)

Do not write in these blocks.

Personal Interview Document Check

Previously Forwarded Field Investigation

Information about your alien fianc(e).

3. Place of Birth (Town or City) Budd Lake 4. Date of Birth (mm/dd/yyyy)

5. Gender Male Widowed Female

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

9. A# (if any) None Date(s) Marriage(s) Ended

Form I-129F (Rev. 07/30/07) N

Information about your alien fianc(e).

13. List all children of your alien fianc(e) (if any)

456 Laurel St, #78, Mumbai, 400001 India

(Town or City) Mumbai

(State or Province) Maharashtra 400 001

Part C. Other information.

Part D. Penalties, certification and petitioner's signature.

Firm Name and Address

Daytime Telephone Number (with area code)

E-Mail Address (if any)

Form I-129F (Rev. 07/30/07) N Page 3

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